17 claims over $1 million. That's what one Massachusetts health plan, Mass General Brigham's, logged last year. KFF's Matthew Rae told state regulators Monday: "Where we used to talk about a high-cost drug being a six-digit number, we now have many drugs that are at seven digits." Fine. That's exactly what insurance is for. Rare, huge bills nobody can budget for. It is not for the strep test, the A1c, or the blood pressure refill. Yet we run those through the same machine, with the same claims, codes, and overhead, and then wonder why premiums keep climbing. Massachusetts just approved a 10.4% average increase for 2027. Pull the everyday care out. A flat membership, wholesale meds, cash-price labs. Then let insurance do the one job it's actually good at.

90%. That's how much of its revenue a California safety-net clinic would have to spend on care each year under Prop 44. Today they average about 80%. Find a way to deliver the same care for less? That's a surplus. Under Prop 44, a surplus gets penalized. We've run this experiment before. Federal agencies with use-it-or-lose-it budgets spend 4.9x their normal weekly amount in the last week of the fiscal year. When an ACA rule required insurers to spend a minimum share of premiums on claims, claims went up. Premiums didn't come down. Measure dollars spent and you get dollars spent. Direct primary care runs the other way: one flat fee, and the practice keeps what it saves by keeping you well.

Yale's Health Care Affordability Lab maps about $450 billion in annual savings across 23 policies. Over the weekend I asked @grok what America would save if Direct Care's pricing went national on meds, labs, and ER use. Three replies. Hundreds of billions. The research menu and the clinic math are pointing the same direction.

A new report says specialty practices leave $108B on the table every year. About $125K per physician. Here's where that money would come from: • ~$12B from patients' pockets (chasing unpaid balances) • ~$71B from more calls answered and more follow-up visits booked • ~$25B from fighting more claim denials That's not found money. It's next year's premium hike. Direct care went the other way: one flat membership, transparent prices. Nothing left on the table because nothing was hidden.

Every day at 6 p.m., every Ascension hospital gets a report showing volume, discharges, and ER visits against budget. Their CFO calls it relentless incrementalism. The number I'd want on a primary care version: how many patients got an answer the same day. What's one number you'd want your doctor's office to improve every day?

Nike's stock is down roughly 80% from its November 2021 peak: from a $179.10 high to around $35 in September 2026. It's not fair to pin all of that on one person. The stock kept falling after a longtime Nike executive took over in 2024, and China and competition played a part too. But the lesson analysts drew from the John Donahoe years is worth hearing. Nike hired a former Bain CEO and eBay and ServiceNow CEO to run a shoe company. It pushed hard into direct-to-consumer and pulled back from retailers. Wedbush analysts put it this way: Nike "focused too much on WHERE they were selling and lost focus of WHAT they were selling." Donahoe himself later said Nike had "over-rotated away from wholesale." Great operator. Wrong fit for the business. Healthcare has the same problem at scale. We let MBAs run medical systems, so the systems got optimized for billing, throughput, and market share. Of course the technology made care more expensive. It was built for the business model it was given. The fix isn't doctors collecting MBAs. It's physicians who understand primary care and put patients first designing the technology, the business model, and the workflows themselves. Do that and technology does in medicine what it does everywhere else: better care, lower prices. The right leader for the right business model.

43%. That's how many American adults told KFF this year they didn't take a medication as prescribed because of the cost. 27% never filled the prescription. 19% split pills or skipped doses. Epic's answer: a Prescription Marketplace that shows cash prices at Amazon Pharmacy, Costco, LillyDirect, and Cost Plus Drugs before the prescription leaves the room. Good. Genuinely. It's a crack in the wall. It ships summer 2027. And read Epic's own line: paying cash "can sometimes cost less." Sometimes. People pay a premium every month for drug coverage, and the coverage can be the more expensive way to buy the drug. At AtlasMD, meds are cost plus 10% and the price is posted. You ask. We answer. Many common meds go home with you from the office. Why did the price ever need a marketplace to be found?