Evolving Beyond Zero-Sum Healthcare
U.S. healthcare—and, by extension, employee benefits—is profoundly shaped by the “Game A” logic of extraction, competition, and profit maximization. Employers, health systems, and benefits vendors all operate within this finite game: each is compelled to “win” in the short term, even if that means passing costs, risks, or complexity downstream to employees, patients, and communities (ACHI, 2025).

Yet, the compounding cracks in the system are impossible to ignore. The relentless pressure to produce ever-increasing profit - now! - doesn’t just force for-profit employers to make suboptimal choices—it requires them. When public companies or private equity (PE)–backed entities control hospitals, clinics, insurance companies, or even benefit consultancies, the core imperative is always “how do we drive EBITDA?” not “how do we promote flourishing?” This zero-sum mindset is so baked-in, it often escapes notice, even as its consequences grow more obvious: rampant burnout, declining health outcomes, rising medical debt, and the growing commodification of care (FACS, June 2025).

Zero-sum vs. “float all boats” — from extraction to regeneration
"Game B" offers an alternative: a shift from rivalry-based, win-lose dynamics to cooperative, regenerative, “infinite game” frameworks. In James Carse’s Finite and Infinite Games, the distinction is simple but profound: finite games are played to win; infinite games are played to keep the game going, to enable ongoing play and collective benefit.

Healthcare in the U.S. is, unfortunately, a finite game played with people’s lives and well-being. PE ownership of healthcare entities only amplifies the incentives to extract short-term value: cutting costs, outsourcing staff, consolidating to reduce “redundancies,” and prioritizing margin over mission. Multiple studies and real-world examples have documented negative outcomes associated with PE buyouts in healthcare, including higher costs, lower staffing ratios, and even worsened clinical results.

Contrast this with the “float all the boats” approach—the essence of Game B and regenerative economics. Here, the goal is not to outcompete or exploit, but to increase the capacity for everyone to thrive over time. When applied to benefits and healthcare, this means structuring incentives, policies, and even product design around mutual benefit, not mere transactional gain. It means valuing health outcomes over service volume and engagement over enrollment (CharmHealth, 2024).

The evolutionary imperative: human flourishing as the real ROI
Why does this matter? Because human systems, like natural systems, evolve toward greater complexity, collaboration, and resilience when not artificially constrained. The imperative to flourish—to “float all boats”—is evolutionary, not ideological. Yet, our benefits and healthcare systems have been, at best, unconsciously thwarting this imperative by rewarding zero-sum thinking, opaque pricing, and adversarial bargaining.

If the emergence of Game B thinking is inevitable—and there’s mounting evidence that a transition is already underway—then it’s time for benefit leaders, employers, and vendors to reorient their playbooks. The next wave will not be about squeezing the last drop of profit from legacy models. It will be about designing self-reinforcing ecosystems: ones that reward cooperation, reward proactive health, and create compounding returns for all stakeholders—especially employees and their families.

The last word
It’s not just possible—it’s necessary. The infinite game is the only game truly worth playing.

~ Mark Head
© 2025. All Rights Reserved.

Aspirations
“Game B players are already everywhere, and Game B is already emerging. Game B is merely a means to make the organism self‑aware, to show its players that they are already in community.”

~Game B Wiki

Click the green button or the blue button (below) to visit our scheduling page.