GLP-1s Are a Bigger Business Than AI

He argues that whoever controls the flow of money at the point of purchase becomes the true “customer,” and that in most healthcare interactions it isn’t the patient. He links this to opaque pricing, misaligned incentives, and low trust.

He points to LASIK, cosmetic surgery, and other cash-pay settings where costs fall and quality and convenience rise. His claim is that consumer choice plus transparent prices forces providers to compete in ways that are largely absent in insurance-driven care.

He describes GLP-1s as a “foil” that exposed the list-to-net pricing gap, and says going direct-to-consumer removed PBMs and largely removed insurers for cash-pay use. He claims this can lower prices while drug makers can still earn more through higher volume.

He says US healthcare is strong at acute care (e.g., strokes, heart attacks), while worsening outcomes and spending are driven more by chronic disease (“slow clock”) plus other mortality drivers (“fast clock” like overdoses and car accidents). He frames the issue as value-for-dollar and unit costs rather than total spend alone.

He argues employers care about employees “in plural” over shorter horizons, while individuals care about themselves and family over a lifetime—creating structurally suboptimal outcomes. GLP-1 adoption and cash-pay behavior, in his view, are already challenging employer-driven coverage decisions.