Ignition by RocketTools

Over the past year, roughly once a month, someone in Texas called me in the middle of a medical crisis. A parent in the emergency room. A spouse who needed to be admitted. In every single one of those cases — 100% of them — the hospital said the same thing: no inpatient beds available. 100% isn't bad luck. That's a pattern. So I went looking for the error, and found a business model inst...

There's a question every business owner is going to have to answer over the next couple of years: which of the tools you pay for every month could you just own? In this episode, Dan McCoy walks through a real example from RocketTools — a tool they actually paid for, actually left, and actually replaced. When Vimeo's price to add AI/API access got steep, Dan and his team ran it through th...

Everyone treats enterprise AI as a technology problem — which model, which vendor, GPT vs. Claude vs. Gemini. But an MIT report found that 95% of enterprise AI pilots deliver no measurable return. Most never make it out of the pilot. So why did the U.S. State Department succeed where almost everyone else stalls? They built an internal AI assistant called StateChat and scaled it to more than 62,000...

What to actually do with the severance, the time, and the expertise that just walked out the door with you. I'm going to make an argument that sounds insane for about ninety seconds, and then I hope stays with you for the rest of your career: getting pushed out of your job might be the single best thing that happens to it this decade. I'm not saying that from the cheap seats. A while bac...

In February 2024, hackers walked into the largest healthcare clearinghouse in America through a Citrix portal that didn't have multi-factor authentication. They used credentials stolen from a previous breach — someone, somewhere, had reused their password. Within hours they had ransomware running. Within days, pharmacies across the country couldn't fill prescriptions. The ransom payment...

Twelve years ago, a Target statistician built a model that could predict pregnancy from 25 shopping items. The story usually gets told as a privacy parable. I'm telling it differently — as a preview of how healthcare AI is going to work for the rest of our lives. Your smartwatch can already flag atrial fibrillation days before a cardiologist would. It can detect depression weeks before clinic...

Y Combinator has a name for it: burn tokens, not headcount. A health insurance company called Decent runs with nine people total. Twofold does revenue cycle management with three. Deep Cura Health handles patient scheduling, prior authorization, and insurance verification with two humans and seven AI agents. The AI-first model is real. It's working. And in healthcare, every one of these compa...

In March 2026, the Blue Cross Blue Shield Association published research blaming hospitals' AI billing tools for $2.3 billion in added healthcare costs. It was a grievance — not a strategy. And it stands in sharp contrast to 1981, when the same Association faced a national-platform problem and built something: BlueCard, the shared claims-routing layer that turned 36 independent regional plans...

You've been told American healthcare is expensive because of greedy insurers, pharma profits, or the cost of innovation. That story is incomplete to the point of being misleading. The largest single driver of US healthcare spending isn't drug companies — it's hospitals. And hospital prices haven't merely risen; they've grown roughly 3x faster than overall inflation since 2...

There's a billionaire fight happening in an Oakland federal courtroom right now. The headlines are calling it Elon Musk versus Sam Altman—tech titans, AI drama, billions at stake. But here's what almost nobody is telling you: if Elon wins this case, the next phone call won't be from Silicon Valley. It'll be from the general counsel's office at every nonprofit hospital in A...

A 6-month-old named KJ Muldoon just received the first personalized CRISPR gene therapy ever made — designed, manufactured, and administered for his exact mutation in six months. Nature  named him to the Top 10 People Who Shaped Science of 2025. The miracle is real. The financing model isn't. Gene therapies run $2M to $3.5M each. Insurance contracts are annual. Gene therapy benefits last a li...

If you're a medical student picking a specialty in 2026, you're being asked to bet a decade and $300,000 in debt on a market nobody is teaching you to read. This episode is the framework I wish someone had given me — plus the data nobody else is putting in front of med students. In this episode: • Why 76% of all FDA-cleared medical AI targets a single specialty — and why residency applic...

Last week the Texas Medical Association joined a federal antitrust lawsuit against MultiPlan — recently rebranded as Claritev. The story being told is doctors versus insurers, an unlawful cartel, $19B in alleged underpayments. It's a clean story. The moment you look at the actual fee math from the complaint, it falls apart. In this episode I walk through MDL 3121, the $1,000 → $200 cascade, t...

49% of plan sponsors reported claims exceeding $1 million last year — double the rate from the year before. And stop-loss carriers are responding not by covering you better, but by finding creative ways to limit their exposure to the most expensive treatments. In this episode, I break down: → Why stop-loss insurance was built for a different era (when catastrophic meant $300K, not $4.25 million) →...

Andrej Karpathy just released AutoResearch — a 630-line Python tool that lets AI agents run hundreds of experiments overnight on a 35-cent GPU rental. In one test, 35 autonomous agents completed 333 experiments while everyone slept and found 20 improvements that worked. No humans involved. Meanwhile, your benefits broker spends maybe 20 hours on your entire annual renewal — most of it pulling quot...

The AI labs are selling you $10,000 a month in computing power for $600. They're doing it at massive losses. And they have very specific reasons you should understand. In this episode, I break down the $670B subsidy era fueling healthcare AI — what it means for builders, when it ends, and four strategies to exploit it before the economics correct themselves. We cover: Why AI pricing follows t...

Amazon launched an AI health agent inside the Amazon Shopping app — the same app where you order paper towels. It books appointments, manages prescriptions, explains lab results, and connects you to real doctors. Prime members get five free virtual care visits covering 30+ conditions. This isn't a chatbot experiment. Amazon built this on Bedrock using a multi-agent architecture with auditor a...

Anthropic just announced Claude Mythos Preview — an AI model so capable at finding software vulnerabilities that they won't release it publicly.  Instead, they launched Project Glasswing with Apple, Google, Microsoft, and others, committing $100M to use the model defensively. In weeks, Mythos found thousands of zero-day vulnerabilities across every major operating system and browser — includi...

Meta acquired Moltbook. OpenAI put ads in ChatGPT. Microsoft found 31 companies actively poisoning what AI assistants recommend. Everyone's calling it AI-native marketing — but what they're really describing is an influence mechanism with no disclosure, no regulation , and direct access to how people make decisions. In this episode, I break down Microsoft's AI Recommendation Poisoni...

What's really happening with AI in healthcare? The common story is that health systems just need to find the right tool — the best ambient scribe, the smartest chatbot. But the reality is more complicated. In this episode, I break down why Sutter Health's AI agent deployment through Hyro tells us everything about where healthcare AI is actually heading, why 63% of healthcare leaders say...

The telehealth boom was supposed to revolutionize healthcare forever—but what went wrong? In this episode, Dan McCoy unpacks the dramatic fall of industry giants like Teladoc and Amwell, revealing how their high-profile bets on nationwide distribution networks failed to stand the test of time. More importantly, you'll hear why the real disruptor isn’t a return to in-person care, but the explo...

Most employers think they're getting a deal on healthcare. They're not. The exposed rate data tells a different story — one where the same knee replacement costs wildly different amounts depending on which hospital and which network you're in, even within the same city. In this episode, I break down the network arbitrage game: how hospital systems use their leverage to extract premi...

Mount Sinai just published the first independent safety evaluation of ChatGPT Health — and the findings should change how you think about AI in healthcare. Published in Nature Medicine, researchers ran 960 patient interactions across 21 medical specialties. What they found wasn't that ChatGPT gets medicine wrong. It's that it gets the diagnosis right, then tells you to do the wrong thing...

Mark Cuban's Cost Plus Drug Company sells a cancer drug for $47 a month. That same drug often costs well over $2,000 at your pharmacy. Both include a 15% markup. The markup is the same — the price is dozens of times higher, and nobody's asking why. In this episode, I break down why percentage-based pricing is the single most inflationary structural design choice in American healthcare. N...

Everyone's pitching AI as the solution to prior authorization . And they're right — the technology is about to solve it. Ambient scribes capturing every detail. Clinical decision support guiding every order. Automated systems submitting perfectly optimized requests. Approval rates heading toward the high 90s. But here's what nobody's talking about: what happens to healthcare co...