The health care tax; clones flood Apple Books; Climate.us reborn: Newsletter 1 July 2026
Newsletter 158. Why health care reform is essential to save creative work. Plus, are AI books really overwhelming online bookstores, how DOGE couldn’t kill climate.gov, three people to follow, and three books to read.
How health care friction is destroying creativity
As a nation, America nurtures innovation, startup vigor, and creativity more effectively than any other region in the world.
There’s only one problem. Entrepreneurs are humans. Humans have bodies. Bodies require maintenance. And her in America, maintaining the health of our bodies is inordinately expensive and confusing.
Ask any American freelancer, entrepreneur, artist, or “solopreneur” attempting to make a unique and valuable contribution to the world. We cannot do this until we deal with protecting ourselves and our families from health care costs. If you don’t work for a company, these are your options:
- Don’t get health insurance; hope nothing big goes wrong. That’s scary as hell, and even if you’re willing to do that for yourself, it’s a risk you’re unlikely to want to take if you have a spouse or children.
- Be married to someone working for a company (or be under 26 and on your parent’s health insurance). Lots of people use this option, but do we really want to restrict the ability to freelance to people who are married to workers with health insurance or are under the age of 26? What happens if both of you are entrepreneurs or both want to freelance?
- Sign up for the most basic health insurance you can find. Pay exorbitant premiums out of pocket, then navigate the health care system as needed. Any entrepreneur or freelancer will tell you that the main profitability question for their business starts with “Can I pay for health insurance?” Your cheap insurance will probably deny coverage for many of your basic needs for medications and procedures. (My advice: don’t trip on the front walk and go to the emergency department; don’t get appendicitis; and for lord’s sake, don’t get diagnosed with cancer.)
- Sign up for decent health insurance. Now the premiums are through the roof, in the multiple thousands per month, and you’re still going to be stuck navigating a complex system if anything goes wrong.
I am part of a class of well-educated, creative, technically knowledgeable, and business literate individuals: the very class that includes most entrepreneurs and top consultants. Not only that, I’ve been navigating the health care maze now for 50 years. I have a wonderful nest egg set aside from my long and lucrative working life. And I continue to find mystifying and counterintuitive ways that the health “industry” invents to charge me or deny me services. You could assume that I’m just not smart enough to navigate this industry (admittedly I was trained at the Ph.D level in logic, which puts me at a disadvantage in using and paying for health care.)
Among the things I’ve had to deal with are these: Moving to a new state in the middle of a prostate cancer diagnosis, which required signing up quickly with a new primary care physician where hardly any are taking new patients. (I solved that one by asking a friend who teaches family medicine in a Boston medical school to twist the arm of one of his former students here in Maine — in other words, I got lucky.) And taking not one but two sleep studies, in one of which I intentionally slept as poorly as possible, just to jump through the hoops necessary to get authorized to have my expensive doctor-prescribed GLP-1 drugs covered.
I’m 67 now. I still have decades of productivity left (ask my clients). I have Medicare, which is far cheaper, but still comes with a confusing and confounding set of options. My wife won’t be 65 for a little while and she’s an artist, so my business still needs to cover her highly expensive and confusing insurance.
I’m not here to whine about my situation. Every American is in this situation, many are far worse off. The problem is generally not the doctors, who in my experience are empathetic, creative, competent, and dedicated. (They hate the insurance industry even more than I do; they need to fight it every day.) The problem is that every American pays a hefty tax generated by the fight among greedy health insurance companies; greedy pharma companies and PBMs; and greedy private-equity fueled health-care organizations. No one voted for this tax, and it goes up every year without any meaningful checks and balances.
Anyone with a credible plan to reform this system gets my vote. Free enterprise is not the solution — the “marketplace” of health care has been financialized for profit and as a patient you can rarely find out what things will actually cost nor can you make choices to keep your costs low. Things took decades to get this bad and it will many years to bend things back into a shape that serves patients/taxpayers more than greedy companies.
For America to continue to be competitive — for it not to lose its edge — we need a health care system that works, not one that soaks up every free dollar available, saps entrepreneurs and freelancers’ energies with pointless and enervating bureaucracy, and forces us to choose between our own physical and mental health and our ability to be creative.
As a politician, you cannot say that you believe America’s entrepreneurial spirit is the engine of our economy and at the same time allow our health care system to fester in waste and neglect. Fix this, or accept that you’re destroying the spirit that powers all of what matters in our economy.
News for writers and others who think
Jane Friedman interviews Brian O’Leary, outgoing executive director of the Book Industry Study Group, on the persistent problems of the publishing industry.
Mark Williams of TNPS deconstructs what’s really happening with the “flood” of AI-generated slop books appearing in online bookstores. It’s a sign of big changes, but not the apocalypse.
Joanna Stern wrote the bestseller I Am Not A Robot. Then lots of AI clones and ripoffs of her book started to appear in Apple’s iBook store. Her narrative of how this happened and what she did about it is both fascinating and funny.
From Soren Kaplan in Inc: Students who used AI to help them think became smarter. Those who used AI so they didn’t have to think became dumber. Shocking, I know.
Climate.gov used to attract a million visitors a month; it was dashboard for climate data. DOGE it down. So a bunch of climate scientists rebuilt and published it as climate.us. Impressive. Heroic, even.
Sarah Wynn-Williams , the writer who wrote the tell-all Careless People about Meta has sued Meta for trying to shut her up.
Three people to follow
Phil Fersht founder and CEO of HFS research, a provocative alternative analyst firm
Vitaly Friedman , wizard of interface design
Savannah Peterson , putting the human in tech
Three books to read
Actually, Nevermind by Taylor Tomlinson (Gallery Books, 2026). Essays from a wicked smart, boundary-busting comedienne.
The Lost Founder: James Wilson and the Forgotten Fight for a People’s Constitution by Jesse Wegman (Celadon, 2026). The mysterious man who helped craft both the Declaration of Independence and the Constitution — and said the people were the wellspring of all political power.
The Infinity Machine: Demis Hassabis, DeepMind, and the Quest for Superintelligence by Sebastian Mallaby (Penguin, 2026). Could this supersmart guy be inventing the replacement for human cognition?
My husband has been struggling for several years now to find a doctor willing to be a doctor. The one before his current PCP morphed into believing that the patient shouldn’t be touched. None of these doctors is able to find and hire staff willing to work. He cannot get prompt responses from his current PCP for his needs, like filling prescriptions (she has a part-time office person to answer the phone and voicemails) and he’s been waiting since January for her to send a prescription to the pharmacy to fill. She may be a very good doctor, when it comes to medicines, health, etc., but she has not figured out that it takes more than that to run a business/practice.
His allergist’s staff treats the patients with contempt and scolds them as if they were toddlers, and they refuse to keep regular office hours, closing at whim any day of the week without notice; he’s fed up with them, but he can’t find a time when they are open to retrieve his serums and records (to go somewhere else), because they ignore their own posted hours. Despite all the online information out there, there’s no way to vet the next allergy office for competency.
My annual physical has evaporated into a mere computer conference, with a nominal peek at a few organs – eyes, ears, heartbeat. No thorough examination of the whole body. No clothing removed and donning of a paper robe. No urine samples, which used to contain important indicators of innumerable conditions. (My biology has not evolved in the past few years to make useless the factors of my urine.) At age 72, I am blessed with good health and good genes, good mobility, good brains. Not everyone is as lucky, for many reasons.
The health care industry is forcing us to manage our own health, including doing the doctors’ jobs for them and their staff, but it refuses us the tools, access, or authority to do so. My advice: Take care of yourself, mind what you ingest (not only food, but also injections and medications), take your vitamins and supplements, get exercise, and stimulate your brain. Also, maintain a positive attitude, for that will carry you much farther, with better health, than you can imagine.
I am fully in favor to amending the Constitution to allow for national and portable healthcare, even with my (incomplete) understanding of the failures in other countries.
No one in the US that I know of has actual insurance (that is a great topic to explore as most people, including a lot in the insurance industries do not understand how it works). Insurance is a mechanism that transfers some of the risk of unusual situations that can harm an organization/person. Most people in the US pay a fee to get regular care—that is not insurance—and most do not have catastrophic insurance to cover things that require loads of money and other resources.
Some doctors have tried to address the crisis, but I am not aware of any successes.
It is unfair to blame “free enterprise “ or the “marketplace” as we do not have either for most people in the US. The government controls a lot of the game.
And you did not directly mention this, but lots of folks make the mistake of saying the US pays lots for healthcare and gets little. That is not true on several levels; two big ones: we pay for healthcare for lots of other countries and we are so rich we pay for stuff we do not need. The former can be corrected, the later should not be. Healthcare does zap a lot from our economy as there is lots of layers between patient and payment, so moral hazard plays.
It is interesting too that we see that lots of the best healthcare options do not make money. Vaccines be the classic example.
Maybe healthcare needs to be like the highly regulated utilities. That of course leads us to examine the significant failures in those industries and the ones we know are coming down the line.