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Above the Fold

Arnold Ventures Part II “Structuring Information Felicitously”

Feb 3, 2026

By JEFF GOLDSMITH

In the first part of our look at Arnold Ventures, we explored its business model and generous support of elite University health policy experts to further an ambitious health policy agenda. In this second part, we will explore some of the questions raised by Arnold’s aggressive approach.

Zack Cooper is an Associate Professor of Economics and Health Policy at Yale University*. He is the academic investigator at the heart of the so-called the 1% Solution, an Arnold Ventures funded project which encompasses most of its health policy agenda. The core idea of the “1% solution” is that while comprehensive health reform (e.g. “Medicare for All”) may not be achievable, pursuit of a bevy of policy goals with smaller price tags could generate savings that could be reinvested in policy improvements.

Cooper was the object of unwanted press scrutiny for receiving extensive sub rosa funding from United Healthcare for research work and writing instrumental in the enactment of the No Surprises Act in 2021, which was aimed at controlling out-of-network health insurance billing. United was expected to be the largest single beneficiary of this legislation. (The biggest “surprise” emerging from the No Surprises Act was that providers are winning 80% or more of the independent mediations of these disputes, suggesting that it was health insurers, not providers, who were gouging the public).

According to Arnold’s 990s, Cooper and his Yale policy shop, the Tobin Center for Economic Policy, received over $5 million from 2018 to 2024. Of this amount, $700 thousand funded the 1% Project itself, including more than a dozen papers by academic colleagues on topics ranging from surprise billing to PBM reforms to site neutral outpatient payment to hospital market concentration.

As part of this project, Cooper and a University of Chicago colleague, Zarek Brot-Goldberg, published a paper in early 2024 of the economic impact of hospital mergers: “Is There Too little Anti-trust Enforcement in the Hospital Sector?” which found that 20% of hospital mergers had an adverse economic impact on their communities. The alternative off-message headline, “80% of hospital mergers had no adverse economic on their communities” never surfaced.

However, a follow on piece got wide circulation thanks to a June, 2024 Wall Street Journal article, which exposed it to millions of readers without any reference to Arnold Ventures funding. The paper, which featured an astonishingly complex multivariate econometric model, was originally published by the National Bureau of Economic Research (NBER is also funded by Arnold Ventures). This paper linked hospital mergers to widespread layoffs in the communities where the mergers took place and a subsequent wave of suicides and drug overdoses (!).

Primary care, Concierge Care & AI – How to fix health care

Feb 2, 2026

At last week’s HITLAB January 2026 Symposium, Matthew Holt gave a talk about what’s wrong with primary care, how concierge care for all can fix it, and how the most advanced primary care telehealth groups are using AI now.

John Arnold: The Most Powerful Man in Healthcare Nobody has Ever Heard Of (Pt I)

Jan 30, 2026

By JEFF GOLDSMITH

It has happened at least a dozen times. I mention John Arnold and am greeted by knowledgeable healthcare colleagues with a blank stare. Houston billionaire John Arnold is the most powerful man in US healthcare that nobody has ever heard of. An investing savant, Arnold made $50k in high school trading collectors’ hockey cards over the Internet. He became the star natural gas trader at Enron in his early twenties. Arnold, who played no role whatever in Enron’s storied collapse, left the company in 2001 with an $8 million bonus. In 2002, at age 28, Arnold founded a hedge fund, Centaurus Advisors, focusing on energy investing, and reeled off a decade of 100% annual returns.

Bored with investing and by then a multi-billionaire, Arnold shut down Centaurus in 2012, and decided to change the world. With his Yale trained attorney wife Laura, John created a family foundation. and funded it with a large share of their personal wealth. For reasons we will explore more fully below, in 2019, Arnold converted their foundation to a ”for-profit charity” known as Arnold Ventures. At nearly $4.7 billion in assets in 2024, Arnold Ventures was about a third of the size of the lions in foundation world, Robert Wood Johnson ($14.7 billion in 2023) and Ford ($13.7 billion in 2024). Arnold Ventures 501c3 grantmaking subsidiary gave away a cool $194 million in 2024 to a bewildering array of grantees from American Enterprise Institute to Families USA.

But Arnold’s business model is fundamentally different than these legacy charitable foundations.

Shifting Sands Part 3

Jan 28, 2026

By GEORGE BEAUREGARD

Fifteen months ago, I wrote in The Health Care Blog about the “incoming tide” of early-onset cancer.

At that time, the global rise in the incidence of early-onset cancer in younger people that had occurred over three decades had been noticed and was being monitored by researchers, scientists, and other healthcare professionals. Articles on research discoveries in this topic sporadically appeared in top medical journals such as Nature, The New England Journal of Medicine, and The Lancet.

From 2005 to 2011, some early warning articles surfaced in generalist publications in mainstream media outlets like The Wall Street Journal and The New York Times. Those stories were framed as tragic “one-offs” or medical mysteries. Following a landmark study published by the American Cancer Society (ACS) in 2017 (1), the narrative shifted from “anecdotal” to “epidemic”. In 2020, the death of actor Chadwick Boseman, who was diagnosed with colorectal cancer at the age of 43 catalyzed mainstream media reporting on the situation. Chadwick died one month before my son, Patrick, who was 32 years old. Patrick was featured in a WSJ article in January 2024.

Since then, other reputable national publications like Time magazine and The Economist, and major media news outlets have featured stories about the growing situation. Stories about it have even appeared in some popular supermarket tabloids.

Over the past year, articles about the potential causative roles of diets high in ultra-processed foods, obesity, environmental factors, sedentary lifestyle, and a gut bacterium’s genotoxin remnant mutagraph, so-called Colibactin, have appeared.

The recently released ACS report Cancer Statistics, 2026, presents a jarring “good news, bad news” dichotomy and has garnered wide attention. The good news: overall, five-year survival rates for people with cancer have increased from 50 percent to 70 percent since the mid-70s. A 40 percent increase. Certainly a cause for celebration. (Mary Lasker would be smiling.)

But a dark reality persists.

Indiana – It is the best of times, and the worst of times

Jan 26, 2026

By MIKE MAGEE

“Hoosiers receive heroes’ welcome in return to Bloomington” screamed last week’s ESPN headline, as IU claimed top spot in college football nationwide. It’s been awhile since sports elevated that state’s mood.

In his classic review of the famous movie, “The Hoosiers,” Roger Ebert writes, “This is a movie about a tiny Indiana high school that sends a team all the way to the state basketball finals in the days when schools of all sizes played in the same tournaments and a David could slay a Goliath. That’s still the case in Indiana.”

That final sentence came to mind last month, as the Midwestern state with a population of around 7 million (17th in the nation) punched above its political weight and landed headlines like this one on December 11, 2025 in The Hill – “Indiana Senate rejects new House map, defying Trump.”

Some facts were clear: Twenty-one Indiana state senators had joined all 10 Democratic state senators to defeat a proposed redistricting map that would have assured a gain of 2 additional House of Representative seats for Republicans in the 2026 mid-term elections. But most political pundits misread why they did it, and ignored a crucial economic report from 10 months earlier that informed their actions. More on that in a moment.

First a bit of history. A century ago, Eli Lilly Jr. (grandson of the founder of the famous pharmaceutical giant Lilly & Co.) cut a deal with the University of Toronto to be the sole supplier of their life-saving drug – insulin. Headquartered in Indianapolis, Indiana, they were ideally positioned because the state’s three economic pillars were manufacturing, agriculture, and health sciences.

To secure adequate supply of insulin was both a scientific and logistic challenge of historic proportions. Eli Jr.’s focus on line manufacturing helped. Raw material demands required the design of a refrigerated railway support system dead ending at Lilly manufacturing sites. This was made necessary since purifying 8 ounces of insulin required two and a half tons of beef or pork pancreas readily available from state farms. Sourcing the raw materials locally was not a problem. At the time, 86% of the state’s lands were controlled by 195,786 farming families committed to farming (including livestock management and slaughter houses).

Fast forward a century and the state remains heavily dependent on its tripartite pillars – manufacturing, agriculture and health sciences. That was the message broadcast with great political effect on April 15, 2025 in a first ever economic forecast update from Muncie, Indiana, the home of Ball State University and its’ well-respected Center for Business and Economic Research led by Michael J. Hicks, PhD. For over 50 years CBER has published “data-rich, nonpartisan research relevant to communities and businesses throughout Indiana.” Their reputation is built on one word – trust.

A $2,000 Voucher and 600 Patients: The Math Behind Fixing Care

Jan 20, 2026

When I was at HLTH last October Bradley Bostic invited me on his BoomBostic Health podcast. I was in the mood for ranting about the health care system and promoting my desire for getting everyone concierge level primary care. Bradley was very generous in giving me a mike and a lot of rope. I am embedding the youtube version and if you want just audio it’s here. (I was also losing my voice so there’s a cleaned up transcript below)–Matthew Holt

Bradley:

Well, hello and welcome back to another episode of Boombostic Health in the Wild here at HLTH 2025 in Las Vegas. I’m thrilled to have Matthew Holt with me, who is the leader at The Health Care blog, a blog I follow, and I appreciate you being here, Matthew.

Matthew

Bradley, thank you very much. I count my readers, you know, on about two hands, so I want to keep you in good health. I have a little joke. We used to have a podcast that actually wasn’t that well-followed called the THCB gang and one of my colleagues on THCB gang was at a conference and a guy in the row behind him said “oh I recognize your voice, my father used to listen to the podcast but then he died.” When my colleague told me the story I said, we don’t have enough listeners and subscribers to lose them like that – we’ve got to keep them alive in order to keep the podcast going!

Bradley

Well, Boombostic Health was really born out of my pension for building companies in the health tech world and investing in companies. When we first started this. I wasn’t sure if anybody would listen to it. My mom passed away from cancer 25 years ago. So, I knew she wouldn’t be listening to it unfortunately. But that was a big thing that inspired me to get into healthcare. And lo and behold, there is a really interested audience out there that wants to know how innovation is transforming our broken health care system. And clearly with your background with Health 2.0 and The Health Care Blog, this is an area that you’re focused on. And I think you said you have two easy steps. Oh no, two steps, not necessarily easy to fix healthcare.

Matthew

So the preamble to this is I’ve been doing this for a long time. I came to America in 1989.

Hospitals can soften the blow of Medicaid’s retroactive coverage change, if they choose to

Jan 16, 2026

By BRIAN STANLEY

Patients waiting on Medicaid enrollment face more bills, while Congress touts that as cost savings. Hospitals need to choose their stance.

Medicaid covers the lion’s share of short- and long-term health care expenses for low-income, older, and/or disabled Americans. Until now, the program paid for care received up to three months before someone filed for Medicaid, as long as the person was eligible at the time. That grace period has long been a safety net for people who fall ill before navigating the maze of Medicaid enrollment.

In a quiet change tucked into the “Big Beautiful Bill,” lawmakers shrunk that window by one to two months, depending on the state.

Now, for adults in Medicaid expansion programs, retroactive coverage stops at one month before enrollment. For traditional Medicaid enrollees, it’s two months.

The Congressional Budget Office estimates this change will “save” the government billions over the next decade. But those “savings” don’t reflect fewer illnesses or better care. Instead, they are unpaid bills and costs that move downstream to patients, nursing homes, and other parts of the health care system.

These changes can impact any of us.

Any health event can set off a chain of care – hospitalization, rehab, then long-term nursing home placement – that easily stretches past 30 or 60 days. Under the new rules, that early care will fall outside Medicaid’s reach: the first month or two of costs now sit squarely with the patient or facility.

Still, this change is especially harmful for dual eligible beneficiaries. Americans on Medicare who become eligible for Medicaid enrollment – think older adults or people with disabilities – are at particular risk.

This scenario plays out often: a person has Medicare and then experiences an illness or injury that drives their assets down. They then become eligible for Medicaid, in addition to holding their Medicare enrollment. For these Americans, the shift in the “Big Beautiful Bill” means that they face significant bills while they wait for their Medicaid enrollment to be completed.

We know that this population, and realistically, all Americans, suffer when retroactive coverage is taken away from them.

It’s Only a Subsidy If You’re Poor

Jan 15, 2026

By KIM BELLARD

Even though most ACA enrollees/would-be enrollees have made their 2026 enrollment decisions assuming the expanded premium subsidies are not going to be renewed, the renewal of those subsidies is not entirely dead. Last week the House narrowly passed an extension, relying on a discharge petition and 17 Republican Congressmen willing to go against their leadership. Meanwhile, in the Senate, Senator Bernie Moreno (R-OH), of all people, is leading an effort to come up with a bill to expand them as well.

Whether it will eventually get passed is uncertain, as is how/when it might be reconciled with the House bill, and the President might just veto whatever extension might manage to emerge. The expanded subsidies aren’t dead yet, they’re just “mostly dead,” as Miracle Max would say.

The seeming indifference to the concerns of over twenty million ACA enrollees is appalling, but in character. This is an Administration and a Republican Congress that doesn’t like SNAP, Medicaid, school lunches, or aid to starving people in Third World countries, among other things. If you’re poor, they think, too bad; get a job, or a better job, and pull yourself up yourself. No handouts.

If they were against federal subsidies generally, out of fiscal prudence or other guiding principles, I could respect it. I wouldn’t agree with it, but it’d at least be intellectually honest. The trouble is, they’re not against subsidies per se; they just don’t like them going to poor people. I.e., the ones who need them most.

What set me off on this was a ProPublica/High Country News investigation into grazing on public lands. If you live in the East you probably don’t think much about either grazing or public lands, but if you live in the West you are probably very familiar with both. Almost 50% of land in Western states is federally owned. It ranges from 85% in Nevada to 4% in North Dakota. Almost half of California is federal land. You might be forgiven if you assume federal lands must be national parks, but they are small relative to land managed by the Bureau of Land Management (BLM), the U.S. Fish & Wildlife Service (FWS), and the U.S. Forest Service (USFS).

According to ProPublica: “The federal government allows livestock grazing across an area of publicly owned land more than twice the size of California, making ranching the largest land use in the West.” Well, you might think, that’s not inherently bad; we might as well use the land for something, maybe even make a little money from it. That’s the problem; the federal government is practically giving it away. Its analysis found that the grazing fees charged amount to a 93% discount relative to the market rate. You read that right: ninety three percent. That’s not a discount, that’s a giveaway.

OK, that’s eye-opening, but if it helps a bunch of ranchers who are struggling to survive, maybe that’s not so bad; ranching goes back to frontier days and has a certain cowboy appeal. Unfortunately, that stereotype isn’t quite true.

Jim Gallic shows off Wondr Health

Jan 14, 2026

Jim Gallic is Chief Growth Officer at Wondr Health, a company specializing in creating the behavior change required for weight loss. He was a satisfied client who lost a ton of weight (see that before and after photo on the right!) and changed his eating habits completely using Wondr (no drugs involved!). Later in life he joined the company. I spoke to him and got a tour of the experience. A great demo about how Wondr works, and about how GLP1s are altering the conversation. Jim’s stance is that the behavior change works first to create a readiness program for the medication, and then the weight might stay off when the medication ends. Matthew Holt

Even When Healthcare Has a Clear Price Tag, Are We Getting What We Pay For?

Jan 12, 2026

By OWEN TRIPP

Move over, GLP-1s. This year the healthcare spotlight is on alternative plan design. Alternative health plans offer cost transparency and a consumer-friendly shopping experience. But can the capabilities under the hood deliver on quality and value? Though it may not sound buzzworthy, it has the potential to trigger a seismic shift in the commercial insurance market.

After years of disappointing returns and unmet promises from traditional insurance models, innovators and big-name insurers themselves are doubling down on alternative plans aimed at reducing healthcare costs through preferred care pathways with transparent pricing. Though these plans come in many flavors, common features include tiered networks, variable copays, care steerage, and an emphasis on primary and virtual care — often packaged in a digital-first (and AI-powered) “shopping” experience.

Alternative plans seem like a win-win. For consumers struggling with surprise bills and medical debt, replacing confusing deductibles and coinsurance with predictable copays offers much-needed peace of mind. For employers facing the highest increase in healthcare costs in 15 years, getting their workforce on a trusted path to quality feels like a sure bet.

There’s a catch, though: Alternative plans won’t help much if they lead people to the same old, fragmented healthcare experience. Innovative cost-sharing and a slick front-end experience must be backed by high-quality clinical care, dynamic population health management, and personalized engagement that represent a significant upgrade from what’s been delivered to date.

Otherwise, signing up for an alternative plan will be a lot like buying a shiny new smartphone, only to discover that its operating system only supports a handful of outdated apps.

Alternative plans: what must be under the hood?

While cost transparency and a streamlined shopping experience offer immediate benefits to consumers, it’s the deeper capabilities and levers under the hood of alternative plans that will drive long-term value and create an alternative model worth embracing.

1. A primary care-led integrated care model

Most insurer-led alternative plans are built on top of existing care delivery networks (and existing provider contracts), often leading people to well-worn pathways and settings, including those that have produced status-quo outcomes for people and minimal cost improvement for employers.

Alternative plans need to create new dynamics around primary care, removing access barriers, creating flexibility and incentives, and repositioning expectations for provider interactions. Simply doing more of the same is inadequate. A true primary care-led plan is one that creates new channels and opportunities, dedicates time for immersive one-to-one discovery, and empowers physicians to lead people to quality across the network based on individual needs — supported by data, technology, and system-wide connections.