I’m starting another company to try to fix U.S. healthcare. It’s an AI-native health insurance brokerage focused on continuous optimization of employer health plans: we believe your health insurance should get better every month, not just once a year. And it's called Decent, again.
Why this? Years ago, a big insurance company increased my startup’s health plan rates by 30% in January because an employee had started an expensive infusion medication the February before. I asked the insurance company why they hadn’t said anything sooner, and they said it was my data so it was my fault for not looking at it. I rocked myself to sleep that night thinking that even if I had known in February, there was probably nothing I could have done. And even if there was, it would have been bad for the employee. Right?
Wrong. The employee told me later that she drove 45 minutes to the hospital every week for her infusion; she would have preferred to get it from a nurse in the comfort of her home, eliminating hospital fees and reducing total cost by 30%. She paid a $500 copay every month; she would have preferred an equally effective drug that cost 25% less and could have been free to her. An international source for the same drug could have cut another 20% with no impact on her at all. 75% of the cost was waste, the byproduct of me taking my eye off the ball in a system that often rewards cost escalation over effective patient care.
Since we started building AI agents to parse plan data at scale, my cofounder Andrew and I have found dozens of examples like this. One-time costs like a corrective nose surgery get priced into next year’s rates as if they were recurring. Small business owners get charged for former members who haven’t been on their plans for months. Employees use the ER as a first stop and incur costs that could cover Direct Primary Care memberships for their whole team. Normally I believe you should never attribute to malice that which is adequately explained by incompetence. In this situation I think it’s a little bit of both.
Why now? Small business rates just saw the largest increase ever, but I believe we are living in a perfect storm to fix it. For the first time in history, most small business employees are on self-funded and level-funded plans, which produce auditable claims data constantly. And with the rise of AI, we suddenly have the capacity to use that data to optimize and personalize coverage and care, each year and then month and then week and then day and then second, for the company and for the member. In the future, we will think it was silly that we got most of our healthcare via health insurance but only changed our plans once a year. As silly as setting a yearly marketing budget in the world of ad platforms. As silly as buying servers annually in the age of AWS. Those things changed. We’ll change this one too. And we’ll do it as a brokerage, so our work can be free to you.
If this sounds interesting, check us out at https://www.decent.com. You can book 15 minutes to talk to me, or use our self-serve tools to quote the whole market (think Kayak for health plans) without talking to a human at all. We’ll look at every option to get your team better benefits for less money and then we’ll work to make your plan better all year. If you already have a broker you love, we’re happy to be a second pair of eyes. If not, now you have me.
Why call the new company Decent, again? Well, I chose the name the first time because in FDR’s Second Bill of Rights he said every American deserves “a decent living, a decent home, and the opportunity to achieve and enjoy good health”. I still believe that. Some people have complained that they think decent just means good enough. To me, that is kind of the point. U.S. healthcare should be good enough to keep you healthy and safe: physically, mentally, and financially. Good enough to trust it to take care of the people you love. Good enough to make you proud to be an American.
Rilke wrote that “The purpose of life is to be defeated by greater and greater things.” I don’t want to lose. I want to fight battles that are worth my team’s time. Today, U.S. healthcare is a broken system creating broken outcomes. I’m working on it again because I didn’t get it right the first time. The job is not finished. So we’re going bigger this time, to bite off more than we can chew and then chew like hell. My work won't love me back, but I still love my work. New entity, new team, new vision, same mission. Affordable healthcare for all. I still believe U.S. healthcare should be Decent.
I'm doing this for my sons, Boone and Ben, who are growing up in a world where sound and fury often outpaces significance. For my dad, my partner, my colleagues, and my friends. For my mom. The fact that she isn’t here anymore stops me in my tracks sometimes. I never became a primary care doctor. I still want to make her proud. But if she was right, about all of it, maybe she can see me now. I'm happy.
And when I think about what we can do, with the help of millions of good people working in and around healthcare, it’s easy to find meaning in the work. I feel like waking up early tomorrow to put on my pirate shirt and keep trying.
That's enough talk. It's time to get moving, before there's no time left at all.
It’s never too late to save the world.
