 Personal note: I'm deep in building Prosper when I realized I needed to write this. Not as a manifesto or call to arms, but as someone who believes we can do better. The thoughts here have been keeping me up—not because I want to tear anything down, but because I can see a path where everyone thrives by putting health first. Sometimes you just have to share what you see. The most profitable business model in healthcare isn't treating sick people. It isn't denying their claims either. It's making sure they never get sick in the first place. Insurance companies can't do this. They need you sick. But AI doesn't. Consider the economics: Every diabetes diagnosis generates $15,000 in annual costs. Every heart attack creates $100,000 in claims. Every late-stage cancer represents a million-dollar treatment journey. The current system has evolved to manage illness, not prevent it. It's not malicious—it's just math. Insurance companies make money by collecting more in premiums than they pay in claims. Healthy people are overhead. Sick people are revenue. But here's where everything changes: AI companions operate on completely different economics. When AI prevents someone's diabetes, that's $15,000 in value created every year. Employers would happily invest $3,000 annually for that outcome. The AI company captures $12,000 in pure value—not from managing sickness, but from maintaining health. This isn't wishful thinking. It's a fundamental shift in how healthcare economics work. Because once you build a system that thrives on keeping people healthy, that learns your patterns better than any doctor could, that's present in those quiet moments when health decisions are made—you've created something transformative. You've created healthcare that profits from wellness. The shift has already begun. Direct primary care is growing 24% annually. Cash-pay surgery centers are multiplying. Employers are exploring alternatives. The question isn't whether this transformation will happen—it's who will build the platform that connects it all. The opportunity is profound: Align profit with prevention, technology with compassion, and business success with human flourishing. That's not just a better business model. It's better healthcare.  The American healthcare system isn't broken—it's been perfected. Perfected to extract maximum profit from human suffering. Insurance companies have built a $4.9 trillion extraction machine, multiplying costs through vertical integration while 92.5% of Americans technically have "coverage" that denies care at every turn. They own the hospitals, the pharmacies, the PBMs, creating a closed loop where they profit whether you're sick or well, treated or denied. But their fortress has a fatal flaw: it was built on infinite government funding and captive consumers. Both foundations are crumbling. And in the spaces between their bureaucratic walls, a revolution is already beginning. This isn't speculative futurism. The revolution is already unfolding in the quiet spaces between doctor visits—those anxious midnight moments when symptoms arise, the weeks between appointments when questions accumulate, the daily decisions about whether something is "worth" seeing a doctor. AI's transformative potential isn't in replacing physicians or automating paperwork. It's in creating healthcare's first true relationship: a constant companion that witnesses your patterns, holds your complete story, and stands beside you when you feel most alone. This is the profound shift from episodic transactions to continuous presence—from navigating healthcare's maze alone to having a trusted guide who knows you deeply and is always there. The Skills Gap ChallengeHealthcare's AI adoption faces a fundamental obstacle: traditional health tech leaders are trapped in yesterday's paradigm. They've spent careers mastering HIPAA compliance, navigating insurance billing codes, and optimizing for a system designed around episodic sick care. But "Always On" healthcare isn't about treating disease—it's about preventing it entirely. The real skills gap isn't technical—it's conceptual. Today's health tech leaders are asking the wrong questions:
That last question reveals the deepest misunderstanding. The insurance-dominated system has created a masterful illusion—expanding coverage while multiplying costs through vertical integration. They've rigged the game: owning the hospitals, the pharmacies, the PBMs, extracting profit at every step while patients navigate byzantine networks and prior authorizations. Getting their buy-in means accepting their rules, their economics, their vision of healthcare as a profit center rather than a human right. But the ground is shifting. As government funding tightens and the schemes that enabled infinite money extraction face scrutiny, the fortress walls are cracking. This isn't a time to seek permission from gatekeepers—it's time to build around them entirely. The leaders succeeding today aren't bridging AI with insurance requirements—they're building entirely new models. They understand that preventative, consumer-driven health doesn't need prior authorization because the consumer pays directly. They don't worry about billing codes because they're creating value outside that system. They're not seeking payer buy-in because they're empowering consumers to bypass payers entirely. This requires leaders who see healthcare not as a regulatory maze to navigate, but as a massive consumer market ready for disruption. The winners won't be those who best understand traditional healthcare—they'll be those brave enough to ignore it and build something genuinely better for the people who matter: patients.  "Always On" Healthcare: From Vision to RealityThe future of healthcare isn't episodic visits to overwhelmed doctors. It's continuous, proactive care enabled by AI that monitors, predicts, and intervenes before crises occur. But more profoundly, it's about filling the vast spaces between medical moments—those anxious nights when symptoms arise, the weeks between appointments when questions accumulate, the daily wellness decisions made without guidance. The Relationship Revolution: True "Always On" healthcare creates something unprecedented: a genuine relationship with a health companion that knows your patterns, understands your context, and provides trusted guidance whenever needed. This isn't about sensors and algorithms—it's about never navigating health uncertainty alone. Progressive Trust Building: The most sophisticated implementations start with simple interactions—sleep tracking, symptom assessment—then gradually deepen as trust develops. Over time, this companion learns not just your medical history but your lifestyle patterns, stress triggers, and personal health goals. Measurable Impact: Remote monitoring has already cut 30-day readmission rates by 50% for chronic illnesses like heart disease. AI systems are processing medical images 30 times faster than conventional methods. But the real transformation is in prevention—catching issues before they require treatment at all. Beyond Clinical Metrics: The profound shift is from reactive treatment to proactive partnership. When AI can predict health deterioration days in advance, when it notices subtle pattern changes you might miss, when it provides personalized guidance based on your complete health story—we move from managing disease to optimizing wellbeing. Yet challenges remain. Without thoughtful implementation, continuous monitoring can overwhelm rather than empower. Success requires systems designed around human needs, not technical capabilities—prioritizing meaningful insights over data collection, relationship over transaction. The Consumer-Driven TransformationThe paternalistic model of healthcare—where insurance companies own every link in the chain from pharmacy to hospital—has created a masterful extraction machine. Under the guise of expanding coverage, they've built a system that multiplies costs at every step, extracting profit whether you're getting a prescription, seeing a specialist, or walking into an emergency room. The Vertical Integration Trap: Six of the largest for-profit insurers control 30% of total U.S. health spending. Through vertical integration, they've created a closed loop where they profit from denying care, marking up medications, and steering patients to their own facilities. Studies show this integration alone adds $315M in unnecessary Medicare spending for just two common procedures. The Coverage Illusion: Yes, 24.2 million selected ACA marketplace coverage for 2025. But look deeper: healthcare spending exploded to $4.9 trillion in 2023, with private insurer per-enrollee spending growing 80.4% from 2013 to 2023. More people are "covered," but at costs that would have been unthinkable a generation ago. The Extraction Engine: This isn't sustainable healthcare—it's a sophisticated mechanism for extracting maximum revenue from government programs and employer benefits. Insurance companies positioned themselves as essential middlemen, then bought up the entire supply chain to ensure money flows to them regardless of health outcomes. But three forces are converging to crack this monopoly:
The insurance giants built their fortress on the assumption of infinite government funding and captive consumers. Both assumptions are crumbling. Silicon Valley doesn't need permission to disrupt this system—it just needs to offer something better directly to consumers.  Tech's Strategic AdvantageWhile Babylon Health's spectacular collapse—from a $4.2bn valuation in October 2021 to bankruptcy in summer 2023—serves as a cautionary tale, it shouldn't obscure real progress. The failure wasn't in AI's potential but in trying to replicate traditional healthcare digitally rather than reimagining it entirely. Today's true innovators understand the difference: The Relationship Paradigm: Companies like Prosper aren't building faster ways to see doctors—they're creating AI companions that fill the gaps between medical moments. These systems provide continuous presence, building trust through thousands of small interactions rather than episodic transactions. Validated Progress: K Health's AI Physician Mode matched doctors' clinical decisions in two-thirds of cases, but more importantly, emerging models show 97% of AI health insights are rated as helpful by patients, with 67% showing measurable health improvements. Market Recognition: The AI in healthcare market reached $26.57 billion in 2024 and is projected to grow at 38.62% CAGR through 2030. But the real growth isn't in digitizing old models—it's in companies brave enough to build entirely new ones. The winners won't be those who make healthcare more efficient. They'll be those who make it more human—who understand that between every appointment, test result, and prescription is a person seeking not just treatment, but understanding, reassurance, and genuine care. The Trust Paradox: Why Your Data is Safer with AI Than InsuranceHere's the uncomfortable truth no one wants to discuss: while consumers agonize over sharing health data with innovative AI companies, insurance giants are already using that same data—through AI algorithms—to systematically deny care. The trust deficit in healthcare is real, but we're worried about the wrong villains. The Shocking Status Quo: Insurance companies already have your most intimate health data. They're using AI algorithms to deny 49 million claims annually, with medical directors signing off on rejections in under 2 seconds without even opening patient files. In California alone, 26% of insurance claims are denied. When UnitedHealthcare's denials are appealed, 90% are overturned—proving the algorithms are designed to deny first, hoping you won't fight back. This is the system consumers trust by default. A system where your data is weaponized against you, where algorithms are optimized for profit extraction, not health outcomes. Where less than 0.2% of patients appeal denials because the process is so arduous that many die waiting. The Trust Reality Check: Yes, consumer skepticism about sharing health data is justified:
But here's what's missing from this conversation: trust isn't about avoiding data sharing—it's about ensuring your data works for you, not against you. The Privacy Inversion: "Always On" healthcare, designed correctly, offers something revolutionary: more privacy and control than you've ever had. Consider Apple's approach:
This isn't theoretical. Apple has proven you can build health technology that's both powerful and private. The model exists—it just needs to be applied to continuous AI health companions. Building Trust Through Design: Progressive Relationship Building: Trust isn't demanded upfront—it's earned over time. Start with simple, low-risk interactions like sleep tracking or symptom assessment. As value is demonstrated and trust grows, users can choose to share more. Radical Transparency: Not buried privacy policies, but clear, ongoing communication about what data is used, how it's protected, and what value you receive in return. No surprises, no fine print. User Ownership: Your health data belongs to you. Period. You can export it, delete it, control it. The opposite of insurance companies that hoard your data and use it against you. Value Exchange Clarity: Research shows 66% of consumers will share data for personalized experiences, and 40% for personalized health advice. But the value must be clear: better health outcomes, prevention of serious conditions, continuous support when you need it. Zero Exploitation Commitment: No advertising. No data sales. No sharing with insurance companies. Revenue from subscriptions or direct payment, not from monetizing your vulnerabilities. The Generational Shift: The trust equation is already changing:
This isn't naive optimism. It's pragmatic recognition that the current system already violates our trust daily. Young consumers understand a simple truth: a health companion that helps you prevent disease is infinitely more trustworthy than an insurance algorithm designed to deny you care. The Real Question: The choice isn't whether to trust technology with your health data. That ship has sailed—insurance companies already have it and are using it against you. The real choice is this: Do you want your data controlled by extraction machines that profit from denying care? Or by AI companions designed to keep you healthy, with privacy protections that put you in control? The trust deficit in healthcare is real. But it's not a barrier to "Always On" healthcare—it's the very reason we need it. Because the alternative isn't protecting your privacy. It's surrendering it to a system that's already proven it will use your most vulnerable moments for profit. Build it right—with user control, radical transparency, and zero exploitation—and consumers won't just trust it. They'll flee to it from a system that's already betrayed them.  The Reality Check"Always On" healthcare isn't inevitable—it's a battle for the future of human health. The insurance monopolies won't give up their extraction machine without a fight. They'll lobby, they'll regulate, they'll spread fear about "unproven" technologies while defending a system that already fails millions daily. But this isn't primarily about technology adoption or business model innovation. It's about recognizing a profound truth: the gap in healthcare isn't measured in technologies or treatments, but in moments. Those spaces between appointments when we feel most vulnerable, most alone with our health concerns. The real revolution isn't in AI's diagnostic accuracy or administrative efficiency—it's in creating healthcare's first genuine continuous relationship. A trusted companion that witnesses your everyday patterns, holds your complete health story, and stands beside you through uncertainty. This shift from transactional episodes to continuous presence changes everything. We don't need leaders who understand how to navigate the old system—we need those brave enough to build outside it entirely. We don't need business models that seek reimbursement from gatekeepers—we need direct relationships with consumers. We don't need regulatory approval from those who profit from the status quo—we need to create value so compelling that consumers choose us directly. The insurance giants built their empire on the assumption that healthcare was too complex for disruption, too regulated for innovation, too important to trust to Silicon Valley. They're about to learn how wrong they were. The tools are here. The old system is crumbling. The consumers are ready. Let's build the future of continuous, compassionate, AI-enabled care—not by asking permission, but by creating something so much better that the old system becomes irrelevant. The Business Model That HealsThe question isn't whether "Always On" healthcare can be profitable—it's whether we can finally align profit with healing. The insurance industry has proven you can extract $4.9 trillion annually by denying care. But what if the most profitable model is actually keeping people healthy? The math is surprisingly simple. When someone avoids diabetes, that's $15,000 per year in saved costs. Prevent a heart attack? $100,000. Catch cancer at Stage 1 instead of Stage 4? $500,000. In a system where value is created by prevention rather than treatment, the economics completely invert. The Direct Path: Consumers already pay $50-150 monthly for meditation apps, fitness trackers, and wellness subscriptions that offer fragments of health support. An AI companion that actually prevents disease, guides through health crises, and stands beside you in those 2 AM moments of fear? That's worth multiples more. Not because it's exploiting vulnerability, but because it's ending the loneliness of navigating health alone. The Employer Imperative: Companies lose $3,000 per employee annually to presenteeism—people at work but unproductive due to health concerns. They lose another $2,000 to unnecessary ER visits for conditions that could have been managed at home. An AI companion that keeps employees healthy, present, and confident in their health decisions doesn't just save money—it transforms workplace productivity. The Platform Emergence: As millions trust their AI companion for daily health decisions, a new economy emerges. Cash-pay providers need qualified patients. Patients need trustworthy providers. The platform that connects them—taking a small fee for successful matches—builds a sustainable business on transparency rather than opacity. But here's the profound shift: In the insurance model, the customer (employer), payer (insurance), and user (patient) have misaligned incentives. In the "Always On" model, everyone wins when health improves. The employer saves money, the patient stays healthy, and the platform profits from wellness rather than sickness. This isn't about finding clever ways to monetize data or exploit the worried well. It's about recognizing that the most profitable healthcare business model might simply be the one that actually works—keeping people healthy, supported, and never alone in their health journey. The insurance giants built their fortress on a fundamental lie: that healthcare must be expensive, complex, and adversarial. They're about to discover that the most dangerous competitor isn't another insurance company. It's a model that proves healthcare can be affordable, simple, and compassionate—and still be wildly profitable.  The Choice Before UsRight now, as you read this, someone is sitting in an emergency room at 3 AM, terrified and alone, unsure if their chest pain is heartburn or a heart attack. Someone else is staring at a denial letter for their child's cancer treatment, not knowing that 90% of appeals succeed—if only they knew how to fight. Another is skipping their diabetes medication because they can't afford the copay, while their insurer's CEO collects a $20 million bonus.
This is the system we've accepted. Not because it works, but because we've been told there's no alternative. There is. The technology exists today to create an AI companion that knows you better than any doctor ever could—not because it's smarter, but because it's always there. It notices when your sleep patterns shift before depression strikes. It catches the subtle changes that precede a cardiac event. It stands beside you in those dark moments of health anxiety, providing not just information but presence. The economics are already proven. Direct primary care is exploding. Cash surgery centers offer procedures at 80% discounts while maintaining healthy margins. Employers are abandoning traditional insurance in droves. The parallel system isn't coming—it's here, waiting to be connected. But this isn't really about technology or business models. It's about a fundamental choice: Do we continue to accept a system that profits from our suffering, or do we build one that profits from our wellness? The insurance giants want you to believe their fortress is impregnable. That healthcare is too complex for Silicon Valley to understand, too regulated to disrupt, too important to trust to startups. They're counting on your learned helplessness—the same helplessness that keeps people from appealing denials, from questioning bills, from demanding better. They're wrong. And deep down, they know it. Every denied claim is a betrayal that pushes someone toward alternatives. Every bankruptcy from medical bills creates another evangelist for change. Every employer watching their healthcare costs spiral while outcomes worsen becomes a potential partner in revolution. The moment is here. The tools are ready. The market is desperate. All that's missing is the courage to build it. To the builders and investors reading this: The next healthcare unicorn won't emerge from making the current system 10% more efficient. It will come from making it obsolete. From proving that healthcare can be continuous rather than episodic, preventive rather than reactive, compassionate rather than adversarial. To the employers drowning in healthcare costs: You don't have to accept 6% annual increases while your employees go without care. The alternative exists—you just have to be brave enough to embrace it. To everyone who's ever felt alone in their health journey: That loneliness isn't necessary. It's a choice the current system makes for profit. We can choose differently. The end of "alone" in healthcare isn't a utopian dream. It's an achievable reality that starts with a simple recognition: The most radical act in American healthcare isn't building new technology—it's building with love. Love for the scared patient googling symptoms at midnight. Love for the family destroyed by medical debt. Love for the human being behind every claim, every diagnosis, every moment of health uncertainty. Build with that love, and you don't just create a unicorn. You create a lifeline for millions who've been abandoned by a system that sees them only as profit centers. The insurance industry has perfected the monetization of misery. It's time we perfect the monetization of compassion. The revolution isn't coming. It's here, waiting for those brave enough to build it. Who's ready to end "alone"?
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