The Trump-Supreme Court battle is not really the crisis.

The crisis is here now. Trump is enacting an insidious coordinated attack on our institutions of democratic accountability, designed to crater democracy before next fall.

1/ A long 🧵to explain the plan & how we stop it.

8x cost savings for 4 patient exercise coaching over 1:1 coaching. 6mo assisted + 3 months self-guided.

scaling up coaching matters and transition to self-guided matters.

Terrific take by @mmasnick.bsky.social — fair assessment and clear eyed. Meta has been bad at moderation (others have not btw) but Zuckerberg’s free speech blather is just a lame excuse for sloppy work: www.techdirt.com/2025/01/08/t...

Meditate more in 2025. This is the world's cheapest exercise, therapy and diagnostic. It builds a stronger brain, alleviates perseveration, and tells you what junk you need to get rid of. There is no failure in meditation, only failure to practice.

Be a goldfish - there is no past nor future.

when i strike oil im getting that P. Thiel vein installed in my skull that sucks the moisture out of my brain and pisses it all over my head

If you want to understand why healthcare pricing is horrific, the first thing to know is that our system puts 100% of the credit risk for deductibles, copays and co-insurance on hospitals and doctors. That's insane.

We have turned them into Sub Prime Lenders 🧵

Once again those of us who are anti-Trump but pro-Stupid are being left out of the coalition. This kind of purity politics is what keeps the left from power imo

Nationwide competition => lower cost for the barest minimum.

Is this a true market? It's painful to figure it out, but I shall.

Are you interested in this? Know something more about it? /end

Asking because it would seem to be an appealing low cost product for many. High deductible plans allow for tax-free healthcare savings accounts (self-insurance really). You pay your bills, record them, then withdraw from the savings account. Keep records in case of an audit /4

I'm talking about insurance not from a state healthcare exchange (Vermont in my case), and not directly from an insurance provider in my state - I've done both and they work reasonably well.

If an insurance company can (must?) sell via a national "broker" for a PPO policy, is this what we get? /3

Sure I let it all go to voice mail. I am on DoNotCall list, but I did solicit a call.

I don't expect much from the FCC, but it's surprising that it has no end.

From a health insurance perspective, is this market real and is this the best sales prospect funnel they've arrived at? /2

What's up with the inter-state health insurance market and does the FCC still control who can dial your phone number?

Short story is I pursued getting a high-deductible health plan (national PPO) from google searches, filled out forms for info, and now I get 5+ calls per day (3 weeks so far) /1

Most people know of the European Krampus who collected and punished bad children.
There are quite a few German cards from early and mid-century that show a female version of Krampus.who punishes bad men 👹

#TisTheSeason 😉💋

Like the supplement industry, regulatory-adjacent is best for self-service to expert-assisted therapies.

Win with clear value and low friction, in smaller discovery markets (for now).

2/2

Critiques of U.S. healthcare?
Like shooting fish in a barrel.

Where is entrepreneurial innovation possible?
On the edges; the interstitials.

Two filters (don't aim here):
1. Regulatory capture deployed (eg PBM; except: MC CostPlus)
2. Payor leveraged (eg billing noose)

1/2

Healthcare is in a climate of change again. The assault of truth is a major setback for health science. Without common beliefs we cannot have common faith in medicine.

Put another way, how many medicines do we want to have?

Swearing is associated with more honest behaviour.
🧵 1/15

*Message in a bottle*

Help, I'm lost in a strange world. I want to follow you if you talk about self-service medicine.

Or if you _really_ love toast.
Well done is proper, no?

same. planned obsolescence! 😁 someone should write a utility to keep it going. call it Hospice 2.0.