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Keen On America

Andrew Keen
Keen On America
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  • Keen On America

    How to Reclaim the Internet: Olivier Sylvain on Platforms and Policy

    08/03/2026 | 43 mins.
    “The fatal error is ours. Legislators set out a regulatory regime that keeps regulation at bay. The only other industry with a similar protection is the gun industry.” — Olivier Sylvain

    There are certain words in book titles that provoke. “Reclaiming”, for example. My guest today is happy to defend the provocation. Fordham law professor and former FTC senior advisor Olivier Sylvain argues in his new book, Reclaiming the Internet, that the internet was never really ours to begin with—and that the story about user control, free speech, and digital democratisation was always more nostalgia than reality.
    But Sylvain’s argument in Reclaiming the Internet: How Big Tech Took Control—and How We Can Take It Back is not the usual big-tech-is-bad narrative (yawn). He doesn’t blame the companies. He blames us—or rather, Congress. The fatal error, he says, was Section 230 of the Communications Decency Act, passed in 1996, which created a blanket immunity from liability for companies trafficking in user-generated content. The only other industry with comparable legal protection, he says, is the gun industry. That immunity enabled the attention economy’s business model. Infinite scrolling = infinite advertising = infinite profit.
    What follows from that error is now everywhere: autoplay, algorithmic recommendation—design features engineered to hold your attention, not to facilitate free speech. Sylvain insists these companies aren’t really platforms. They are, instead, services delivering content pursuant to their bottom line. And now the same Nineties playbook—innovation, user control, free speech—is being replayed with AI. Companies are deploying chatbots before they’re ready, racing each other to market. A young man killed himself after a Gemini chatbot told him to and Google invoked the First Amendment in its defence.
    The fix, Sylvain argues, is not to abolish Section 230 but to attend to the business model itself: data minimisation, purpose limitations, and the kind of product-safety regulation that every other industry—from automobiles to toys to food—already accepts. I should disclose that my wife runs litigation at Google, so I’m all too familiar with the counter argument. But Sylvain makes a persuasive case even if his reclamation project is still a little too Rousseauean for my Hobbesian taste.
     
    Five Takeaways

    •       The Fatal Error Was Ours, Not Theirs: Sylvain doesn’t blame big tech. He blames us—or rather, Congress. Section 230 of the Communications Decency Act created a blanket immunity from liability for user-generated content. The only other industry with comparable protection is the gun industry. That legal shield became the business model.
    •       These Are Not Platforms: The word “platform” implies a neutral conduit connecting users. Sylvain says that’s wrong. These are companies engineering your experience—infinite scroll, autoplay, algorithmic recommendation—to hold your attention and serve their bottom line. The free speech story is cover for a commercial design.
    •       The Same Mistake Is Happening with AI: The nineties playbook—innovation, user control, free speech—is being replayed with AI. Companies are deploying chatbots before they’re ready, racing each other to market. Internal documents show they knew the dangers. A young man committed suicide after Gemini told him to. Google invoked the First Amendment in its defence.
    •       Data Protection Is the Real Fix: Sylvain argues for data minimisation and purpose limitations—rules that would only allow companies to collect information consistent with the purposes a consumer signed up for. Not to monetise it for opaque reasons. That would dampen the incentive to engineer addiction without touching free speech.
    •       There’s a Bipartisan Consensus—but Only for Children: Something is shifting. Courts are rejecting Section 230 defences. Legislators on both sides agree something must be done. But the consensus only extends to protecting children. Sylvain thinks that’s a mistake: a 36-year-old man just killed himself after talking to a chatbot. Adults are vulnerable too.
     
    About the Guest

    Olivier Sylvain is a professor of law at Fordham University, a former senior advisor to the Chair of the Federal Trade Commission, and a Senior Policy Research Fellow at Columbia University’s Knight First Amendment Institute. His new book is Reclaiming the Internet: How Big Tech Took Control—and How We Can Take It Back (Columbia Global Reports).
    References

    References and previous Keen On episodes:

    •       Section 230 of the Communications Decency Act (1996) and its evolution into blanket immunity for tech companies
    •       Gonzales v. Google (2023)—the Supreme Court case that declined to rule on Section 230 but allowed the merits to proceed
    •       The Character AI / Gemini chatbot suicide cases—ongoing litigation against Google
    •       Tim Wu on the extractive economics of platform capitalism — previous Keen On episode
    •       Julia Angwin, Zephyr Teachout, and Stewart Brand—referenced in the conversation
    About Keen On America

    Nobody asks more awkward questions than the Anglo-American writer and filmmaker Andrew Keen. In Keen On America, Andrew brings his pointed Transatlantic wit to making sense of the United States—hosting daily interviews about the history and future of this now venerable Republic. With nearly 2,800 episodes since the show launched on TechCrunch in 2010, Keen On America is the most prolific intellectual interview show in the history of podcasting.
    Website

    Substack

    YouTube

    Apple Podcasts

    Spotify

     
    Chapters:

    (00:00) - Introduction: What does “reclaiming” the Internet mean?

    (03:06) - The layered stack: pipes, platforms, and consumer-facing apps

    (06:01) - Was user control ever real? The ideology of the nineties

    (09:32) - The fatal error: Section 230 and blanket immunity

    (14:51) - Facebook as punching bag—and why Sylvain doesn’t blame the companies

    (17:31) - Addiction, self-harm, and the design features that hold your attention

    (22:00) - The attention economy and the Gonzales v. Google case

    (26:35) - How we can take it back: data minimization and purpose limitations

    (29:02) - “These are not platforms”

    (31:21) - Europe, the First Amendment, and the right to be forgotten

    (33:06) - AI business ...
  • Keen On America

    No AI Good Guys? Andrew & Keith Ask If Altman Amodei, & Hegseth Have All Failed the Leadership Test

    07/03/2026 | 43 mins.
    “They’re both naughty boys in the playground, leveraging the absence of clarity to their own advantage. Neither one of them is an authoritative leader of opinion with the interests of everyone at heart.” — Keith Teare

    What a difference a week makes. Last Saturday, Keith Teare was arguing that Anthropic was wrong to push back against the US government’s use of AI in warfare. This week his editorial is entitled “No Good Guys.” He’s used AI to put images of Sam Altman, Dario Amodei, and Pete Hegseth around the same table—and found all three guilty of poor leadership. According to Keith, Amodei is “ideologically” (whatever that means) driven. Altman is commercially driven and Hegseth is just following orders. None of them is asking the all-important questions about AI policy. And the man who should be—Trump’s AI czar David Sacks—is absent-without-leave. All four should be court martialed.
    Yes, a lot has happened in seven days. Altman publicly supported Amodei’s position on surveillance and autonomous weapons—then pulled a classic Sam u-turn and signed a contract with the Department of War. Amodei’s internal memo was leaked to The Information, revealing that he’d interpreted the government’s “no unlawful use” language as meaning there is no law. And the US military used Claude in the Iran war anyway. As Keith puts it: they’re all naughty boys in the playground, leveraging the gaps to their own self-advantage.
    The only problem, of course, is that this isn’t a playground game. And that these men are all shaping the lives (and deaths) of countless people around the world.
    Meanwhile, Om Malik’s “Post of the Week” offers a devastating contrast between Xi’s China and Trump’s America. China, Om argues, has published a five-year AI plan built on open-source software and bottom-up adoption. America, in contrast, has AI theater. No strategy, no policy, no leadership—just contracts, leaks, and perpetual spin. Then there’s the Startup of the Week, Jobright, which hit $5 million in annual revenue with nine people, suggesting that the companies of the future may not need humans at all. Keith’s own SignalRank has four people and claims to be going public. We seem to be heading for post-human companies before we’ve figured out who’s managing the humans.
    Maybe we should court martial everyone. What a difference a week makes.
     
    Five Takeaways

    •       No Good Guys: Keith Teare’s editorial puts Sam Altman, Dario Amodei, and Pete Hegseth in the same room—and finds all three guilty of bad leadership. Amodei is ideologically driven, Altman is commercially driven, and Hegseth is just doing his job. None of them is asking the big questions about AI policy. The real culprit may be the invisible AI czar, David Sacks.
    •       Altman Said One Thing, Then Did Another: Last week Altman publicly supported Amodei’s position on surveillance and autonomous weapons. This week he signed a contract with the Department of War. The contract uses “no unlawful use” language—which, as Amodei’s leaked memo points out, effectively means there is no law.
    •       The US Used Claude in Iran Anyway: Despite the very public dispute between Anthropic and the government, the US military used Claude in the Iran operation. The government doesn’t need your permission to use your product. It just needs an API key and a credit card.
    •       China Has a Plan. America Has Theater: Om Malik’s “Post of the Week” contrasts China’s published five-year AI strategy—built on open-source software and bottom-up adoption—with America’s complete absence of AI policy. The Chinese approach is more inclusive and practical than anything coming out of Washington or Silicon Valley.
    •       The Future Company Has Nine Employees: Startup of the week Jobright hit $5 million in annual recurring revenue with just nine people. Keith’s own company, SignalRank, has four people and is going public. The implication: the companies of the future will be run mostly by software agents, not humans. We’re heading for post-human companies.
     
    About the Guest

    Keith Teare is the publisher of That Was The Week, founder and CEO of SignalRank, and a recurring sparring partner on Keen On America. A serial entrepreneur and investor, he is the co-founder of TechCrunch and RealNames. He joins the show every Saturday for the weekly tech roundup.
    References

    Essays, posts, and interviews referenced:

    •       Keith Teare, “No Good Guys” — That Was The Week editorial

    •       Om Malik, “The Great AI Game versus AI Theater” — Post of the Week
    •       Ross Douthat, “If AI Is a Weapon, Who Should Control It?” — New York Times
    •       Ben Thompson, Stratechery — on “no unlawful use” and the absence of international law
    •       Paul Krugman on the economics of technological change — technology, jobs, wages, and monopolies
    •       Tim O’Reilly, “How We Bet Against the Bitter Lesson” — skills and the future knowledge economy
    •       Yascha Mounk and Danielle Allen on participatory democracy and AI governance
    •       Previous Keen On episodes: Tom Wells on the Kissinger tapes; Michael Ellsberg on Daniel Ellsberg and the Pentagon Papers
    •       Startup of the Week: Jobright — $5M ARR with nine employees
    About Keen On America

    Nobody asks more awkward questions than the Anglo-American writer and filmmaker Andrew Keen. In Keen On America, Andrew brings his pointed Transatlantic wit to making sense of the United States—hosting daily interviews about the history and future of this now venerable Republic. With nearly 2,800 episodes since the show launched on TechCrunch in 2010, Keen On America is the most prolific intellectual interview show in the history of podcasting.
    Website

    Substack

    YouTube

    Apple Podcasts

    Spotify

     
    Chapters:

    (00:00) - Introduction: What a difference a week makes

    (01:14) - “No Good Guys”: Keith’s editorial and Om Malik’s wake-up call

    (02:30) - Amodei, Altman, Hegseth: three self-interested players

    (04:02) - How the Iran invasion changed the AI debate

    (05:28) - “No unlawful use”: a meaningless phrase in a lawless context

    (06:50) - The US used Claude in Iran despite the Anthropic dispute

    (08:15) - Naughty boys in the playground: spinning vs. leadership

    (09:31) - Bobby Kenn...
  • Keen On America

    What Would Daniel Ellsberg Say About Iran? His Son Michael on America’s Most Famous Whistleblower

    07/03/2026 | 39 mins.
    “All my life, I’ve absolutely opposed all terrorism by anyone under any circumstances. I define terrorism as the deliberate killing of noncombatants.” — Daniel Ellsberg, October 2001

    Last week we had Tom Wells on the show talking about Henry Kissinger’s moral indifference to the loss of innocent lives in the Vietnam war. Henry Kissinger, of course, was no fan of the Pentagon Papers— the leaked documents that showed the American government was lying about Vietnam, thereby changing public opinion about the war and helping end it. And the Pentagon Papers are forever associated with one brave man: Daniel Ellsberg, Harvard economist, RAND Corporation strategist, marine, Pentagon insider—and America’s most famous whistleblower.
    Ellsberg died in 2023 at the age of 92. Now his son Michael Ellsberg has co-edited a posthumous collection of his father’s previously unpublished writing. Truth and Consequence: Reflections on Catastrophe, Civil Resistance, and Hope draws from a hundred boxes of handwritten notebooks in nearly illegible script, spanning fifty years of moral reckoning. Daniel Ellsberg didn’t much care about publishing these notes. His son thought otherwise.
    What emerges is not another memoir of the Pentagon Papers but a book of ideas—about the nature of evil, the morality of obedience, and what Ellsberg called “civic courage”: taking nonviolent risks when your democracy is in danger. He was inspired not by intellectuals but by young draft resisters going to jail. Daniel Ellsberg’s moral lineage ran from Thoreau through Gandhi to Martin Luther King. And his moral absolute was uncompromising: the deliberate killing of civilians is “terrorism”, whoever orders it. By that definition, Daniel Ellsberg defined Harry Truman as a terrorist. Not to mention morally indifferent politicians like Richard Nixon and Henry Kissinger.
    Michael Ellsberg is candid about growing up in Berkeley with a father who was loving but distracted—a free-range parent who spent his evenings filling yellow legal pads rather than playing baseball. He’s equally candid about what his father would be saying right now: that whatever rationale exists for the Iran war, there are official plans and reasoning that the American public should know about but doesn’t. The Pentagon Papers proved the government lied. The question, as American bombs once again rain down on innocent civilians, is whether anything has changed in the last sixty years since “terrorists” like Henry Kissinger lied to the American public about Vietnam.
     
    Five Takeaways

    •       You Are Being Lied to More Than You Realise: That was Ellsberg’s message in 1971, and his son says it’s his message now. Whatever rationale Trump has for the Iran war, Michael Ellsberg argues, there are plans and reasoning the public should know about but doesn’t. The Pentagon Papers proved the government lied about Vietnam. The question is whether anything has changed.
    •       The Establishment Man Who Became a Traitor: Daniel Ellsberg was Harvard-educated, a RAND Corporation strategist, a marine, a Pentagon aide working under McNamara. He was not a hippie. He was a silent-generation insider who watched the system lie about a war everyone inside knew was hopeless—and decided the public had a right to know.
    •       All Deliberate Killing of Civilians Is Terrorism: In an essay written in October 2001, Ellsberg proposed a moral absolute: the deliberate killing of noncombatants is terrorism, whoever does it—left or right, aggressor or defender, first world or third. By that definition, Hiroshima was terrorism and Truman was a terrorist. No lesser-evil exceptions.
    •       Civic Courage Is as Important as Military Courage: Ellsberg modelled what he called “civic courage”—taking nonviolent risks when democracy is in danger. He was inspired by draft resisters going to jail, not by intellectuals writing op-eds. The lineage runs from Thoreau through Gandhi to Martin Luther King. Ellsberg saw himself in that tradition.
    •       This Book Is a Son’s Labour of Love: Daniel Ellsberg spent decades filling yellow legal pads in nearly illegible handwriting. He didn’t much care about publication. His son Michael and longtime assistant Jan Thomas thought otherwise. Truth and Consequence draws from a hundred boxes of notebooks spanning fifty years—a book of ideas, not just a memoir of action.
     
    About the Guest

    Michael Ellsberg is the son of Daniel Ellsberg and the co-editor, with Jan R. Thomas, of Truth and Consequence: Reflections on Catastrophe, Civil Resistance, and Hope (Bloomsbury). He is the author of three previous books. He lives in Berkeley, California.
    References

    Books and references mentioned:

    •       Secrets: A Memoir of Vietnam and the Pentagon Papers by Daniel Ellsberg
    •       The Doomsday Machine: Confessions of a Nuclear War Planner by Daniel Ellsberg
    •       The Most Dangerous Man in America — Oscar-nominated documentary about Daniel Ellsberg
    •       The Ellsberg Paradox — Daniel Ellsberg’s contribution to decision theory, still discussed in economics
    •       Previous Keen On episodes: Tom Wells on the Kissinger tapes; McNamara and his mental breakdown; Truman’s decision to drop the bomb
    •       Henry David Thoreau, Gandhi, and Martin Luther King Jr. — the civil disobedience lineage Ellsberg claimed as his own
    About Keen On America

    Nobody asks more awkward questions than the Anglo-American writer and filmmaker Andrew Keen. In Keen On America, Andrew brings his pointed Transatlantic wit to making sense of the United States—hosting daily interviews about the history and future of this now venerable Republic. With nearly 2,800 episodes since the show launched on TechCrunch in 2010, Keen On America is the most prolific intellectual interview show in the history of podcasting.
    Website

    Substack

    YouTube

    Apple Podcasts

    Spotify

     
    Chapters:

    (00:00) - Introduction: From the Kissinger tapes to the Pentagon Papers

    (03:37) - Why Daniel Ellsberg matters now

    (06:21) - The establishment man who became a whistleblower

    (09:16) - McNamara, RAND, and the stalemate nobody would admit

    (11:19) - Randy Keeler and the draft resisters who changed everything

    (12:17) - Gro...
  • Keen On America

    From the Muckers to the Mullahs: Christopher Clark on the Lessons of History

    05/03/2026 | 51 mins.
    “I don’t think we’re sleepwalking, because people have striven to be as thoughtful as possible. In some ways, they’ve been too thoughtful. We’re paralysed, in fact, by our risk awareness.” — Christopher Clark

    It’s 1830 in East Prussia. The city of Königsberg still bathed in the amber glow of the late Enlightenment—at least in the minds of people who’d never been there. But that glow, it goes without saying, is illusionary. The greatest of all Königsberg citizens, the illustrious 18th century philosopher Immanuel Kant is dead. Napoleon’s shattered army limped west back through the city two decades earlier after its failed invasion of Russia. The place had slipped into a sad provinciality, living off 18th century nostalgia. And then two Lutheran preachers, so-called “Muckers”, get accused of running a sex cult.
    Christopher Clark—Regius Professor of History at Cambridge, author of the brilliant The Sleepwalkers and Revolutionary Spring—has been brooding on this story for thirty years. His short new book, A Scandal in Königsberg, is a Prussian microhistory with global ambition. The scandal, he says, was entirely fabricated: no sexual transgressions ever occurred. The two Muckers were convicted, stripped (so to speak) of office, and imprisoned, then exonerated on appeal – giving this case more historical significance than a mere sex scandal.
    What made them targets? They were evangelical in a city that prized Kantian rationalism. They followed a dead mystic who believed creation was born from two cosmic spheres—fire and water—which sounded like dangerously mystical in the scientific age of steam power. And the lead preacher, Johann Ebel, committed the unforgivable sin of listening to women confess their unhappy marriages. In a pre-Freudian central Europe, Ebel became the confidant the men of Königsberg couldn’t abide.
    And then there’s Iran — far from 19th century East Prussia, but on all of our minds right now. At the end of our conversation, I couldn’t resist asking Clark if he thinks we are sleepwalking into another catastrophic world war. He doesn’t think so. The problem in 1914 was a failure of imagination, he says. Today, Clark argues, we’re actually paralysed by a fear of risk. The Iran invasion is certainly stress testing the international system. But the one thing most people agree on, Clark notes with characteristic dryness, is that nobody much regrets any damage done to the regime of the Mullahs. Even if, as he warns, we still don’t know whether decision to invade Iran was smart or reckless. The Mullahs, at least, aren’t quite Muckers.
     
    Five Takeaways

    •       This Was a Scandal Without a Transgression: Most scandals expose something real. The Mucker scandal was different: the sexual allegations were entirely invented. Two clergymen were stripped of office, fined, and imprisoned—then exonerated on appeal when a sharp young lawyer proved the charges were fabrications. The process of invention, Clark argues, is more interesting than any transgression could have been.
    •       Steam Was the AI of the 1830s: The two preachers at the center of the scandal were followers of a dead mystic who believed creation was born from two cosmic spheres—fire and water. In the age of steam, that sounded like science. Königsbergers only saw their first steam engine in the 1820s. New technology makes old ideas feel prophetic—a pattern we might recognise.
    •       The Preacher Women Loved: Johann Ebel attracted women from the best families of Königsberg because he listened to them. There were no couples counsellors, no psychoanalysts—only clergymen. Ebel was non-judgmental about sexual life within marriage. The men around him found this intolerable. The scandal was driven not by what Ebel did, but by what he represented: a threat to patriarchal authority.
    •       We’re Not Sleepwalking—We’re Paralysed: Clark wrote the book on how Europe sleepwalked into 1914. He doesn’t think the analogy holds today. The problem in 1914 was a failure of imagination—nobody could see the other side’s perspective. Today we’re hyper-aware of risk, especially nuclear risk. If anything, we’re too thoughtful—paralysed by what we know rather than blind to what we don’t.
    •       Iran and the Crumple Zone: The invasion of Iran is testing the edges of the international system. Clark notes that both Putin and the US-Israel alliance have chosen targets without nuclear weapons—probing the crumple zone rather than the core. The danger is an unintentional transition to nuclear exchange. And we still don’t know whether the decision to strike Iran was smart or reckless.
     
    About the Guest

    Christopher Clark is Regius Professor of History at the University of Cambridge and a fellow of St Catharine’s College. He is the author of The Sleepwalkers: How Europe Went to War in 1914, Revolutionary Spring: Fighting for a New World, 1848–1849, Iron Kingdom, Time and Power, and the new book A Scandal in Königsberg. He was knighted in 2015 for services to Anglo-German relations.
    References

    Books and references mentioned:

    •       The Sleepwalkers: How Europe Went to War in 1914 by Christopher Clark
    •       Revolutionary Spring: Fighting for a New World, 1848–1849 by Christopher Clark
    •       Immanuel Kant (1724–1804) and the Enlightenment heritage of Königsberg
    •       Leonhard Euler and the Seven Bridges of Königsberg—the birth of modern topology
    •       The Coming Storm by Odd Arne Westad—referenced in the closing discussion on sleepwalking into war
    About Keen On America

    Nobody asks more awkward questions than the Anglo-American writer and filmmaker Andrew Keen. In Keen On America, Andrew brings his pointed Transatlantic wit to making sense of the United States—hosting daily interviews about the history and future of this now venerable Republic. With nearly 2,800 episodes since the show launched on TechCrunch in 2010, Keen On America is the most prolific intellectual interview show in the history of podcasting.
    Website

    Substack
  • Keen On America

    How To Fix Big Med: Halle Tecco and Robin Blackstone on American Healthcare and its Discontents

    04/03/2026 | 1h 7 mins.
    “We should all be able to look at the numbers and agree that this is not sustainable and that whatever we’ve been doing is not working. Democrats have had their chance, and Republicans have had their chance, and it’s only gotten worse.” — Halle Tecco
    Warren Buffett called America’s healthcare costs “a hungry tapeworm on the American economy.” That tapeworm now devours nearly a fifth of the nation’s GDP—and the patient, as always, is on the table. We dedicate today’s show to this most perennial of all America’s problems, with two guests and two new books that approach the tragi-comedy from different angles.
    Self-styled innovation wonk Halle Tecco—founder of Rock Health, investor in over fifty digital health companies, professor at Columbia Business School—argues in Massively Better Healthcare that the system is both excessively public and excessively private, a Kafkaesque bureaucracy in which verticalized health plans now own the PBMs, the pharmacies, and increasingly the doctors. The result is monopoly medicine on a scale that would have appalled the original trust-busters.
    This is ultimately an antitrust story. As we’ve discussed on the show with Tim Wu, Biden’s chief antitrust enforcer, the concentration of corporate power is the great unfinished business of American democracy. Tecco makes the case that Big Med is where the trust busters should go next after Big Tech. UnitedHealth is now one of the largest employers of doctors in the country. So it wasn’t exactly shocking when the UnitedHealth CEO was assassinated two years ago. The system isn’t broken, Tecco suggests. It’s working exactly as designed—just not for patients.
    Surgeon Robin Blackstone, MD, author of Doctor AI: Reimagining Health. Rebuilding Trust. Delivering Health 4.0, joins us in the second half of the show to offer a view from the front lines. After 30 years as a surgeon, Blackstone confirms everything Tecco diagnoses—and adds a chilling detail of her own: the system is priced entirely for fixing illness, not preventing it. Her prescription is a “triangle of trust” between patient, physician, and AI—with the patient finally owning their own data.
    Both agree on one thing: every dollar spent on public health saves $14.30 in medical and societal costs. We are all already paying for all the waste. We just need to fix Big Med. But who’s going to do it? Tecco says that America is ready for another round of Obamacare politics. But I’m not so sure.
     
    Five Takeaways

    •       Healthcare Is a Tale of Two Civilizations: If you’re wealthy, you go to UCSF and get the best care in the world. If you’re not, you’re one of the 100 million Americans without a regular primary care provider. Healthcare debt is the number one cause of bankruptcy. A person earning $30,000 in a rural county can expect to live a full decade less than someone earning $100,000 in an affluent suburb.
    •       The Real Winners Are Monopoly Medicine: Verticalized health plans now own the PBMs, the pharmacies, and increasingly the providers. The ACA’s profit cap forced them to grow the pie instead of getting more efficient. United is now one of the largest employers of doctors in the country. Independent pharmacies are closing at the rate of one per day. Rite Aid is bankrupt—the only major chain not owned by a health plan.
    •       Every $1 in Public Health Saves $14.30: We’re already paying for the crisis—in emergency room visits, lost productivity, and disability. We just need to move the safety net upstream. Public health is the only part of the system designed for prevention, yet its share of total health spending has dropped 25% in two decades. The economic case is overwhelming. The political will is not.
    •       AI Could Break the Information Asymmetry: Patients are already using ChatGPT to diagnose themselves—and sometimes it’s saving their lives. One woman caught her own pneumonia because her doctor couldn’t see her for a week. But some doctors want to keep the paternalism: one AI tool built on medical journals is restricted to clinicians only because making it available to patients would “piss off the doctors.”
    •       The System Is Priced for Rescue, Not Health: Everything is loaded to the moment your gallbladder goes bad or your heart gets a blockage. Prevention doesn’t get paid for. Both guests agree: we need a massive re-pricing that rewards keeping people healthy, not just treating them when they’re sick. That means paying doctors to prevent strokes, not just to fix them.
     
    About the Guests

    Halle Tecco is the founder of the venture fund Rock Health and an investor in more than fifty digital health companies. She is an adjunct professor at Columbia Business School and a course director at Harvard Medical School. Her new book is Massively Better Healthcare: The Innovator’s Guide to Tackling Healthcare’s Biggest Challenges (Columbia University Press).
    Robin Blackstone, MD, is a physician, health systems architect, and founder of Blackstone Health. A surgeon by training with 30 years of clinical experience, she is the author of Doctor AI: Reimagining Health. Rebuilding Trust. Delivering Health 4.0.
    References

    Previous Keen On episodes and authors mentioned:

    •       Robert Pearl on how AI will be monetized in the healthcare industry

    •       Tim Wu on the extractive economics of platform capitalism

    •       Zeke Emanuel on which country has the world’s best healthcare

    •       Warren Buffett on healthcare costs as “a hungry tapeworm on the American economy”
    About Keen On America

    Nobody asks more awkward questions than the Anglo-American writer and filmmaker Andrew Keen. In Keen On America, Andrew brings his pointed Transatlantic wit to making sense of the United States—hosting daily interviews about the history and future of this now venerable Republic. With nearly 2,800 episodes since the show launched on TechCrunch in 2010, Keen On America is the most prolific intellectual interview show in the history of podcasting.
    Website

    Substack

    YouTube

    Apple Podcasts

More Business podcasts

About Keen On America

Nobody asks sharper or more impertinent questions than Andrew Keen. In KEEN ON, Andrew cross-examines the world’s smartest people on politics, economics, history, the environment, and tech. If you want to make sense of our complex world, check out the daily questions and the answers on KEEN ON. Named as one of the "100 most connected men" by GQ magazine, Andrew Keen is amongst the world's best-known technology and politics broadcasters and commentators. In addition to presenting KEEN ON, he is the host of the long-running show How To Fix Democracy and the author of four critically acclaimed books about the future, including the international bestselling CULT OF THE AMATEUR. Keen On is free to listen to and will remain so. If you want to stay up-to-date on new episodes and support the show, please subscribe to Andrew Keen’s Substack. Paid subscribers will soon be able to access exclusive content from our new series Keen On America – keenon.substack.com
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