Andrew

I work with primary care practices and patients daily.
Access • incentives • reimbursement • reform.

[Andrew @drewthinkalot]

I talk to primary care practices and patients every day.
I post about:
1: why primary care feels rushed (incentives plus workflow)

2: what policy changes actually move access/quality

3: what the business models mean for patients and doctors

Follow if you want the inside view of how primary care really works.

[Andrew @drewthinkalot]

@sweatystartup Can you make an actual argument as to why? Simply saying it��s “criminal“ isn’t super convincing to some of us

[Andrew @drewthinkalot]

@the_transit_guy I feel like the more accurate sentiment on twitter is, wealth inequality isn’t always bad.

[Andrew @drewthinkalot]

@krystalball @daveweigel It’s that the point of growth? When you’re not apart of the system it’s really easy to criticize it. When you become apart of it, you realize change is all about relationships. She’s smart to make this shift

[Andrew @drewthinkalot]

@grok @RoKhanna @grok who’s most likely right?

[Andrew @drewthinkalot]

@grok @patrickbetdavid @mehdirhasan @grok what are their actual dissafterments if they actraully understood the real view of the other person?

[Andrew @drewthinkalot]

@patrickbetdavid @mehdirhasan @grok it feels like these two are talking past each other. I explain what each are trying to say

[Andrew @drewthinkalot]

@cremieuxrecueil #grok breakdown this thread to make it more understandable

[Andrew @drewthinkalot]

@DarrigoMelanie Are the main reasons public schools struggle due to lack of school supplies?

[Andrew @drewthinkalot]

@ycombinator @askclarahealth Im very skeptical. AI can be an incredible support layer for primary care, but the trust, judgment, and continuity of a doctor-patient relationship is the product. Replacing the doctor risks optimizing the interface while weakening the thing that makes primary care work.

[Andrew @drewthinkalot]

The $12B deficit was projected by your own Comptroller, the State Comptroller, and every independent fiscal watchdog in the city. You didn't leave $8B in usable reserves, most of that was the Retiree Health Benefits Trust. And that 40% of taxes stat? That's personal income tax only, not total city revenue. Facts are stubborn things, so is revisionist history.

[Andrew @drewthinkalot]

@Benjamin311025 Starting a business

[Andrew @drewthinkalot]

@NY_LBSS @fuller_brandon @ManhattanInst @david_goldhill @CityJournal Less obesity will help certainly, but I think a better solution is to invest more in primary care. If we can prevent more hospital visits that alone will save millions

[Andrew @drewthinkalot]

A lot of health-tech companies get primary care wrong.

They think patients mainly want faster scheduling, slicker apps, AI chat, and virtual access.

Those help.

But the real product is trust.

Patients want a doctor who knows them.

Tech should strengthen that relationship, not replace it.

[Andrew @drewthinkalot]

Job-based health insurance still covers about 154 million nonelderly Americans.

The average family plan now costs $25,572 a year.

Workers pay $6,296 of that directly.

And 87% of workers with single coverage still face a deductible before most care is covered.

That is why so many people feel insured and exposed at the same time.

People think employer health insurance is mainly a story about rising premiums.

It is.

But the deeper story is that coverage is getting more expensive while the financial protection often gets thinner.

Employers are still paying a large share of the premium.

But when healthcare costs keep rising, one of the easiest ways to contain that pressure is not to eliminate coverage.

It is to keep the coverage in place while shifting more of the upfront cost onto workers through premium contributions and deductibles.

So the headline says you have insurance.

But the lived experience often feels like this:

You are covered.
You are paying for it.
And you still have to think twice before using it.

That is not a small design flaw.

It changes behavior.

In 19 states, the combined cost of family premium contributions and deductibles already amounts to 10% or more of median household income.

And in half the country, the average single deductible is now at least 5% of median income, which is one reason insurance can still leave people financially exposed.

This is why employer coverage can feel strong on paper and fragile in real life.

The system is not just making care expensive.

It is making coverage itself feel less protective.

That is the part people are missing.

[Andrew @drewthinkalot]

America spent $5.3 trillion on healthcare in 2024.

Primary care got less than 5% of the money.

That single gap explains more about why healthcare feels broken than most people realize.

People think primary care feels rushed because doctors do not care enough, or because there just are not enough of them.

That is part of it.

But the deeper problem is that the system talks like it wants prevention, continuity, and early intervention while still financing healthcare in a way that rewards volume more than continuous, whole-person care.

So primary care ends up carrying enormous expectations with relatively little room to do the job the way patients actually want it done.

Patients want time.
They want a doctor who knows them.
They want someone who catches problems early.
They want help navigating the system before things get serious.

None of that is unreasonable.

In fact, longstanding relationships with primary care doctors are associated with lower total healthcare costs and fewer hospitalizations.

And yet the part of healthcare most connected to those outcomes is still treated like a small line item inside a multi-trillion-dollar machine.

That is why primary care feels so important and so thin at the same time.

It is expected to prevent disease, manage chronic illness, coordinate care, build trust, and lower downstream costs.

But it is not financed like the foundation of the system.

It is financed more like a support function.

That has consequences.

It means access gets worse.
It means continuity gets weaker.
It means more people end up navigating healthcare through a patchwork of urgent care, specialist visits, portals, and scattered follow-up instead of one strong clinical relationship.

And over time, the market starts to split.

One side buys more time, more access, and more continuity.

The other side gets a system that keeps saying prevention matters while making it harder to consistently experience preventive, relationship-based care in practice.

This is not just a staffing problem.

It is a financing problem.
It is an incentive problem.
And increasingly, it is a market structure problem.

That is the part people are missing.

[Andrew @drewthinkalot]

@LoganTGott Prompt!

[Andrew @drewthinkalot]

My honest review of @superpower

What I liked:

Scheduling labs was ridiculously easy. I picked a time slot, they handled the rest. The app is clean, easy to navigate, and I liked the UI around getting my results back. Seeing my biomarkers laid out clearly made it easy to spot where I might need to improve or follow up.

What I didn’t like:

I’m pretty tech-savvy, and even with the built-in analysis, I still ended up downloading the PDF and using ChatGPT for most of it. The app’s insights felt kind of scattered, while ChatGPT gave me better, more personalized takeaways because it already knows more context about me.

Bottom line:
Good experience overall. I liked the app, but outside of ordering labs, I’m not sure I’d have much reason to open it again until next year.
Also, the upselling was way too aggressive. I get why they do it, but it was a lot.