I didn’t set out to build healthcare companies.
In the early 1970s, I set out to leave. I bought a round-the-world ticket, hitchhiked across New Zealand, worked odd jobs, sang in pubs, lost my passport in India, and learned—sometimes the hard way—how people actually survive when systems fail them.
What I didn’t realize at the time is that I was being trained.
Not in business school.
Not in policy.
But in observation.
When you travel with no real plan, you start paying attention. You notice incentives. You notice workarounds. You notice how people adapt when rules don’t make sense or resources are scarce.
That mindset followed me home.
My first job in healthcare was at a psychiatric hospital in Silicon Valley. It didn’t take long to see something deeply wrong: well-intentioned insurance benefits were being exploited, turning inpatient psychiatric care into something closer to a summer camp for troubled teens.
The result wasn’t health.
It was harm.
Patients learned destructive behaviors from one another. Families outsourced responsibility to the system. And the system happily billed for it all.
That was my first real lesson in healthcare:
when incentives are misaligned, even good intentions create bad outcomes.
My early ventures weren’t driven by clever ideas as much as practical questions:
Who pays?
Why do they pay?
And what behavior does that payment encourage?
In one case, the solution wasn’t a new service at all—it was a different funding mechanism that already existed in public law. That experience shaped every company I’ve built since.
If you don’t understand the payment model, you don’t understand the business.
And in healthcare, misunderstanding payment leads to overuse, underuse, or abuse.
Somewhere along the way, Americans were taught that caring for themselves requires permission—and reimbursement—from a third party.
That’s backwards.
Food is healthcare.
Hygiene is healthcare.
Social connection is healthcare.
Insurance should be reserved for catastrophic, unpredictable events. But we’ve blurred the line so badly that people now believe they need an insurance claim to take responsibility for their own well-being.
At Healthrageous, we intentionally reject that framing.
We don’t start with reimbursement games.
We start with human needs.
One of the things I’m most proud of is how Healthrageous operates:
A small, highly compensated team
Technology used to amplify—not replace—judgment
Revenue that reflects value delivered, not headcount multiplied
Healthcare has convinced itself that scale requires massive, high-churn labor models. It doesn’t. It requires clarity, restraint, and respect for the people doing the work.
Efficiency isn’t just good business.
It’s ethical business.
I’m not anti-technology. I’ve spent decades building with it.
But I am deeply concerned about what happens when innovation outruns responsibility.
AI offering mental health advice to teenagers.
Financial tools that encourage addiction and debt.
Platforms that optimize engagement without conscience.
We don’t let cars on the road without seatbelts or brakes. Software shouldn’t be any different. Regulation isn’t the enemy of innovation—it’s what keeps innovation from hurting the people it claims to serve.
Every successful idea I’ve seen—every one—hinges on finding the first small group that truly believes. Not the masses. Not the late adopters. The first 10%.
Once they lean in, momentum takes care of the rest.
That’s true in business.
It’s true in healthcare.
And it’s true in life.
If I could give my younger self one piece of advice, it would be this:
Don’t over-optimize the plan.
Say yes more often than feels comfortable.
Pay attention to what doesn’t make sense—and ask why.
Most breakthroughs don’t come from following the script.
They come from stepping off it.
That’s been the through-line of my life—and it’s the philosophy behind everything we’re building at Healthrageous.
Want to hear more? Listen to Legacy Unscripted! Podcast.
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