Brandt Welker · Essays
Thirty years building systems people's lives depend on — at NASA, at the VA, and in the software that runs a hospital.
I'm a healthcare technology executive who writes about how these systems actually work: where the incentives point, why good engineering is mostly subtraction, and what changes — and what doesn't — when the tools get smarter.
A Reimbursement Machine in a Business Costume
No real business runs blind to what its product costs. Healthcare does, by design, because knowing the cost would expose the spread everyone in the chain is feeding on. The provider who names its real number first gets flooded.
Start here
If you're new, these two are the argument in miniature: how the money works, and what rigor means now.
- 01
The Denial Machine
One in five claims gets denied on the first pass. A system that says no to a fifth of everything is not making mistakes. It is doing exactly what it was built to do.
- 02
Raising the Bar: Why AI Doesn't Erode Rigor, It Redefines It
Every major tool in history lowered one threshold and raised another. AI is no different — it resets the floor and forces excellence upward.
More essays
All essays →- A Reimbursement Machine in a Business Costume
- Moravec Inverted: 500 Million Years of Pretraining
- The Second Law Is Undefeated
- Building 30
- Stop Auditing the Phrases
- Culture Doesn't Shape Behavior. Incentives Do.
- Raising the Bar: Why AI Doesn't Erode Rigor, It Redefines It
- The Power of Simplification: Lessons from Spacecraft Design
- The Denial Machine
- Are You in an Abusive Relationship with Your EHR?
- Don't Let Health IT Go Extinct
- Care Coordination on FHIR: The Case for API-Based Exchange