Jun 1, 2023 · 34m · american-optimist
Ep 60: Dr. Rebekah Gee & Nest Health Are Saving Lives by Reinventing In-Home Care · Joe Lonsdale
gold bands on the timeline = statements, start to end. Hover to read, click to jump. CC turns on captions
In this episode of American Optimist, host Joe Lonsdale interviews Dr. Rebekah Gee, founder of Nest Health and former Louisiana Secretary of Health, to discuss reforming U.S. healthcare through in-home family medical care and value-based policy innovation. Dr. Gee shares insights from her pioneering health policy work and details how Nest Health delivers proactive primary care directly to Medicaid-covered families.
How this conversation actually went
Every chapter scored 0–10 on four independent dynamics. Hover any point for the reasoning behind the score. Joe holds 24.8% of the talking time here. How this is scored →
speaking balance: gold is Joe, purple is the guest (3 minute bins)
When Lonsdale suggests that healthcare models should incorporate life coaching and cultural guidance, Gee reframes the issue around fundamental unmet needs like hunger and basic stability.
Hardest push from Joe ▶ 10:13 Insisting on competition to provide healthcare floorsWhen Gee suggests a national floor system like expanded Medicaid, Lonsdale interjects to insist that private market competition must be the mechanism delivering that floor to ensure efficiency.
Biggest teaching moment ▶ 10:51 Lobbyist ratio in state healthcare policyGee educates Lonsdale on the immense power of special interests by revealing that pharmaceutical companies hired three lobbyists for every single state legislator in Louisiana.
Joe holds their own ▶ 22:06 Lonsdale synthesizes value-based shared savings mechanicsLonsdale demonstrates sharp financial fluency in healthcare by breaking down the contrast between fee-for-service hospital monetization and value-based shared-savings structures for whole families.
the scores for every segment, with the reasoning behind each
| Chapter | Topic | Joe as informed peer | Guest teaching | Guest disagreement | Joe pushing back | Why |
|---|---|---|---|---|---|---|
| American Optimist Title Sequence | 4 | 1 | 0 | 0 | Lonsdale introduces Gee's extensive career in Louisiana state health and hospital management. Gee warmly shares anecdotes about her upbringing and public service background in a collaborative exchange. | |
| Tackling Drug Pricing and the Hepatitis C Initiative | 4 | 5 | 1 | 1 | Gee details her pioneering work on emergency contraception access and the subscription-based Hepatitis C drug pricing model in Louisiana. Lonsdale actively prompts her on the math, state budget implications, and political negotiations involved. | |
| Structural Challenges and Transparency in U.S. Healthcare | 5 | 5 | 2 | 2 | Lonsdale questions why healthcare productivity is dropping, emphasizing competition and cronyism. Gee explains state-level zero-sum budgeting constraints, lack of surgical outcome transparency, and intense pharma lobbying. | |
| Nest Health's Whole-Family Care Model and Impact | 5 | 5 | 1 | 1 | Gee describes the operational realities of treating Medicaid mothers and children at home in one comprehensive visit. Lonsdale links the model to preventive healthcare paradigms and probes into maternal and child clinical outcomes. | |
| Economics of House Calls and Incentive Alignment | 6 | 4 | 0 | 0 | Gee explains Romer's law and how post-war hospital infrastructure created fee-for-service facility billing incentives that destroyed house calls. Lonsdale articulates the value-based shared-savings economics required to reverse this trend. | |
| Innovating in Medicaid and Scaling Nest Health | 5 | 4 | 1 | 1 | Gee outlines the challenges of Medicaid innovation and explains how proprietary closed-cohort algorithms allow them to target unmanaged populations without threatening hospital patient volume. Lonsdale explores payer partnerships and scaling timelines. | |
| Venture Capital, Founder Diversity, and Social Sector Reform | 6 | 3 | 1 | 1 | Gee advocates for venture capital backing domain experts over typical tech founders to tackle systemic public problems. Lonsdale and Gee strongly agree on aligning for-profit market incentives to scale social and criminal justice reforms. |