Modern medicine can do things Charles Dickens could barely imagine. American healthcare then wraps those miracles in bureaucracy he would recognize immediately. Tiny Tim, Oliver Twist, Scrooge, and Bleak House enter the patient portal.

For 20 years, I’ve built healthcare brands for markets nobody wants to need. From Stupid Cancer to We the Patients, I’ve learned that the hardest part isn’t creating demand. It’s giving people a way to recognize something that was already there.

After 30 years in patient advocacy, I seem to have wandered into healthcare policy. A conversation with Chuck Melendi about insurance, incentives, political power, and what happens when patients stop merely navigating the system and start organizing to change it.

I went to RosettaFest expecting to give a keynote. I left with the Marshall Allen Award and a completely different understanding of employer-sponsored healthcare, patient advocacy, and why the companies we work for may be one of the most overlooked forces shaping American healthcare.