A north star to return to when the work gets complicated.
In one breath
I'm building a health plan that pays for care in cash on the day it happens, at a real (lower) price agreed before the visit — sends each member to a good option that costs less — handles the confusing parts for them — and charges them nothing when they use it: no copay, no deductible, no network, no figuring out where to go. It makes money not by denying care, but by paying for care more cheaply and intelligently than anyone else can.
The problem I'm solving
Two people I know skipped care they needed because the cost in the moment was too high. That's the whole reason this exists — and it isn't rare. It's the normal experience of being insured in America.
It happens because the system is built backwards. Today, nobody knows or cares what care costs at the moment it's given. You hand over a card, the provider charges an inflated number, your insurer argues it down months later, and you get a confusing bill for the rest. Because no one is shopping on price in the moment, prices float free of reality and climb forever. And because care is expensive, confusing, and frightening, people do the rational thing — they avoid it, or they go into debt to get it.
Healthcare has escaped the normal forces that keep prices honest everywhere else in the economy. There's no real supply and demand, because the person receiving the care never sees the price and never reacts to it. That's the deep brokenness — not greed, but the absence of a functioning market.
What I'm building
I'm flipping the model around.
Instead of paying after the fact in a fog, the plan pays on the spot — in cash, the day care happens, at a cheaper price agreed in advance. Instead of letting a member wander into the most expensive option, it routes them to a good one that costs less. Instead of making them fight bills and decode the system, it does that work for them. And because the plan gets care cheaper, it can afford to charge the member nothing at the point of care.
For the employee, the experience goes from "scary, confusing, expensive — I'll skip it" to "it's free, and someone handled it." For the employer, three things they juggle today — the insurance, the cost control, and the administrative headache — collapse into one.
Why it's genuinely new — not just a nicer plan
Two layers, and both matter.
What the member feels is new. $0 out of pocket, no network, nothing to figure out — for the person living it, that isn't a 10% improvement, it's the difference between using care and avoiding it. That experience, delivered whole, doesn't exist today.
What makes it possible — and uncopyable — is new underneath. When you pay a provider in full, in cash, on the day of care, they accept less than they'd bill insurance, because what they hate is waiting months and fighting to get paid. That real, lower price — what a provider will actually take for instant, certain cash — exists nowhere. It isn't published. No insurance company has it, because their entire business is built on paying the slow, old way. The only way to learn it is to pay it, one transaction at a time, and write it down.
So the plan, just by operating, builds something no competitor can buy or copy: a private map of the true cash price of care. The more care it pays for, the more real prices it knows, the cheaper and smarter it gets, and the further ahead it pulls. A normal insurer can't follow, because to copy it they'd have to tear up how they make money.
The plan is the body. The price map is the soul — and the soul is the new thing.
What I'm really trying to achieve
The small version: free people from the fear, confusion, and debt that make them skip the care they need.
The big version — the actual north star: build insurance for ordinary people that forces healthcare back into a real market. Every time the plan routes a member to the cheaper option and pays cash, it creates the one thing healthcare lost — a customer who shops on price. Do that at scale, and providers have to compete on price and quality again, the way every other industry does.
The mission isn't only to save my members money. It's to drag an entire escaped market back under the gravity of supply and demand — and to make the cheaper, honest prices a public good that bends the whole system, even for people who never become my members. I capture the savings on my own members; the market getting cheaper for everyone is the point, not a side effect.
Principles I won't compromise
- The member pays nothing on the routed path — no copay, no deductible, and no network telling them where they're allowed to go.
- Freedom, not a wall. Every provider stays available. If a member chooses a more expensive option, they simply pay the difference. The price steers; nothing is forbidden.
- Always the cheapest clinically valid option, in the moment — never the cheapest at the cost of good care.
- Pay cash the day care happens — never negotiate for guaranteed volume. Providers earn the routing by being cheaper or better, never by cutting me a private back-room deal. Healthcare should face a real market, not another hidden rate.
- The data is the moat. Every cash payment is a true price recorded. Protect it — it's the one thing that compounds and can't be copied.
- Run on as few people as the law allows. Automate everything that can be automated; that lean cost structure is what turns an honest, thin margin into a real business.
- Survive the catastrophe; don't pretend to beat it. Where there's no cheaper option — emergencies, the must-have hospital — transfer the risk to a reinsurer, pay a defensible price, and fight the unfair bill on the member's behalf.
- Own the risk only when scale makes it safe. Integrate everything from day one except the catastrophic backstop, which I rent until I'm big enough that owning it is arithmetic, not a gamble.
Who it's for first
Not everyone at once. The beachhead is the smallest, most underserved employers — the tiny companies the big players don't bother serving — entered through the friendliest door: a small business that has already moved to a self-funded (level-funded) plan. They've already accepted the structure, they have the data, and the savings are easy to prove. Win the door no one else is fighting for, then widen.
How it becomes real
It starts as a service done by hand — not as software.
- By hand, now. For real people I know, do the whole loop manually — find the cheaper option, pay cash, deliver the $0 experience, fight the bill. This proves it works in the real world and writes the first rows of the price map. No money, no permission required.
- One employer. Get a single already-level-funded small business to commit: "deliver this at my renewal and I'm in."
- Make it legal and priced. With a real group and its data, bring in an actuary and an ERISA attorney to confirm the numbers and paper the plan — single employer, to stay on the clean legal path.
- Rent the machinery. A rented captive cell, a fronting carrier, stop-loss, and claims administration — the established infrastructure, rented cheaply, for a fraction of what becoming an insurer would cost.
- The zero-to-one moment. Enroll the first group. The plan runs in the real world — real employees, $0 care, real cash-pay routing, a thin slice of risk I bear with the catastrophe reinsured. I run the engine by hand and capture everything.
- Then scale. Build the software to do by machine what I proved by hand, and expand — carefully, one step at a time.
The idea becomes a company at step 5. Everything before it exists to get there cheaply, safely, and fast.
The shortest version
I pay for care in cash the day it happens — at prices agreed in advance — so it's cheaper, send people to good care that costs less, charge them nothing, and handle the hard parts — and in doing it, I build the one thing no one else has: the real price of everything.
I make care affordable for my members, and I force healthcare back into the honest market it escaped.