No surprise, Sunday’s article about 10 possible fixes for American healthcare sparked lots of reader suggestions, from minor to radical. I may run a second list with your ideas (or host a chat to discuss the issue).

But I was struck by how many of you pushed one seemingly simple change: requiring open pricing for medical procedures, services, and drugs whenever possible. This suggestion came up more than any other, even restricting drug advertising.

I agree. Open pricing may seem like a small change, but in fact it would have major philosophical and practical benefits.

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Our $5 trillion system encourages consumers, aka patients, to think of care as free — while setting up a maze of hidden financial incentives and honeypots that providers and administrators spend huge amounts of time navigating and fighting over.

Pretending medicine isn’t about money hasn’t made medicine less about money. It has just distorted the system in deeply destructive ways.

Even if doctors do not let financial incentives drive treatment decisions for individual patients (and some clearly do), profit drives every structural decision in American medicine, from where hospitals open satellite clinics to the drugs pharmacy benefits managers push to how quickly patients are discharged.

The list is endless.

Yet at the most crucial point of contact, we simply hide the price of treatments. Among other distortions, this fiction encourages patients to overconsume medical services. We implicitly assume we do not need to discourage people from seeking out healthcare. We imagine most healthy people will not go to doctors if they do not have to, so we do not have to regulate access to care.

But in the United States in 2026, that assumption no longer seems to hold.

We have an ever-increasing number of chronic conditions, often driven by unhealthy lifestyle choices, as well "sort-of" diseases with a strong psychosocial component. Drug company advertising fuels patient demand for the costliest possible treatments for all these conditions. (To a lesser extent, so does hospital and physician group advertising.) Under the circumstances, even completely healthy people may feel almost compelled to use the system, if only because they pay so much into it and get nothing back.

Meanwhile, the lack of open pricing discourages competition on price (obviously). This cartel-like behavior is particularly harmful because many procedures, particularly imaging and blood testing, have very low marginal costs. And routine imaging doesn’t always require expensive new equipment. Cheaper, older machines can deliver more than adequate results.1

In other words, independent providers may have more flexibility on price than patients (or even they) realize, especially for cash payors where insurance overhead isn’t a major cost.

As one reader wrote:

An absolutely crucial fact--that almost no one with conventional insurance even realizes--is that most day-to-day, routine medical tests, procedures, and drugs are very inexpensive. That's especially so in markets like Las Vegas, where I live, where there are many cash-pay customers. A chest X-ray is $23; a standard MRI is about $125; I had a CT scan 2 weeks ago that cost $103…

Of course, there are any number of conditions, medical emergencies, and specialized drugs that are astronomically expensive--that's why we all need some form of catastrophic insurance. But for the day-to-day, routine stuff, the less any 3rd party (insurance company, employer's benefits manager, government, hospital corporation) is involved, the better off everyone is.

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And so we should require transparent pricing for a broad array of routine services — in doctors’ offices, in outpatient and urgent care facilities, in testing labs, even in hospitals where possible. Doing so will encourage price competition. It may also convince some people to start paying for routine services themselves and switch to higher-deductible insurance plans.

Most importantly, it will encourage people to think of routine medical care as simply another service — and help restore their agency over not just health, but the healthcare they consume.

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Another reader put the problem — and the solution — in a larger context:

The core problem in American healthcare is not simply cost. It is complexity, and more importantly, the velocity of complexity.

Rules, reimbursement structures, compliance requirements, coding systems, network rules, and incentive structures change so rapidly that only very large institutions can realistically keep up. Hospitals, insurers, private equity groups, pharmaceutical companies, and large regulatory/compliance infrastructures adapt because they have armies of administrators and lawyers. Independent physicians and patients cannot.

That instability itself becomes a mechanism of control.

Direct physician-patient relationships, transparent pricing, and simple market feedback become harder and harder to sustain because the system is constantly shifting underneath everyone. The result is opacity. And opacity is where fraud, waste, abuse, and rent-seeking thrive.

The public can understand simple ideas:

* transparent pricing,

* aligned incentives,

* direct accountability,

* same rules for everyone,

* and reducing unnecessary intermediaries.

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Implementing four out of those five suggestions would require massive structural changes that are essentially politically impossible in the current system.

But transparent pricing? That’s hard to argue against. That’s at least theoretically possible.

And maybe moving towards it will eventually help drive the rest.

First things first: One week to Father’s Day. I’ll have more to say about THE FATHERHOOD MANIFESTO soon. Your emails have been very supportive, and the great reviews keep pouring in on Amazon.

So don’t wait. Get your copy now, in time for Father’s Day!

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American medicine is a $5 trillion mess that eats anyone who tries to fix it (the knives are now out for Robert F. Kennedy Jr.).

But our healthcare doesn’t have to be this bad. I woke up thinking of 10 ways to improve it. (Yes, this is actually what I woke up this Sunday morning thinking about. I know, I need more hobbies.)

The first two are probably the most popular politically — and the least likely ever to go anywhere. But even the simplest of these would face huge political and economic obstacles. Still, that doesn’t mean we shouldn’t try for them.

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So, without further ado, here are 10 changes I’d make to the healthcare leviathan if I were in charge:

1: Break up local health care monopolies and oligopolies, particularly the “nonprofit” regional and academic hospital systems that have grown spiderwebs around nearly every metro area. Set strict limits on local concentration, recognizing that nearly all health care is delivered locally.

2: Set windfall salary taxes on executives at those systems. These hospitals pay no taxes. They are supposed to serve the public interest, not their executives. If they want to receive the benefits of ordinary charities, they should run like charities.

3: Move to the Danish vaccine schedule for children. Most importantly, end the recommendation for universal Hepatitis B shots at birth. Vaccinations are not public health theater and shouldn’t be treated that way. If a child isn’t at reasonable risk for contracting an illness she shouldn’t have to be vaccinated against it because other children are.

4: Prevent pharmaceutical companies from profiting from any medicine sold under the Food and Drug Administration’s “accelerated approval” program — that is, without proof of clinical benefit. In general, I think accelerated approval is a mistake. “Surrogate endpoints” like changes in the amount of protein a cell produces may or may not actually help a patient feel better or live longer, the changes that actually matter.

But if we are going to allow accelerated approvals, we have to force drug companies to follow through by producing real data proving those benefits. And pharma companies have shown they will drag their feet as long as they are making money from a drug sold under the accelerated program.

5: Begin a long-term program of funding placebo-controlled clinical trials to determine if common minor surgeries are helpful compared to rehabilitation, rest, and waiting. It’s more than surgery for meniscal tears — many surgeries have much weaker clinical evidence than people realize.

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6: End all gain-of-function research designed to increase viral or bacteria transmissibility or dangerousness. Propose an international agreement making all such research a crime against humanity. Covid proved the risks of such research.

Beyond that, Covid revealed the fatal flaws in the theory (propounded by virologists, of course) that virologists need to run such research to determine the dangers of newly emerging viruses. After all, they didn’t predict Covid, or any of the evolutionary pathways it took. We cannot predict how pathogens will evolve in the wild, only respond to them when they do.

Setting a bright line on this issue is particularly important at a time when artificial intelligence tools may give private and non-state researchers a greater ability to pursue gain-of-function research.

If such research must be conducted at all, it should be run in a handful of government-run labs worldwide — no more than one in any country — that are internationally supervised.

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7: End insurance parity between mental health and physical health conditions (except for psychiatric drug treatments that have randomized controlled trial evidence supporting them). I know this one will be very controversial with many of you.

But we have next to no evidence that mental health care works, and the nebulousness of these conditions allows the creation of expensive honeypots like autism behavioral therapy.

8: At a minimum, sharply cut back on drug addiction rehab coverage, which is incredibly expensive, fails to reduce addiction or relapse when it is tested, and actually encourages unscrupulous operators and companies to recycle addicts through programs to survive. Insurance companies should be required to provide one 30- to 60-day rehab every five years; after that the addict or his family is responsible for covering the cost.

9: Allow insurance companies to create and sell inexpensive, high-deductible health insurance products — true catastrophic insurance. This would return health insurance to its roots and make it more like other insurance products; your home insurance covers serious damage to your house, not fixing a faucet.

10: End medical aid in dying programs. When a patient has days or weeks left with a terminal illness, the difference between pain control and hastening life’s end can be impossible to distinguish. (Even then, physicians should be cautious.) Outside of that boundary, doctors should not be in the euthanasia business. The experience of Canada, Belgium, and other countries shows these programs inevitably metastasize.

If people are too afraid to kill themselves to do so without a doctor’s help to make the process effortless and painless, they probably shouldn’t be killing themselves. And doctors — who are in the business of healing —- should not be helping them.

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(Whew! That was 10! Reward yourself for getting to the end with a subscription.)

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So. At least for today, Those are my Top 10 American Healthcare Fixes (TM).

Looking forward to hearing what you think of them — and your own suggestions.

"It's a complete overreaction," Katie Moussouris said of the order that pulled Anthropic's two most capable AI models off the market on Friday. Moussouris, chief executive of the security firm Luta Security, had read the report the government acted on. Citing national security, the United States told Anthropic to cut off Fable 5 and Mythos 5 to every foreign national on earth, including the company's own foreign-born engineers, and to comply the company shut the models off for everyone.

The triggering finding is narrow. A researcher prompted Fable to read a codebase and patch its software flaws, the daily work of the people who defend networks for a living. Moussouris told the Wall Street Journal that the model's output would be of more use to defenders than to attackers, "exactly the kind of prompting that defenders would do." Anthropic says rival public models, OpenAI's GPT-5.5 among them, surface the same minor bugs with no jailbreak at all.

The quarrel behind the order is not new. The Pentagon branded Anthropic a supply-chain risk in March, advisers including David Sacks accused the company of "fear-mongering" and regulatory capture, and officials had pressed it to delay these very models. Commerce Secretary Howard Lutnick's letter arrived on a Friday evening, days before an expected public offering that values Anthropic at $965 billion. Dean Ball, who advised the previous Trump White House on AI, called the order "baffling" and warned that "you should expect to have to prove your citizenship to use Anthropic models."

ITAR and the PGP years.

We have run this experiment before. In the 1990s the government classified strong encryption as a munition under the International Traffic in Arms Regulations and investigated the programmer Phil Zimmermann for letting PGP loose on the internet. The export rules treated mathematics as ordnance, and they failed for a plain reason: the math was already abroad, so the controls handicapped American firms while the capability spread anyway. In 1999 a federal appeals court ruled in Bernstein v. United States that source code is protected speech, and the munitions theory of cryptography collapsed within a year. Peter Girnus, a threat researcher at the Zero Day Initiative, drew the same line to Business Insider, noting that this time "the munition is in the building and the people who made it are not allowed to look at it."

The rule Anthropic asked for.

Anthropic spent the spring arguing for the exact power Washington just used, with one condition on it. In its Policy on the AI Exponential, the company wrote that government should be able to block unsafe deployments through a process that is "transparent, fair, clear, and grounded in technical facts." A letter that withholds its evidence, offers only verbal proof of a narrow jailbreak, and locks out a company's own engineers meets none of those conditions. Recalling a model "deployed to hundreds of millions of people" over a finding this thin, Anthropic argued, "would essentially halt all new model deployments for all frontier model providers."

Make them show their work.

The honest position is not that models are harmless. Some may not be, and the state should be able to halt a genuinely dangerous one. The open question is who decides, and on what evidence. The Pentagon's chief information officer, Kirsten Davies, gave her answer on X: "Some things are simply more important than revenue cycles, clickbait, and pre-IPO valuation. America First. Always." That is a political standard, set by an antagonist in an ongoing fight.

A standing board would answer on different ground.

Seat AI researchers, security scientists, ethicists, and constitutional lawyers on it, wall it off from the administration of the day, and swear its members to the Constitution rather than to any Secretary. Give it the evidence in writing and let it rule in the open, on the technical record, with reasons a court could read. A body like that could still have pulled Fable, had the facts demanded it. The country would know why.

The government may take a tool away from the world. It should at least have to show its work.

Marcus Schuler

San Francisco

Editor-in-Chief and founder of Implicator.ai. Former ARD correspondent and senior broadcast journalist with 10+ years covering tech. Writes daily briefings on policy and market developments. Based in San Francisco. E-mail: <a href="mailto:editor@implicator.ai">editor@implicator.ai</a>

The U.S. military has likely been quietly broadcasting codes for its global encryption network using public GPS for nearly 20 years, turning each satellite into a hidden “numbers station,” according to Steven Murdoch, an information security expert, who detailed his findings in a new article in Inside GNSS.

That means every device that uses GPS has been receiving hidden government information for years, and nobody outside the military knew it until now. 

Murdoch, a professor of security engineering and head of the Information Security Research Group at University College London, presented evidence that a 176-bit GPS sequence labelled “Subframe 4, Page 17” is encrypted material from the Pentagon’s Over-the-Air Distribution (OTAD) network, which delivers cryptographic keys to military personnel around the world.

“I think the evidence that it's for key transmission—for use in distributing the keys for accessing the military GPS signals—is pretty strong now,” Murdoch said in a call with 404 Media. He noted that the military has “specialized receivers that have the ability to have keys loaded into them” and “presumably have the ability to decrypt these special messages.”

In his new article, Murdoch described how this “forgotten 176-bit slot in the world’s most successful navigation signal turned out to be its quietest and most consequential broadcast.”

Murdoch first spotted the sequence more than a decade ago while he was a graduate student tasked with writing a decoder for raw GPS data while working on a project funded by the European Space Agency.

“I noticed that there was this random-looking data present in the subframe,” he recalled. “I looked at the specification, and thought that was a little bit unusual. I recorded a bunch of it to look for any obvious patterns, but that wasn't the main role of the project, so we moved on.”

From the beginning, he suspected that the subframe field contained encrypted transmissions because the data was so random. “Random data is actually very unusual to get in nature,” Murdoch said. “If you see it, either it's been carefully designed to be random—but then, why is someone sending out random data?—or it's encrypted data. I thought encrypted data is by far the most likely explanation.”

He returned to the subframe on and off over the years, and solicited guesses about its content on Stack Exchange in 2023. Ahmed Kamruddin, a master’s student at UCL, developed the project further in 2025. Then, this year, Murdoch put the last pieces of the puzzle together over several weeks by analyzing open archive Global Navigation Satellite System (GNSS) recordings collected since 2007 and kept by GFZ Helmholtz Centre for Geosciences.  

This dataset included more than 12 million observations of Subframe 4, Page 17, yielding 3,994 unique 176-bit messages. Within this corpus, Murdoch pinpointed key-repeating “sentinels” including a pattern that appeared in February 2010 and was broadcast on and off across dozens of satellites for more than a decade. 

Murdoch discovered that this particular sentinel was transmitted by all 31 operational satellites within a window of a few hours on May 26, 2011, potentially heralding the activation of a new operational system. He confirmed that this timeline coincided with the rollout of the military’s Over-the-Air Distribution (OTAD) and the Over-the-Air Rekeying (OTAR) by cross-referencing declassified documents, including a 2015 presentation about the dates of the operation. 

“There was a perfect match between the timeline and that presentation and the change points that were automatically identified from the data,” Murdoch said. “That was the smoking gun that made me think: This is what it's for.”

These automated systems replaced the cumbersome manual distribution of cryptographic keying material, allowing military GPS receivers around the world to be rekeyed remotely through satellite broadcasts rather than through onsite procedures.

For the next 11 years, this expansive rekeying operation was overlooked in public GPS data. In 2022, the system entered a new phase, according to Murdoch’s analysis. The shift was characterized by a slowing in the message rotation rate. Later, in December 2023, broadcasts carrying a distinctive "TEXT" prefix emerged then gradually spread across the constellation.

Murdoch isn’t sure what explains the recent transition, though it could be a possible modernization of the infrastructure or the introduction of a new protocol. But to him, the bigger takeaway is that the signals were always available for anyone willing to take a closer look, a discovery that suggests that there could be more revelations hidden for the cryptographically curious among us.

“Every receiver in the world decodes Subframe 4, Page 17,” Murdoch said in his new article. “Almost none of them have ever looked at it. The lesson generalizes: There is more to learn from the bytes already arriving at our antennas than from the bytes we wish were specified differently. The data are publicly available. The signal is overhead, twice a day, every day.” 

“Every GPS satellite is a numbers station,” he concluded. “The receivers were always listening. We just had not been.”