Out of Patients
with Matthew Zachary
Welcome to 2026: The Year of the Patient where the sick shall inherit the ballot.
52 Years Old and Still Here
Brain cancer at 21 forced Matthew Zachary into the American healthcare system decades before he understood its economics, incentives, and failures. At 52, he reflects on how surviving long enough to see the whole machine clearly led to writing We the Patients.
The Healthcare System Works Exactly as Designed. Cancer Patients Pay the Price.
Cancer patients increasingly absorb the financial risk of surviving disease in America. A brain cancer survivor examines how healthcare incentives, insurance design, and policy decisions shifted instability onto patients and families while institutions protect margins.
How I’d Spend $1 Billion to Fix Healthcare Alongside Mark Cuban
Mark Cuban attacks healthcare through pricing transparency and market discipline. I would attack it through patient infrastructure, legal protection, accountability, and civic power. Together, those strategies could finally begin realigning the incentives driving American healthcare.
When Patients Stop Trusting Dermatology
Millions of eczema patients increasingly distrust the treatments medicine tells them to rely on. Matthew Zachary examines topical steroid withdrawal, chronic inflammation, patient distrust, and the healthcare incentives driving one of medicine’s fastest growing credibility crises
Hospitals and Insurers Keep Blaming Each Other While Patients Finance the Entire System
Hospitals blame insurers. Insurers blame hospitals. Patients finance the entire system through premiums, deductibles, debt, and confusion. Matthew Zachary examines the incentive structures, financial flows, and institutional dependencies that keep American healthcare expensive, opaque, and exhausting.
The Chemical Safety Gap: How Incentives Still Outpace Protection
For 20 years, chemical reform promised protection. The system still allows widespread exposure while shifting risk to patients. This analysis explains how incentives, not science, determine what ends up in the products people use every day.
Cost Plus vs Walgreens: My 90 Day Prescription Cost Less Without Insurance
I paid $13.18 for a 90 day prescription through Cost Plus. Walgreens charged $30 with insurance. Same drug. Same supply. This is what PBMs do to pricing and why transparency exposes the middlemen.
Prior Authorization Works Exactly as Designed and That Is the Problem
Prior authorization persists because it works for the system that created it. This essay explains how cost control, risk management, and delay shape patient outcomes, why reform keeps falling short, and what must change to align financial incentives with timely care.
What Happens If More Patients Appeal Insurance Denials?
Only 0.2% of patients appeal insurance denials, yet 80% succeed. This article examines how even small increases in appeals could shift insurer behavior, raise costs, influence Wall Street expectations, and reshape the economics of American healthcare.
Why American Healthcare Delays Care and Denies Treatment
American healthcare delays care and denies treatment by design. Insurance rules, prior authorization, and administrative barriers control access to care, often slowing or blocking what doctors recommend and patients need.
American Harmcare: The System Working Exactly As Designed
A 30 year brain cancer survivor breaks down how insurance delays, denials, and red tape harm patients by design. This is not dysfunction. This is the business model.
When an Insurer Calls Your Treatment Investigational and the Alternative Is Brain Surgery
When an insurer labels trigeminal nerve blocks investigational, patients may face brain surgery instead. This essay examines how coverage policy, coding decisions, and actuarial incentives shape care for trigeminal neuralgia and what must change to align patient protection with economic logic.
Patients Should *NOT* Have To Write Policy Briefs
Sally Neely Nix manages chronic pain with nerve block injections. No opioids. Her insurer calls them experimental. So she built a policy brief and sent it to the CEO. While in extreme pain. Patients shouldn't have to become researchers to access care that works.
An Open Letter (Again) to Mark Cuban on Behalf of American Patients
Mark Cuban walked into the Senate with spreadsheets and receipts. He called PBMs a cartel. He saved Medicare $2 billion. But math doesn't show up at town halls. Receipts don't vote. Here's the hole in his equation and an invitation to fix it.
Mark Cuban Wants to Take Us Back To 1955
Mark Cuban exposes PBM corruption and champions transparent drug pricing. He is right about generics. He is wrong about cash solving catastrophic care. A brain cancer survivor explains why $12 prescriptions and $960,000 transplants live in different universes.
$1.7 Trillion Dollars. $54 Billion in Profits, 10 Million Fewer People.
In 2025, seven insurers generated $1.7 trillion in revenue and $54 billion in profit while covering 10 million fewer people. Premiums hit $26,993 for families. Public funding expanded. Consolidation deepened. The incentive structure driving American health insurance stands exposed.
Medicare Advantage Works Until the Math Changes
UnitedHealth dropping Medicare Advantage plans for 600000 beneficiaries exposes a structural flaw in how private insurers manage public healthcare risk as costs from emergency care and specialty drugs accelerate faster than payment models can adjust.
Healing The Sick Care System
A personal reflection on Gil Bashe’s Healing the Sick Care System and the growing revolt against insurance driven harm. From hospital memories to national accountability, this piece calls out who holds the wheel and why 2026 signals the rise of the patient voter bloc.
The Health Insurance Industry is the new Joe Isuzu #TrustMe
Blue Cross Blue Shield says insurers protect patients from high drug prices. The real world shows delays, denials, and blame shifting while patients wait, appeal, and deteriorate. A closer look at how insurers deflect responsibility in the drug pricing debate.
No Care For You!
A new KFF poll shows prior authorization now ranks as the biggest burden in American healthcare. Delays and denials affect nearly half of insured adults, with severe mental, financial, and physical consequences. Patients across every plan agree.