The Health Care Blog – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The ‌Missing ‌Vital ‌Sign: Why Modern Medicine Still Won’t Measure Sleep

Jun 16, 2026

By COLIN LAWLOR

A patient comes in for an ordinary primary care appointment. The nurse runs through the usual checklist: temperature, blood pressure, pulse, weight, sometimes pulse oximetry. Sleep probably won’t come up. If it does, it will be a side note, and if the patient says, “not great,” what often follows is a brief look of sympathy and the familiar advice to relax a bit before bed.

That is, more or less, what sleep looks like in the most common diagnostic interaction in American medicine. Don’t worry, it is not much, if any better in any other country. The other vitals get numbers, while sleep gets small talk. Calling this a minor gap misses the point.

What the Evidence Says

Sleep sits among the strongest behavioral and physiological predictors we have for chronic illness, cognitive decline, mental health outcomes, and burnout.

Work out of Stanford recently showed that just one night of sleep data (admittedly from a hospital sleep lab), processed by a foundation model called SleepFM, could flag elevated risk across 130 disease categories with high accuracy. The outcomes on that list are not trivial and include all-cause mortality, dementia, myocardial infarction, and heart failure.

A 2025 umbrella review that pooled 29 systematic reviews found two-way, physiologically mediated links between sleep and depression, anxiety, plus a long catalog of cardiometabolic conditions.

And researchers at Washington State University published what is, so far, the longest objective description of sleep in chronic insomnia. Eight weeks of continuous, in-home measurement pointed to something clinicians have struggled to capture for years: night-to-night swings in sleep efficiency, sleep latency, and intermittent wakefulness are central to the condition. Sleep diaries and one-night lab studies kept missing that pattern.

The clinical rationale for measuring sleep is settled, but what remains unclear is whether medicine intends to behave as if it believes its own evidence.

Ellipsis Health

Jun 15, 2026

Ellipsis Health has come a long way from its roots in detecting depression via vocal biomarkers. Sage, its charming voice AI agent, is now helping health plans and care management companies directly interact with patients and members, helping them with medication reminders, program recruitment, postop follow up and much more. I spoke with two of the brains behind Sage, COO Melissa McCool and CMO Mike Aratow. We got into what she does, what she’s good at and whether the world (or at least the health care world) needs specific voice AI specialists–Matthew Holt

Good News: Teen Pregnancies Hit New Low In the US

Jun 12, 2026

By MIKE MAGEE

Last week, policy wonks from the right and the left, finally found a topic they could agree on – Kids are no longer having (as many) kids.

Specifically, teen pregnancies dropped an additional 10% in the US in 2025. This is an acceleration of a trend which began two decades ago. Teen births peaked in America in 1991 with 62 births per 1000 girls/women age 15 to 19. In 2025, the rate was below 12 per 1000, a drop of 80%, with the majority of that (72%) occurring since the 2008 Great Recession.

Obviously, this is “good news” for these young women according to Congressional reports. And most agree the causes are multifactorial, and include gains in health education, declines in sexual activity in youth, access to contraception and the Plan B pill, and expanded economic and professional opportunities for women in society.

But for societies worldwide, leaders look on with angst as the birth rates in their nations have broken through the replacement line, with deaths exceeding births. This “replacement rate” is roughly 2.1 births per woman. The CDC recently reported that without immigration, the 2023 total fertility rate was only 1.6 births per woman (1,616 per 1000 women over a lifetime).

Since 2007, trend lines have pointed decidedly downward. In that year, there were 4,316,233 births in the U.S. In 2025, American women gave birth to only 3,606,400 newborns (a 23%) decline.

Oceans, Away

Jun 11, 2026

By KIM BELLARD

It probably didn’t show up on your calendar, but Monday was World Ocean Day. It’s a day meant to catalyze “collective action for a healthy ocean and a stable climate,” and has been around since 2002 (although the U.N. didn’t officially recognize it until 2008). Its website claims a network of over 2,000 organizations, in 180 countries.

I wish we had more to celebrate.

Many have recognized the irony of humans calling our planet “Earth,” when, in fact, 71% of its surface is covered with water. Even more amazing, oceans account for 99% of the biosphere. We come from the ocean and still owe much of our existence to it.

Unfortunately, these are not good times for oceans, and we’re to blame. The most recent World Ocean Assessment from the U.N. highlights:

The ocean matters to everyone, everywhere;
The ocean is under intensifying stress;
Climate change is transforming conditions;
Biodiversity is declining across nearly every marine habitat;
Pollution is widespread and increasing;
Ocean food systems are threatened.

The report concludes: “The coming decade is decisive: without rapid, coordinated global action, ocean health will continue to decline, threatening climate stability, biodiversity resilience, food security, livelihoods and the wellbeing of billions.”

I think about this in light of last month’s announcement by the National Science Foundation that it was “descoping” the Ocean Observatories Initiative (OOI) Major Facility, beginning next week. That’s a $368 million deep-ocean observation system “that delivers real-time data from more than 900 instruments to address critical science questions regarding the world’s oceans.” Some 900 instruments will be removed, in both the Pacific and Atlantic oceans.

Good News on the HIV Front

Jun 5, 2026

By MIKE MAGEE

In a 1996 JAMA editorial Nobel Laureate Joshua Lederberg MD wrote “Our fight with microbes is far from over …odds are tipped in their favor…they outnumber us a billion fold, and mutate a billion times more quickly…pitted against microbial genes, we humans mainly have our wits.”

Now three decades later, our scientists remain in a “battle of wits” with this amazing viral foe, but even without a vaccine, have maintained a slide edge for humanity. Experts recently confirmed that we are unlikely to have a vaccine bullet by 2030. And it’s not because we haven’t tried. There have been more than 250 official HIV vaccine trials, with fewer than 10 making it past the safety threshold to test efficacy – and the best performer only had a moderate success rate in triggering some immunity in 31%.

HIV is just a bad actor according to Professor Anna Durbin at the Bloomberg School of Public Health at Johns Hopkins. To start with, it embeds its chemistry in the host’s DNA genome, blurring the boundaries between “self” and “non-self.” Most of our successful vaccines focus in on a protein portion of the virus envelop or capsule. But the HIV virus has a “glycan shield” – a protein envelope that incorporates around 95 different sugar molecules which shield or disguise the viral protein from detection by our immune system. As one expert described it, “The immune system’s antibodies approach the virus and effectively see a blurry cloud of sugars rather than the vulnerable protein underneath.”

The second problem is the virus’s “sloppy gene duplication” is riddles with mutations. This yields dozens of different versions each with endless subtype variations. This is not typical disciplined viral behavior. Today’s measles viral genome for example is nearly identical to its late 20th century version.

And finally, HIV’s favorite target for invasion is the CD4 lymphocyte, otherwise known as the “Helper T-cell.” That happens to be the cellular key that unlocks our entire immune apparatus. This virus effectively decapitates the lead generals of our defensive force. And yet, we’re gaining on the virus. How have we done it?

First, by focusing on two “work-arounds” that trigger “passive immunity” without the help of our own immune machinery. Three decades ago, breakthrough discoveries first offered a glimmer of hope in the form of antiretroviral medications. With a variety of different combined therapy approaches, HIV/AIDS emerged as “no longer a death sentence,” but a chronic disease, like diabetes, that could be managed. In the modern era, this effective approach has spawned PrEP, or “Pre-exposure Prophylaxis,” – a preventive regimen for HIV negative individuals who are at risk of contracting HIV.

What Happens When Insurance Companies Become More Powerful Than Medicine?

Jun 4, 2026

By MATTHEW ZACHARY

The American healthcare system behaves exactly as its incentives tell it to behave. That sentence sounds almost boring until you follow it to its logical conclusion.

Insurance companies now influence clinical decisions more aggressively than many physicians. They shape hospital consolidation. They determine startup viability. They influence venture capital allocation. They dictate which drugs succeed commercially. They pressure physician behavior through reimbursement design. They decide who accesses diagnostics, rehabilitation, home care, specialty drugs, imaging, mental health services, and sometimes whether a patient gets enough time left on Earth to watch their kid graduate college.

And somehow we still spend an astonishing amount of time talking about apps.

I have spent almost 30 years inside this machine as a brain cancer survivor, nonprofit founder, media mogul, healthcare conference producer, policy advocate, and accidental anthropologist of American institutional failure. I have watched every corner of healthcare promise transformation. Precision medicine. Digital therapeutics. Patient engagement. AI. Consumerism. Value based care. Coordinated care. Interoperability. Navigation. Ambient listening. Population health. Personalized medicine. Blah blah blah,.

Meanwhile millions of Americans spend their afternoons arguing with an insurance company employee named Chad who has never met them but somehow possesses the authority to overrule their oncologist.

At some point we need to admit the obvious. Innovation stopped driving healthcare years ago. Insurance drives healthcare now.

That realization sits underneath every chapter of my new book, We the Patients: Understanding, Navigating, and Surviving America’s Healthcare Nightmare. I wrote it because after decades inside the system I finally understood something uncomfortable. Americans think they are angry about healthcare costs, wait times, medical debt, or inaccessible care. They are. But underneath all of that sits a deeper fury most people struggle to articulate.

People understand, instinctively, that somebody they never elected now controls enormous portions of their lives during moments of maximum vulnerability.

That changes a country.

You call this a system?

Jun 3, 2026

By TOMMY BEVERIDGE

Just like the Holy Roman Empire was none of those things, America’s health care system is neither health care, nor a system. Both are in fact decentralized commercial arrangements clothed in things that sound good, like Holy-Romanness, or Consumer-driven Health Care. Rather than health care, we have a patchwork of consumer products and government subsidies designed to pay a vast cadre of individuals and interests to perhaps incidentally provide health care. To even call it a system would imply something centrally coordinated, which no one in their right mind would do.

It feels hopeless. Health insurance is expensive, arbitrary, and capricious. It profits off of slices of an ever-growing pie, regardless of margins. The providers we cannot live without often charge whatever the market will bear. On top of this, the government, directed by laws written by politicians unwilling to upset powerful interests, has spent the past two decades pushing complex payment ideas with little result except a growing ecosystem of consultants specializing in gaming such incentives. Then there are the consultants— arms dealers in both sides of a war, selling hospital systems software that helps them bill as much as they can for their work, and health insurance companies software that helps them deny claims wherever they can.

We all know this. It’s the learned helplessness about it all that gets me. Sometimes a sob story about chemotherapy denied enters the zeitgeist, or the tale of a lone vigilante taking out a health care executive, but mostly we just take the 7 percent annual premium increases and deductible hikes with a stiff upper lip. Meanwhile, few of the players: payer, provider, government, or software slinger, put American’s health at the top of their agendas. Customer satisfaction? Maybe. Public ire? Occasionally. Shareholder value? Certainly. But our actual health?

Something that isn’t health care or a system can’t be a health care system. Not when this how we pay for care:

The Uninsured Crisis: Letter from Arizona

Jun 2, 2026

By EMMANUEL SARKEES

Arizona consistently ranks among the states with the highest uninsured rates in the nation. Over 800,000 residents lack health coverage, a number shaped not by failure, but by a consistency of structural, geographic, financial, and linguistic barriers that have been poorly addressed for decades. What makes Arizona’s situation this severe is that the demographic makeup, geographic issues, policy history, and high uninsured rate do not exist as separate problems, but as a link of issues where each difficulty increases the next.

In the United States, health insurance is not just a financial factor, but it is the primary mechanism through which people gain access to healthcare. Without insurance, an annual checkup becomes a pricey luxury, a chronic illness becomes undealt with, and a slight emergency can devastate someone’s life finances. This can be seen at its highest in Arizona, where Arizona ranks 43rd in the nation for its uninsured rate at 10.3%, carrying higher rates of disease mortality and late stage sickness as a result.

Who Arizona’s Uninsured Actually Are

One of the most common misconceptions about uninsured communities is that they are mostly unemployed. In Arizona, that is simply not accurate. A huge part of the state’s uninsured population works full time in agriculture, construction, and food service, where there is a shortage of health benefits. Although coverage is technically available through an employer, the costs to maintain these benefits are often too high in relation to their earnings. This leaves a large group of people in an unfortunate circumstance: they make too much to qualify for AHCCCS, Arizona’s Medicaid program, but too little to afford insurance plans. They fall into a coverage gap that lacks a current policy built to close it.

The data is also clear that the consequences do not distribute evenly. Hispanic and Latino residents are uninsured at higher rates than white Arizonans, while Native American and Indigenous people endure similar circumstances, surged through the federal government’s history of underfunding tribal healthcare and the fact that these communities often live in remote areas where there is a lack of healthcare infrastructure. Geography adds to this further, as uninsured rates are highest in rural and border areas like Yuma, Santa Cruz, Apache, and Navajo, communities that already greatly lack economic opportunities and healthcare infrastructure compared to urban areas like Phoenix and Tucson.

What Happens When People Can’t Get Care

All of these barriers have real consequences. Conditions that are quite easy and simple to treat become serious issues by the time they are finally caught. Social factors like insurance status stand as one of the greatest predictors of whether someone gets cancer and whether they survive it. Late stage cancer diagnoses are not just bad luck, but in some cases, are dependent on whether the patient was able to access the routine checks that would have easily caught it earlier.

Chronic conditions like diabetes and hypertension are another area where being uninsured causes serious, life-altering harm. These conditions need to be managed consistently with regular checkups and medication. Uninsured people often cannot afford visits or medication, so the conditions go unmanaged and worsen over time. A striking example: GLP-1 medications increased 442% in price between 2021 and 2023, creating a market three times larger than cancer spending, with list prices reaching $1,400. The fundamental issue is not just prices, but a system where everyone is focused on maximizing revenue rather than patient outcomes.

When uninsured patients consistently resort to the emergency room because of a lack of options, those costs do not disappear.

Schrodinger’s Co-pay

Jun 1, 2026

By MATTHEW HOLT

More tales of the woes of dealing with health insurance. I live in Marin County, California and one of the things that comes with that is a diagnosis of ADHD for my children. (OK, I have made that joke before but it is true!). My kids now visit a psychiatrist for more sophisticated med management than they receive at their pediatrician. We were (until recently) on a Blue Shield HMO via the Covered California exchange.

While I was at the doctor’s office, I talked to the staff. They told me I owed a $50 copay. I didn’t pay them (yet) and I went online and saw the claim

The reasonable, informed consumer might think that I owed nothing. The clue being that
“Patient Responsibility” was $0.

But if you click the “See More” in the top right it shows you this

You probably still think that I owe $0. But if you add the numbers on the right you might notice they don’t total $0.

Meat Computers of the World, Unite!

May 29, 2026

By KIM BELLARD

Until a couple of days ago I hadn’t heard of the phrase “meat computer.” Apparently this has been around for some time, and, as Lora Kelley discusses in The New York Times, the tech elites are increasingly using it, either as a way to humanize AI or as a way to disparage what humans can do relative to AI (e.g., Elon Musk posted last summer, “We are all dumb meat computers compared to digital superintelligence.”).

Raphaël Millière, an associate professor at the University of Oxford, told Ms. Kelley that the metaphor aims to“move the public perception on how humanlike and intelligent frontier models are.”

Well, Pope Leo isn’t buying it.

On Monday he issued his first encyclical, “Magnifica humanitas: On Safeguarding the Human Person in the Time of Artificial Intelligence.” It’s some 200 pages long, so forgive me if I’m having to rely on summaries, but he raises issues that I hope our politicians and business leaders will pay appropriate attention to.

Encyclicals are, it appears, one of the highest forms of teaching that a pope can give, and it is rare for a pope to deliver one himself, so this is something he takes very seriously. As he should.

AI, he asserts, is the new industrial revolution, and he calls for us to “disarm” it: “Disarming AI means freeing it from the mentality of ‘armed’ competition, which today is not limited simply to the military context, but is also an economic and cognitive phenomenon. Disarming does not mean renouncing technology, but preventing it from dominating humanity.”

“Artificial intelligence needs to be disarmed, freed from the logic that turned it into an instrument of domination, exclusion and death,” he said. “It must be at the service of all, and of the common good.”

The pope makes it clear that he is not against technology per se – “technology should not be considered, in itself, as a force antagonistic to humanity” – but the question is how it is used and what the impact on people will be. “For this reason, merely regulating it is insufficient; it must be disarmed, welcoming and accessible,” he said.

He is particularly concerned about control over AI, and the wealth that comes from it, should not be concentrated among an elite few: