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

Above the Fold

AI and Professional Nursing: On a Collision Course

Jul 6, 2026

By JEFF GOLDSMITH

In his wonderful and pragmatic new book, A Giant Leap, Dr. Robert Wachter cautions his professional colleagues that simply confiscating potential administrative and clinical staffing savings created by AI could foster a whirlwind of negative consequences for healthcare enterprises.

Nowhere is the explosive potential for reaction to AI incursions into care delivery greater than in nursing, hospitals’ largest single professional expense category. Hospitals employ more than 1.8 million Registered Nurses (RNs) and another 400 thousand non-RN nursing personnel. RNs alone are more than 30% of the hospital salaried workforce, and more than 40% of overall staff costs.

Nursing productivity is a central issue in overall hospital performance, and a key intervening variable both in clinical quality and patient satisfaction. So the capacity of AI to improve nursing productivity will be a core issue in determining AI’s effect on overall hospital operating performance.

There is clearly room for improvement. Studies have shown that nurses spend only 25-30% of their work hours in direct patient care activities. AI’s potential for alleviating the huge administrative burden damaging nursing productivity might be the biggest benefit AI could provide. AI could materially increase nursing time at the bedside, increasing both patient and nursing satisfaction.

However, AI could also reduce hospitals’ nurse headcount, a factor which could, in turn, reduce nursing union membership, the largest and fastest growing single category of hospital employees’ union membership. Almost 18% of all hospital employed RNs are members of labor unions (AFSCME, AFT Healthcare, National Nurses Union, etc. and their local affiliates). Union dues from nurses represent hundreds of millions in annual income to the unions that represent them.

Nursing unions’ most visible public policy initiative, which appeared first in California twenty years ago, was getting its state legislature to mandate nurse to patient staffing ratios in hospitals. These were designed to compel hospitals to hire more nurses with the intention of improving patient safety. What the ratios actually did was throw more nursing bodies at broken processes and systems. These laws had the important collateral benefit of assuring a “guaranteed income” in union dues from more nurses employed by hospitals subject to these ratios!

Formal (though less comprehensive) mandates for nurse staffing ratios have since spread to Oregon, Massachusetts and New York, with legislation pending in Maine, New Jersey, Pennsylvania. Michigan, Minnesota and Washington State. The research on the intended qualitative benefits of California’s state-mandated ratios confirm the expected benefits to patients, though the studies relied upon correlational analyses vs. states without the ratio mandate, not pre- and post- studies of the ratios’ effects on patient care.

Other studies concluded that the ratios pushed up both RN numbers and compensation vs other job categories as well as damaging hospitals’ operating margins relative to states lacking the mandates. The point-counterpoint of these studies gives one a sense of an issue rapidly becoming politicized.

July 4, 1862

Jul 3, 2026

By MIKE MAGEE

When I asked my brilliant literary agent, Jill Kneerim, when I would know that my book proposal was ready for submission, she replied directly, “It will be ready when I say it is ready.” Eleven months later, in April, 2018, she finally green lit the project, and two weeks after that, in an orchestrated two-round public auction, it “sold” to Grove/Atlantic Press.

I passed over the highest bidder in choosing to earn the opportunity to be associated with a literary and cultural publication – The Atlantic Monthly– that dates back to November, 1857, when it “quickly became known for the quality of its fiction and general articles, contributed by a long line of distinguished editors and authors that includes James Russell Lowell, Ralph Waldo Emerson, Henry Wadsworth Longfellow, and Oliver Wendell Holmes.”

Their book publishing arm, the Atlantic Monthly Press, was incorporated in 1917. A merger in 1993 with Grove Press gave birth to Grove/Atlantic. Grove was no slouch when it came to social activism. Founded in 1951, it purposefully republished D. H. Lawrence’s Lady Chatterley’s Lover: Complete and Unexpurgated, and Henry Miller’s Tropic of Cancer as a challenge to U.S. obscenity laws at the time. And in 1965, they were the original and first publisher of The Autobiography of Malcolm X.

The Atlantic Monthly’s name change to The Atlantic officially occurred in 2007 and signaled a broader and more modern editorial platform, a digital presence and engagement with multi-platform modern media. At around this time, corporate offices were moved to Washington, D.C., and the magazine focused down on politics featuring a longtime journalist, Jeffrey Goldberg. A decade later, noted philanthropist, Laurene Powell Jobs, purchased a majority stake in the growing empire, and Goldberg was elevated to editor-in-chief.

Now a decade later, with America’s 250th birthday upon us, the very same Jeffrey Goldberg penned an opening editorial – “America’s Promise” – in the July, 2026 edition. Meant to provoke, it opens with “It is quite interesting, and somewhat chastening, to realize that the most important piece of journalism published across the 169-year history of this magazine was not journalism at all, but a poem…”

That poem appeared on page 10 of Vol. IX – February, 1862. -No. LII. It had five stanzas, and no title when it was submitted. The author, an abolitionist poet and pacifist, Julia Ward Howe was a contributor and friend to then editor, James J. Fields. In November, 1861, while visiting Washington, D.C. with her husband Samuel, she was drawn to a group of Union soldiers who had joined voices to sing a familiar tune titled “John Brown’s Body” with the original hymn credited to John William Steffe, a South Carolina born Philadelphia bookkeeper in 1856, and lyrics added five years later by Mass 2nd Infantry Battalion.

THCB Spotlight: Warris Bokhari, Claimable

Jun 26, 2026

One of the most interesting follows on Linkedin is Warris Bokhari from Claimable. He’s a British MD, who has had stints not only as a doc in the UK, but also as a health tech and health insurance exec in the US. But now he’s at war with the system, in particular working for patients to overturn denials from insurers using AI. But what exactly is the big picture aim, and how does Warris think that he’s going to fix American health care? We had quite the discussion and we sort of agree, but also don’t. Great discussion and transcript is below the video–Matthew Holt

This was such a great discussion I wanted to publish the transcript. The way I do that is to copy the Youtube generated transcript and drop it into Claude to smooth it over. I then read it and if I think it’s made an error, dip back into the video and listen to what actually happened and make a correction. This is all code therefore for me saying I think this transcript is pretty accurate but it might have a bunch of AI and human generated mistakes.

THCB Spotlight: Warris Bokhari, CEO of Claimable

How The Patient Rights Revolution Builds on America’s 1776 One

Jun 25, 2026

By MICHAEL MILLENSON

It took 129 years for the inalienable rights proclaimed in America’s Declaration of Independence to apply to the rights of patients in relationship to their doctors.

In 1905, an Illinois appellate court ruled in favor of a woman who’d sued her surgeon for performing a hysterectomy without disclosing in advance what procedure he was doing. The court declared in what became one of the foundational principles of informed consent that “under a free government,” all citizens had the right to know what a doctor planned to do to their body before he did it, no matter how “skillful or eminent” the physician.

Today, in the era of artificial intelligence chatbots and data democratization, the lessons of America’s 1776 political revolution continue to be reflected in the push for patient rights.

The most important lesson pertains to power. The American colonists learned from hard experience that those holding power rarely concede it voluntarily. Similarly, every advance in information sharing with patients can be linked to sustained economic or legal pressure.

Just as the British genuinely believed they practiced “benign colonialism,” the surgeon who performed a hysterectomy on 40-year Parmelia Davis to treat her epilepsy not only believed deceiving her was necessary for her health, but might also have cited as support the American Medical Association’s Code of Medical Ethics. Patients, the code then declared, should not allow their own ”crude opinions” to obstruct “prompt” obedience to the doctor.

Although that admonition was subsequently axed, patient rights remained minimal for decades.

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.