5HT #132: incoming presidential healthcare debates, dark nutrition, and 3 more

The midterms are officially behind us (okay TX!), annnnd we’re full steam ahead toward the 2028 presidential election 🍿. Health is going to be a major fight—and no, I’m not just saying that because I write a consumer health newsletter (though hard to imagine all the presidential candidates aren’t already subscribed, amiright???). 

KFF’s latest poll found health care costs tied with gas costs as voters’ top economic concern. And it’s going to get worse before it gets better 🥴. Employer healthcare costs are expected to rise 9% in 2027, and 5–10 million people could lose Medicaid coverage in 2028 (!). It’s impossible to imagine a world where health isn’t on the debate stage. 

So what exactly will candidates fight about? Here’s my predicted power ranking, ordered by how much debate-stage oxygen I think each one gets. Okay, let’s throw down 👇:

5️⃣🥊 The debate over GLP-1s

Seems like everyone wants to be on a GLP-1—and plenty are willing to pay OOP. Buuut they’re also fighting HR and insurers to get coverage, going DTC, or going compounded to save money. I expect semaglutide + tirzepatide costs will go down once reta enters the market, but coverage is still, well, up for debate. 

Plus, Medicare began covering obesity drugs for eligible patients at $50/mo this July—but it’s a pilot expiring EOY 2027. The next president walks in right as it runs out! I doubt that genie goes back in the bottle, but someone still has to decide who pays, who gets coverage, and who gets the credit moving forward. My bet is GLP-1 politics will be a veryyy big thing—and “more people, cheaper” is the popular side. 

4️⃣🥊 The debate over MAHA

We saw Dems pushing for MAHA votes ahead of the midterms (did it work?), and I expect both parties will run on food and environmental agendas. Think campaigning against things like UPFs, pesticides, and food toxins. “Real food” probably won’t be much of a showdown, but vaccines are where I expect the gloves to come off. The real tell: how voters grade the RFK Jr./the Trump MAHA era once someone has to run on its record.

3️⃣🥊 The debate over AI

AI is moving into the space between doctor and patient—and fast 🚀. But who’s liable when it’s wrong? The doctor? The AI company? The state that waived the rules? What exactly is the best health AI recommendation, and who decides its priorities? Cost? Risk mitigation? Best care no matter the cost? These are all tricky questions! And I think we’ll see them being asked a lot in 2028.

Utah (which I wrote about last month) is previewing the fight: its own medical licensing board demanded the pilot be suspended… and state regulators kept it running anyway! My bet is “AI means cheaper, faster care” will win with voters, even if it loses with the AMA. Buuut even that has a snag: people may want those benefits, but they don’t want a data center next door. 76% of voters (!!) opposed new construction in their communities, according to an NBC exit poll. TBD how this fight plays out.

2️⃣🥊 The debate over coverage

A coverage cliff is coming, and people are already, er, falling off. Enrollment in the individual health insurance market fell 18% between June 2025 and June 2026—that’s over 4.6M people (!)…and that’s before projected Medicaid losses. That’s a lot of people shopping for alternatives (maybe more health shares like CrowdHealth?). I’d love to see real innovation here, but I’m not holding my breath. What I do expect: the coverage cliff becomes the line every candidate uses to make the case for how they’ll fix everything in healthcare, and their opponents just want more of the same.

1️⃣🥊 The debate over wallets

There’s no question health insurance premiums are too damn high, and it’s not just premiums, either. KFF found the average marketplace deductible jumped up about $1K/person. And Medicare’s hospital trust fund problem is looming. People can only stretch their budgets so far, so the fight comes down to one question: who holds the money? One side wants to put it in your HSA and let you shop. The other wants to expand public coverage (two-thirds of Americans now favor Medicare for All, fwiw). At least both are admitting the current system is broken.

I’m not running for office, buuut my platform sits right between them: a universal health wallet. I’ve written about this in depth, but essentially it’s a souped-up HSA everyone qualifies for—funded by your employer, the government, or you; spendable on everything from premiums to copays; tax-free; and yours forever. The pitch to the right: it’s an account! The pitch to the left: everyone gets one! That’s why I think it could actually win, just saying.

Bottom line: My conclusion from Tuesday’s midterms was there are actually A LOT of independent-minded voters. Those votes are up for grabs in 2028… and there’ll be no shortage of fights. My hope is both sides point that energy at the actual broken system, because *waves at everything* something’s gotta give. And imo, the winning argument is the one built on life, liberty, and the pursuit of affordable healthcare.

2027 marketing idea for health cos: make your brand costume-worthy. And I’m not talking about a nurse costume here. 

A great example of this is Ro’s Megan Fox ED ad that inspired parodies like this: 

Here are a few more from the healthyish Halloween aisle:

Okay, so 5HTer Amy K. shared this NYT article on “dark nutrition” 👇 in our Slack channel. It’s really thought-provoking, I think! The growing popularity of “n of 1” food journeys—no matter which kind—I actually think is promising for the future of nutrition. 

Yes, it’s true the people in this piece are obviously extreme. I seriously regret clicking on the Instagram video of Kelly Pi eating roadkill 🤢. Buuut they're extremely driven to find a fix. Sure, sometimes those fixes are placebo (probably a lot of the time?). But sometimes those things work—just look at keto.

My take is we’ve got a broken food system (many other broken systems, too) and people really are different. So it’s inevitable more people will run their own “n of 1” food experiments. Plus, AI is and will continue to make it easier to track how our bodies respond. And while I, tbh, don't want to be the one eating raw buffalo brains, science is slow, and I’m curious what we’ll learn from those experimenting. 

Hopefully we learn something that applies more broadly. (Or just continue to get grossed out, because I just can never unsee that roadkill, yeesh🤮).

I often say to Healthyish Content clients that creating quality content is only one ☝️ part of getting your health co discovered, trusted, and chosen. You also have to keep it updated. I see tons of health cos publish a looot of content—and then never look at it again. 

Eventually, consumers land on pages with broken links, outdated studies, and irrelevant images—and it’s awfully hard to earn a consumer's trust when they land on a 404 page 🥴. (Reminder: yes, I’ll be looking at this when grading health content in my upcoming webinar.)

At Healthyish Content, we use this 5-step process to revive content when your traffic starts to drop. But here’s where I’d tell all brands to start:

Believe it or not, this is much more than housekeeping. Deleting or merging 5–40% of low-value or weak pages can actually increase traffic by 20-50% within a few weeks to months. 👍

I hurt my back recently (I think jumping off a rock climbing wall, weird?), and for a couple of days my lower back felt like it had been rammed by a jouster at Medieval Times. Then I spent a night walking miles for Pumpkin Nights with friends and carrying my kiddos, and I could barely move by the end.

If you’ve been here a while, you know my back has a history. Both my parents have had back surgery. My last Prenuvo scan showed herniated discs near my neck and at the base of my spine, plus bulging discs basically everywhere in between. 🥴

For a few years, I’d sleep in a weird position or lean down strangely and wind up in debilitating pain for days and days and days. It happened at least once a month, and it was brutal. 😫

Eventually I went into full optimizer mode. I did a ton of PT, started rock climbing (hanging suuuper helps decompress my spine), committed to daily stretching, and got a walking pad. I also lost weight, which I think honestly had the biggest impact.

But weirdly, it took this recent back flare-up to realize how far I’d come. 

I’ve gone over a year without back pain, and I was back to working out less than a week after this recent flare-up. That pain may never truly go away, but there are interventions I have agency over that can help prevent it from taking me out of the game completely. 

So, despite last week, I think I’m getting the hang of it. 😉

3 other healthyish things I’m into right now:

Most clicked last week: Are y’all still in the Halloween spirit? Cause Glitch candy was a biiiig hit!

👋 Who are you again? I’m Derek Flanzraich, and I’m in the business of healthyish. I founded two venture-backed startups–Greatist (👍) and Ness (👎)—and helped dozens of brands you know grow including Ro, GoodRx, Midi, BetterHelp, and LMNT. I now run Healthyish Content, plus a few other healthyish things (like Fixie Dust, launching this fall).

Every Thursday, I share what’s hot, what’s not, and what’s next in consumer health. (Disclosure: I invest in and advise companies in this space—when I cover one, I'll say so.) I sometimes add affiliate links, but they influence my picks zero. Have something to share? Hit reply, I respond to every email.