Yikes- Packy. Great job. Your insurance man, grandfather would really be proud. Quite a contribution to helping people level up. You would be surprised how many people that are responsible for buying med insurance, don't know all that you were able to succinctly (not a word heard around here often) make it understandable. Sounds like a wonderful service- keep going!
I'm considered in some circles an "amateur healthcare anthropologist" 😎. I gotta say: I don't know if there's been some other healthcare Not Boring articles I've missed - but you really nailed the history with this one!
How you started from 80 years ago with FDR-Truman and the Bismarck and Beveridge models, through Baylor's Blue Cross, all the way up to the idea of the ACA and that pivotal moment with McCain... You really nailed the history of U.S. healthcare. In ways where I've listened to tons of podcasts and read tons of books - It just really validated the story.
And even for disruptors like Julie Yoo (Raising Health podcast is a great one to see health VCs) and Mario Schlosser from Oscar.... and how they view the market is ripe for an incentive model change.
What I was less familiar with was the personal story of the founders of Thatch (I heard of Thatch and know what ICHRA is)... but I think just telling this story and the market opportunity with US Healthcare the way you described it is a huge unlock and gets me super-jazzed about potential for incentive reform around employer-sponsored healthcare. Being able to break into a more consumer and market-driven approach that will ultimately hope to reduce healthcare costs (your scientific drawings definitely helped as well).
I'm gonna repost this to my LinkedIn because I think this is something that a lot of people in my healthcare circle are going to love to see because of how impressive the opportunity really can be.
P.S. Really enjoyed learning your writing journey all the way from David Perell's "How I Write" until your success now. You're one of my inspirations for Substack writing!
I really appreciate that, Andrew! Healthcare is probably still the category I get most worried that insiders are going to tell me I got wrong when I write about it, so means alot. And thanks for sharing with your Linkedin!
Same, I'm just starting my LinkedIn posting and essay writing journey - my biggest fear is, "Not only do I sound like an idiot, but am I going to say something actively harmful?"
I have been reading your essays for awhile whenever during the pandemic I went searching for people that believe like me that the world is ripe for innovation. I devoured every word of this. One thing that you allude to but do not say is that part of our problem is that we have a sick care system, not a healthcare system. People make or lose money when people are not well. Those incentives drive their behaviors. I could nerd out with you on this. If you ever want to, lmk.
Packy - as a health tech veteran, I appreciate the positivity that is expressed so well in this article. It helps me start the day with enough energy to survive the blows that come with innovating in Health Care. I shared your article in the Health Tech Nerds community, and I thought I'd share Kevin's (the man behind HTN) opinion:
I go back and forth on the piece, particularly when I think about Not Boring's more generalist audience.
On the one hand, I think it's a helpful piece of content going into the history of employer-sponsored insurance. It's pretty clearly a cheerleading piece from an investor in Thatch and I think articulates the bull case about why to be excited about ICHRA really well. If nothing else, the 401k for health benefits is an excellent analogy in the way it simplifies a really complex topic in a really tangible way.
On the other hand, I very much agree the tone of the piece is almost like a straw man argument making ICHRA out to be this game changing thing that isn't helpful because it oversimplifies all the tradeoffs at hand. When The article says things like this:
Mario at Oscar Health, which I wrote about in January 2022, expressed caution, as well: “We’ve been here before. ACA, private exchanges. The US healthcare system has shown remarkable inertia.”
But Julie, Mario, and everyone else I’ve spoken to, believe that ICHRA really will be different.
It makes me think they didn't look very hard to find other perspectives on that, because there are a lot of folks who don't necessarily think ICHRA will be all that different. That's even before getting into the whole conversation about ACA insurance all of a sudden covering $50k per year clinics, or Prenuvo scans and whatnot.
It's definitely an exciting opportunity, there are a lot of cool startups working on the sector, and is something that in ten years could take off as a major market. But I think it'd be more helpful to talk through both the exciting parts of ICHRA as well as the challenges of it in a more meaningful way.
As one investor told me about the rationale behind an investment in an ICHRA startup - employer insurance has to change in the next decade, nobody knows how it will, so might as well place a call option on betting on ICHRA as an idea and folks you believe in. I can't fault that energy at all in this piece, but I do wish it took a more reasonable view of the reality of the market
Packy-this was well done, really appreciate you setting the table with the historical perspective. Many business owners feel forced by the market to continue offering a "traditional" group health insurance program out of fear of losing the ability to recruit and retain top talent. Thatch has done a great job in building a better mousetrap to administer an ICHRA programs. The incentives of untenable renewal increases are moving some of my clients in this direction.
Brilliant analyses. IHCRA may face challenges if the exchange premiums explode or certain benefits get removed in order to get subsidies. The problems facing the employees go much deeper in the assistance needed to help them negotiate bills (AI can solve this), no where to go to get cash rates below the copay etc. (eg Function Health and Quest direct are going to be cheaper than the health system). Thatch+ a few other pieces could truly change the entire industry. 35 year industry veteran, 3 x CEO. Love to connect.
As a bit of a health policy nerd I think there are a lot of open questions on whether the average person can make an informed choice on health care plans. If you look at Medicare advantage a lot of insurers just try and add gym memberships and luxuries to terrible plans. You end up in situation where you think your plan is good until you have a medical crisis. Ultimately to have a working market place you need informed buyers and the devil with health plans is truly in the details
I do think this is helpful for small business that would not otherwise offer coverage. But realistically if everyone was on such a marketplace people would often buy the cheapest plan (already common in MA) and subsequently have coverage that doesn’t really cover them. Hope I’m wrong about this but I would much rather just see us follow other countries models that work than try invent a new one.
Yikes- Packy. Great job. Your insurance man, grandfather would really be proud. Quite a contribution to helping people level up. You would be surprised how many people that are responsible for buying med insurance, don't know all that you were able to succinctly (not a word heard around here often) make it understandable. Sounds like a wonderful service- keep going!
I don’t know if it was succinct but was very happy to get to write it.
Great synopsis. Really pulling for Thatch! 🙌
Thanks Scott!
Oh snap - a Not Boring article on U.S. healthcare! Time to buckle in 🍿
Let me know how I did!
I'm considered in some circles an "amateur healthcare anthropologist" 😎. I gotta say: I don't know if there's been some other healthcare Not Boring articles I've missed - but you really nailed the history with this one!
How you started from 80 years ago with FDR-Truman and the Bismarck and Beveridge models, through Baylor's Blue Cross, all the way up to the idea of the ACA and that pivotal moment with McCain... You really nailed the history of U.S. healthcare. In ways where I've listened to tons of podcasts and read tons of books - It just really validated the story.
And even for disruptors like Julie Yoo (Raising Health podcast is a great one to see health VCs) and Mario Schlosser from Oscar.... and how they view the market is ripe for an incentive model change.
What I was less familiar with was the personal story of the founders of Thatch (I heard of Thatch and know what ICHRA is)... but I think just telling this story and the market opportunity with US Healthcare the way you described it is a huge unlock and gets me super-jazzed about potential for incentive reform around employer-sponsored healthcare. Being able to break into a more consumer and market-driven approach that will ultimately hope to reduce healthcare costs (your scientific drawings definitely helped as well).
I'm gonna repost this to my LinkedIn because I think this is something that a lot of people in my healthcare circle are going to love to see because of how impressive the opportunity really can be.
P.S. Really enjoyed learning your writing journey all the way from David Perell's "How I Write" until your success now. You're one of my inspirations for Substack writing!
I really appreciate that, Andrew! Healthcare is probably still the category I get most worried that insiders are going to tell me I got wrong when I write about it, so means alot. And thanks for sharing with your Linkedin!
Same, I'm just starting my LinkedIn posting and essay writing journey - my biggest fear is, "Not only do I sound like an idiot, but am I going to say something actively harmful?"
Keep on rocking!
I have been reading your essays for awhile whenever during the pandemic I went searching for people that believe like me that the world is ripe for innovation. I devoured every word of this. One thing that you allude to but do not say is that part of our problem is that we have a sick care system, not a healthcare system. People make or lose money when people are not well. Those incentives drive their behaviors. I could nerd out with you on this. If you ever want to, lmk.
Packy - as a health tech veteran, I appreciate the positivity that is expressed so well in this article. It helps me start the day with enough energy to survive the blows that come with innovating in Health Care. I shared your article in the Health Tech Nerds community, and I thought I'd share Kevin's (the man behind HTN) opinion:
I go back and forth on the piece, particularly when I think about Not Boring's more generalist audience.
On the one hand, I think it's a helpful piece of content going into the history of employer-sponsored insurance. It's pretty clearly a cheerleading piece from an investor in Thatch and I think articulates the bull case about why to be excited about ICHRA really well. If nothing else, the 401k for health benefits is an excellent analogy in the way it simplifies a really complex topic in a really tangible way.
On the other hand, I very much agree the tone of the piece is almost like a straw man argument making ICHRA out to be this game changing thing that isn't helpful because it oversimplifies all the tradeoffs at hand. When The article says things like this:
Mario at Oscar Health, which I wrote about in January 2022, expressed caution, as well: “We’ve been here before. ACA, private exchanges. The US healthcare system has shown remarkable inertia.”
But Julie, Mario, and everyone else I’ve spoken to, believe that ICHRA really will be different.
It makes me think they didn't look very hard to find other perspectives on that, because there are a lot of folks who don't necessarily think ICHRA will be all that different. That's even before getting into the whole conversation about ACA insurance all of a sudden covering $50k per year clinics, or Prenuvo scans and whatnot.
It's definitely an exciting opportunity, there are a lot of cool startups working on the sector, and is something that in ten years could take off as a major market. But I think it'd be more helpful to talk through both the exciting parts of ICHRA as well as the challenges of it in a more meaningful way.
As one investor told me about the rationale behind an investment in an ICHRA startup - employer insurance has to change in the next decade, nobody knows how it will, so might as well place a call option on betting on ICHRA as an idea and folks you believe in. I can't fault that energy at all in this piece, but I do wish it took a more reasonable view of the reality of the market
Appreciate you sharing this, Paul!
Great article. It educated me more than the many hours I spent understanding the US healthcare system.
Packy-this was well done, really appreciate you setting the table with the historical perspective. Many business owners feel forced by the market to continue offering a "traditional" group health insurance program out of fear of losing the ability to recruit and retain top talent. Thatch has done a great job in building a better mousetrap to administer an ICHRA programs. The incentives of untenable renewal increases are moving some of my clients in this direction.
That’s great to hear! Appreciate it Geoff.
Brilliant analyses. IHCRA may face challenges if the exchange premiums explode or certain benefits get removed in order to get subsidies. The problems facing the employees go much deeper in the assistance needed to help them negotiate bills (AI can solve this), no where to go to get cash rates below the copay etc. (eg Function Health and Quest direct are going to be cheaper than the health system). Thatch+ a few other pieces could truly change the entire industry. 35 year industry veteran, 3 x CEO. Love to connect.
Steve Lefar
Great article. Learned a ton. Thanks for writing it!
Related article here: https://yuzu.health/blog/a-clear-explanation-of-ichras
As a bit of a health policy nerd I think there are a lot of open questions on whether the average person can make an informed choice on health care plans. If you look at Medicare advantage a lot of insurers just try and add gym memberships and luxuries to terrible plans. You end up in situation where you think your plan is good until you have a medical crisis. Ultimately to have a working market place you need informed buyers and the devil with health plans is truly in the details
I do think this is helpful for small business that would not otherwise offer coverage. But realistically if everyone was on such a marketplace people would often buy the cheapest plan (already common in MA) and subsequently have coverage that doesn’t really cover them. Hope I’m wrong about this but I would much rather just see us follow other countries models that work than try invent a new one.