A Turnkey Path for Small Businesses: Introducing the Hybrid ERISA Implementation Bundle
For months, readers have asked some version of the same question:
“This all makes sense — but how do I actually do it?”
Until now, my writing here has focused on explaining why the system behaves the way it does — the incentives, constraints, and tradeoffs facing small businesses trying to offer health benefits in the post-ACA world.
Implementation is harder.
Not because the ideas are complicated, but because the rules are layered, unforgiving, and poorly aligned with how small businesses actually operate.
Why “Turnkey” Matters — and Why It’s Rare
Most benefit resources fall into one of two categories:
High-level explanations with no implementation path
Fill-and-sign kits that quietly assume away legal reality
Neither is adequate.
Small employers need something different:
Structured, not vague
Flexible, not one-size-fits-all
Actionable, but not reckless
That’s what this release is meant to provide.
What’s New in the v1.2 Release
I’ve now published a turnkey, white-label ERISA implementation bundle designed specifically for small businesses.
It includes:
A modular ERISA wrap plan
Section 105 MER framework
Direct Primary Care integration
HSA compatibility guardrails
Health care sharing treated correctly as non-insurance
Employer adoption resolution
Modular Summary Plan Description (SPD)
Claims and appeals procedures
Employee-facing overview
A step-by-step “Getting Started” checklist
Guidance on how to customize safely
This is not legal advice, and it is not a substitute for professional review.
It is a coherent, defensible architecture that reflects how the system actually works today.
Who This Is For
This bundle is designed for:
Small business owners
Professional practices
Operators trying to control benefit costs without cutting care
Advisors supporting multiple employers (under a commercial license)
It is not designed for:
One-click adoption without review
Employers seeking to bypass ERISA obligations
People looking for loopholes
How Access Works
The materials are offered under license, not sold.
Two options are available:
Licensed Implementation Access For employers/businesses adopting the framework within their own business. Requires Foundation Subscription
Authorized Commercial License- $2,500 Annual Fee For professionals deploying the framework with clients- information available upon request. I will discount your Foundation Subscription toward the commercial license payment.
Access is provided via a private download, with clear versioning and update policies.
A Closing Thought
Health benefits have become one of the most distorted areas of small-business decision-making — not because employers don’t care, but because the system punishes clarity.
This framework won’t fix the system.
But it does give small businesses a way to operate honestly, deliberately, and defensibly within it.
More to come. I will provide a link to materials via email reply.
Swinging And Missing… But Wait? A Fowl Ball! Free Market Health Care Is Still In The Game!
In July, I published a post titled “I Woke Up Surprised.” It was written half in disbelief, half in relief.
The disbelief came from watching Congress finally do something meaningful for Health Savings Accounts — expanding eligibility and flexibility in a way many of us had argued for years was necessary. The relief came from realizing that, at least on paper, small businesses and families might finally have a tool that made economic sense again.
But paper reforms and real-world implementation are not the same thing.
Since that post, I’ve spent months trying to answer a much harder question:
How does a small business actually implement the implications of expanded HSAs — legally, sustainably, and without accidentally breaking half a dozen other rules?
What I learned surprised me.
The Promise of HSA Expansion — and the Wall You Immediately Hit
The HSA expansion in the so-called Big Beautiful Bill opened doors:
Broader eligibility
More flexibility
Greater usefulness for families and employers
But almost immediately, anyone who tries to implement those ideas runs into a familiar obstacle:
Obamacare’s existing legal architecture.
Affordable Care Act (ACA)-era rules — particularly around employer-sponsored coverage, affordability testing, premium tax credits, and what “counts” as insurance — still dominate the terrain. They weren’t designed for flexibility. They were designed for standardization.
That matters.
Because once you’re a small business owner trying to help employees:
Pay for care
Preserve Health Savings Account (HSA) eligibility
Control costs
Avoid penalties
And remain fair across different employee roles
…you discover that the system quietly funnels you toward a narrow set of viable options.
Why Small Businesses Drift Toward a Hybrid Model
After several iterations — some that worked on paper but failed legally, others that worked legally but failed economically — the conclusion became unavoidable:
For small businesses operating under current law, a hybrid model isn’t clever. It’s inevitable.
The model that consistently survives contact with reality looks like this:
Defined employer contributions, not open-ended promises
Reimbursement structures that require receipts and preserve employer control- accountability and actual consumption documentation.
HSA compatibility, where legitimately possible
Optional insurance or health sharing, treated correctly under the law
Clear class distinctions (owner/officer, manager, hourly staff), because pretending everyone is the same is neither honest nor compliant
This isn’t ideological. It’s structural.
When you trace the incentives, restrictions, and safe harbors, small employers are pushed — intelligently— into this kind of hybrid architecture.
“Small Business Benefit Paths Under ACA Rules”
The cafeteria model health benefits offering serves small businesses the best. You can budget your support and spend only what is used by employees who take you up on the offering. Emphasizing the long term relationship of primary care results in the best long term health care model for small business owners AND their employees.
What This Looks Like in Practice (High Level)
At a high level, the workable model has a few defining characteristics:
Employers cap their exposure. Benefits are defined, not unlimited.
Employees choose how to layer coverage (insurance, health sharing, HSA-qualified plans) within guardrails.
Care delivery (DPC) is separated from catastrophic risk financing.
Reimbursements are substantiated and documented — not stipends.
Nothing relies on wishful interpretations of ACA or Internal Revenue Services (IRS) rules.
Importantly, this is not a loophole strategy. It’s a compliance-aware design that accepts the rules as they are, not as we wish they were. I am convinced that over time, government legislation will open up more clear paths for individual ownership of health care dollars. This present framework allows small businesses to ACT AND BENEFIT immediately.
Why I Decided to Publish the Framework
Until now, my writing here has been explanatory and analytical — policy, economics, incentives, tradeoffs.
This is the first time I’ve decided to publish something actionable.
Not because I want to become a consultant or benefits broker (I don’t), but because enough readers — business owners, physicians, operators — kept asking the same question:
“Okay, but how would I actually do this?”
The honest answer is that doing this responsibly requires:
A coherent ERISA (Employee Retirement Income Security Act) framework
Clear licensing boundaries
Documentation discipline
And an understanding of where the law ends, not just where we’d like it to go
So I’ve made that work available as a white-label, licensed framework for those who want to implement — not just read. The following is clarification of my offering.
Dr. Kordonowy's Newsletter is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
For Readers Who Want to Implement A Turnkey Path for Small Businesses: Introducing the Hybrid ERISA Implementation Bundle
I have put together a set of templated files to help small business owners with a tool kit to accomplish a formal health benefits plan and procedures to do this without additional staff or consultants.
“This all makes sense — but how do I actually do it?”
Until now, my writing here has focused on explaining why the system behaves the way it does — the incentives, constraints, and tradeoffs facing small businesses trying to offer health benefits in the post-ACA world.
Implementation is harder.
Not because the ideas are complicated, but because the rules are layered, unforgiving, and poorly aligned with how small businesses actually operate.
Why “Turnkey” Matters — and Why It’s Rare
Most benefit resources fall into one of two categories:
High-level explanations with no implementation path
Fill-and-sign kits that quietly assume away legal reality
Neither is adequate.
Small employers need something different:
Structured, not vague
Flexible, not one-size-fits-all
Actionable, but not reckless
That’s what this materials file was put together.
I’ve now published a turnkey, white-label ERISA implementation bundle designed specifically for small businesses.
It includes:
A modular ERISA wrap plan
Section 105 MER framework
Direct Primary Care integration
HSA compatibility guardrails
Health care sharing treated correctly as non-insurance
Employer adoption resolution
Modular Summary Plan Description (SPD)
Claims and appeals procedures
Employee-facing overview
A step-by-step “Getting Started” checklist
Guidance on how to customize safely
This is not legal advice, and it is not a substitute for professional review.
It is a coherent, defensible architecture that reflects how the system actually works today.
Who This Is For
This bundle is designed for:
Small business owners
Professional practices
Operators trying to control benefit costs without cutting care
Advisors supporting multiple employers (under a commercial license)
It is not designed for:
One-click adoption without review
Employers seeking to bypass ERISA obligations
People looking for loopholes
How Access Works
The materials are offered under license, not sold.
Two options are available:
Licensed Implementation Access For employers/businesses adopting the framework within their own business. Requires Foundation Subscription
Authorized Commercial License For professionals deploying the framework with clients- information available upon request. I will discount your Foundation Subscription toward the commercial license payment.
Access is provided via a private download, with clear versioning and update policies.
A Physician’s Look at Hepatitis B Policies in Infants
By Raymond Kordonowy, MD
The Great Debate of Modern Times- Vaccine Policies and Government Authority
Every few months, someone online declares with great conviction that “If we stop vaccinating infants for Hepatitis B, millions of people will die.”
That kind of rhetoric may sound authoritative, but it collapses several different realities into one dramatic—and misleading—statement.
Doctors, as scientists and patient advocates, need to take an unpassionate, Spock-like view of health issues. As a physician who believes in evidence, risk‑stratification, and informed consent, I want to show readers what the data actually demonstrate about:
• Hepatitis B mortality in infants and children
• What universal newborn vaccination does—and does not—prevent
• The availability of highly effective adult Hepatitis B treatments
• What we know (and do not know) about serious adverse events in infancy
• A rational, targeted alternative strategy that respects both science and autonomy
This is not anti‑vaccine content. This is pro‑transparency. This should not be a political nor corporate lobby issue. This definitely falls in the wheelhouse of the medical profession.
The Claim: “If we stop Hepatitis B vaccination, millions will die.”
This claim is made frequently on social media—including by physicians who should know better.
Let’s be clear:
This is not true for U.S. infants. This is not true for U.S. children. This is not even true globally in the short or medium term.
It is only true if one:
1. Aggregates all global adult cirrhosis and liver cancer deaths for decades,
2. Assumes every country stops vaccinating,
3. And then sums those adult deaths into a single dramatic figure.
That is a global adult epidemiology argument—not a pediatric risk argument.
• Estimated infant Hepatitis B Virus deaths per year: ~7–11 (these appear to be absolute cases (the entire US population).
• Childhood HBV deaths (ages 1–18): 0–2 (these appear to be absolute cases (the entire US population).
• Many years recorded zero deaths
Post‑vaccine era (today):
• Infant HBV deaths: 0–1 per year
• Childhood HBV deaths: 0 per year
• Essentially no measurable pediatric mortality signal
Stated plainly:
Hepatitis B was not a significant cause of death in American children before vaccination, and it is not a cause of death now.
Universal vaccination took “very rare” and made it “almost zero.”
The Natural History Of Hepatitis B In Humans- Who Remains Infection Positive Beyond 6 months After Initial DX (chronic).
We Can Intervene With Efficacy In Infant Hepatitis B Exposure/Infection
Hepatitis B Immune Globulin (infused antibodies against the Hep B virus) works in creating seronegative status in infants. It works even better when combined with Hep B vaccination series in conjunction with the passive immunity infusion.
Why Do Public Health Authorities (and Politicians) Still Push Universal Infant Vaccination?
Because for public health authorities the goal is not protecting infants from death.
The goal is reducing adult deaths decades later. It is expedient to capture babies and parents in the hospital and perinatal care system. Further, it is also expedient to force vaccination requirement onto access to the public school system.
Infants infected with hepatitis at birth have a 70–90% risk of chronic infection. By definition they contracted it from their mothers.
Chronic infection carries a ~25% lifetime risk of death from cirrhosis or liver cancer.
Those deaths occur in middle or later age—not childhood.
So the public health argument is:
“By vaccinating newborns today, we lower adult liver cancer 40–60 years from now.”
Parents are rarely told this plainly.
What Are We Really Talking About?
An Important Point In The Vaccine Debate. Having Effective Treatments Temporizes The Importance and Relevance of Vaccination As Policy. Modern Adult Hepatitis B Treatments Are Highly Effective
Dr. Kordonowy MD Is Begging Pharma To Provide Treatments For Viral Infections
Today we have Tenofovir and Entecavir: These Drugs
• Suppress viral replication to undetectable levels
• Prevent disease progression
• Dramatically reduce risk of cirrhosis and hepatocellular carcinoma
• Achieve viral suppression rates above 90%
• Are extremely safe and well‑tolerated
The idea that chronic infant infection leads inevitably to death is no longer consistent with modern antiviral therapy.
What About Serious Adverse Events in Infancy?
The Hepatitis B vaccine is generally considered safe, but several concerns deserve honest exploration:
1. Temporal association with SIDS (Sudden Infant Death Syndrome).
– Some studies show no link, others show clustering after well‑child visits.
– By definition, SIDS has no identified cause, making subtle causal signals difficult to detect. I find it strange that we never attribute sudden death in infants to “rhythm or heart attack”.
2. Combination vaccine adverse events
– Infants receive multiple vaccines simultaneously. Their body mass is a fraction of that of an adult. That is a relevant point. Further their immune system and all other organs are in no way fully developed as an adult.
– Trials rarely evaluate real‑world combinations given in a single session. Yet the list of recommended and coerced vaccines is ever increasing.
3. Underreporting in passive surveillance systems
– CDC and FDA acknowledge these systems miss most events unless extremely common.
4. Autoimmune and neurologic events. It is important to note that there is evidence (suppressed) that stacked vaccination and potentially carrier molecules/adjuvants (especially aluminum) combined with single nucleotide polymorphisms in individuals genetics is a plausible explanation for the unprecedented incidence of US modern day autism rates.
– Rare but documented. Causality often debated.
The correct stance is humility: absence of evidence does not equal evidence of absence.
FACT: Vaccinating Children For The Claim of Saving Childhood Lives Is Not Nearly Cost Effective.
If we evaluate only pediatric mortality (0–18 years), the program costs tens of millions per life saved.
Using the U.S. cost of vaccinating one annual birth cohort (~$444 million):
If the pre-vaccine U.S. saw 10 infant deaths per year, → $44 million per pediatric life saved
If the true number was closer to 5 deaths, → $88 million per pediatric life saved
These numbers come directly from the extremely low baseline mortality.
This has nothing to do with whether the vaccine “works.” It has everything to do with what risk the newborn population actually faces.
Let’s Consider A Rational, Targeted Alternative Strategy
Today, with prenatal screening and modern technology, we can implement a targeted strategy:
1. Screen all pregnant women for active Hepatitis B.
2. Confirm maternal status at delivery with rapid testing.
3. If mother is positive:
• Give HBIG + Hepatitis B vaccine to infant affected.
• Treat the mother when indicated
4. If mother is negative:
• Defer vaccination until childhood or adolescence, or offer optional vaccination
This respects proportionality, risk‑based medicine, and parental autonomy and the best interest of the infant. Society owes a balanced protection of those unable to defend themselves.
Does Infant Vaccination Hold?
Yes is the answer.
Honest Takeaways
• Hepatitis B vaccination in infancy does not prevent pediatric deaths.
• Pediatric HBV mortality in the U.S. has always been near zero.
• Modern antivirals dramatically reduce adult HBV mortality.
• Serious adverse events in infancy are understudied due to passive surveillance.
• A targeted maternal screening + HBIG strategy is scientifically rational in low‑prevalence nations.
And the claim that “millions will die if we don’t vaccinate infants for Hepatitis B” is not supported by U.S. data, pediatric data, or therapeutic reality.
An update on premium subsidies, catastrophic plans, and what you need to know before open enrollment begins on November 1st.
The last vote on a stopgap bill to fund the government through Nov. 21 failed after a 54-46 vote on Oct. 23. While three senators who caucus with Democrats, including Maine Independent Sen. Angus King, have joined Republicans to support the bill, they need another five to reach the 60-vote threshold needed to pass. The pundits and politicians are promising various rate hikes yet we truly won’t know the actual quotes until enrollment actually begins.
Open enrollment details and dates
For most Americans, the critical dates for securing 2026 health insurance coverage are:
November 1, 2025: The official start of the 2026 open enrollment period.
December 15, 2025: The deadline to enroll or change plans for coverage to begin on January 1, 2026.
January 15, 2026: The final day to enroll in a 2026 health plan.
Even if you are currently enrolled, it is crucial to re-evaluate your options during this period. Your current plan’s costs and benefits may change drastically next year, and you need to shop around to find the best fit for your situation.
The end of enhanced premium subsidies is coming
The most significant financial factor for 2026 is the expiration of the enhanced premium tax credits, which were established during the COVID-19 pandemic and extended through 2025. A local health insurance broker has shared that he feels most individuals and small businesses will be looking to go with minimal/catastrophic coverage as the proposed quotes of $22,400 per year for an individual. Family plans could be north of $50,000 with deductibles of 7 thousand (word in the street).
The subsidy cliff returns: Previously, federal subsidies were unavailable to households with incomes above 400% of the federal poverty level (FPL). The enhanced subsidies removed this “subsidy cliff,” but it is scheduled to return in 2026. This means many middle-income families could see a major jump in their out-of-pocket premium costs.
Projected cost examples:While actual quotes will not be available until November 1, analysts forecast significant rate increases, especially for those receiving subsidies.
Average ACA enrollees receiving subsidies could see their out-of-pocket premium more than double, with an average annual increase from roughly $888 to over $1,900.
A 60-year-old earning just above the 400% FPL thresholdmight face an annual premium hike of nearly $9,600.
Catastrophic health insurance policies are more accessible
There is one piece of good news for those anticipating high costs: the federal government is expanding access to catastrophic health plans for 2026.
Eligibility expansion: Historically, these plans were limited to people under 30 or those who qualified for a hardship exemption. As of November 1, 2025, a new hardship exemption will be available for consumers who expect to be ineligible for premium tax credits based on their income.
Coverage and cost: Catastrophic plans cover the same essential health benefits as other marketplace plans and provide free preventive services.
High deductible: It’s important to understand the trade-off with these plans: they have lower premiums but come with a very high deductible. For 2026, the deductible is set at $10,600 for individuals and $21,200 for families. Subsidies cannot be used to pay for a catastrophic plan.
What should you do now? It makes NO SENSE to pay a mother or father’s entire year’s salary on a family health insurance policy. BEFORE ENGAGING IN HEALTH CARE CONSUMPTION.
To prepare for open enrollment, consider these steps:
Assess your needs: Review your family’s health usage over the last year. How many doctor’s visits did you have? What were your prescription costs? Use this information to estimate your healthcare needs for the coming year.
Estimate your costs: Use online calculators (search for “ACA subsidy calculator 2026”) to get a preliminary idea of what your costs might look like without the enhanced subsidies.
Review plan options: Be prepared to compare plans carefully once open enrollment begins. Don’t assume your current plan is still the best or most affordable option.
Consider all options: For those facing the subsidy cliff, look at all plan tiers, including catastrophic, to find the right balance of premium cost and out-of-pocket risk.
In 2017 I warned the public that the puck was taking the game into a new direction.
And here we find ourselves. The Direct Primary Care (primary care membership health care service) is looking like the inevitable fiscally prudent family health care access point. There are a total of nine confirmed DPC practices in Lee and Collier County. These are physicians in Internal Medicine, Family Medicine and Pediatrics. I believe there are at least 16 doctors within these options. Given the dynamics, more are sure to develop.
Business Owners TAKE HEED: And Now Enter The Brave New World. This Is What The Democratic Party Is So Fearful Of. And Why The Republicans Refuse To Negotiate Until The ShutDown Ends
How small businesses can pay for catastrophic coverage
A small business generally cannot directly pay for catastrophic insurance premiums for employees, as these plans are typically purchased by individuals through the ACA Marketplace. However, small businesses can provide tax-advantaged funds for employees to purchase their own coverage using a Health Reimbursement Arrangement (HRA).
Individual Coverage HRA (ICHRA): This arrangement allows businesses of any size to provide tax-free reimbursements to employees for individual health insurance premiums and other medical expenses.
How it works: An employer sets a monthly budget, and employees purchase an ACA-compliant plan (including a catastrophic plan, if eligible) on their own. The business then reimburses the employee for the premium.
Catastrophic plan compatibility: For 2026, eligibility for catastrophic plans has been expanded. Employees who are not eligible for premium tax credits can apply for a hardship exemption to purchase one.
Important note: Employees who accept the ICHRA offer cannot also receive ACA premium tax credits, unless the ICHRA is deemed unaffordable.
Qualified Small Employer HRA (QSEHRA): Designed for businesses with fewer than 50 employees that do not offer a group health plan, a QSEHRA functions similarly to an ICHRA but has specific annual maximum contribution limits set by the IRS.
AND FURTHER:
How small businesses can pay for DPC membership
Paying for employee DPC memberships is simpler, especially with new regulations that take effect in 2026.
Compatibility with HSAs starting in 2026: New legislation clarifies that DPC memberships are no longer considered a disqualifying health plan. This means employees can contribute to and use a Health Savings Account (HSA) while also having a DPC membership, as long as the DPC fee does not exceed a monthly cap ($150 for individuals, $300 for families in 2025).
Paying with an HRA: Under an ICHRA or QSEHRA, the employer can also reimburse employees for DPC membership fees, which are now considered a qualified medical expense under tax law, as long as they are billed correctly.
Direct employer payment: An employer can also pay for DPC memberships directly. This is a simple arrangement where the business contracts with a DPC practice.
Key advantages of this approach for small businesses
Cost control: DPC memberships typically have predictable, flat monthly fees, which helps small businesses manage their budget. By pairing it with a high-deductible catastrophic plan, the business insulates itself from the high, unpredictable premium costs associated with traditional group plans.
Employee choice: Using an ICHRA empowers employees to select the catastrophic plan that best fits their needs, while the DPC benefit provides access to high-quality, continuous primary care.
Enhanced access: The DPC model’s smaller patient panels allow for same-day or next-day appointments, longer visits, and direct communication with a doctor. This improves employee health, reduces absenteeism, and can prevent more serious health issues from developing.
Tax benefits: Both the HRA reimbursements and the cost of the DPC memberships can be tax-advantaged for the business and tax-free for the employee.
The present overly subsidized health insurance government policies are simply not sustainable nor affordable. Policies have shielded market participants from directly engaging in health care price discovery. All of this has been to the benefit of Hospitals and their 15-year consolidation business wrap-up model. Insurance companies and Medicare have provided preferential and much higher payments for services that can and could be offered in independent physician owned offices and facilities.
The Pendulum Is Finally Swinging Back For Affordability. Things Have To Break For This to Happen
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This week, it has become apparent to me that ChatGPT is moving towards censorship. Multiple project requests have timed out with various reported excuses for the failure to complete tasks. During this work, the illustrative “artistic” rendering I requested was not produced. Reportedly my requested imagery “violated” policies. Chat replied - Note “I wasn’t able to generate that image because the request violates our content policies”.
This has never been an issue in my past Substack presentations until this week. This folks…. is not a good sign.
My intended request was as follows: “Referencing the movie, Face Off, featuring Travolta and Cage, create an image of the “ripping the face” off. The mask to remove is “free health care” for the real face, Free Market Access to healthcare” Usually, ChatGPT provides us with a wonderful rendition of such a request. Now you get the crappy generic rendition above.
So… let’s move on.
Wrestlemania. The Democrat Vision of Health Insurance for All vs The Alternative- Health Care Market Deregulation.
Who Will Win???
This is from a post I penned in 2015!!!Please note. This particular blog is loaded with links to references and past posts that support and highlight my comments. I encourage readers to click these links and dive deeper. I have been commenting on this development for past a decade and my supportive material is in my past posts.
Anyone applying logic and open eyes to what was happening to Medicare access and Medicare insurance products could predict that this present “face off” was inevitable. In my opinion, the medical profession failed patients and society by allowing this charade to continue all this time. Throughout this political process, doctors have been automatically enrolled into Medicare.
Meanwhile, we have been continuously regulated, price fixed and burdened with higher operating costs on an annual basis. We have not been compensated nor allowed professional license to fully practice our craft during this entire process. Further, residency slots have been capped, foreign graduates invited and policies to replace U.S. doctors with less trained providers has been the “standard of care”. This folks, is still the case. Upon completing residency and getting licensed, U.S. physicians automatically become a Medicare provider, regardless of specialty, pediatrics included. This is a coercive government policy.
Doctors have always had the opportunity to opt out of Medicare with each annual payment update. Getting out has significant direct costs to physicians. Getting out/electing to not participate is even more coercive than the auto enrollment policy. In order to opt out, doctors have to formally apply for this option. Upon notification, the doctor cannot return to the program of 2 years.
Opting out of being a Medicare provider means doctors have to formally inform existing and new patients we are leaving this social program. The doctors must have patients sign this “informed consent” when they make this choice. This is basically Medicare’s formal notice process to attempt to severe the patient from the “uncoerced” physician’s care. IF the patient wishes to maintain a patient/physician relationship, Uncle Sam is not going to provide any financial renumeration for this personal choice. Neither before nor after the care is provided.
The aforementioned facts have successfully kept the overwhelming majority of physicians from standing up for themselves and their patients. We have been too peevish to take on the tough love of saying no to this abuse. As a result, physicians and patients have had our relationships severed and in exchange, hospital systems, Medicare and Insurance companies have “owned” both doctors and patients. This has and is a collaborative effort. Don’t be mistaken nor fooled by either lobby. Neither Big Pharma nor the doctors are the real reason for your financial pain. The national hospital lobby and the Health Insurance Cartel are the root of this market capture. Our politicians are also working hand in glove to allow this.
We Have Hit The Point of Leaping
It is Abundantly Clear To The Average American That Health Insurance IS NOT Health Care. On This, OBAMCARE Has Been A Colossal Failure.
Exhibit A
Big Changes Are Coming for 2026 Medicare Plans. What You Need to Know.
Skinnier benefits, higher premiums and fewer options mean more than a million seniors should shop for new coverage during open enrollment
Seems like Republicans aren’t hearing it enough: Americans are ANGRY that Republicans would rather shut down the government than work to lower health care costs. Republicans need to do something about it.
The Gravy Train Is Drying UP and That Is A Good Thing
To Whit:
Necessity is the mother of invention.
Opportunities- Let Me Count The Ways…
Direct Primary Care: Direct Primary Care (DPC) has experienced significant growth over the past decade, with the number of practices more than doubling, driven by physician dissatisfaction with traditional models and patient demand for personalized, cost-transparent care. A rough estimate shows a trend line from about 100-125 practices in the early 2010s to over 2,100 practices by 2023. As of 2025, estimates place the number of Direct Primary Care (DPC) practices in the United States at around 2,600 to 3,600, a number that continues to grow. Key trends include the integration of technology and telehealth, a rise in employer-sponsored DPC plans, and increasing interest from investors. This trend, IF the CITIZENS HOLD THE LINE, will grow logarithmically in the coming years. Disclosure, most doctors are afraid of this fact.
Key features of Direct Primary Care
Membership-based model: Patients pay a monthly fee directly to the provider, bypassing traditional insurance billing for primary care services.
Direct access: Patients can contact their physician directly via phone, email, or text.
Personalized care: DPC practices often have a lower patient-to-physician ratio to allow for longer and more personalized visits.
After-hours and urgent care: Some DPC practices provide access to after-hours or urgent care services.
Discounted services: Reduced costs for labs and some medications may be available. I would add reduced costs are made available by physicians’ offering generic wholesale medication dispensing. Wellness can be pursued in this model as opposed to the sick care of codified insurance based health care delivery.
Direct-to-consumer (DTC) pharmacy fulfillment is the process of a pharmaceutical manufacturer or online telehealth service selling and delivering medications directly to patients, bypassing traditional channels like retail pharmacies. This model relies on specialized logistics, technology, and often requires partnering with fulfillment pharmacies to handle prescriptions, payments, and delivery, while navigating regulatory compliance.Our Medical Practice and frankly nearly all States in the Republic, allow physicians to procure and dispense medications directly out of our offices. In the past year spurred by price wars, Lily Direct, and now TrumpRx will create the platform of direct pharma, name brand consumer pricing. Mark Cuban’s pharmacy is another example. I have written about the potential of the International Market given the present administrations policy changes.
The Fee Market Medical Association. This association is now moving into its eleventh year because it is the future. The traditional insurance broker is going to get thrown on the ash heap. One key pillar of being a participant in the Free Market Medical Association is that “Price Is Not The Product”. This is the health suppliers forcing the removal of network pricing arbitrage from the market. The entire Medicare Advantage Model is the antithesis of the Free Market.Price is being arranged behind the scenes and frankly, it is the tool trapping the patients in Stockholm. The latest articles on health insurance point out that brokers are getting massive commission cuts to steer patient purchases to the will of the Insurance companies. This will only accelerate as their greed forces a more robotic market delivery. If the broker’s don’t push back expect the insurance companies to design automated insurance purchasing. See item 5 below.
Patient health monitoring. Technology is burgeoning in this space. Individuals are now able to affordably track and document their vital signs and biometrics. My readers and patients are using various fitness monitoring devices. We can record our heart rhythm. We have continuous glucose monitoring. We have devices that can be mailed or delivered to the home to take your EKG, record your lung and cardiac exam onto an unloadable audio file. This information can be sent to your clinician. The virtual hospital, managed again( good bye hospitalists) by your primary care physician- directly from your home, can now become reality. The doctors have to be released from the stale, codified present health insurance and Medicare codified payment model in order to offer this to you.
Why do you need an insurance broker? An AI agent should be able to help you determine your insurance needs and provide you with a narrow and specific insurance policy. This opportunity is not presently available specifically because our politicians are supporting the now antiquated Health Insurance Model. Due to regulation, AI can’t presently.
Hold or use a state insurance license.
Collect premiums or enroll members in an insurance or sharing plan.
Provide specific underwriting advice or guarantee plan performance.
But do you see the potential here? That isn’t happening if the Frantic Elizabeth Warren group convinces us to stay in the cartel.
