What structural change would most improve US healthcare?

Andrew Dudum · Apr 4, 2026

The subscription model is Hims & Hers' most powerful asset because the company only makes money if patients feel happier and healthier and keep paying

Patients pay Hims directly and stop paying if they don't feel better, so incentives align only with the patient, letting the company apply pressure to drug and diagnostic companies on the patient's behalf

43:34 20VC: Hims & Hers: $4.3BN Market Cap on $2.3BN of Revenue: The Comeback | Why Being Public is 10x Better | The Death of the "Strategy" Hire | Why Performance Marketing is Worse than Brand Marketing with Andrew Dudum

Andrew Dudum · Apr 4, 2026

Healthcare distribution will shift away from PBMs, insurance and reimbursement intermediaries toward direct consumer channels offering on-demand access, price transparency and choice

The US system's reimbursement and cost incentives are convoluted and paternalistic, while every other industry we love — food delivery, financial services, banking, retail — is already simple, on-demand and transparent

Scope: accelerating dramatically over the next five years

48:25 20VC: Hims & Hers: $4.3BN Market Cap on $2.3BN of Revenue: The Comeback | Why Being Public is 10x Better | The Death of the "Strategy" Hire | Why Performance Marketing is Worse than Brand Marketing with Andrew Dudum

Fred Turner · Jul 18, 2026

Owning hospitals is a poor vehicle for changing healthcare because the fragmented payer mix limits what a hospital can actually change

Roughly half a hospital's customer base is the government and the rest is many small insurance plans that all want different things and change their minds constantly, so you spend your time keeping them happy rather than transforming care

36:26 Hospital ownership is the wrong lever payer mix limits change

Fred Turner · Jul 18, 2026

The single highest-leverage fix for US healthcare would be to break negotiations into smaller units — more smaller payers and smaller health systems

Healthcare is an efficient market when counterparties are small; extreme consolidation on both sides creates loggerheads where nobody has an alternative and everyone overpays

38:23 Break negotiations into smaller payers and systems

TJ Parker · Jun 5, 2023

Consumers will ultimately shop for healthcare the way they shop for everything else, and healthcare will stay broken until that happens

Healthcare's dysfunction persists because consumer shopping behaviour hasn't yet arrived in the category

54:40 Consumer shopping behavior not yet arrived in healthcare explains its dysfunction