Just when you thought a $10,000 a month gym was the craziest membership NYC had to offer Cedra Pharmacy said “hold my beer”. Their highest tier Cedra Grand membership reportedly costs $6,500 a month, of which they donate $500 to a charity of your choice after a year of membership (so don’t worry you can still sleep at night).

Oddly enough Personal training is included in the cost, but a gym membership itself is not (suppose we’ve seen stranger things on the streets of NYC). Even more reassuring for those of us on a budget is that inline with Cedra’s mission to “ensure that you get the care you need, regardless of cost” (or better put despite the cost) they offer financial assistance!

2. A new limbo Queen has been crowned. The video will make your knees hurt

Nothing, I mean nothing, will age you more than watching Shemika Campbell skirt under a 12” limbo pole like you avoiding a bad HR policy. As Michelle Obama once said “when they go low, Shamika goes lower”.

3. A staggering 78% of NVIDIA employees are millionaires

Few things draw top talent to start ups more than the prospect of life changing financial gain. Still, startups are strange beasts. About 90% of startups eventually fail and of the ones that don’t <1% go on to become unicorns. Even unicorn status itself though is not a guaranteed payday - a lesson I learned personally.

The start up I joined as employee #1 almost 8 years ago, has done phenomenally well - most recently having been valued at $7 billion. Yet, having not gone public, and without a liquidation event that potential upside is still all theoretical. This makes it even more impressive that over 3/4’s of NVIDIA employees are millionaires and over half are worth $25 Million or more. If NVIDIA is any indication, AI appears to be as good at making money out of thin air as it does lines of code.

4. A 1400 lb cow can yield as little as 80lbs of steak

If you love red meat even a sliver as much as I do get ready to say “HOLY COW”! Its little surprise how much the cost of beef has gone up since COVID. A non grass-fed Ribeye can cost over $30/lb these days at many meat counters. But even before COVID steaks were not cheap and it all has to do with scarcity and demand.

On a recent episode of “The Economics of Everyday Things” podcast the host dove into the economics of processing a heifer and let’s just say the findings were nothing to moo at. While many factors such as cut, size, and breed affect the final yield lets look at just one variety, the supreme cut, a ribeye.

If you start with the basic anatomy of a cow they have 26 ribs - 13 per side. This means center cut Ribeye yield can be as low as just 2 dozen steaks per cow! When it comes to tenderloin steaks that number gets cut in half (pun intended).

So next time you go to buy a steak of any kind take some solace (at least until you have to swipe that card) knowing you are getting the top 5% of that animal.

5. The Ponzo illusion shows how our brains interpret objects based on their environment

The Ponzo illusion gets its name from Italian psychologist Mario Ponzo (although they say he didn’t actually come up with this illusion). It uses two seemingly parallel lines that actually taper in towards one another (think train tracks running away into the horizon) with lines drawn across them to show how our brains automatically interpret an objects size based on its background.

Besides just being fun, optical illusions remind us that our brains often subconsciously play tricks on us that we must be aware of in our every day decision making.

6. On a typical day Netflix makes up 11% of internet traffic in North America

America officially has a Netflix and chill problem (and mostly the Netflix part, we got no chill). A recent WSJ article highlighted how on a typical day Netflix makes up 11% of the total internet bandwidth used. When you consider all the other things that use internet these days that is mind boggling. For one internet provider during the Paul vs. Tyson fight Netflix peaked at 39% of their total traffic.

For prerecorded content Netflix relies on some 20,000 servers stashed at 5,000 locations worldwide to push the stored content to users homes. Live TV is different however. With no content stored (since its all happening live) everything must be moved in real time from where it happens, to a production facility, then a network of servers, and ultimately your home.

For a company accustomed to streaming pre produced content their foray into live sports was not without stumbles as seen in the many glitches and “unavailable” messages that met viewers throughout the fight. On the flip side if Netflix is able to successfully deliver high quality live content consistently they may be able to form Americas next great Monopoly!

7. Rochester, NY wins another housing record no one wanted

There is a lot to love about life in Upstate NY, namely the 3 months of amazing summer weather, lack of earthquakes, hurricanes, wildfires or other natural disasters, and garbage plates. When it comes to housing in Rochester, NY though, my home town, there is a lot to hate.

Last year 14609 felt more like 90210 ranking as the hottest market in the nation - with homes selling in an average of just 8 days. As someone who owns and manages 6 units in that zip (and also grew up in it) I can tell you the pain is real. Then a month ago it was reported that Rochester NY has the highest percentage in the country of homeowners with mortgages where tax + property insurance costs are more than their principle and interest.

Compare the 35% of home owners in Rochester who find themselves in this situation to the national average of just 9% for single family home owners and you can quickly see how a lower median home price does not go very far. It is a painful reminder that the area you buy in may have more of an impact on your mortgage than the price of the home itself. In just 3 years the insurance on my personal home has gone from $1100/year to just under $2400/year without any chance in coverage.

Take it from someone who won the Hungry award at their last company for being the most likely to eat on a zoom call - not all races are worth winning.

8. The average new car loan costs $730 a month

Most of us can remember the first “real car” we purchased. For me it was a new 2011 VW Jetta GLI (autobahn edition of course). I still remember thinking how crazy it was to pay $311 a month for a car and to this day it frames my scope of reference for car payments (aka everything over $311 seems expensive).

However between rising car prices and interest rates todays buyers face a new normal in the realm of purchasing a car, with almost 1 in 5 new car loans costing $1,000+ per month and the average payment clocking in at $730. If you put that same payment away every month for 20 years, assuming an 8% average return, you would walk away $400,000 in your pocket.

Talk about the most expensive way to get around.

9. The weight of water dropped by tanker aircraft’s used to fight the LA wildfires is equivalent to 24 Ford F-150’s.

Nothing brings out the arm chair quarterbacks more than a crisis, and the recent LA wildfires are no exception. There has been much talk about why planes didn’t use the Pacific ocean to refill tanker planes and why larger water drops were not done. Both are very fair questions so I took to the internet to find out.

On the first front, why was the ocean water not used, it comes down to one thing, salt water. Salt is a highly corrosive compound - meaning it causes rapid deterioration of other materials, namely metals. For a tanker to use a salt water payload would require enormous amounts of cleaning and maintenance after each flight to prevent destruction of the tanks and pumps that it comes in contact with. Furthermore salt causes significant damage to soil and vegetation.

For those non-biology majors osmosis is the process by which fluids move through a membrane to create an equilibrium in ion concentration on either side. When you dump large quantities of salt in the soil it causes water to leave the cells of the plant to try and dilute the highly concentrated soil. This causes dehydration and plant death.

The second point, why did planes did not operate at full tank capacity, is less straight forward. There are literally dozens (if not several dozens) of factors that affect the max amount of fluid a tanker plane can load up with. The size of the runway, the amount of fuel needed for the flight, the altitude of flight, the winds, the time it has to refill, and so many more.

One thing not on my bingo card was the weight of water. At over 8 pounds a gallon, a fully loaded Douglas DC-10 tanker plane, like those used in the LA wildfires, is capable of carrying 12,000 gallons of water. If full, it would be dropping more than 96,000 pounds of water onto houses. That is equivalent to the weight of 24 Ford F-150’s.

If you prefer your cars parked in the driveway and not falling through your roof it may be best to yield emergency management to the professionals.

10. BMW set the world record for longest drift. It lasted over 8 hours.

To round us out- the content we need, but don’t deserve. BMW set the world record last month for the worlds longest continuous drift by skidding a car in circles for 8 hours straight. How do you drive for 8 straight hours that you may ask?

Some things are best answered by a video.

Right about 1030pm I see a text appear on my phone from one of my tenants. Though I love my tenants dearly seeing any of their names pop up on my phone, particularly at that hour, automatically triggers a strong sympathetic nervous system response.

Did the basement flood knocking out hot water?

Is the boiler failing?

Is a bat trapped in a window?

Did a contractor (aka me) drill through a drain pipe thats now flooding the apartment?

Did the lawn guy skip mowing the backyard for 2 months and now your teacup yorkie is lost in the tangle of overgrown weeds?

Is a tenant locked out?

While these are all real emergencies I have faced, I knew what lie in wait.

Three strikes and you’re out

There are few things that give people pleasers (🙋‍♂️) more anxiety than unpleased people. If ever I got a tattoo it very well might be a quote from a talking candle stick that said “life is so unnerving for a servant who's not serving”.

One of the main reasons I got into property investment and management was to create a better more human experience for the guests and tenants I am lucky enough to accommodate.

I am confident that if you have not had a bad landlord experience yourself you know someone who has. Some of it is born from an abundance of legal caution (ie. they know they should do X but don’t want the legal risk), some from ignorance (ie. people who shouldn’t be landlords buying investment properties), and some of it from opportunists (ie. they know we can get away with it).

I knew when I saw this text message it was going to be a noise complaint. I knew that because it was the third one. The hard part of being in the middle of humans at odds is that matters are rarely black and white.

One persons hot is another persons cold.

One persons loud is barely audible to another.

One persons “late hour” is 8pm, while anothers is 2am.

Complicating matters further is that most tenant disputes boil down to he said she said since you as a landlord are rarely a first party witness to the transgression. You gather facts, you consider motives, and ultimately evaluate the broader impact of any action you do or don’t take.

This is where being a compassionate manager pays dividends. The complainee and I had chatted at length after the first two noise violations and because we had a good rapport they voluntarily admitted that they were in violation.

So when strike three came across the plate it was obvious the decision that had to be made, but that did not make it easy.

The Long Game

With my first ever 30 day notice given the day before Thanksgiving suffice to say it was not the start to the holiday season I envisioned. Given the circumstances I volunteered my services in helping the outgoing tenant find new accommodations. Much to my surprise they offered to leave by 12/1 to avoid paying December rent. I was amenable.

I have thought about the decision to enforce the lease often since doing so. This particular unit is a mid term (30 to 90+ day stays) furnished rental. The economics are already incredibly tight. You bear the additional expenses of furnishing the house, paying all utilities, all exterior maintenance, and consumables. If you assume ~1 week vacancy between stays (which typically are 3 months) that starts you out with 8% vacancy.

Add to that the fact Rochester is a highly seasonal market. A last minute hole in the winter calendar is unlikely to get filled (and as of writing this the unit is still vacant) and if it does it will be at significant discount to the standard rent. Even a 2 month vacancy can flip a unit red for multiple years.

So why move ahead knowing this poses significant economic risk? Simply because it was the right thing to do.

When tenants sign on with me I am committing to provide a housing experience as outlined in their lease to the best of my ability. One of the most important provisions of which is quiet enjoyment of their space.

Inside and outside of real estate I see businesses too often prioritize profit over the customer. Not issuing a refund for a faulty product because it is a day outside the return window. Making the cancel button harder to find than the Epstein Island guest list. Burying important terms in legal jargon.

As it turns out the right thing and easy thing are often at odds. The best brands and businesses understand the importance of accepting short term (or mid-term :) pain for long term success.

No that was not a typo, or the cost per year. Continuum is a self proclaimed “precision wellness” club in the West Village that intends to be a beacon for the who’s who of Manhattan.

With amenities ranging from cold plunges and saunas to float tanks and hyperbaric chambers it is safe to say this is not your run of the mill high end fitness club. Still the biggest draw for membership are the social elites you might brush shoulders with among one of their well appointed lounges, cafes, or work areas.

Though their unlimited membership tops out at an eye watering $10,000 a month there is still hope for us plebeians with their basic membership - a comparative bargain at $1,000 a month.

It is anyones guess what they spend those massive monthly dues on, but we can be certain that it is not their 3 page website.

#2: Immigration was 84% of US population growth last year*

As a nation founded by immigrants perhaps it should come as no surprise that our growth remains fueled by them, but it did. At least to me.

The combination of declining birth rates and the in progress “silver tsunami” of aging boomers has made immigration the most significant part of the US population growth.

Interestingly over 1/3 of all immigration occurred in just two states - FL & TX and three states experienced a net decrease in population (deaths > births): VT, WV, & MI.

*Note- The federal calendar year ends June 30, so this data is July 23 through June 24.

#3: India has the only holiday I never want to celebrate: “Pollution Holidays”

You’ve heard of a snow day…but what about a pollution day? Well actually more like pollution weeks - but they are a real thing! Each year weather patterns in India, coupled with excessive pollution, create a hazardous atmosphere that causes schools to close and outdoor activity to screech to a halt.

Delhi’s air quality declines at this time of year because cooler temperatures mean polluted air doesn’t rise and disperse as it does in the summer.

“Air pollution and temperature are inversely related”, said B.S. Murthy, a senior scientist at the Pune-based Indian Institute of Tropical Meteorology. “As temperatures go down, pollution goes up,” he said - Vibhuti Agarwal /WSJ

On Dec 15 the air quality reading in Delhi India was over 450. Thats 38x than times worse than NYC and 150% above the threshold for hazardous air.

#4: Walgreens entire company is now worth less than 50% of Ozempic’s 2024 sales.

This one felt a little personal. Having started my career as a pharmacy tech, then intern, then pharmacist at Walgreens it has been startling to see its fall from grace.

This week the stock price hit its lowest price since 1996 at <$10/share, off its high of nearly $96/share in 2015. How we got here is no great mystery - Walgreens made bad bets and remained too entrenched in the faltering business of pharmacy (compared to its peers like CVS who bought up PBM’s and insurers).

With a current market cap of ~$8 billion it is quite stark to put into context how little remains of the more than 120 year old drug store:

• Walgreens entire company (which also includes the largest pharmacy chain in Europe, Alliance Boots) is worth half of the popular diabetes drug that gained popularity for weight loss Ozempics projected 2024 sales ($16 billion).

• Ro, the Telehealth company I was employee #1 at, was last valued at $7 billion. They operate 6 pharmacies. Walgreens has 8500.

#5: Inflation can be >10% worse for lower income households

A recent WSJ journal article detailed how despite receding inflation over the last year America’s most budget conscious households continue to be disproportionately effected.

The underlying data makes an obvious point, albeit one I have never considered: inflation readings and the CPI are a broad mix of spending categories but how inflation actually affects you depends on which of those categories you spend money on, which tends to vary between income brackets.

A reduction in cost of big ticket items like a used car or mortgage interest rate can skew measured inflation downwards. Since lower income houses tend to make fewer of these purchases though their inflation reality is more closely tied to the prices of goods and services like groceries and the cost of a plumber (which have remained stubbornly high).

Since 2002 the lowest quartile of income earners have experienced cumulative inflation at a rate almost 10% higher than those in the 75th percentile of income - making the only thing that is deflating this disparity.

#6: An uber ride can cost more on an iPhone than android

A recent LinkedIn post detailed the diverging cost for ordering an uber from and to the same location on difference devices.

As with everything from the internet - let’s take it with a grain of salt. I have not yet tested this myself (mostly because I don’t associate with android users - how could we ever be friends I can’t even charge my phone at your house!) but I think it hits home on a pretty interesting point: companies have a lot of data on us and personalization is not always a net benefit.

#7: The US spent 17.6% of GDP on healthcare last year

Despite our competitive culture here in the US, one race we did not want to win (but did) is the one on healthcare spending.

As a country we spend much (much) more on healthcare in virtually every dimension. Last year we spent nearly $1 out of every $5 on healthcare related expense. On a graph of healthcare spending per capita by country the US looks like a stray mark from a toddler who’s not learned to color inside the lines yet. We spend 50% more than the next closest country, which happens to be Switzerland.

What do we get for all of our excessive healthcare spending? Certainly not the longest life. We place 49th in that race behind countries like Saint Pierre and Miquelon (pop. 5,800) and Wallis and Futuna (and island 15x smaller than rhode island where the US embassy recommends flying to Australia or France for emergent or specialized care - a 15 or 32 hour flight respectively).

Maybe there is something to be said about good chocolate and dodgy bank accounts after all.

#8: Apparently owls can swim

Yea not much more to add to this one - but here’s a cool video of an owl swimming.

Source: National Geographic

#9: A company will build you a glamping resort, just bring the land

As a part of my usual daily doom scrolling on Linked In I came across an interesting company called Posh Outdoors who specializes in building incredible glamping resorts on your land.

One thing led to another and I had a fantastic intro call with one of the Cofounders, Nick (who ironically is from the same town in England my dad grew up in and every bit as cheeky).

For some time now my ambition has far exceeded my ability in the hospitality space to open a nature first resort - primarily due to a lack of funding and expertise in site design. That is why I am so bullish on what the team at Posh Outdoors is doing because they bridge that gap while allowing land owners to own and operate the finished product.

They work off a simple revenue share model that aligns both the upside interest and risk with yours. They will open the doors at their first concept resort this spring just outside of Banff in BC, Canada.

With moving deeper into hospitality on my 2025 bingo card l look forward to following along and maybe just maybe partnering up with the team there to bring my own resort to life.

While this is not a sponsored post (although by all means Posh if you’d like to pay me my venmo is @clafayette) you can learn more about the industry on Nicks blog - The Glamping Insider (or by blowing him up on Linked In like I did).

#10: Hanukkah will start on Christmas Day for the first time in 19 years

Tis the season as they say and this year the seasons will start on the same calendar date for the first time since the iPhone was invented.

Ironically the start of Hanukkah and Christmas always share the same the date but because the Hebrew Calendar is based on a lunar year it is somewhat rare that the actual day lines up with Christmas Day which is based on the solar calendar.

If you are in a household lucky enough to be celebrating Chrismukkah remember menorah’s and pines trees don’t mix well so take extra caution to provide each their own window.

At check in for a routine procedure I had done this week I was first asked to sign a statement saying “I agreed to pay whatever my insurance did not cover”. Being asked to sign this statement wouldn’t be out of the ordinary were it not for the fact that I was paying for the procedure out of pocket (cash).

Ironically, insurance has become the default form of payment throughout much of healthcare. And while its utility shrinks more and more each year it is so engrained in our system that even our cash pay flows still feel its presence (and respectfully, why spend resources designing a separate flow that historically is rarely used).

When I originally planned this post I had intended it to explore the wildly expensive world of self-funded insurance through the exchange marketplace. However given the recent events surrounding the untimely death of Brian Thompson, the CEO of United Health Care, and the resulting public outcry it only felt right to dive deeper into one of the most divisive and critical issues facing our country - health insurance.

What is health insurance?

In theory - health insurance is no different from any other form of insurance. You are trading a small guaranteed loss (your premium), for protection against an uncertain future loss (like a huge hospital bill). Historically we have seen insurance cross industries with a high degree of fidelity to this core principle of trading small certain losses for protection against unknown potential future loses.

The mechanism by which insurance companies work is through studying the probability of the insured event, then spreading risk and cost across large pools or people. Take car insurance for example.

On average ~5% of auto policies have a claim in a year. Geico can take those odds, along with the average claim cost and back into how much to charge for premiums so that they can be both competitive and profitable.

Importantly, this not only makes business sense but it makes logical sense. Most individuals couldn’t afford to replace their car or pay significant medical bills if they were injured in a wreck so it is prudent to give up a small known amount to guard against this larger loss. The same applies to home insurance - $1,000 a year to guard against losing your $350K house - a universally prudent decision.

In fact when you look at almost any type of insurance you see a very consistent theme in the risks which they guard against. Namely that they are infrequent, unpredictable, and well defined.

The one insurance product where this does not apply? Health insurance

In many ways health insurance is not insurance at all, it in fact is the antithesis. As my accountant reminds me every tax season “the only place I want you to lose money every year is on insurance - it means your house didn’t burn down, you didn’t get in an accident, you were healthy, and you didn’t die”.

Ask anyone around you “do you plan to use your car or home owner insurance policy this year?” and you’ll get a weird look and a resounding “No”! But ask them if they plan to use their health insurance this year and most will probably tell you they already have.

One of the primary problems with health insurance is that it has been co-opted into a de-facto protection plan, like a slimy used car warranty or the $6.99 protection plan for your $9.99 toaster from Walmart. A simple rule of thumb is if you plan to use the policy- it is not insurance.

A reasonable person might ask why has health coverage failed to conform to the standards of insurance, and indeed that is a topic worth exploring.

How did we get here?

It should come as no great surprise that our modern health insurance system was not planned but merely an unintended collateral consequence of other decisions.

In the earliest days (we’re talking 1800’s) health insurance did not cover any medical payments, it’s primary purpose was to cover lost income from an inability to work due to sickness. Given the primitiveness of medicine at that time which largely centered on containing the spread of contagious disease and snake oil remedies - it made sense there was no going concern for how to make medical payments because they didn’t exist.

While it is generally agreed that the first modern insurance plan was formed in 1929 between Baylor University Hospital and Dallas public school employees (later given the name Blue Cross), it was not until more than a decade later that widespread adoption of private health insurance took off.

The year was 1943 and we were deep in the throws of WWII. As a part of the wartime economy strict wage and price controls had been introduced in the US. In an economy already short on labor wage caps made it even more difficult for companies to attract talent. The body that set these restrictions however (the aptly named War Labor Board incase you are wondering) did not consider expenses for insurance as a wage expense.

The result was employers, desperate to attract workers, adding health insurance as a benefit. Employment based insurance was further bolstered in 1954 when the IRS clarified that employee health insurance expenses were tax exempt - incentivizing employers to offer insurance as a lower cost way to compensate employees than straight cash.

This was the first misstep - tying healthcare to an arbitrary, and often transient arrangement like employment.

As healthcare services expanded and medicine became more advanced what was once a fringe, rarely used benefit, gradually became a large cost center. Whats more, because insurance abstracted those costs (ie. a $5 copay for a $150 doctor visit), the person consuming the service was woefully unaware of what the service actually costed.

This lead to vast amounts of over consumption of healthcare due to a phenomenon known as moral hazard - when an insured party behaves differently than they would if not insured. This is a topic we will discuss at more length in the next section but importantly this detachment between the person who pays for a service and the person who receives it resulted in massive price inflation.

Why healthcare makes a horrible insurance product

At the outset I discussed how health insurance does not conform to the general principles of insurance. So why don’t we just make it conform? Well, much like your relationship status on Facebook - it’s complicated.

Healthcare is DEEPLY personal and often indelibly consequential. Deny someone their water back up claim and sure it sucks but life goes on. Deny someone’s request for chemo or a surgery and quite literally their life might not go on. Yet, no matter how heart wrenching healthcare is the laws of economics know no exceptions.

It is this duality - being bound both by the expectation of compassion and the principles of economics and risk - that makes health insurance so menacing.

Take the basic actuarial principle of moral hazard- which is described in the excerpt below:

“In its most traditional usage, moral hazard is identified with an increased probability of loss due to various kinds of unethical or imprudent behaviors on the part of an insured individual. These behaviors include extravagance, malingering, indifference to accident avoidance, claims fraud, dishonest failure to disclose a known hazard as part of an application for insurance, and imprudent failure to purchase insurance until the hazard is at hand (e.g., one's house is burning down).”

Employment and Health Benefits: A Connection at Risk

Then take the following set of exclusions for common types of insurance:

• If your house is currently on fire you are not eligible for property insurance coverage

• If you are a smoker with a history of 3 heart attacks you are not eligible for life insurance

• If you have had 5 accidents in the last year your auto insurance premium will be extremely high or you will be ineligible for renewal

And then consider similar statements but tweak them for how health insurance actually works:

• If you have a pre-existing condition we will cover it, and at no additional expense

• If you engage in negligent behavior (sedentary lifestyle, poor diet, alcoholism, etc) we will still cover claims resulting from that negligence

• If you had $100,000 in medical claims last year we will charge you the same premium next year as the person who never saw a doctor once

Or to really drive the point home take the health insurance logic, but apply it to any other other insurance product:

• If your house is currently on fire we will issue you insurance to cover replacement.

• If you are a smoker with a history of 3 heart attacks we will sell you life insurance at the rate of a healthy person your age.

• If you have had 5 accidents in the last year we will renew your auto coverage and not raise your premium

If the last set of statements were true, we would see the same moral hazard in other insurance industries that we do in healthcare. People wouldn’t buy car insurance preemptively, they would buy it after the crash. They wouldn’t worry about buying the house that is about to fall over - they would just file a claim.

It becomes immediately clear that healthcare is not an insurable product. Not because it cannot be, we certainly could apply typical underwriting standards, but because we don’t want it to be…and that is a good thing.

A State of Upheaval

This week we saw the undercurrent of tension in healthcare come to a head. Regardless of your view on the state of our health insurance system no person deserves to lose their life in that fashion and I feel for the family, friends, and colleagues of Brian Thompson.

As someone who’s entire career has centered around healthcare I know full well the tale of two cities that has been playing out for decades. Even so it was no less shocking to see the overwhelming response of rage from vast swaths of Americans in light of the recent events. And while it would be easy to dismiss the sentiment expressed as reprehensible or juvenile that would only be further missing the point.

For those who must get their insurance through the exchange like myself (primarily self employed individuals) there is no time of the year that more poignantly reminds us of how broken our health insurance system is.

As a healthy 33yo, lifetime non-smoker, who takes no meds, and consumes almost no healthcare in the average year, these are the BEST options I have for health insurance for 2025:

Busy table - I know. Let me give you the highlight.

The cheapest HSA eligible plan in my zip code will cost me in excess of $6,000/yr in premiums, plus another $5,500 in deductible spend. That means I will pay no less than $11,853 (remember there is healthcare that insurance doesn’t cover so that number is likely to be more) before my insurance contributes anything towards care.

Five figures is a high price to pay just for the “benefit” of having insurance - even more so when you consider the fact that to qualify for medicaid in NYS (insurance for low income individuals) as an individual you must make less than $20,784. Is it any surprise that such angst exists when someone making $21,000 could be on the hook for $12,000 in healthcare expenses before their insurance pays a dime?

Whats worse is the is just the ticket to the dance- we won’t get to dive into the world of prior authorizations, formularies, and restrictive networks which limit the ways in which individuals can receive care.

Where do we go from here?

The resounding question at this point is no longer “what is broken with our system?” but “how do we fix it?”

Health is complex and health insurance bears those same complexities. Every health insurance model created to date has its draw backs and so it becomes a matter of finding best practices for a given population.

Call me biased (I was the first employee at Ro) but I have been encouraged by the recent move to more direct to consumer health offerings. Reconnecting payor and patient is a critical first step in commoditizing care where appropriate.

In a similar light seeing the rise of direct primary care has also given me hope we are on the right path as the care provided is often much more holistic in nature with an emphasis on prevention.

Above all else though what restores my faith is that there is an increasingly large segment of the population who cares deeply about personal health and is making the investments in food, exercise, and socialization to simply require less healthcare over the long run. We are questioning everything and demanding answers to questions we previously were told had already been answered (like is red meat bad, is cholesterol actually the widow maker molecule, and should we really not feed peanuts to kids till 3 years of age?)

As the adage goes an ounce of prevention is worth a pound of cure. So while we have much work to do fixing our health insurance system, if history has taught us anything it is that meaningful change always start with a frustrated and motivated group of individuals using that energy productively.

As someone who counts themselves as a generalist, much of our superpowers rely on abstracting concepts from completely unrelated topics and using them to build our skills in the current area of focus. It was a refreshing reminder that while outcomes matter, the process by which you arrive at them does too.

Are You Tracking?

For those unfamiliar with what a differential is you might be surprised to learn they are in every car, including yours. They were designed to solve a fairly straight forward physics problem- when you make a turn your outside wheel necessarily moves faster than your inside wheel.

If you don’t believe me go to your nearest high school track and run a lap on the inside most lane and the outside most lane - except you MUST record the exact same time for each lap. You will find you must run faster in the outside lane to record the same lap time that you did on the inside lane since it covers a greater distance.

Now imagine you have two wheels on that same track affixed to a single axel. When you hit the corners of the track the outside wheel must be free to accelerate to stay even with the inside wheel.

This is the problem a differential solves.

So why am I so hype for a 1937 video on car engineering? Well, mostly because it has a simplicity to it that I envy and find missing in the breakneck pace of todays world.

But also because there is much to learn from how the video clearly breaks down the dilemma and subsequently works through the solutions from the basic solve (we need wheels that can move independently) to the final product (a smooth and robust gearing so efficient no-one knows its there).

A transcript of the progressions would look something like this:

“How should we build a car axel?”

• Attempt 1: Wheel on each side of a fixed rod - works on straight aways but is terrible on corners

  • Learning: we need the wheels to move independently of each other when turning

• Attempt 2: Spoke on a pivot - this solves the problem of allowing independent movement, but provides a poor ride

  • Learning: we need smaller spaces between spokes so that there are less gaps between contact from the motor and the wheels

• Attempt 3: Add more spokes - the more spokes, the more improved the ride, however it still remains choppy

  • Learning: no amount of spokes will be enough- we need something that always touches

• Attempt 4: Replace spokes with gears that allow constant contact - this allows independent movement and an exceptional ride

  

Dare to be Different(ial)

This iterative process is critical not only when you are designing and building new products and processes, but also when you are learning existing ones. Why?

For one, when the next generation of engineers comes in if all they know are that cars work because they have differentials they lose valuable context and skill building that will help them to then tackle the next (yet unsolved) hurdle. You see this manifest in a couple of ways in organizations:

Massive bubbles: when no one truly understands what is going on “under the hood” issues compile without detection until they build into huge bubbles big enough to burst, and they inevitably do.

Inability to troubleshoot: not having a firm grasp of the underlying decisions, failures, and mechanics that went into a technology or data point make it near impossible to effectively troubleshoot when issues arise.

A second less explored consequence is that it diminishes the time and effort taken to arrive at the final product. When we reduce a complex process to only its end result it discourages those tackling the current problems by diminishing the actual work done. If you’ve ever looked at a product or solution and said “Jesus Christ whoever figured this out must have been a genius” you have felt this.

On the other hand it also creates unrealistic expectations by those overseeing the development of a solution. They internally ponder “I know Rome wasn’t built in a day but we already have a working model of X, why is it taking this person so long to deliver?”.

In a world that is so hungry for quick solutions, let us not forget that if we do not fully understand the core problem we wish to solve (why wheels need to spin at different speeds) or the iterative progress that has come before (why spokes failed) we are at best likely to spin our own wheels mired in confusion repeating past mistakes and at worst likely to build incomplete solutions.

So the next time you are tasked with solving or overseeing a complex problem take a differential mindset - even if if means moving independently from the organizations expectations.

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