I just had a conversation that made me genuinely excited about the future of healthcare.

It also reminded me that there’s a lot of work that still needs to be done.

My guest Brian Reid, health policy expert and former science writer for Bloomberg Health spent years covering the FDA, followed by 20 years of PR, and now runs his own consultancy while writing the Cost Curve newsletter- a fascinating publication covering the technical bits of the business of healthcare - which is how I found his work and decided I had to invite him on.

What he shared wasn't just another doom-and-gloom take on our "broken" system.

It was something much more complex: including proof that we're already fixing it, even as entrenched interests are actively working against us.

Let me show you what I mean.

The $60 Billion Shell Game

There's a program called 340B that perfectly captures everything wrong with healthcare today.

Created in 1992 to help vulnerable patients get cheaper drugs, it now generates $60 billion annually for hospitals.

Here's the scam:

* Hospitals buy drugs at massive discounts (i.e. a $50 drug for 10 cents)

* They give those drugs to insured patients

* Then bill the insurance the full $50 (or maybe $500 since they make it up as they go along)

* They pocket the $40+ difference

* And there’s zero oversight on where the money goes

You might be thinking… well, okay, but at least it’s helping uninsured or more vulnerable patients, right?

Well, no actually.

Brian shared that there’s no evidence of that. Uninsured and lower income patients often still pay “full price.”

So you also might be wondering why am I telling you this awful story and pretending it’s good news, but here’s the exciting part…

You are reading about it right now.

Instead of it flying under the radar as it has for the past 30 years, people are talking about it. A lot.

It’s not just me.

Even better, solutions are being highlighted.

And not just for 340B.

We’re beginning to pay attention to corrupt practices in many areas of healthcare that previously would have gone completely unnoticed.

Brian put it perfectly: "Complexity has been weaponized. Complexity is a barrier to access."

It isn't incompetence. It's intentional.

Every confusing form, every price you can't comparison shop, every procedure that mysteriously costs different amounts at different places – it's all designed to extract maximum profit while keeping you confused and compliant - but the scheme is cracking as more and more of us are waking up.

The Beautiful Counter-Revolution

But here's where it gets exciting.

While the old guard plays their shell games, entrepreneurs are building the future.

Mark Cuban looked at the pharmaceutical pricing mess and said "screw this" – then launched Cost Plus Drug Company to sell medications at transparent prices.

Pharmacists are leaving the corporate chains to start consulting practices, giving families the medication guidance they actually need.

Direct Primary Care doctors are cutting out insurance middlemen entirely, offering unlimited access for monthly fees.

Telehealth platforms are connecting patients directly with specialists, bypassing geographic gatekeepers.

And it’s not theory. It’s happening right now.

The Information War

Complexity isn't just annoying – it's expensive and hurtful.

When you don't understand the system, you make worse decisions. When you can't comparison shop, you pay more. When the system is opaque, you get ripped off.

But here's the thing: You can fight back with information.

Every term you learn arms you against exploitation. Every price you comparison shop is a vote against the old system. Every time you choose transparency over complexity, you're funding the companies leading the revolution.

The Trade-Offs They Don't Want You to See

Brian dropped this truth bomb: "There's no tooth fairy."

Every healthcare solution involves trade-offs. Want cheaper care? You'll have to do more work to find it. Want unlimited access? You might pay premium prices. Want government-controlled costs? You'll get fewer innovations.

The establishment pretends these trade-offs don't exist. Politicians promise more for less. Insurance companies claim better coverage at lower costs. It's all BS.

The entrepreneurs building the new system? They're honest about the trade-offs:

* Direct Primary Care: Lower cost and more access, but you still need something to help with catastrophic events.

* Transparent drug pricing: Better prices, but fewer locations or you wait for shipping.

* Telemedicine: Convenient access, but there’s no real physical examination.

Honesty about trade-offs is how you know who's actually trying to help you.

The Innovation Explosion (Despite the Resistance)

Here's what makes me optimistic: The medical breakthroughs are so good that even the broken system can't stop them.

Gene therapies are curing "incurable" diseases. AI is revolutionizing drug discovery. The free market is fixing access and pricing.

Yes, the old system tries to gatekeep these innovations. Insurance companies deny coverage. Pharmacy benefit managers extract their cuts. Hospitals mark up prices 400%.

But the companies providing real value are so good that they’re breaking through anyway.

We are seeing patients transform their lives with medications that seemed impossible five years ago. That's not happening because the system works – it's happening despite the system being broken.

Your Role in the Revolution

You don't have to wait for Congress to fix anything. You can start opting out today.

Become Healthcare Literate Yes, it's annoying that you have to learn this stuff. But every term you understand is money in your pocket and power in your hands.

Vote with Your Wallet Choose employers with transparent health benefits. Support businesses that post clear prices. Use services that respect your time and intelligence.

Ask Uncomfortable Questions When your hospital can't explain a bill, demand answers. When your insurance denies something, ask for written justification. When prices don't make sense, make them explain the math.

Build Your Own Safety Net Find direct-pay doctors. Research cash prices for procedures. Build relationships with consulting pharmacists. Create backup plans that don't depend on the broken system.

The Compound Effect

Here's what gets me excited: Every person who opts out makes the system a little less profitable.

One employer choosing transparent pricing forces competitors to follow suit. One patient comparison shopping pressures providers to post real prices. One person learning to navigate the system teaches ten others. One entrepreneur solving a healthcare problem inspires a hundred more.

The old system depends on your confusion and compliance. Every act of clarity and choice weakens their grip.

The Future We're Building

Brian mentioned we're in a "thousand flowers blooming" moment.

Not all these experiments will succeed. The entrenched interests will fight back. Some innovative companies will get bought out and neutered. Some regulations will try to protect the status quo.

But enough flowers will bloom to change the landscape forever.

Ten years from now, you'll look back at today's healthcare system like you look back at taxi medallions before Uber.

Expensive. Inefficient. Propped up by regulation. Actively hostile to customer needs.

Your kids will ask why hospitals were allowed to buy drugs for $10 and charge patients $50 with no oversight. They won't believe the answer.

The Revolution is Personal

This isn't just about policy abstractions.

It's about your family getting honest care at fair prices. It's about your community having access to real innovation instead of corporate theater. It's about your future being healthier because you refused to accept b******t as normal.

The healthcare revolution is happening. The old guard is fighting it.

The question is: Which side are you on?

Ready to join the healthcare revolution? Subscribe to get weekly insights on the innovations and entrepreneurs transforming medicine – and the entrenched interests trying to stop them.

Dive deeper into the opportunities emerging from healthcare's broken systems with Brian Reid's Cost Curve newsletter at reidstrategic.com

The future of healthcare is being built right now. Help build it.

Until next week,

Tiffany

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit signalandnoisepodcast.substack.com

I had a fascinating conversation with Dr. Dan Neissany, a former physical therapist turned practice optimization consultant, that reframed how I think about the challenges facing private practice clinicians today.

What emerged wasn't the typical "doctors are bad at business" narrative we hear so often, but something far more nuanced and actionable.

The Rules Changed Mid-Game

It's not that physicians can't run businesses. It's that someone went around back and changed all the rules after they started.

The system that once worked- where you could see a reasonable number of patients and keep the lights on- has been systematically undermined.

Reimbursements are declining, denials are increasing and the result is physicians having to see 20%+ more patients just to make the same income they made before.

Which creates, essentially, a “burnout” trap. A doctor seeing 52 patients in one day with 10 surgical cases the next day might technically be capable of handling that load, but as Dan asked:

"Do you want to do it? And how long can you do it for?"

The real issue isn't capability- it's sustainability.

When your passion for medicine starts to fade because you're drowning in volume, what then? By the time most physicians realize they need help, it's often too late.

What Actually Needs Measuring

Here's where the conversation got really practical. Most private practices are flying blind when it comes to basic metrics that could dramatically improve their operations.

Dan highlighted several key areas:

Daily Metrics:

* Cancellation and no-show rates (many practices don't calculate this)

* Schedule fill rates

* Patient flow efficiency

Weekly/Monthly Metrics:

* First-pass claim acceptance rates

* Denial reasons and patterns

* Patient retention rates

* Revenue per visit

The shocking reality? Many established practices have been around for 10-15 years but have only a handful of online reviews. They have no social media presence. They're essentially invisible to potential patients making decisions in 2025.

The Missing Infrastructure

What struck me most was Dan's point about getting outside help.

Unlike other business leaders who surround themselves with experts in different areas, many physicians feel they need to master everything themselves.

"You take the CEO of any company, they're not expected to be the expert at web design and cybersecurity... The skill set that they need is the ability to listen to the people who are experts at those things and then make the best decisions."

Clinicians are smart and well educated. They have these executive functioning skills. What they often lack is knowing there's a framework of trusted experts they can build around their practice - and using them.

The Opportunity Hidden in the Crisis

Rather than just complaining about everything wrong with the system, Dan advocates for a different approach:

Instead of focusing on everything that's going wrong... let's look at the opportunity here.

But it isn’t about accepting a broken system- it's about building resilience while working toward systemic change.

The practices that thrive are those that:

* Build systems early rather than waiting until they're overwhelmed

* Use data to identify revenue leakage they didn't know existed

* Create authentic connections with patients through modern channels

* Develop leadership teams that can handle business operations while physicians focus on patient care

The Social Media Blind Spot

One of the biggest missed opportunities Dan identified is social media presence. Not silly dancing videos, but authentic content that shows the personality and culture of the practice.

When patients are choosing between five similar practices with similar reviews, the one with an active, authentic social media presence often wins. It's free marketing that builds trust before patients even walk through the door.

The Bottom Line

The narrative that "doctors are bad at business" is not only wrong- it's harmful. Physicians are dealing with a system that's been deliberately stacked against private practice success. The solution isn't to become MBAs; it's to build the right support systems and focus on what actually moves the needle.

As Dan said:

Healthcare is still business. If you're not making money, nobody's staying open... It's like you don't want to treat it as business but newsflash if you're not making money you're closing down or you're going to be forced to sell.

The physicians who will thrive are those who acknowledge this reality while staying true to their mission of excellent patient care. They're not selling out- they're building sustainable practices that can weather whatever changes come next.

This conversation reminded me that the best solutions often come from stepping outside our industry silos and learning from unexpected places.

Sometimes the insights we need are hiding in plain sight- we just need the right lens to see them.

Want to connect with Dan Neissany?

* Podcast: "All Things LOCS" (Leadership, Operations, Culture & Strategies)

* Website: tbpstrategies.com

Until next week,

Tiffany

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit signalandnoisepodcast.substack.com

I assume most neurosurgeons just care about neurosurgery.

Period.

They fix brains, they fix spines, they save lives and they go home to their very nice houses in the suburbs.

Dr. Anthony DiGiorgio probably does all that too.

But he also spends his free time studying Medicaid policy. He testifies before Congress about healthcare reform.

He respectfully addresses the concerns of his obnoxious internet trolls on X.

He writes papers with titles like: "Medicaid Insurance is a Predictor of Prolonged Hospital Length of Stay After Traumatic Brain Injury”

And for a long time, I’ve wondered:

Why would a surgeon who will always have a job, will always make good money and will always be essential to the healthcare system care so deeply about family medicine, poor people and about how patients pay for healthcare in general?

I had to know, so I asked.

I actually first 'met' Anthony through his writing, his research and his relentless advocacy for making sure that people in need have real access to care.

And with the recent passing of the One Big Beautiful Bill and the lively, sometimes aggressive, surrounding discussion regarding changes to Medicaid, I thought it would be a great time to have him on to discuss.

His analysis changed a lot about what I thought I knew about the most vulnerable patients in our system.

I think you'll enjoy the conversation, and benefit from his insights as I have.

The problem hiding in plain sight

Every week, Dr. DiGiorgio sees patients who need follow-up care.

Not brain surgery or spine surgery - just regular primary care. The kind of care that can help patients manage non-surgical conditions or prevent bigger problems down the road.

"The wait list is six plus months long just to get a primary care appointment," he told me.

Six months.

Think about that for a second. If you're seen by any specialist or discharged from the ER and need to see a family doctor to make sure you're healing properly, you can't.

The earliest appointment is in six months.

And by then, a small problem becomes a big problem. A big problem becomes a catastrophe. A catastrophe becomes... well, another trip to the emergency room, where the cycle starts all over again.

This isn't a bug in the system. This IS the system.

DiGiorgio is in a position to see it clearly- and is one of the few who is doing something about it, often against significant resistance.

Is Medicaid a ‘safety net’ or has it become something else entirely?

DiGiorgio said something that completely reframed how I think about Medicaid reform.

He compared fixing Medicaid to... food stamps.

(I know, I know. But stay with me here)

"Food stamps work so well because it's a cash equivalent," he explained. "There's minimal involvement of a third party, which means the beneficiary receives most of the benefit. They're accepted at almost every food establishment."

When you have food stamps, you're not forced to shop at the "poor people grocery store." You go to the same store as everyone else.

But when you have Medicaid? You get a card that half the doctors won't accept.

You get shuffled to the "poor people clinic" for second-class healthcare after an extended wait at a first-class price.

The huge sums of money spent doesn't seem to be resulting in adequate access for patients or come with reasonable terms for physicians.

Here's what DiGiorgio understands that most people don't:

Medicaid isn't failing its purpose because it doesn't spend enough money. It's failing because of how it spends money.

About 60% of Medicaid spending now goes to people who weren't originally supposed to be on Medicaid. The program was designed for disabled individuals, elderly poor, poor children, and poor pregnant women.

Now it covers healthy adults, and in some states, people making up to 400% of the poverty level.

That means the people who truly need a safety net are competing for resources with people who could potentially be served other ways.

Meanwhile, the truly vulnerable: the homeless patient with schizophrenia, the elderly woman with dementia, the child with cerebral palsy- are lost in the shuffle.

DiGiorgio sees these patients every day. A quarter of his patients are homeless. And he's fighting for them in ways that would surprise you.

His solution? More choice.

His approach is refreshingly simple: "As Milton Friedman says, the problem with poor people is they don't have any money. So give them a cash-based equivalent so they can get into the private market."

When people pay directly for routine care- like the $60 per month direct primary care he mentions- they get better access and doctors can focus on patients instead of paperwork.

"If physicians, instead of taking an early retirement, instead go into this direct primary care model, then you have physicians practicing longer and you're alleviating the physician shortage," he explained.

The key insight?

When there are fewer middlemen between you and your doctor, doctors are happier, stay in practice longer, costs go down and access goes up.

Why this gives me hope.

Here's what still gets me about DiGiorgio: he has nothing to gain from fighting these fights.

He'll always have patients. He'll always have a good income. He could easily focus on surgery and ignore the policy discussion entirely.

Instead, he's chosen to be a voice for people who don't have voices.

Homeless patients, medicaid patients, and people trapped in a system that doesn't work for them.

He's not doing this because it's good for his career or because it’s easy. He's doing it because it's right.

And he's not just complaining about problems, he's proposing solutions.

Real, practical, evidence-based solutions that could make life better for all of us.

What it means for you.

Even if you have insurance, or an alternative like CrowdHealth, this affects you.

When emergency rooms are clogged with people who can't get primary care, your wait time goes up.

When hospitals are full of patients who can't discharge to appropriate facilities, your surgery gets delayed.

When the system is inefficient and wasteful, everyone pays more and everyone suffers.

We're all in this together, whether we like it or not.

But here's the hopeful part: DiGiorgio sees change happening.

More people are choosing direct primary care even when they have insurance. More physicians are staying in practice longer by getting out of the insurance-based system.

"I think the culture is starting to shift," he told me.

We need more people like Anthony DiGiorgio.

Not necessarily more neurosurgeons (though we need those too), but more people who are willing to look beyond their own immediate interests and fight for a new paradigm that will work for everyone - especially the people who need it most.

Not through virtue signaling, name calling or moral arguments, but through thoughtful reform that goes beyond the status quo.

If we’re honest, it’s clear that throwing money into a broken system hasn’t ‘solved’ anything at all. It’s made things worse.

His message isn't complicated: give people choices, remove barriers to care and create direct payment options and real access instead of a bureaucratic maze.

It's not about politics. It's about people.

And it's about time we listened to someone who actually knows what he's talking about.

Want to hear the full conversation? DiGiorgio explains the research, the policy solutions, and why he's optimistic about the future of healthcare.

Follow Dr. Anthony DiGiorgio here:

* The Doctor's Lounge

* X: @DrDiGiorgio

* Healthcare Comic: offlabelideas.com

And a BIG thank you to CrowdHealth!

If you’re ready to experience healthcare differently? Visit joincrowdhealth.com. Use code “Liberty Lab” for $99/month for the first 3 months.

Until next week yall!

Tiffany

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit signalandnoisepodcast.substack.com

Most people think all eye doctors do is fix blurry vision with glasses.

Turns out, that's totally wrong.

Today I’m sharing a conversation I had with Joel Ciolek— Stanford Professor and one of only 80 ophthalmology physician associates in the world. After hundreds of rejections to work in the specialty he loves, he carved out a position that barely existed and built something remarkable.

Joel has since created a professional society. He teaches at medical schools worldwide. He proved that innovation is still possible in healthcare - even when everyone tells you ‘no.’

But most importantly, what he has learned about eyes will change how you think about your health.

Your eyes aren't just for seeing. They're diagnostic windows into every major system in your body.

Heart disease. Diabetes. Brain tumors. High blood pressure. Autoimmune disorders.

All visible through your eyes- often before symptoms show up anywhere else.

Joel has literally saved lives during routine eye exams.

But here's the problem: If you don’t know this, you might be approaching eye care all wrong (or avoiding it all together).

The Category Mistake Costing You Time and Money

Joel points out that most people think all eye problems are "vision" problems.

They're not.

Here's the distinction that you need to understand:

* Vision concerns = glasses, contacts, routine “read the bottom line” checkups (optical)

* Medical concerns = pain, redness, infections, sudden changes (health)

Have a red, painful eye? That's a ‘medical’ issue. Not a ‘vision’ issue.

You benefit from knowing the difference because otherwise:

* People end up with chronic disease that worsens undetected for years because they don’t understand the value of ophthalmology in preventative care.

* Or they waste hours in emergency rooms because they don’t know how or when to get help for their eyes.

* Others avoid care all together because they think they need "vision insurance" for what is actually a medical problem.

Whether you have traditional insurance, CrowdHealth, or pay cash, understanding this distinction gets you to the right provider faster, and often cheaper.

"Essential Eye Health" In 3 Steps

Step 1: Establish a relationship before you need it

Don't wait for problems. Find an eye doctor now so you know who to call and where to go if you need it.

Don't have one yet? Literally Google "ophthalmology" + your city.

If it's urgent, most will see you quickly if you can get there.

Here's what Joel told me: Just about every eye clinic has 24/7 on-call coverage for emergencies.

"If you have established care with an eye clinic, honestly, I would call them before you go to the ER because even if it's after hours, every eye clinic is going to have an on-call ophthalmologist... you're going to be able to get a hold of someone that's no different than your ER provider calling that on-call ophthalmologist."

Step 2: Learn when it’s important to act quickly

* Sudden vision loss

* Severe or deep eye pain

* Flashing lights or curtain-like vision changes

* New floaters with flashes

These are "call/be seen immediately" situations.

Not "wait and see."

One benefit to having an established relationship with an eye doctor is that you can ask them what would constitute an ‘emergency,’ and they want you to do if that happens.

Step 3: Think systemic, not just vision

Your eyes reflect your entire body's health:

* High blood sugar shows up in eye blood vessels

* High blood pressure damages the retina

* Cholesterol plaques appear in eye arteries

Once the damage starts reaching a critical mass, these warning signs can be observed and more importantly can allow you the opportunity to do something about it - before it’s too late.

Take home message:

Regular eye exams aren't vanity- they're actually early warning systems for your whole body.

Your eyes are talking to you.

The question is… are you listening?

Short and sweet this week, but I want to know: Have you had to seek emergency care for an ‘eye issue’? Did you know the difference between medical problems versus vision problems?

Joel practices in California, but teaches all over the world. He can be found at:

joelciolek.com

Connect with him there!

And of course, a BIG thank you to our sponsor CrowdHealth.

If you’re ready to experience healthcare differently, visit joincrowdhealth.com and use code “Liberty Lab” for $99/month for the first 3 months.

Until next week,

Tiffany

*Never Medical Advice

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit signalandnoisepodcast.substack.com

Most people think they understand healthcare.

They don't.

They think insurance protects them financially.

It doesn't.

They think being "uninsured" means being screwed.

Wrong again.

I just spent an hour talking with Bridget Babione, Head of Operations at CrowdHealth, and what she told me will make you question everything you believe about healthcare in America.

The stat that should terrify you.

Medical debt is the number one cause of bankruptcy in this country. And the majority of Americans who declare bankruptcy due to medical debt actually HAVE health insurance.

Read that again.

Having insurance didn't save them. It took funding out of their family budget month after month, and then failed them when they needed it most.

Meanwhile, there's a parallel economy of healthcare happening right under your nose. Cash-pay patients getting better care, at lower prices, with a team of patient advocates and actual transparency.

The $80,000 Heart Surgery Story

Bridget and I chatted about a CrowdHealth member who needed a heart ablation procedure. His local hospital quoted $80,000.

Instead of accepting that price like a good little consumer, CrowdHealth helped him shop around.

They found an excellent surgeon at a top facility. Flew him first class. Put him up in a nice hotel. Covered all his travel expenses.

Total cost to the crowd: $27,000.

He got great care, a weekend vacation with his wife AND saved the Crowd $53,000.

Total out of pocket for the member: $500.

No surprise there.

Because ‘health events’ (outside of pregnancy) are always a max of $500 out of pocket.

This isn't some weird edge case. This is what happens when you actually shop for healthcare like you would for anything else you buy.

Why Doctors Love Cash-Pay Patients

When you pay cash, something magical happens:

* No insurance company dictating treatment protocols

* No "Do A, then B, then C even though A & B are unnecessary"

* You start having real conversations about what you actually need

* And you support doctors who remember why they became doctors

I've sewn up countless wounds in the ER and urgent care.

I have no idea what any of those patients were billed. The billing company looks at my notes and bills "maximally" because they're playing games with insurance companies.

When someone pays cash? The whole dynamic changes.

But what about those financial consent forms?

Everyone wants to know what to do about those iPad forms at the ER.

Here's what Bridget told me:

Instead of signing your name, just write "won't sign."

That's it. No one's paying close attention anyway.

And if you already signed?

You didn't sign your life away.

There was no agreement on a specific price, which means they can only charge you a "reasonable cost" - not whatever number they make up.

The Cancer Patient Getting Top $0 Treatment

Three CrowdHealth members are currently fighting cancer.

All three have qualified for ‘Manufacturer Assistance Programs’

That means they're getting their cancer medications for free.

Not because they're broke. Because the drug companies have to provide charity care. Most people don't know these programs exist, but the Crowd does, and they hired a service to help members apply.

And if they didn't qualify? No big deal.

They would pay $500 and the submit to the Crowd for funding. Because that's what community actually looks like.

We take care of each other.

The Real Revolution Isn't Technology

Everyone thinks healthcare will be disrupted by some app or AI breakthrough.

They're missing the point.

The revolution is happening already through community. Through people taking responsibility. Through transparency instead of the current shell game.

CrowdHealth members save money every month compared to traditional insurance. They get better care. They know exactly what they're paying for.

And when someone needs extra help - like the family who just adopted a 3-year-old from Africa and needs specialized testing - the community steps up voluntarily.

No bureaucracy. No forms. Just humans helping humans.

What This Really Means

This isn't just about healthcare.

This is about taking back control from systems designed to extract maximum profit while delivering minimum value.

This is about building real community in a world that's become increasingly isolated.

This is about what happens when you stop accepting "that's just how things work" as an answer.

The Questions You Should Be Asking

* Why are you paying $800/month for insurance that still leaves you with $5,000+ deductibles?

* Why don't you know the price of medical procedures before you get them?

* Why are you not shopping for healthcare like you shop for everything else?

* Why are you accepting a system where the majority of medical bankruptcies happen to insured people?

Listen to the Full Episode

I barely scratched the surface here. Bridget breaks down exactly how CrowdHealth works, what happens in emergencies, how they handle pregnancy and cancer, and why this model actually makes financial sense.

The old system is broken beyond repair.

The new one is being built by people who refused to accept broken as permanent.

Which side of history will you be on?

Until next week.

Tiffany

Thank you to CrowdHealth for sponsoring The Healthcare Liberty Lab this and every week.

If you’re ready to experience healthcare differently? Visit joincrowdhealth.com. Use code “Ryderlab” for $99/month for the first 3 months.

If this resonated with you, share it.

The people who need to see this most are the ones still trapped in the old system, thinking they have no other choice.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit signalandnoisepodcast.substack.com

You're sad.

You go to a doctor.

They give you a pill.

You take the pill for 40 years.

You die.

This is the modern mental health system in action. And it's destroying lives.

The Medication Assembly Line

I just had a conversation with Susan (the "Rogue Psychologist") that should terrify every thinking person.

Here's what Susan revealed after 27 years of practice:

* She's worked with 3,000+ patients

* Only 2 physicians refused to prescribe medication when consulted

* Kids are getting cocktails of psychiatric drugs thrown at them

* There's no protocol to get anyone off these medications

Read that last point again.

There is no standard protocol to get you off psychiatric medication.

You know what that means implicitly? Once you're on, you're expected to stay on. Forever.

The Numbing of America

Here's the part that should make you angry:

These medications don't just treat "chemical imbalances" (a theory with shaky scientific support). They numb your natural responses to a life that isn't working - which is okay on a temporary basis or in extreme circumstances, but that’s not how we use them.

We’ve made it ‘the standard of care.’

Here's a story that perfectly illustrates this broken system:

A woman was prescribed Zoloft during an unfulfilling marriage and career. The medication didn't fix her issues- it helped her tolerate them.

For 17 years in a state of chemical-induced mediocrity.

Only when a foreign doctor in a foreign country asked the obvious question-

"Why are you taking these medicines? There's nothing wrong with you"- did she stop. And realize she'd been avoiding the real work of building a life worth living.

That woman, was me.

But it doesn’t have to be this way.

Discomfort is the signal, not necessarily the problem

Here's what Big Pharma doesn't want you to understand:

Psychological discomfort is information.

* Feeling trapped in your job? Your brain is telling you something.

* Anxious about your relationships? Pay more attention perhaps something needs to change.

* Depressed about your life direction? That's not a ‘chemical imbalance’- that's clarity.

But instead of helping you decode these signals, the system hands you a pill to numb the emotional pain and make them go away.

Susan puts it perfectly:

"How do you learn anything if you don't feel discomfort?"

The Real First Steps (That No One Talks About)

Before you even consider medication, Susan recommends a radical approach: treating yourself like a worthy, complete human being.

The basics that actually work:

* Get your vitamin D levels checked and optimized

* Exercise 30 minutes daily (even just walking)

* Clean up your diet- eat whole foods, more protein

* Rule out medical conditions causing symptoms

* Prioritize sleep

* Take an honest assessment of what might need to change in your life.

These aren't sexy. They don't make pharmaceutical companies money. They take time. But outside of severe, or emergency situations - they work.

The N=1 Approach

Susan treats every patient as "an experiment of one."

She asks:

* What's the context of these symptoms?

* What story is this person telling themselves?

* What environmental factors are contributing?

* How can we measure progress scientifically?

This is the opposite of the checklist mentality that dominates modern psychiatry, where symptoms get you a diagnosis and a diagnosis gets you a prescription.

I'm not anti-medication. Neither is Susan.

Sometimes people are so destabilized they can't even participate in therapy or life.

In those cases, medication can be a bridge- temporarily- while they develop coping skills.

But here's the key: it should always be considered temporary with a plan to reassess.

The problem is that reassessment never happens.

There's no protocol. No regular evaluation of whether you still need chemical support.

The questions your doctor won't ask

If you're considering psychiatric medication (or currently taking it), demand answers to these questions:

* What are the long-term studies on this medication?

* What's the plan for eventually getting me off this?

* How will we measure if this is actually helping?

* What non-pharmaceutical options have we explored?

* Are we treating symptoms or root causes?

If your doctor can't answer these, find a new doctor.

The ‘wise mind’ solution

Susan mentions a concept from dialectical behavior therapy: the "wise mind."

Imagine a Venn diagram:

* Circle 1: Rational thought

* Circle 2: Emotional awareness

* Overlap: Wise mind

The goal isn't to eliminate emotions or live purely rationally. It's to access both, pause, and make thoughtful decisions aligned with your actual goals.

You can't develop wise mind while chemically numbed.

Breaking free

The mental health industrial complex profits from your dependence.

They make money when:

* You stay on medication forever

* You believe you're "broken" and need fixing

* You avoid the discomfort that leads to growth

* You outsource your agency to "experts"

You get your power back when:

* You treat discomfort as information

* You address root causes, not just symptoms

* You take responsibility for your mental health

* You develop actual coping skills that work for you

The Real Work

Building mental resilience isn't about avoiding discomfort—it's about learning to move through it skillfully.

This means:

* Facing anxiety-provoking situations gradually (exposure therapy)

* Developing emotional regulation skills

* Creating a life aligned with your values

* Building physical and mental practices that support well-being

It's harder than taking a pill. It takes longer. But it actually works.

Your Move

The system wants you medicated and manageable.

Your soul wants you awake and agentic.

Choose wisely.

The discomfort you're feeling might not be a chemical imbalance to fix. It might be your authentic self trying to break free from a mindset that's too small for you.

Listen to it.

What's your experience with the mental health system? Have you found ways to reclaim your agency? Share in the comments—your story might help someone else break free.

And if this resonates, please share it.

Susan writes under the name: Rogue Psychologist. Follow her there! And if you’re ready to experience healthcare differently? Visit joincrowdhealth.com and use code “Liberty Lab” for $99/month for the first 3 months.

Until next week,

Tiffany

*Never medical or financial advice (obviously)

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit signalandnoisepodcast.substack.com

The ambulance arrives at your door at 3 AM.

Your elderly father's urinary catheter is blocked. He's in pain, anxious, and can't urinate. Your family called 911 because you know it’s bad and you didn't know what else to do.

The paramedic takes one look at the situation and knows exactly what's wrong. The catheter needs to be flushed or replaced - a 10-minute procedure that any experienced paramedic can handle with the right supplies.

But here's what happens next: Your father is getting loaded into that ambulance anyway.

Not because he needs to go to the hospital. Because the paramedic can't bill insurance unless they transport him and company policy says transport pays the bills.

There are no CPT codes for "problem solved at home."

Over 65 years ago in Alexandria, Virginia, 4 physicians established America’s first 24/7 year-round “emergency room” to avoid always being on call.

Today, the ER has grown to many rooms and we’ve rebranded it as the “emergency department” It’s accessed (and over-accessed) for everything and everyone - for treatment of the most minor ailments to the most life-threatening ones.

Back then, an ER visit cost just $8.

Today's reality is very different, and one of the reasons is our attachment to health insurance and medical billing.

And when no transport = no billing = no revenue, things change quickly.

So, the paramedic who could have fixed your father's catheter in 10 minutes at home?

They're required to take him to the ER anyway, where he'll wait 4-6 hours for the exact. same. procedure.

This isn't a training problem. It's not a competency issue. It's a billing system that punishes efficient medicine.

What Really Happens When You Keep Someone Out of the ER

Let's talk about what's actually at stake here.

That unnecessary ambulance ride costs $1,500. The ER visit for a blocked catheter? Another $3,000-5,000. Total bill: $6,500 for a 10-minute procedure that could have been done in your father's bedroom.

But the real cost isn't just your money.

While your father sits in the ER for 6 hours waiting for someone to flush his catheter, he’s exposed to whatever cold or flu is going around. The stroke patient who comes in behind him waits. The heart attack patient waits. The trauma victim waits.

And those other ambulances that transported patients with blocked catheters, minor cuts needing stitches, and medication refill issues? They're not available for the actual life-threatening emergencies.

“911. What’s your emergency? Please hold.”

Every unnecessary ER visit creates a cascade effect that makes the system worse for everyone.

Here's a real story that illustrates the insanity:

A 90-year-old physician with metastatic cancer was in hospice care. He had a recurring medical issue that flared up every few days - something completely manageable by an experienced paramedic.

Under the current system, this man would have needed to go into the ER 2-3 times per week. Each visit would have meant 6-8 hours in a hospital bed, massive bills and pure misery for someone who just wanted to die peacefully at home.

Thankfully they access to Tony Barone’s company, Emergility, a private EMS service that operates outside the insurance billing system.

They responded to this patient 34 times over 6 months with a trained team. Every single response was for a genuine emergency that would have otherwise been a 911 call. Every single response was handled at home.

Total cost: $10,000.

Compare that to 34 ER visits at $4,000+ each. You're looking at $136,000+ in hospital bills.

But here's the beautiful part: Because his emergencies were handled at home, this dying physician had the energy to attend church, visit the Kennedy Center with his wife and maintain his dignity during his final months.

When he passed away, his wife mentioned the Emergility team in his eulogy. A hospice patient - someone who was literally dying - kept telling them they were "saving his life."

The solution is embarrassingly simple: Remove insurance from the equation.

Barone and his team operate on a ‘direct-pay model.’

No insurance billing, no CPT codes, no bureaucratic nonsense.

When you call them, a team responds with hospital-grade equipment: 12-lead EKGs, ultrasound, advanced medications, the works. Depending on your needs, this might be an experienced paramedic, or for more complex cases, a PA or nurse practitioner working alongside EMS personnel.

If they can solve your problem at home, they do. If you need to go to the hospital, they facilitate that transport and can even accompany you to ensure continuity of care.

The pricing is transparent and affordable.

No surprise bills, no insurance hassles, no network restrictions

Most importantly: The incentive structure is aligned. They succeed when they solve your problem efficiently, not when they generate maximum billing.

Why This Benefits Everyone (Including Hospitals)

This isn't about putting hospitals out of business or competing with 911 services.

It's about right-sizing the response to the actual problem.

For patients: Faster response, better care, lower costs, no unnecessary hospital exposure.

For hospitals: ERs can focus on actual emergencies instead of being clogged with routine issues.

For 911 services: Ambulances stay available for true life-threatening calls.

For the healthcare system: Massive cost reduction, better resource allocation, improved outcomes.

But, as Tony shared,

"Hospital protocols are not about patient safety. Hospital protocols are about risk management and protecting the hospital."

This of course also extends to billing maximization.

The current system forces everyone into the most expensive setting for care, regardless of whether it's appropriate.

That's insane from every angle.

A team with the right equipment can handle a broad range of conditions that would otherwise require ER visits - without the wait, the expense, or the hospital exposure.

And if the emergency requires a hospital visit? That’s easy. They make sure they get there.

Let's break down the real numbers:

Traditional path for blocked catheter:

* Ambulance: $1,500

* ER visit: $4,000

* 6-hour wait time

* Total: $5,500+ for 10-minute procedure

Direct access paramedicine:

* Based on Tony’s math… $10,000/34 visits?

* Total: $294 for a better, more convenient outcome

You're looking at HUGE cost reduction with dramatically better patient experience - especially for elderly or frail patients who shouldn't be sitting in ERs for hours, or for those who require additional privacy for security reasons.

Scale this across the calls that don't need ER-level care, and you're talking about hundreds of billions in healthcare savings annually.

Why the System Fights This So Hard

If you could solve even 50% of "emergencies" at home for 5% of the cost, several powerful entities lose money:

* Hospitals lose ER revenue

* Ambulance companies lose transport fees

* Insurance companies lose justification for high premiums

The current system isn't broken. It's working exactly as designed - to maximize revenue extraction from human suffering.

Direct access medicine threatens that entire model by proving you can deliver better care for less money when incentives align properly.

The Future is Here

During our conversation, Tony emphasized that this model isn't about competing with hospitals or 911 services - it's about filling the gaps. As he put it, "We are here to be the change we demand in healthcare."

Tony's Emergility is operational in Northern Virginia right now, handling real emergencies and keeping real people out of ERs they don't need to visit. They've proved the model - navigated the regulatory maze, secured the proper insurance, and built the infrastructure.

Hopefully other entrepreneurs are taking notice. The model is scalable and desperately needed everywhere.

I believe this is the future of care.

Maybe soon you won't have to accept 8-hour ER waits for minor issues.

You won't have to accept $5,000 bills for problems a paramedic could solve in your living room.

The alternatives exist. The technology exists. The expertise exists.

The only missing piece is enough people demanding something better.

Every time you choose direct access over the traditional system, you're voting for a future where:

* Healthcare costs reflect actual value delivered

* You and your doctor determine what's best

* Real emergencies get immediate attention

* Routine issues are handled efficiently

* Your dignity matters

Your Move

In the future maybe we'll all be asking ourselves:

Do I really need the ER, or do I need a competent medical professional with the right equipment to assess my situation?

More importantly: Am I willing to pay a reasonable fee for that assessment at my home, or do I want to spend 3x more to get the same assessment after waiting 6 hours in a hospital?

The choice will be yours. The infrastructure is being built.

The question is whether you'll use it.

Learn more about Tony, direct access paramedicine and protective medicine at emergility.com. I have no financial ties to disclose, but I am proud to support the amazing work Emergility is doing!

And as a reminder:

Direct pay medical care is AMAZING and pairs perfectly with CrowdHealth

Ready to experience healthcare differently? Visit joincrowdhealth.com and use code “Liberty Lab” for $99/month for the first 3 months.

Until next week,

Tiffany

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit signalandnoisepodcast.substack.com

The nutrition industry has a bit of a dirty secret.

If they actually solved your ‘diet-related’ problems, a LOT of people would go out of business.

The workers on the front lines - our registered dietitians - are equipped with conflicted guidelines, a laughable food pyramid and industry ‘studies’ that are better described as pseudoscience.

It’s a recipe for failure.

These professionals are doing their best, but patients still end up with meal plans that don’t work for their bodies, calorie counting that drives them insane, "good" and "bad" food lists that don’t make sense and shame spirals (of course).

Then when they inevitably "fail" to get healthy, we blame their lack of willpower and start the cycle over again.

Leslie Urbas, a registered dietitian, broke the pattern.

She left her position at the hospital and stopped playing the game that keeps people dependent and instead started teaching something revolutionary:

How to trust your own body.

Throughout our conversation Leslie shares many stores. She recounts the time her kids tried the Spanish version of Cheetos.

“They spit them out immediately”

Why? Because Spanish Cheetos taste like cardboard compared to American ones.

Different ingredients. No additives. No synthetic dyes or chemicals engineered to make you crave more.

She then tells me a story of how her son got blue ice cream all over his white shirt in Spain.

Anyone who's tried to remove American food dye knows it's impossible without the use of harsh chemicals - but this dye washed out easily with water from the hose.

Water.

Meanwhile, American food companies have been coloring your cereal with dyes made from petroleum (yes THAT petroleum, the same stuff that powers your car) - for decades.

The FDA finally made a move to change this in April 2025, announcing they're phasing out synthetic dyes by 2026.

Avoiding these chemicals is unquestionably in line with good common sense (and rule of law in most of the rest of the Western world)

And whether you agree with the FDA’s role in regulation of food additives or not - the implication of this is hard to miss:

We’ve been knowingly poisoned with chemicals for profit for decades

It begs the question: If food wasn’t packed with substances designed to disrupt our bodies’ natural responses, and we learned to trust our bodies’ responses instead of ‘trusting the experts’

Would we even need meal plans (or an abundance of pharmaceuticals)?

Maybe. Maybe not.

So they put chemicals in the food. Teach you to ignore your hunger. Count calories instead of paying attention to energy levels. Follow the food pyramid instead of your body's intelligence.

Leslie figured this out after watching client after client fail on traditional approaches.

The Permission Method That Actually Works

I’m a huge fan of keto, because that’s the eating pattern that makes me feel good, but Leslie says she doesn’t recommend that we restrict foods at all.

Instead, she teaches awareness.

Here's her secret weapon: Take whatever food you "can't stop eating." Rate the first bite 1-10. The moment a bite drops below that rating, stop eating.

Wash, rinse, repeat.

That's it.

Most people who try this approach discover they only enjoyed the first few bites and then moved to unconscious consumption - mindless eating because you stopped paying attention.

Leslie is not promoting the use of willpower, but of awareness.

And awareness is the enemy of every system trying to control you.

Your body knows when it's hungry. When it's satisfied. When something makes you feel good or terrible.

The result of ignoring this is a nation of people who can't manage their own appetite and a booming market of patients begging for Ozempic.

If every diet you've tried has failed, it's not because you lack willpower.

It's because the system is designed to make you fail and you haven’t figured that out yet.

The solution might not be another meal plan. It might be choosing carefully and learning to trust yourself again.

Leslie's clients eat chocolate cake. They drink wine. They enjoy meals with friends.

But they do it consciously. They eat chemical-free food and pay attention to how food makes them feel. They own their choices completely.

No guilt. No shame. No "falling off the wagon."

Just personal responsibility and conscious decisions made by adults who trust their own bodies.

Because this isn't just about food. It's about who gets to make decisions about your body.

The same system that profits from your repeated diet failures is the same system that wants to manage your healthcare, your medical decisions, and take away your personal autonomy.

Food is just the entry point.

When you learn to trust your body's signals around hunger and satisfaction, you start questioning other areas where you've handed over control to "experts."

Maybe you don't need their meal plans. Maybe you don't need their one-size-fits-all medical protocols either.

Maybe you're more capable of making informed decisions about your own body than they want you to believe.

The full conversation goes much deeper into European vs American food systems, the psychology of eating and practical strategies for trusting your body again.

I hope you enjoy it as much as I did and I’m curious to hear what you think in the comments.

Ready to experience healthcare differently? CrowdHealth puts YOU in control of your healthcare decisions and spending. Visit joincrowdhealth.com and use code “Liberty Lab” for $99/month for the first 3 months. Tequila not included.

Until next week,

Tiffany

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit signalandnoisepodcast.substack.com

Most people think Big Pharma is the villain in healthcare.

They're wrong (partially).

Don't get me wrong- pharmaceutical companies aren't saints. But they're also not the only reason your insulin costs $300 instead of $30.

The real villains are hiding in plain sight.

One example is the Pharmacy Benefit Manager (PBM).

They've built the most profitable middleman business in human history by inserting themselves covertly between you and your medicine.

Here's how they did it- and how you can fight back.

The Middleman Mafia

Imagine if every time you bought coffee, seven different companies took a cut before it reached your cup.

The coffee farmer gets paid. Then a regional distributor takes 15%. Then a logistics company takes another 12%. Then a benefit manager takes 20%. Then a processing company takes 8%. Then a retail coordinator takes 10%. Finally, Starbucks takes their cut.

Your $2 coffee now costs $15.

This is exactly what's happening with your prescriptions.

Today’s guest, Rachel Strauss, who works in a transparent sector of the PBM industry, shared something that should make you furious:

"There are like seven or eight components or parties that are all part of the supply chain of getting that drug to you as the customer. And that is where all the margin is going."

Rachel emphasizes that it should be something like…

Manufacturer → Pharmacy → You.

But instead it's more like…

That graph hurts my head.

In other words maybe…

Manufacturer → Distributor → Wholesaler → PBM → Insurance → TPA → Retail Network → Pharmacy → You

Each middleman takes their cut. Each one adds complexity. Each one makes the system more expensive and less transparent.

The International Arbitrage Opportunity

Here's a fact that will make you question everything:

The same FDA-approved drugs available in Canada, Israel, the UK, and Australia cost 70-80% less than in the United States.

Same drug. Same factory. Same brands. Same safety standards.

The only difference? Other countries didn't allow a cartel of middlemen to capture their healthcare system.

Think about this:

* The US has 4% of the world's population

* Americans fund 75% of pharmaceutical companies' global profits

We're not sicker than everyone else… well maybe we are, BUT ALSO… we're getting scammed harder.

And here's the kicker that Rachel points out,

Personal importation of medications is currently legal and tariff-free in the US.

No one advertises it, but apparently you can legally order your prescriptions from ‘Tier 1’ countries (like Israel or Canada) - right now and save thousands of dollars.

The Rebate Lie

The most insidious part of this scam is something called "pharmaceutical rebates."

Here's how they're supposed to work:

Drug companies offer 30-60% discounts on medications to make them more affordable.

Here's how they actually work:

* You pay at the pharmacy

* Your employer gets a rebate 6-12 months later

* Nobody knows if the "discount" is real because there's zero transparency

* Big PBMs control the entire process and take a big cut (true for most Americans with ‘prescription coverage’)

It's like buying a car where the dealership gets the rebate instead of you, even though you paid full price.

The Vertical Integration Death Spiral

The real genius of this scam is vertical integration.

One company now owns:

* The pharmacy

* The insurance company

* The pharmacy benefit manager

* Increasingly even the doctor's practice

When you control every step of the supply chain, you can shift profits around to avoid regulation.

Here’s how that plays out…

If the government cracks down on insurance company profits? No problem—just make your money in the PBM division.

If PBM margins get regulated? Easy. Shift profits to the pharmacy side.

It's a shell game where patients always lose.

The Information War

The most powerful weapon in this scam is complexity.

They've made the system so complicated that most of the time:

* Pharmacists can't explain pricing

* Doctors don't know how much drugs cost

* Patients can't figure out how to comparison shop

* And regulators can't track the money - especially when rebates are handled offshore (as they often are)

When I ask my doctor about drug prices, he doesn’t know how much anything is.

When patients try to use GoodRx at independent pharmacies, they're told "we don't accept that." And even more interesting - BEHIND GoodRx is… you guessed it!

A PBM

When anyone asks for transparency, they're buried in 47-page documents full of technical jargon. And of course, that’s just the contract LANGUAGE to ‘define’ transparency.

It’s all garbage because complexity is the enemy of accountability.

Your Action Plan (Because Complaining Doesn't Pay Your Bills)

While we're waiting for the system to collapse under its own corruption, here's what you can do right now:

1. Become Price Literate

* Always ask your pharmacist for the cash price

* Don't accept "I don't know" as an answer about drug costs

* Download GoodRx (despite its flaws, it's a pricing reference)

2. Go Direct When Possible

* Many drug manufacturers offer direct-pay programs

* Research online and international pharmacy options

* Some independent pharmacies offer cash discount programs

3. Support System Disruptors

* Use independent pharmacies

* Support direct primary care doctors

* Look into peer-to-peer funding networks (like CrowdHealth)

* And if you are an employer mandated to work within the system - look into smaller, regional, boutique PBMs. (Because if it’s owned by private equity, Wall Street or a national pharmacy chain - it’s contributing to the problem)

4. Build Your Own Intelligence Network

* Join patient advocacy communities (like this one right here!)

* Follow healthcare transparency advocates on social media (like me 😉)

* Share pricing information and helpful resources with other patients & your clinical team

The Coming Disruption

This system is unsustainable.

Just like the financial services industry got exposed for 401k fee gouging 20 years ago, PBMs are about to face their reckoning.

The signs are everywhere:

* Media coverage is growing

* Patient advocacy groups are organizing

* Government investigations are increasing

* Technology is making price comparison easier

President Trump's executive order on “Most-Favored-Nation Prescription Drug Pricing” was just the beginning.

The next wave of reform will focus on transparency, vertical integration limits, and direct-to-consumer options.

The Bigger Picture

This isn't just about saving money on prescriptions.

This is about who controls your healthcare decisions.

Right now, a handful of companies control:

* How much you pay

* Where you can get them

* What drugs you can access

* Whether your local pharmacy survives

They've turned your health into their profit center.

But here's the thing about middleman businesses- they only exist as long as customers don't realize they can go direct.

The internet destroyed travel agents, stockbrokers, and music distributors.

Healthcare middlemen are next.

The Real Solution

The PBM industry provides some legitimate services- managing drug interactions, coordinating care, negotiating with manufacturers.

The question isn't whether these services are valuable. The question is whether they are the best ones to provide them and if they're worth $500 billion per year in fees.

What Comes Next

The pharmaceutical pricing crisis is a feature, not a bug.

It's designed to extract maximum profit from captive customers who literally need these products to stay alive.

But every monopoly eventually falls.

And this one is starting to crack.

The next few years will determine whether we build a healthcare system that serves patients or profits middlemen.

Choose your side carefully.

The revolution is coming, and it starts with you refusing to accept "that's just how the system works" as an answer.

The only way we change this is by spreading awareness faster than middlemen can spread confusion.

Your move.

Quick note! CrowdHealth is our amazing sponsor (seriously amazing) and since we spent time with the team in Vegas last week, I’m even more pumped about watching them grow.

Devin Ryder and I have been members for 18 months now and we’ve never been happier with our healthcare.

If you are ready to take control of your health and experience freedom from health insurance (and PBMs) you should join us- we’re a cool, obstinate, happy group.

Use code “Liberty Lab” for $99/month for the first 3 months. If you ever have questions about it - DM me personally or comment below!

Rachel Strauss - we appreciate you!

If you want to learn more about health policy and the prescription drug market follow Rachel on Substack, Linkedin and TikTok!

Until next week!

Tiffany

*Never legal, financial or medical advice! Ciao!

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit signalandnoisepodcast.substack.com

Everyone obsesses over finding the perfect doctor, the right diet or the optimal workout routine.

But what if I told you that if you’re only focused there, you are missing a huge piece of the puzzle?

In this week's episode of The Healthcare Liberty Lab, I share a conversation with ER Social Worker Christina Rodriguez that flipped everything I thought I knew about health and community upside down.

Christina hit me with a stat that should terrify every American:

The World Health Organization says 80% of our medical outcomes depend on what social support is available to us. Yet less than 10% of healthcare funding goes to social care.

Which means: we are literally funding healthcare backwards.

Christina has worked with everyone from wealthy suburban families to homeless populations.

Here's what she's discovered:

Clinical outcomes often have little to do with access to fancy specialists or expensive treatments.

She told me about dementia patients who get "dumped" in emergency rooms at midnight because they have a simple UTI and their caregiver is just unable to keep up.

These aren't medical emergencies - they're social support failures.

She's watched patients with severe, intensive behavioral problems transform overnight. Not because of new medications or breakthrough treatments. Because they finally got the right social support and environment.

"It can be pretty dramatic," Christina said. "You have these really high intensive, severe behaviors turn into a night and day difference just because of the right environment."

Not procedures - Environment.

Not prescriptions - People.

Not doctors - Community.

The current healthcare system profits greatly when you show up desperate and alone. A isolated person having a mental health crisis becomes a $50,000 days or weeks long hospital stay.

It costs society, taxpayers, families and individuals a fortune.

But that same person with proper community support? They never end up in crisis in the first place.

Christina discussed how the Covid response further contributed to the decline in community support. Fear responses, government lockdowns and remote work all affected the systems that have historically kept people healthier. Third spaces disappeared. Businesses shut down. Inflation skyrocketed. People lost support networks.

The result? More teenagers with suicidal ideation in emergency rooms. More elderly people saying they want to die because they can't afford heat and have nobody to help them.

We medicalized what should have been community problems.

I asked Christina what she'd do if someone she loved needed support. Her answer was simple but powerful:

Community first.

Not better insurance. Not more specialists. Community.

She explained how she'd look for other people in similar situations - whether that's online groups, community centers, or local organizations. People who actually understand what you're going through.

Then she'd check what state and local resources are available. Most people have no idea what's out there because it's buried in bureaucratic language that nobody understands.

Her advice that stuck with me most: Get really clear on the exact language and terminology for your situation. The more accurately you can describe your needs in clinical terms, the better you can advocate for yourself.

Your community can help you figure it out.

"It's a horrible burden, but it's just true," Christina said. "The more accurate you can talk about your person at a certain time, the more able you are to advocate for them."

Christina was also clear about who to ask for when you need help navigating inside the system:

Always, always ask for a social worker (or one of the following…)

* Community health workers

* Care coordinators

* Patient advocates

* Care navigators

These are the people who understand how the system actually works and can help you get what you need.

We've been asking the wrong questions about healthcare.

Instead of "How do I find better coverage?" we should ask "How do I build better community?"

Instead of "What's the best hospital?" we should ask "Who are my people when things go wrong?"

Instead of "How do I afford healthcare?" we should ask "How do I stay healthy enough to avoid needing expensive care?"

The math is simple: Prevention through community costs pennies. Crisis intervention costs thousands.

Here’s where to start:

1. Find your people. Look for others dealing with similar challenges. Online communities, local groups, whoever gets it.

2. Learn the language. Research the clinical terms for your conditions. Know how to describe your needs in the system's language.

3. Build your team. Find a primary care doctor who listens, identify local resources, connect with people who've navigated what you're facing.

4. Ask for help. When you're in the system, specifically ask for social workers, navigators, and care coordinators.

The entities who make millions off the current system don't want you to know this. They profit when you're isolated, confused, and desperate.

But now you know what Christina knows: Your health is determined by your community.

Find Christina on LinkedIn or check out her podcast "Outcomes" for more insights on building community-based healthcare solutions.

This is exactly why CrowdHealth exists - to put community back at the center of healthcare. CrowdHealth assigns every member their own patient advocate. Because when people support each other, everyone wins. Check it out (cancel anytime) for $99/month for the first 3 months by using the code “Liberty Lab.”

Until next week,

Tiffany

*never medical advice

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit signalandnoisepodcast.substack.com