Insurance: 85% MLR mandated by law
US law mandates that health insurers spend at least 85% of collected premiums on care, capping their profit margin and incentivizing higher total spending.
Snapshot · The Twenty Minute VC (20VC): Venture Capital | Startup Funding | The Pitch
20VC: $5BN in Revenue, 7 to 7,000 Employees in 9 Months, 206,000 Tests in a Single Day: The Craziest Story in Startups: Curative with Fred Turner
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Jul 18, 2026
Where this was said
Are Legacy Insurers Screwed? What Will Anthropic Be Worth in Three Years?
At 49:13 · chapter starts 48:00
Harry asks whether legacy health insurers are structurally disadvantaged by their inability to rapidly build AI agent capabilities. Fred's answer is blunt: yes, the biggest insurers will struggle. It's not primarily a technology problem — they could hire the engineers. It's an organisational problem. If you have 100,000 employees and AI can replace 50,000 of them, the executives whose fiefdoms just got cut in half will resist at every turn. Change will happen, but over ten years rather than three. Curative, building from a smaller base with a technical culture, can compress that timeline dramatically. The conversation turns to the structural economics of health insurance: 85% of every premium dollar must by law go to care costs, meaning the only way to grow profits is to grow total spending — a perverse incentive Fred traces directly to the ACA's medical loss ratio provision [1] — Fred Turner "Insurance: 85% MLR mandated by law: US law mandates that health insurers spend at least 85% of collected premiums on care, capping their pr…" 49:13 . AI changes this equation: it can deliver better margins within the 15% admin budget rather than requiring increased total spending. Fred then makes his boldest prediction: Anthropic could be worth $10 trillion. His basis is direct — Curative's Anthropic spend has grown 6x every month for the past 6-7 months, from tens of thousands to millions of dollars, as the team keeps discovering new use cases faster than they can deploy them. Gwen, their provider contracting agent, sends 15,000 customised emails every day and follows up relentlessly — the thing Fred says humans can't scale because most salespeople give up after three attempts.
The Broken MLR Rule Incentivises Higher Healthcare Spending
US law requires health insurers to spend 85% of premiums on care. Sounds good. But it means the only way to grow profits is to grow total spending — the exact opposite of what the system should incentivise. Fred Turner calls it one of Obamacare's most damaging second-order consequences.
Anthropic cost 6x/month for 6-7 months
Curative's monthly Anthropic spend has been growing 6x every month for the past 6-7 months, from tens of thousands to millions of dollars per month.
Gwen: The AI Agent Signing 100 Contracts a Day
Curative's AI agent Gwen finds provider practices, researches them, emails them with personalised outreach, negotiates rates, redlines contracts using AI-generated Python, and signs the final agreement — at a cost of $70 versus $1,500-$2,000 with humans. In 8 weeks, she completed 3,500 contracts. The entire human team did 2,300 in all of last year.
Gwen: 100 contracts/week to 100/day
Curative's AI agent Gwen increased provider network contracting speed from ~100 contracts per week to ~100 contracts per day.
3,500 contracts in 8 weeks vs. 2,300 in a year
In roughly 8 weeks, Curative's Gwen agent signed 3,500 provider contracts — more than the entire human team's output of 2,300 contracts in all of last year.
Contract cost: $1,500 to $70 with AI
With Gwen, the average cost per provider contract fell from $1,500-$2,000 with human teams to about $70 with the AI agent.
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