elliot cohen

Almost all healthcare dysfunction stems from the consumer not being the customer. Employers create churn and misaligned incentives; shifting to consumer-directed purchasing (like AT&T phone plans) would create longitudinal relationships and force providers/PBMs to compete on consumer value.

Rebates (40-50% of list price) destroy price signals for consumers and providers. Removing them would restore genuine price competition between drugs. PBMs currently optimize for payer (employer/government) cost, not consumer outcomes; true reform requires making the consumer the arbiter of drug choice.

Current LLMs are exceptional at synthesizing patient history, preparing visits, and stringing together operational follow-ups (prior auths, referrals, prescriptions), but are far from replacing physician judgment on procedural details. The highest leverage is integrating AI into clinical workflows to shrink prep time and improve consumer navigation.

DTx require drug-level clinical trials and payer reimbursement but lack patent protection (easy to copy), creating a go-to-market trap. Most would be better served as direct-to-consumer cash products. The model only works in massive categories (like GLP-1s) where volume justifies the fixed cost.

Society should worry far more about the next Hepatitis C cure (which dropped from $100k to $15k in 6 months) not being invented than about Humira's patent thicket. The learning curve for biologics is the steepest of any technology; optimizing for marginal patent reform distracts from funding breakthrough innovation.