In this episode, we sit down with healthcare economist and consultant Andrew Tsang to unravel the US healthcare economy — a $4.9 trillion “abominable creature” made up of tangled incentives, complex financial flows, and systemic contradictions.

We explore Andrew’s viral system diagram, inspired by Ernst Haeckel’s biological illustrations, and examine how taxes, premiums, Medicare, Medicaid, employers, payers, and providers all interlock in ways that directly shape how hard it is to sell into healthcare.

What you’ll learn:

• Why CFOs are saying “great idea… but we have no money”
• How macroeconomic pressures impact your deals, timelines & value proposition
• Why payer sales cycles are 12–18 months before implementation even begins
• Why $4.9T in spending still results in a $22K hospital janitor
• How aging demographics and the “silver tsunami” will reshape the market
• Why empathy + context are your biggest commercial differentiators
• What startups consistently misunderstand about selling to payers & providers

If you’re a founder, seller, operator, or executive in healthcare technology, this episode is one of the most important macro-level explainers you’ll hear all year.

Links from the episode:

• Andrew Tsang’s Substack
• Stuart’s Substack (including The Knights Who Say No! + The Pauper CFO)
• Andrew’s “Abominable Creature” system diagram
• Haverin About Merch Store

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