One of us had a wicked head cold last week and ended up getting nothing planned for the week done except becoming a professional ginger tumeric peeler and tea maker. Meanwhile the other of us made up for it by programming an entire app that will power the Crusonia venture we are launching.
We decided Friday we would formally kick off the new year for the Substack with a live conversation that started as an attempt at structure and ended, predictably, somewhere between Tom Sawyer and economic theory. The most exciting part for Ellen is that she went an entire hour and a half without a sneeze. As for our ramblings, quite frankly, I think everyone expects that from us and would likely be surprised if it were different.
But here’s what matters. We don’t think 2026 will be another year of incremental change. We think it’s the year the pieces finally converge.
We’re done pre-gaming. The infrastructural forces are aligned. The question isn’t whether healthcare transforms, it’s who dives into System C transformation and what happens to the incumbents who don’t. And the same holds true for food. With GLP-1 now becoming close the cost of some cell phone monthly bills, we expect the food industry will have no choice but to pivot very quickly.
If you want the cliff notes version (Andy Beckman - hopefully you see this) - we added a section at the bottom.
The Predictions
The Gen Z Wildcard
The first prediction. At the end of 2026, we’ll look back and see that Gen Z changed the equation.
Not because they’re better or smarter than other generations. But because they have a fundamentally different relationship with healthcare, information, and self-determination. They’re also the core of pre-chronic cohort - under 40, healthy enough to opt-out of the incumbent healthcare system, tech-native enough to figure out their own solutions.
They’re not buying insurance. They’re using Mark Hyman as their doctor. They’re taking their Function Health data, throwing it into ChatGPT, and building protocols that would take a physician weeks to research. They’re microdosing GLP-1s they bought on the gray market for $25/week while Lilly charges $1,000/month to employers willing to pay the price.
Here’s what matters: They’re predictable in their unpredictability. They’ll do what’s necessary to stay alive in an affordable, manageable way. To them, this looks normal. To those of us over 50, it looks like noise. Especially those over 50 in healthcare. But noise has a way of becoming signal when enough people generate it.
The Minnesota daycare fraud story reached 100 million people, more than 10x what 60 Minutes gets on a good day. Young people moved elections that boomers can’t quite understand. They’re influencing family units upward, the typical matriarch/patriarch structure inverts when Gen Z enters because they actually might know more about navigating this new landscape than their elders.
The GLP-1 Cascade
The second prediction: 2026 is the year GLP-1s hit critical mass. They could easily hit $100 and result in a 25%+ weight loss outcome. The gray market’s already there with next-generation peptides at $25/week, functionally equivalent to what Lilly hasn’t even gotten FDA approval for yet.
This matters because it triggers a cascade:
Q1 2026: Food industry feels it first. We’re already hearing from CPG executives about sales disruption. When you’re not hungry, you buy differently. Think share of stomach instead of selling calories. When 20-30 million Americans are on semaglutide variants by year-end, the grocery cart changes at scale.
Q4 2026: Lilly (and Novo Nordisk) hit their Clayton Christensen moment. They’re losing 30% of sales to gray market peptides. The music industry had to deal with MP3s. Pharma now has to deal with the fact that people are comfortable enough to biohack, mainline, and gray-market their way to outcomes.
Q4-Q2 2027: Healthcare starts seeing it in the data. Health system CEOs are already reporting minimal but noticeable inpatient reductions from people whose A1C dropped from 13 to 7. That’s at $1,000/month. At $200/month? The floodgates open. Not so many “heads in beds”.
They’ll either become Tesla - selling direct, owning the whole value chain including food. Will be curious to see who becomes Blockbuster. It’s likely pharma is virtually forced to stop rent-seeking from healthcare and start building parallel infrastructure.
The Fatal Blows (Or At Least the Dismemberment)
Ellen spoke about this as both fatal blows and death by a thousand cuts, favoring the latter. 2026 is the year healthcare takes enough serious hits that either factions begin to cruble in 2027-2028, or things pivot so fast they won’t know what hit them.
The blows aka tailwinds for System C:
From policy:
* CMS ACCESS unlocks the entire Medicare FFS market (30 million Americans) to technology-enabled chronic disease management. This isn’t incremental. It’s 350+ organizations that have never had direct Medicare access suddenly getting paid for outcomes, not forced to demonstrate an ROI to a middleman who profits from sickness.
* CMS ELEVATE further invests in the interventions that have demonstrated the ability to eliminate/prevent costly chronic disease through lifestyle modification.
* The administration continues to show strong signs of PBM disruption
* The Rural Transformation funding program is putting real dollars into food-as-medicine infrastructure (as well as other chronic disease reversal infrastructure). State pilots accelerate because the federal government just gave them permission and funding.
* The possibility that the projected $100B+ in Enhanced ACA subsidies for FY2026 truly end and the redistribution includes some portion being allocated to increased HSA funding along with the availability of true catastrophic plans.
* The laundry list of new CMMI models beyond those above that appear to have been conconcted during a drinking game of kombucha and wellness tonics that are meant to disrupt the incumbent healthcare delivery system: BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth), GENEROUS (GENErating cost Reductions fOr US Medicaid), GLOBE (Global Benchmark for Efficient Drug Pricing), GUARD (Guarding U.S. Medicare Against Rising Drug Costs), LEAD (basically the ACO REACH model replacement - it’s underwhelming), TEAM (Transforming Episode Accountability Model) and WISeR (Wasteful and Innappropriate Service Reduction)
* $700M earmarked to support Regenerative Agriculture
From markets:
* PBMs are in the crosshairs between policy above and Mark Cuban’s warpath that is focused on destroying their margin arbitrage, private industry doesn’t need the federal government to finish this off. Amazon’s still selling to employers but the direct-to-consumer model is coming. When insurance becomes optional for the healthy and unaffordable for everyone else, the system breaks.
* Health insurance design is ripe for the picking. As soon as there is another option like Crowd Health and employers start to jump onboard, watch out.
From consumer behavior:
* Gen Z doesn’t want to age into chronic disease. The Death Star won’t keep getting fed new patients with AI and DIY healthcare on offer. Especially with the forces above.
* Food industry shifts with GLP-1 impacts. Healthcare’s customer acquisition strategy is society feeding people wrong. What happens when that stops?
Resolutions
The First Piece of Crusonia Unveiled
It’s no secret we are serious about building System C in 2026. It’s game on and Crusonia is the core, based on self-reinforcing capital accumulation with continuous, compound growth and sustainable output without negative environmental impact through health improvement and outcomes and creates it’s own economic flywheels. Not the perpetuation of the current model where cheap calories which fuel chronic disease, where disease perpetuation funds everything.
* The $100M Food Is Health fund focused on strategic corporate partnerships with early commitments already secured
* The Crusonia Syndicate which will create the cross-sector use cases focused on human outcomes bringing together incumbents and start-ups will open up for membership in the coming weeks. Members will of course get a paintbrush. Think Tom Sawyer meets the Rebel Alliance meets Robinson Crusoe meets Crusonia economis (Frank Knight/Tyler Cowen).
* And the latest component - Hayek. Carter spent the last week coding instead of talking to humans because it was easier to articulate in code. He built something called Hayek (yes, after the economist, because Claude is named after Claude Shannon, and these are the fathers of information theory and entrepreneurial thinking). Carter shocked Ellen by dropping live on the call that he would be inviting some of this tribe to test the protoype: crusonia.io:
* A partnership discovery tool. We have CRMs to figure out who to sell to in established systems. But how do you figure out who to partner with for a supply chain that doesn’t exist yet? That’s what Hayek solves—it’s a referral agent that connects half-baked ideas to the companies and people who can make them real.
* A CIA analyst function. If you’re good at connecting dots, you can operate inside Crusonia like an intelligence analyst - seeing patterns across 6,000+ startups evaluated over 10 years (with thousands of incumbents and startups being added), identifying what’s emerging before others see it.
* A collective action mechanism. If you’re Kroger and you know you need nutrient-dense food, you only know how to call CPGs. But maybe you need to talk to farmers first. Crusonia removes that friction.
By end of Q1, we’ll have launched Crusonia formally: the app, a ~$100M fund focused on strategic corporate partnerships, and the syndicate (invitation-only architects plus the broader collective who want to roll up their sleeves on use cases).
We committed on the call to a live design session where we mock up a System C use case with the cross-section of people who actually showed up for this conversation. EMR people, tech people, clinicians, food-as-medicine practitioners, ag, CPG. We have everyone we need. We just need to paint the fence together.
Who We Need at the Table... If you’re reading this and you see yourself in one of these categories, we’re looking for you:
* Ag/regenerative: If you’re producing nutrient-dense food and want direct pathways to outcome-based reimbursement
* Ingredients/CPG: If you’re tired of the street giving you no credit for investing in what’s technically right but won’t show revenue for years
* Retail/distribution: If you’re ready to connect food purchasing to health outcomes in real-time
* Wellness/longevity: If you’re building measurement, feedback loops, CGMs, wearables, biomarker tracking
* Healthcare delivery: If you understand you can’t deliver primary prevention alone and want new partners OR maybe you just want to see the system change
* Capital: If you see the $10 trillion human health economy emerging and want to fund what replaces the $4 trillion chronic disease treatment/management system
While we don’t have the date for this just yet, the date we do have is for our first physical convening - April 29th - 30th, in Nashville at the Food Health LIVE event. We will be holding a half-day Innovation Lab the morning of April 29th, which is the day the full conference kicks-off in the afternoon. There will also be a 2nd track announced soon that is cross-sector and what we will call a “How To”. Here is the subscriber 10% discount code (HEALTHCAREACTUALLY10). We will talk more in the coming days when we hosti a live session on our Food Is Health channel on FoodHealth Live to talk about the event and get feedback. Pej and Tom have a fantastic event planned this year.
Ramblings
Tom Sawyer Chapter 2
Ellen ended up reading part of Carter’s favorite passage from Chapter 2 of Tom Sawyer, because sometimes you need Mark Twain to explain market transformation.
Tom Sawyer had to paint a fence. He started alone, felt overwhelmed, couldn’t convince anyone to help. Then he had a perspective shift: What if painting the fence wasn’t work—what if it was an opportunity so rare that people would line up for it?
By the end, everyone wanted to paint the fence. They brought him apples. They begged for a turn with the brush.
That’s 2026.
The Tom Sawyer System C reality means getting agriculture, food, healthcare, wellness, and pharmaceuticals to see they can paint the fence together. We’ve articulated what System C looks like. Now we need the cohort that understands how to orchestrate it cooperatively rather than each trying to own the whole thing.
Ellen even included a paintbrush in her Christmas package to Carter.
The Uncomfortable Truth About What Insurance Should Cover
Ellen made the controversial statement: We can’t cover chronic disease the way we do today and have insurance remain sustainable.
Adding that healthcare isn’t capable of delivering primary prevention because food and lifestyle are such massive components and healthcare doesn’t have those assets (at scale), nor should it.
We discussed briefly what the future structure should contain (we outlined just before the holidays in a detailed substack):
* Catastrophic insurance for true acute care
* Capped benefits for disease reversal (e.g., $50-100K for a type 2 diabetes reversal program, then you’re done)
* End-of-life annuity so families can plan with dignity instead of bankrupting themselves on ICU care that extends death by days instead of life by years
* Supplemental policies you can buy if you want chronic disease coverage, but you pay the premium that reflects the true cost
This isn’t cruel. It’s honest. Right now we’ve built a system where it’s less expensive to get chronic disease and have it treated, than to avoid it. That’s backwards.
System C makes it hard to make bad decisions at the grocery store, makes nutrition affordable, makes nutrient density the norm, biforcates acute care and health, yields primary prevention and disintermediates the incumbent healthcare system.
The 2026 Roadmap
Christo B Vermeulen challenged us in the comments on the livestream for a quarter by quarter roadmap which was admittedly not easy on the fly but we did our best:
* Q1: GLP-1 disruption accelerates in food. ACCESS applicants are announced—we see who’s jumping in. Rural Transformation awards flow. State pilots launch. Crusonia launches with early fund commitments.
* Q2-Q3: Food industry feels the tides shifting first, possibly in the magnitude of a reckoning - when 20M+ people aren’t hungry the same way, grocery changes. The use cases start: real examples of soil-to-cell-to-outcome value chains with measurement and feedback loops.
* Q4: Pharma hits their Blockbuster-or-Tesla moment. The healthcare incumbents willing to read the tea leaves face the question: are we facing a sentinel moment? By year-end, we have 1-3 functioning System C use cases with cross-sector partnerships proving the model works supported by Cursonia. And it’s possible a few healthcare incumbents will begin to see the early signs of GLP-1 uptick in their admissions data.
Bottom Line
2026 isn’t about whether System C happens. The forces are converging. Gen Z behavior change, GLP-1 price collapse, policy unlocking new markets, incumbents facing margin pressure, and customer signal getting louder.
The question is whether we architect it intentionally or let it emerge chaotically.
Our resolutions for the Substack?
* Get more people painting the fence.
* Have 2-3 functioning use cases by year-end that prove System C works at scale.
Question we have for all of you. Will this group of rebels mobilize with paint brushes to accelerate things or grab the apple and watch?
If you want a paintbrush, you know where to find us.
Want to join the Crusonia collective or the design challenge? Reply to this post or reach out directly. We’re building the infrastructure for what comes next. The only question is whether you’re building with us or watching from the sidelines.
The Cliff Notes
* Gen Z is about to flip the script—they’re using Mark Hyman as their doctor, throwing Function Health data into ChatGPT, and microdosing $25/week gray market GLP-1s. To them this looks normal. To healthcare executives, it looks like noise. Noise becomes signal when millions generate it.
* GLP-1s hit $100 by year-end and trigger the cascade: Food industry feels it first (Q1), (Q4) pharma hits their Blockbuster-or-Tesla moment and when healthcare might start to see it in the data.
* Healthcare takes multiple fatal blows in 2026: CMS ACCESS unlocks Medicare for 250+ tech-enabled orgs, PBMs face extinction, and the Death Star stops getting fed new patients because fewer people are aging into chronic disease.
* We launch Crusonia (named after self-sustaining economics), including $100M fund, Crusonia Syndicate membership and Hayek app (crusonia.io). It’s a compehensive collective action mechanism.
* The uncomfortable truth: Insurance can’t sustainably cover chronic disease the way we do today. We need catastrophic coverage, capped disease reversal benefits, and supplemental policies priced to actual cost. System C makes it hard to make bad decisions instead of profitable to treat them.
* Resolutions: Get more people painting the fence. 2-3 functioning System C use cases by year-end that prove the model works… If you want a paintbrush, you know where to find us.
