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

Above the Fold

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:

Is California Staffed For the Crisis? Not Yet.

May 28, 2026

By JAKE SEGAL and KAREN LARSEN

Call 988 in California and someone picks up. In parts of the state, a mobile crisis team might arrive at your door instead of police. Through Proposition 1, the state is putting billions into treatment beds, supportive housing, and youth services. On paper, California is in the middle of the most ambitious behavioral health expansion in the country.

And yet, about two-thirds of adults and adolescents in need of care don’t get treatment. A behavioral health system that you can’t staff is just a blueprint, not a strategy.

Even as demand for mental health and substance use treatment surges, the supply of trained professionals is not keeping pace. California needs 375,000 behavioral workers by 2030, doubling positions statewide. State officials estimate a 38% shortfall in psychiatrists and a gap of roughly one-third among the 100,000 licensed therapists needed. Rural and underserved communities are especially hard hit; many have no child and adolescent psychiatrists at all. And shortages extend beyond doctors and therapists. Clinical social workers, addiction counselors, peer support specialists, and community health workers are also in short supply.

Building on State Leadership

California is not starting from scratch. The Department of Health Care Access and Information (HCAI) already administers several scholarship and loan repayment programs that encourage clinicians to practice in high-need settings, including loan repayment for nurses, licensed mental health providers, substance use disorder counselors, and psychiatric nurse practitioners. Through the BH-CONNECT federal waiver, HCAI is rolling out five workforce programs over 2025–2030, including a Medi-Cal Behavioral Health Student Loan Repayment Program.

These are important efforts, but they aren’t scaled to the size of the crisis. Loan repayment awards are often a fraction of a graduate’s full debt, and have limited availability. Even the largest programs will only target a few hundred providers; California needs thousands more.

Repayment alone doesn’t solve the immediate affordability problem: people can’t enter training if they can’t pay rent while they are doing it.

A $1 Billion Statewide Workforce Fund for California

California should create a statewide Behavioral Health Workforce “Pay It Forward” Fund: a $1 billion pool that lends money to trainees at zero interest, gets paid back as they get good jobs, and lends those same dollars out again.

The Canaries Are All Dead

May 22, 2026

By KIM BELLARD

MIT is, most people would admit, a pretty good school. Even those who don’t know a lot about universities probably associate MIT with science, engineering, and math, and in fact, it is one of the leading universities in the world for those (and other) areas. E.g., the QS World University Rankings have named it the top university in the world the last 14 years, USN&WR Global Universities Ranking has it #2, as does The Times Higher Education World University Rankings. There have been over 100 Nobel Laureate recipients associated with MIT. If you meet a Harvard grad you might think, oh, they may not actually be all that smart – they could be just a legacy admission, but if you meet an MIT grad you probably do expect that they must be smart, especially since MIT does not have legacy admissions. Even President Trump, who rails against “elite universities” and who has slashed science funding in his second administration (more on that later), can’t help but rave about his smart uncle who taught at MIT.

So when the President of MIT warns about reductions in research funding and in graduate school admissions, we’re not talking about the proverbial canaries in the coal mine dying. We’re talking about miners going down.

In a video message last week, MIT President Sally Kornbluth warned of some startling losses: over 20% drops in federally funded research, in new federal research awards, and in graduate student enrollment. Overall, the school’s research enterprise has shrunk 10% in the last year.

Gulp.

“That is a striking loss for one of the most influential and productive research communities in the world,“ Dr. Kornbluth said. She added:

The fact is that we’re looking at a real drop in research being done by the people of MIT. It’s a loss of momentum for faculty and students and frankly, it’s a loss for the nation. When you shrink the pipeline of basic discovery research, you choke off the flow of future solutions, innovations, and cures, and you shrink the supply of future scientists.

Make no mistake: although MIT itself may be an outlier, what is happening to it is not. Ted Mitchell, president of the American Council on Education, told The Washington Post: “This is the first of many of these kinds of alarms that will be ringing,” Brendan Cantwell, a professor of higher education at Michigan State University, also told WaPo that if MIT is scaling back how it does research, that means universities across the country should be thinking about scaling back and adjusting. The ripple effects will go far and wide, and will have bigger impacts than we realize.

Dor Skuler, Intuition Robotics: Meet ElliQ

May 20, 2026

Dor Skuler is CEO of Intuition Robotics the maker of ElliQ — a remarkable AI robot that is a companion for seniors. I had a lot of fun meeting ElliQ and asking Dor about how she works. This is a wide-ranging interview with Dor and with ElliQ. She tells us about Florence Nightingale, what Dor should do with his kids and really gives you the idea of how she relates to seniors. There’s a ton of capabilities–you really have to watch the whole thing–but the end result is that Medicaid plans including NY and Washington State have determined that ElliQ allows people to stay at home longer and saves $$ on nursing home care. A fascinating view into the present and the future of how AI and robotics is changing the world–Matthew Holt

Healthcare ‘quality’ is broken. Here’s how to fix it.

May 18, 2026

By OWEN TRIPP

For decades, quality in healthcare has been defined on industry terms — not people’s terms. New technology and innovative health plan designs are finally changing that.

People know quality when they see it, and they are definitely not seeing it in healthcare. Fifty-six percent of Americans rate the quality of care as “poor” or “fair,” and 90% believe we’re overpaying for it. Likewise, 80% of employers — collectively the largest purchasers of healthcare in the country — say that higher-quality care is a top priority for their workforce.

And yet, the U.S. healthcare system remains a global leader; a lack of know-how or quality control isn’t the problem. The problem is the wide gap between how the healthcare industry has historically defined quality and how quality is experienced by the people actually receiving and paying for care.

For the past 75 years, healthcare quality has been shaped by a grab bag of federal agencies, accrediting bodies, medical organizations, health insurers, and — more recently — consumer-focused ratings outfits ranging from U.S. News & World Report to Zocdoc. Though many pay lip service to patient experience, none has clearly defined quality — or explained it intuitively enough — to help individuals make smarter healthcare decisions based on their clinical and financial context.

Healthcare needs to move beyond narrow metrics and top doc lists to create a dynamic, value-driven view of quality that consistently connects people to the best care for them, where and when they need it — and ideally, even before they know they need it. Too often, “quality” equates to some numbers on a dashboard, when it needs to be more like a combination of GPS and driver-assist technology: guiding people to their health goals, keeping them in the highest-quality lane, and nudging them if they start to drift.

This was always the vision (for some of us). But we simply haven’t had the right mix of technology and system-wide connectivity to bring it to life. Now we do.