Writing · Healthcare

Healthcare.

Notes from inside the seam between people who move and systems that don't. Routing, deployment, the operator-tier diligence problem.

80 pieces. All writing.

April 24, 2026 · 6 min
Routing is the healthcare problem we should have solved first.
April 21, 2026 · 3 min
Denial works because appealing is expensive. Claimable inverts that.
April 14, 2026 · 2 min
Urgent care has a competitor with no CAC.
April 13, 2026 · 2 min
The imaging RCTs are unimplemented. The LLMs without evidence are everywhere.
April 8, 2026 · 8 min
UnitedHealth invested $1.5B in AI. No Canadian payer invested anything equivalent. That gap compounds.
March 15, 2026 · 8 min
The hospital-at-home pilot data, four years in.
February 13, 2026 · 3 min
Canada tried again. The U.S. 2016 playbook now applies.
January 22, 2026 · 2 min
55% / $36.6B / six IPOs. The number every health-AI deck cites is the same number that calls the top.
January 14, 2026 · 3 min
Value-based care got operationalized on the third try.
January 13, 2026 · 6 min
The 2025 digital health vintage looks like a real industry. The 2021 vintage wore a stethoscope.
December 9, 2025 · 2 min
Provider AI runs ahead. Payer AI lags. Their interop runs slowest.
November 17, 2025 · 3 min
The unowned position is between the watch and the EHR.
November 16, 2025 · 2 min
The FDA hired the substacker. The substack is now policy.
November 14, 2025 · 2 min
Canada is 44 of 47. The number is the citation, not the country.
November 8, 2025 · 3 min
Ambient scribes are the one healthcare-AI category where evidence and adoption moved together.
November 3, 2025 · 6 min
The AI-for-prior-authorization pilots are the CMS mandate bet. Here is how to classify them.
October 30, 2025 · 6 min
The Seam That Ate a Decade
October 20, 2025 · 2 min
Healthcare AI adoption isn't a growth story. It's a redistribution schedule.
September 13, 2025 · 2 min
MAI-DxO is the procurement question now. Where do physicians + tools beat it?
September 1, 2025 · 8 min
The routing layer in healthcare AI is bigger than the diagnosis layer. Six million unattached Canadians prove it.
August 24, 2025 · 11 min
What Medimap Was About to Become
August 14, 2025 · 3 min
OpenEvidence is Nadler's second act. 1M physician questions a day.
July 15, 2025 · 3 min
MAI-DxO reset the room. Position your deck against it.
July 1, 2025 · 3 min
Illinois banned AI therapy. The prohibition names the liability every mental-health startup avoided naming.
June 12, 2025 · 6 min
AI in claim adjudication is the under-discussed health-AI win the prior-auth mandate is about to mainstream.
June 10, 2025 · 6 min
Canada just funded 10,000 AI scribes. The scribe is the wedge. The workflow layer is the business.
May 16, 2025 · 5 min
Amodei skipped the deployment timeline.
May 13, 2025 · 3 min
Topol named the longitudinal-data wedge.
April 10, 2025 · 6 min
AI for hospital staffing is the only optimization that addresses both the burnout data and the org-design problem.
April 1, 2025 · 3 min
The defensible asset isn't the drug, it's the dossier.
March 15, 2025 · 2 min
Witty testified. The policy window opened. Nobody filed the receipt.
February 24, 2025 · 3 min
The first MHMDA private lawsuit names Amazon. The health-data-as-product model just got litigated.
February 18, 2025 · 6 min
The national Canadian primary care crisis is quantified. The 6 million number changes the political calculus.
February 12, 2025 · 3 min
LLMflation is good news for everyone except AI-health startups.
February 11, 2025 · 6 min
Canada's AI regulatory vacuum is not a feature. It is a liability at the investor table.
February 2, 2025 · 3 min
AI workers are unfortunately slowed down by law. At least in some domains.
January 29, 2025 · 6 min
The EHR vendors will eat every health-tech startup that the IPO window validates.
January 28, 2025 · 6 min
OpenAI Operator is the demo of what every travel and healthcare booking flow needs in 18 months.
January 27, 2025 · 3 min
The medical-tourism market is a denial-arbitrage market.
January 12, 2025 · 2 min
The EHR bundling clock starts when the wedge works.
January 2, 2025 · 6 min
AI radiology is real. AI-in-radiology-as-product is mostly not. The FDA data explains the gap.
December 23, 2024 · 3 min
The Canadian digital health adoption gap is wider in rural provinces. The policy doesn't know it yet.
December 15, 2024 · 8 min
The behavioral-health expansion of 2024 was the right size.
December 13, 2024 · 2 min
The r/medicine thread got deleted. Physician anger has a citation now.
December 12, 2024 · 6 min
The FDA just shifted from product approval to process approval. Your AI-cleared moat got drained.
December 10, 2024 · 3 min
Sick care doesn't become healthcare without a longitudinal data holder.
December 9, 2024 · 3 min
TechBio ate the digital health round.
December 6, 2024 · 8 min
Physician burnout is an org-design problem. The Canadian survey data makes the case.
November 13, 2024 · 3 min
When the model is free, the EHR is the moat.
November 12, 2024 · 6 min
Healthcare-AI procurement is its own skill. The Texas AG settlement proved why.
November 10, 2024 · 2 min
DAX Copilot is a CFO product.
October 14, 2024 · 4 min
The wearables stack is now upstream of biology.
September 30, 2024 · 4 min
Even the AGI bulls are quietly long adoption risk.
September 13, 2024 · 3 min
Reddit became the family-doctor referral system Ontario doesn't have.
September 3, 2024 · 3 min
The Canadian primary care wait-time data worsened through Q3 2024. The AI-scribe announcement didn't help.
September 1, 2024 · 2 min
The health data broker layer is now regulated. That changes the pitch.
August 19, 2024 · 3 min
AI triage in the ED keeps not landing. The deployment gap is the reason.
August 8, 2024 · 2 min
Ambient scribes were never going to be a product category.
July 30, 2024 · 4 min
The pediatric-to-adult care handoff is the worst-handled transition in US medicine.
July 9, 2024 · 6 min
Amazon is doing to healthcare access what Booking did to travel. Here is how it ends.
June 14, 2024 · 6 min
Canada legislated in 2024 what the US did in 2016. Here is what that decade of lag costs.
June 5, 2024 · 3 min
Alberta restructured its health system while talking about AI. The restructuring is the story.
May 22, 2024 · 3 min
On 'Epic-as-a-monopoly' framing.
May 20, 2024 · 3 min
The drug commoditizes. The data doesn't.
May 4, 2024 · 8 min
Why the dental-vision-hearing exclusion will outlive every Medicare reform.
April 27, 2024 · 4 min
Health data became travel-insurance data that quarter.
April 24, 2024 · 7 min
Healthcare data doesn't move because nobody owns the pipes.
April 22, 2024 · 3 min
Three reasons the 'health-data-as-an-asset' framing rings hollow.
April 19, 2024 · 3 min
On the medical-school admissions algorithm reform.
April 9, 2024 · 3 min
The clinical-decision-support liability question.
March 27, 2024 · 4 min
Why the 'doctor on demand' branding never quite worked.
March 15, 2024 · 4 min
The patient portal is a marketing artifact.
March 3, 2024 · 3 min
Why the 'GLP-1 supply' story is undercovered.
February 26, 2024 · 6 min
Ontario's primary care shortage is not a supply problem. It is a routing problem TJ already solved once.
February 8, 2024 · 3 min
The single-payer debate is over. The single-payer math hasn't changed.
January 27, 2024 · 4 min
The prior-authorization problem is solvable with current technology.
January 15, 2024 · 5 min
2.5M Ontarians lost their family doctor. Shoppers is filling the gap.
January 11, 2024 · 2 min
AI for medical billing is a labor-market story.
January 4, 2024 · 6 min
Booking became underwriting last winter.
January 1, 2024 · 7 min
AI-driven 'patient journey' tools mostly aren't.

Healthcare.

Routing is the healthcare problem we should have solved first.

Denial works because appealing is expensive. Claimable inverts that.

Urgent care has a competitor with no CAC.

The imaging RCTs are unimplemented. The LLMs without evidence are everywhere.

UnitedHealth invested $1.5B in AI. No Canadian payer invested anything equivalent. That gap compounds.

The hospital-at-home pilot data, four years in.

Canada tried again. The U.S. 2016 playbook now applies.

55% / $36.6B / six IPOs. The number every health-AI deck cites is the same number that calls the top.

Value-based care got operationalized on the third try.

The 2025 digital health vintage looks like a real industry. The 2021 vintage wore a stethoscope.

Provider AI runs ahead. Payer AI lags. Their interop runs slowest.

The unowned position is between the watch and the EHR.

The FDA hired the substacker. The substack is now policy.

Canada is 44 of 47. The number is the citation, not the country.

Ambient scribes are the one healthcare-AI category where evidence and adoption moved together.

The AI-for-prior-authorization pilots are the CMS mandate bet. Here is how to classify them.

The Seam That Ate a Decade

Healthcare AI adoption isn't a growth story. It's a redistribution schedule.

MAI-DxO is the procurement question now. Where do physicians + tools beat it?

The routing layer in healthcare AI is bigger than the diagnosis layer. Six million unattached Canadians prove it.

What Medimap Was About to Become

OpenEvidence is Nadler's second act. 1M physician questions a day.

MAI-DxO reset the room. Position your deck against it.

Illinois banned AI therapy. The prohibition names the liability every mental-health startup avoided naming.

AI in claim adjudication is the under-discussed health-AI win the prior-auth mandate is about to mainstream.

Canada just funded 10,000 AI scribes. The scribe is the wedge. The workflow layer is the business.

Amodei skipped the deployment timeline.

Topol named the longitudinal-data wedge.

AI for hospital staffing is the only optimization that addresses both the burnout data and the org-design problem.

The defensible asset isn't the drug, it's the dossier.

Witty testified. The policy window opened. Nobody filed the receipt.

The first MHMDA private lawsuit names Amazon. The health-data-as-product model just got litigated.

The national Canadian primary care crisis is quantified. The 6 million number changes the political calculus.

LLMflation is good news for everyone except AI-health startups.

Canada's AI regulatory vacuum is not a feature. It is a liability at the investor table.

AI workers are unfortunately slowed down by law. At least in some domains.

The EHR vendors will eat every health-tech startup that the IPO window validates.

OpenAI Operator is the demo of what every travel and healthcare booking flow needs in 18 months.

The medical-tourism market is a denial-arbitrage market.

The EHR bundling clock starts when the wedge works.

AI radiology is real. AI-in-radiology-as-product is mostly not. The FDA data explains the gap.

The Canadian digital health adoption gap is wider in rural provinces. The policy doesn't know it yet.

The behavioral-health expansion of 2024 was the right size.

The r/medicine thread got deleted. Physician anger has a citation now.

The FDA just shifted from product approval to process approval. Your AI-cleared moat got drained.

Sick care doesn't become healthcare without a longitudinal data holder.

TechBio ate the digital health round.

Physician burnout is an org-design problem. The Canadian survey data makes the case.

When the model is free, the EHR is the moat.

Healthcare-AI procurement is its own skill. The Texas AG settlement proved why.

DAX Copilot is a CFO product.

The wearables stack is now upstream of biology.

Even the AGI bulls are quietly long adoption risk.

Reddit became the family-doctor referral system Ontario doesn't have.

The Canadian primary care wait-time data worsened through Q3 2024. The AI-scribe announcement didn't help.

The health data broker layer is now regulated. That changes the pitch.

AI triage in the ED keeps not landing. The deployment gap is the reason.

Ambient scribes were never going to be a product category.

The pediatric-to-adult care handoff is the worst-handled transition in US medicine.

Amazon is doing to healthcare access what Booking did to travel. Here is how it ends.

Canada legislated in 2024 what the US did in 2016. Here is what that decade of lag costs.

Alberta restructured its health system while talking about AI. The restructuring is the story.

On 'Epic-as-a-monopoly' framing.

The drug commoditizes. The data doesn't.

Why the dental-vision-hearing exclusion will outlive every Medicare reform.

Health data became travel-insurance data that quarter.

Healthcare data doesn't move because nobody owns the pipes.

Three reasons the 'health-data-as-an-asset' framing rings hollow.

On the medical-school admissions algorithm reform.

The clinical-decision-support liability question.

Why the 'doctor on demand' branding never quite worked.

The patient portal is a marketing artifact.

Why the 'GLP-1 supply' story is undercovered.

Ontario's primary care shortage is not a supply problem. It is a routing problem TJ already solved once.

The single-payer debate is over. The single-payer math hasn't changed.

The prior-authorization problem is solvable with current technology.

2.5M Ontarians lost their family doctor. Shoppers is filling the gap.

AI for medical billing is a labor-market story.

Booking became underwriting last winter.