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Concierge Care for All: Yes, It Really Is That Simple

Apr 16, 2026

By MATTHEW HOLT & CLAUDE

You’ll recall that a few weeks back I gave Claude some prompts and my entire corpus of work on THCB and asked it to write a piece. It was about 70% my ideas and 50% my writing tone. I’m back trying it again. This time I gave it a lot of prompts from some Linkedin pieces and comments I wrote and then I spent about 20 minutes editing it. This one is about 85% my idea and maybe 70% my tone? I have rewritten something in every paragraph. But it’s a hell of a lot faster than me writing from scratch. So I am going to keep experimenting like this for a while.

This started as a LinkedIn post about Merril Goozner’s plan to cut health care costs. He pointed out that the Center for American Progress’s new 10-point health reform plan is just more incrementalism and worse too boring for anyone to pay attention. Goozner’s own proposal, capping out-of-pocket expenses, isn’t much better. We’ve spent nearly a century proving that incremental reform in American health care doesn’t work — we still have tens of millions uninsured, patients going bankrupt, and outcomes that trail most of the developed world. And of course it enables profiteers to massively extract wealth from the system. In other words, from us.

My alternative: go to the barricades and blow the whole thing up. We need revolution because modest evolution cannot work.

My proposal, which you should go and read is to give everyone a voucher for primary care, but make it Concierge care for all.

The post got some pushback, and some of the objections reveal something important. My idea isn’t too complicated, but so many of us are so imbued in our broken system that we can’t see beyond it. And to be fair, it’s only after 35 years looking at it, that I’ve got the “burn it all down” religion.

My Basic Idea

My proposal is Concierge Care for All. Every American gets a voucher worth somewhere between $2,000 and $3,000 a year, which they have to spend with a primary care physician (or primary care organization) of their choice. Each PCP or equivalent takes on a panel of around 600 patients — roughly 1/3 to 1/4 what a typical fee-for-service PCP practice manages today, and the same as most current direct primary care practices.

That’s $1.2 to $1.8 million in annual revenue per physician; enough to pay the doctor $500,000 to $600,000 a year and still leave $600,000 to $1.3 million for clinical staff, technology, and overhead. This is basically the MDVIP model. It works. People who use it love it. And the latest studies show that it saves a lot (31%) on hospital emergency room use and inpatient costs. That alone saves a significant fraction of what this transition would cost.

The bulk of what a PCP does in this model is managing chronic illness — diabetes, hypertension, heart disease, COPD. These are the conditions that drive the majority of health care spending but which our current system sucks at managing. A well-resourced primary care practice, freed from the hamster wheel of volume-based billing, can do this proactively and can deploy the technology to do it at scale. Remote patient monitoring, AI-assisted care management, continuous data from wearables and home devices — the tools that many digital health companies have shown working well — all of that gets directly integrated into primary care where it belongs. The PCP organization is the purchaser of those technology services. This is basically the logic behind CMS’s new ACCESS program, except that ACCESS tries to bolt these capabilities onto the system from the outside. In this model they’re baked into primary care practice because the PCP wants to manage their patients and has the professional ethics and responsibility to do so.

I’d include a lot of mental health and dental care in the definition of primary care, as well as minor urgent care. Plenty of primary care groups in the US and elsewhere do that now, even though we’ve historically pretended that the head isn’t connected to the body and the teeth are outside it.

What isn’t there is equally important. No co-pays, no coinsurance, no deductibles, no claims. No staff managing all that bureaucratic crap. Your PCP manages your care, knows you, and when you need a specialist or a scan or a surgery, they refer you.

What About Specialty Care?

Give That 1337 a Job!

Apr 15, 2026

By KIM BELLARD

Chances are someone in your family is a gamer. Maybe you are a gamer yourself. After all, somewhere between two-thirds and three-fourths of Americans play video games, and if you just looked at young men, it’d be closer to 100%. Grumpy older people don’t get it, complaining that gaming is just a waste of time, but gamers believe it helps with their problem solving (although at a cost of sleep).

Well, the good news is that if you are, indeed, a gamer, the Federal Aviation Authority (F.A.A.) is looking for you.

Last Friday Transportation Secretary Sean P. Duffy announced the F.A.A.’s campaign to attract “the next generation of air traffic controllers,” It is looking for people “who possess useful skills that are transferable to a career in air traffic control, including:

Demonstrated high cognitive functions
Multitasking
Spatial awareness
Strategy and problem-solving”

By all that, they mean gamers. The announcement goes on to add: “…this effort is focused on reaching talented young people pursuing alternative career paths, many of whom are active in gaming. Feedback from controller exit interviews reinforces this, with several controllers pointing to gaming as an influence on their ability to think quickly, stay focused, and manage complexity.”

There’s a slick YouTube ad too.

“When you bring on someone who has gaming experience, particularly with air traffic control, they have an edge up,” Michael O’Donnell, an aerospace consultant who previously worked as a senior F.A.A. official focused on air traffic safety, told Karoun Demirjian of The New York Times. “They’re coming in with a skill set. But it doesn’t replace aptitude, or discipline, or decision making under pressure.”

Surprisingly, the National Air Traffic Controllers Association supports the effort, with its president Nick Daniels telling BBC:: “Our union welcomes innovative approaches to expanding the candidate pool, including outreach to individuals with high-level aptitude skills such as gamers, so long as all pathways maintain the rigorous standards required of this safety-critical profession.”

To be fair, both the F.A.A. and the NATCA probably would welcome anything that might drive people to apply. The F.A.A. only has about 75% of the target number of controllers, leaving it several thousand short. Individual airports may be staffed even lower, as might certain times of day. It’s not a new problem and it is not a problem that is going to be quickly fixed; it is not as though today you can play a video game and tomorrow you can be an air traffic controller. There is definitely a learning curve.

It also doesn’t help that air traffic controllers aren’t usually paid during government shutdowns, which Congress seems to increasingly allow. “The failure to pay air traffic controllers for 44 days created uncertainty, drove many experienced controllers out of the profession and harmed the recruitment pipeline,” a spokesperson from the Department of Transportation told CBS News in November.

Nor does it help that air traffic controllers rely on technology that is likely to be older than they are. The F.A.A. is trying, for example, to replace its outdated radar system, but NBC reports: “The FAA has been spending most of its $3 billion equipment budget just maintaining the fragile old system that still relies on floppy discs in places. Some of the equipment is old and isn’t manufactured anymore, so the FAA sometimes has to search for spare parts on eBay.”

The National Transportation Safety Board (NTSB) Chair Jennifer Homendy complained: “This is 2026. The secretary talks about upgrading our air traffic control system. We have an old air traffic control system. This is why he talks about that. We need to upgrade.”

I was surprised to learn that gaming might not just be an asset to become an air traffic controller, but also an asset for air traffic controllers. Josh Jennings, a supervisor at the F.A.A.’s air traffic command center in Virginia, told Ms. Demirjian that gaming is both a way for controllers to stay sharp, and as a form of “social currency” among them. “I would say it’s probably tenfold on how fast this new generation is able to pick up on our physical tech, our radar scopes,” he said. Controllers apparently often play video games on their breaks.

In similar approaches to look for unconventional backgrounds, the Marines are looking at dirt bikers to become drone pilots, while Russia is looking at university students for its drone pilots.

Cody Simmons, DermaSensor

Apr 14, 2026

Cody Simmons is the CEO of DermaSensor. I met him when he won the Digital Health Hub Foundation award for diagnostic tools last year. DermaSensor is a device designed to detect early skin cancer using Spectroscopy. Right now only 8% of those with potential skin cancer get the recommended screening. It’s another area where technology can potentially democratize medicine. DermaSensor is aiming for the primary care market. Cody shows how the tool works and explains how the PCP can both improve screening for their patients, and also make money from doing that–otherwise of course they wouldn’t do it! As you can imagine both the technology, the FDA approval process and the roll-out is pretty complicated. Cody explains all–Matthew Holt

Massively Better Healthcare, a review

Apr 13, 2026

By MATTHEW HOLT

This is a very brief review of Rock Health founder Halle Tecco’s Massively Better Healthcare. Halle is trying to do something quite complicated in this book. It’s really a three-part attempt to help somebody who is relatively new to health care entrepreneurship understand what the hell they are getting into.

The first part is a brief assessment of the current US healthcare system. If you’ve been working in health care for a long time you can probably skip this but if you’re an entrepreneur coming into American healthcare for the first time, it’s a good introduction. It may though not be enough given how messed up and complex the American system is. There are of course plenty of other great books to read about that. It’s not really Halle’s aim to do more than warn you about the mess the system is here.

The second part is essentially a guide to how to do innovation and how to build a company. This is very valuable. I wish Halle had written more in this part and included more of the work she’s done with the many companies she has stewarded and invested in because there’s another book to be dragged out of her about this. ( I’m sure she would hate me for saying this having just finished this one!). But I wanted to know more about all the boardrooms and strategy sessions she’d been in and the conversation she had about company building. For me this was the best part of the book because it has a lot of great nuggets about innovation. I just wish there’d been more here and that the examples were longer and deeper.

The last section of the book is four good rules for what works and what doesn’t and that’s a lot of useful stuff in there as well. She ends the book with an impassioned plea for people to come and fix the health care system, by working on individual problems within it by taking what she calls Smart Shots.

To me this appeal is overly optimistic but it’s also probably the only way that people can actually fix anything in health care given the current state of the system. She actually references the cranky old guard (which I think I include myself in) but I think she’s specifically talking about people who have spent a long time in big hospital systems or health plans and feel that nothing can be changed from within. Because those organizations are so rich and powerful I personally think the only way to really change health care is to have a “meteor hitting the Earth” extinction event for them, but I’ve written enough about that elsewhere.

So all in all I think Massively Better Healthcare is a very valuable read especially for somebody coming into healthcare with intention to fix the system. But I think it will help those people make health care better incrementally rather than massively.

I think I will actually prefer the sequel, so long as what happens in that is that we get more out of Halle about the experiences she’s had and the companies she’s worked with. There is probably nobody better to deliver a real tell-all about the “warts and all” of building health tech startup companies and although we got a good flavor from her in this first book, I think that there is actually a lot more to come from her.

Matthew Holt is the publisher of THCB

Quantifying the Rural Access Problem: Emergency Cardiac Care as a Window into American Healthcare

Apr 10, 2026

By ANISH KOKA

I was listening to a conversation between two critical thinkers I respect greatly: geneticist/technologist/blogger Razib Khan and Washington Post columnist Megan McArdle. Their discussion was a freewheeling rant about the problems they see with the rise of populism on the left and right, but a throwaway comment related to the US physician shortage in the context of needing high skilled immigrant labor towards the end of the almost two-hour conversation made me realize how little people really know about healthcare in America. Of course, everyone knows certain aspects of healthcare as a consumer very well, but even if you are a high-IQ individual who can make use of the vast information at all of our fingertips, it is hard to really know what the reality on the ground is without living it / having deep knowledge. Interestingly enough, early on Megan and Razib both acknowledge the impossibility of commenting on the situation in Iran, because the Iraq war taught them the folly of making conclusions from the available information. Bottom line, it doesn’t matter how smart you are if your conclusions are based on reading Colin Powell on the weapons of mass destruction Saddam Hussein must have. The public may not realize it, but health policy has a similar problem. The vast majority of academics “covering” American health policy, and in charge of describing healthcare, are ideologues whose main goal is not to describe reality, but to fashion a story. And as any screenwriter will tell you — do not let the facts get in the way of a good story.

What follows is an examination of what happens when you pull one of the important healthcare threads that forms the bedrock of many healthcare opinions that smart people like Megan and Razib hold: Rural access to healthcare in America.

First, here’s what a Google search reveals — and notice the sources. I assure you that PubMed is not much different. Rural healthcare access in America must be bad, right?

Once we establish that healthcare access in rural America is “bad”, there are all sorts of conclusions that are downstream from that like funding of rural hospitals, and management of the physician labor supply.

But the strange thing about the rural healthcare access problem that should strike anyone over a certain age that has followed/lived healthcare is that we have been talking about this and passing legislation on the matter forever, and yet if you are to believe those who should have the most knowledge about these things, we continue to fall short.

7th and possibly final update on the $39.94 lab test bill

Apr 9, 2026

By MATTHEW HOLT

I know you all care, so I am giving a 7th update on the telenovela about my Labcorp bill for $34.95.

The very TL:DR summary of where we are so far is that in May 2025 I had a lab test to go with the free preventative visit that the ACA guarantees, but I was charged for the lab tests and I was trying to find out why, because according to CMS I should not have been.

For those of you who have missed it so far the entire now 7 part series is on The Health Care Blog (1, 2, 3, 4, 5 & 6). Feel free to back and read up.

Where we left it last, Brown and Toland (the IPA between my plan Blue Shield of California and Labcorp) told me that on 8/29/2025 their benefits department had finished their review and reported that the original lab test wasn’t coded as preventative lab services by One Medical, so that the co-pay of $34.95 was correct. ($34.95 was the total agreed payment for all the tests, charged at a total of $322.28. And as it was less than my $50 copay, LabCorp only charges the patient for the total, not the $50!). That call was on December 18 and resulted in update 6.

I next (well about a week later later because life, etc) requested One Medical to resubmit the bill coding it as preventative. That happened on Dec 24, 2025 and someone called Alexis working for One Medical, while exhibiting terrible life skills, replied on Dec 25 and sent it on to their billing department asking them to recode it. I followed up on Jan 15 and Alexis at One Medical confirmed that the billing department had faxed the updated codes to Labcorp. I presumed that Labcorp would resubmit the claim to Brown and Toland and I would eventually get a $0 bill from them.

However, today (4/9/26) I called Brown and Toland about a different telenova — a coinsurance I had received for a dermatology office visit. While I had the rep on the phone, I asked about the Labcorp bill from May 2025. She told me that the benefits team at Brown and Toland had decided on December 18 — that’s right, before I contacted One Medical to ask them to resubmit the claim — that the codes should have been classified as preventative and that I don’t owe the $39.94. Of course Dec 18 was the last time I called Brown and Toland when they said that I had to have One Medical resubmit the claim to Labcorp. Sounds a little coincidental that very same day their benefits team re-reviewed the claim and decided that it should change to being preventative. But who am I to complain or raise a fuss!

Just to add to the complication, on Dec 29 someone within Brown and Toland (customer service?) received that message from the Benefits team and sent it over to the “Epic team” which I assume deals with outliers, with a request to reprocess it. As of today (April 9, 2026), that reprocessing had not happened.

As it happens they may not bother. Labcorp way back when agreed not to send me to collections, and I don’t know if they care enough to go after Brown and Toland for the $39.94, or have just given up on it. More likely if the claim is reprocessed, it will probably be tossed into the capitated amount they already got paid. Which is why the “payment” for my two subsequent lab tests was $0.

So I think we may be at the end of this series. (OK, if you read part 6 there are a couple of other tests Brown and Toland think I should be paying for but no one has sent me a bill for those yet and I may just let sleeping dogs lie).

But don’t worry, there’s always more stupidity in the way Americans deliver and pay for health care, so I’ll keep talking about it. Until we blow up the system and build one that works.

Mathew Holt is the Founder & Publisher of THCB

Tom Kelly, Heidi Health

Apr 6, 2026

Tom Kelly is the CEO of Heidi Health, another of the many ambient AI scribes that is spreading its wings to other roles, including bringing its own AI Open Evidence competitor! He calls it an AI care partner. Heidi started in Australia, and quickly moved to the UK and Canada, but now are in over one hundred countries. More recently they have come to the US and have now four major health systems and a lot of other mid market users. Tom think’s Heidi will soon do all the “work around the work”, and he doesn’t think it has to be deeply integrated with the EMR. He sees that as a superpower as doctors don’t want to be in the record. Is he right? Are scribes and ambient AI going to be separate? Does the scribe have to be a medical device, as it does in the UK? Will patients use it? Lots of questions about the future and Tom has lots of answers. Some might even be right!–Matthew Holt

Dyslexia Comes Back To Bite President Trump

Apr 3, 2026

By MIKE MAGEE

This past week, Donald Trump decided to get into a war of words with a person with dyslexia. His target was the Governor of California, Gavin Newsom, who has struggled with the learning disability since the age of 5.

The President’s action was premeditated and intended to take the potential Democratic 2028 Presidential contender down a peg. It got pretty personal pretty fast. Trump was direct as is his way. He said simply, “Everything about him is dumb.”

In response, the governor broadened the conversation to include young Americans with the condition with these targeted words of encouragement, “To every kid with a learning disability: don’t let anyone — not even the President of the United States — bully you. Dyslexia isn’t a weakness. It’s your strength.”

Trump seemed surprised by the blowback from his “dumb” remark. It drew a stern rebuke from the Yale Center for Dyslexia and Creativity which reminded the President that approximately 20% of the US population is challenged by some form of this condition.

Fellow dyslectic, author and political commentator, Molly Jong-Fast, quickly connected the political dots to current events: “Mr. Trump is a bully, but beyond that he tries to flatten things. Sometimes voters respond to this flattening, this simplification of complicated issues, but ultimately his refusal to see nuance in things, his inability to plan ahead, to see second- or third-order effects is his undoing (see: this war he has gotten us into).”

As the Yale experts put it, “Reading is complex. It requires our brains to connect letters to sounds, put those sounds in the right order, and pull the words together into sentences and paragraphs we can read and comprehend. People with dyslexia have trouble matching the letters they see on the page with the sounds those letters and combinations of letters make. And when they have trouble with that step, all the other steps are harder.”

Neuroscientists couldn’t agree more. Language is indeed complicated. At least five areas have been identified as role players in coordinating human capacity for language and speech.

There Are Three Kinds of Primary Care, Not to Be Confused With Each Other

Apr 2, 2026

By HANS DUVEFELT

(Note: Hans is rerunning some of his greatest hits. This one is from 2014 and leans right into my current and future obsession with fixing primary care-Matthew Holt)

Primary care doctors, the way things are organized in this country, perform three kinds of services. If we don’t recognize very clearly just how fundamentally different they are, we risk becoming overwhelmed, burned out, inefficient and ineffective. And, if we think about it, should we really be the ones doing all three?

SICK CARE

Historically, people called the doctor when they were sick. That service has, at least in this country, become more or less viewed as a nuisance in primary care offices. We keep a few slots open for sick people, in part because the Patient Centered Medical Home recognition process requires us to. But our clinics may worry that those slots go unfilled and lead to lost revenue.

Instead, sick people scatter toward emergency rooms with crowding, high overhead and liability driven testing excesses or to freestanding walk-in clinics that only sometimes are integrated with the primary care office but universally staffed by providers who don’t know the patient. These providers, due to staffing cost strategies, are sometimes the least experienced clinicians within their organizations, doing what I feel is the most challenging work in health care – sorting the very sick from the only moderately ill or even completely healthy but worried patients.

In the worst case scenarios, the walk-in clinic is freestanding, operating without any access to primary care or hospital records, starting from absolute scratch with every patient. Some of these clinics are well equipped, with laboratory and x-ray facilities and highly skilled staff. But some are set up in a room in the back of a drug store and staffed by a lone nurse practitioner with minimal equipment and no backup.

Because health care in this country has no master plan, this is what has emerged. If we had a national strategy for health care services, does anybody think it would look like this?

CHRONIC DISEASE MANAGEMENT

More and more people suffer from chronic diseases like diabetes, hypertension and autoimmune conditions. This is where the bulk of primary care work is done. Much of it is straightforward and predictable: Diabetics get their glycosylated hemoglobin checked every three months, hypertensives get their blood pressure logs and blood tests reviewed at certain intervals. And, sadly, much of it is ineffective. Few people lose weight, improve their blood sugars or change their lifestyles. Our visits follow the same tired routine from one time to the next – “I’ll do better this time, Doc”.

The more our country’s chronic disease burden increases, the more clinician time and effort this kind of work will consume. And the more we need to question whether there isn’t a better way to deliver chronic disease management.

Oh. Another Moonshot

Apr 1, 2026

By KIM BELLARD

If all goes well, in the next couple of days NASA will be sending astronauts on their way to the moon, for the first time since – gulp – 1972. They’re not landing, mind you, they’re just doing a fly around, something Apollo 8 first did way back in 1968. Given the advances in microchips, computing power, AI, a robust private space industry, and Elon’s grand plans to inhabit Mars, it doesn’t really sound all that ambitious, hardly a “moonshot” in the sense that we’ve come to use that term, but I guess we should be glad that NASA hasn’t entirely conceded space to the billionaires.

The Artemis II mission will send four astronauts – including, if you are counting (and many are), the first person of color, the first woman, and the first Canadian to reach the moon — on a ten day, 230,000 mile trip that won’t actually orbit the moon but just loop around it, not getting closer than a few thousand miles. “Things are certainly starting to feel real,” Christina Koch, one of the four, said during a news conference Sunday morning.

Last week NASA unveiled its “Ignition” strategy that Artemis II is part of. It includes not just the fly-by, but also a follow-up mission in 2027, a manned landing in 2028, and a permanent moon base in the 2030’s, committing $20b over the next seven years to accomplish the latter. “NASA is committed to achieving the near‑impossible once again, to return to the Moon before the end of President Trump’s term, build a Moon base, establish an enduring presence, and do the other things needed to ensure American leadership in space,” said NASA Administrator Jared Isaacman.

He added: “Today, we are providing a demand for frequent crewed missions well beyond (previously announced moon landings in 2028). We intend to work with no fewer than two launch providers with the aim of crewed landings every six months, with additional opportunities for new entrants in the years ahead. America will never again give up the moon.”

I knew Elon and Jeff were going to get something from all this.