The System Works

For the last 20 years or so I've thought about what retirement might look like. 

In retirement, I'd go back to school and write a thesis on... I didn't know what to call it. The "Medical Industrial Complex?" Much of this was due to the many, many, many interactions as it relates to Kate. 

"I'll go back to school, do the research, get my PhD." Mostly so I could participate in Spies Like Us shenanigans: Doctor. Doctor. Doctor. Doctor.

I had this gut feeling that something was...broken; none of it made sense. 

When I didn't have insurance, $115 copay. When I did have insurance, $400. 

As a consultant/contractor, I understood how we measure things in time; n dollars/hour. 

OK, so Doc is $115 x 4 (because it may have been 15 minutes, I'm being super generous here), how is it now $400 x 4/hour? How in the hell does handing over a piece of plastic turn a $460/hr rate into $1,600/hour?

I'm (often) told I need a hobby. Outside of work. What many don't realize is that I'm one of the fortunate ones; what I do for a living is not work.

Choose a job you love, and you will never have to work a day in your life. Or whatever that phrase is. 

So, one Sunday, a few weeks back, I set Antigravity (Gemini) loose on my idea. I just told it: "I have an idea I want to explore."

I didn't expect a book. I expected a conversation. But what happened over the next few hours was the mechanical equivalent of defining the schema for 20 years of observations. I threw two decades of "gut feelings" at the machine, and it started mapping the plumbing. Before I knew it, I had a 23-bullet outline and links to 50-75 outside sources.

"Fully fleshed out, how long would this be?"

"350-400 pages."

"OK, let's pare that back"

Gemini proceeded to suggest serializing it on Substack or just going with an abbreviated manifesto.

I chose the manifesto. We pared it down to 8 dense chapters. It wrote the Intro. 

What...do I...OMG...this is...wow. 

If you spend enough time listening to patients, doctors, or politicians, you will hear a single, unifying complaint spoken across every demographic and tax bracket in America:

The healthcare system is entirely broken.

It is the one rare diagnosis found across every boardroom, breakroom, and waiting room in the country. They point to the soul-crushing administrative bloat that forces practitioners into eight-minute volume appointments. They point to the labyrinthine "prior authorization" processes where algorithms deny life-saving treatments.

And yet, this frustration is born entirely from a profound paradox.

If you strip away the billing departments and the insurance mandates, the actual clinical engineering of the American medical system is nothing short of miraculous. If you are diagnosed with a rare leukemia, or require an unprecedented cardiothoracic intervention, there is quite literally nowhere else on earth you would rather be. The United States produces the most advanced, precision-engineered medical science in the history of human civilization. The people executing that science—the physicians, the bio-engineers, the surgical staff—are elite.

That is not the original, but you get the idea. I spent time reading and editing that introduction, changing the tone, the focus, where I ended up creating a GUIDING_PRINCIPLES.md file to keep it inline:

• Dissect the Maze, Don't Indict the Mice
• Empathy for the Inheritor
• No Emotional Accusations, Only Systemic Mechanics
• Labels are "Pre-Written Baggage"
• Bypass Over Bureacracy

Super cool. A few iterations later, I had an Intro. On to Chapter 1. Same process. Edit for tone and clarity, but otherwise let it loose. Chapter 2, same. After Chapter 2, I just let it rip. By the end of that Sunday session, maybe 5 hours, I had a 40 page "book."

Over the next couple of days, I'd spend 30-60 minutes creating cover and chapter art (with Gemini web).

On Wednesday I had reached my quota for the month, the $20/month plan would reset on 4/11 (Saturday). 

I was exploring publishing options, I've always wanted to be a published writer (as I type that, I realize there are north of 800 articles here, so...). 

But like that, that specific itch was gone. I did not revisit on Saturday. I did share with friends and colleagues. I solicited feedback. I began to incorporate feedback and also track who provided what feedback. 

Fast forward a month, and I came head to head with this system again. It was unpleasant to say the least. 

Now, however, I was armed with new tools. The system hadn’t changed, but I could finally see how it moved; where the paths were, and why people kept ending up in the same places.

The Death of the API Barrier: From Jargon Intimidation to Result Sets and AI

If you were a database guy in the early 2000s, APIs didn’t exactly show up with a gift basket and a smile.

They showed up as these massive, scary-looking blocks of XML that people called SOAP. Or maybe it was a WSDL? Honestly, I could barely spell those acronyms, let alone tell you what they were supposed to do. I didn’t have a Computer Science degree, and looking at those files felt like I’d wandered into a high-level physics lecture by mistake.

I was brand new to IT, and the whole "web service" thing was just...intimidating. It felt like a club I didn't have the password for. I didn't know how they worked, I didn't know why people liked them, and I certainly didn't want to admit I was lost. So I did what anyone does when they’re staring at something that makes them feel out of their depth: I retreated to safety.

I stayed where things made sense. Tables. Sets. SQL and PL/SQL. Logic sitting right next to the data where it belongs. I could look at a table and understand it. I could write a query and get a result. The database was my safe harbor in a storm of jargon I didn't understand.

That bias stuck with me for a long time. 

REST Didn’t Fix the Mindset 

Fast forward a decade. SOAP was finally out of fashion (h/t to everyone who survived that era). REST and JSON were the new hotness. We were told this was "better." And structurally, sure, it was. 

A few years back, I poked around with a Strava app to see if I was just being a crank. Clean endpoints. JSON payloads. Reasonable docs. 

And it was still exhausting. 

Not because REST was inherently bad, but because the underlying mindset hadn't shifted an inch. I was still being handed "object-shaped" payloads and expected to navigate an object graph like a tourist without a map. Nested structures. Lists of things containing lists of other things. Manual parsing until my eyes bled. 

That wasn’t a data problem. It was an OO worldview leaking all over my integration boundary. I wasn’t getting result sets; I was getting objects pretending to be data. 

PL/SQL Was Already the API (We Just Forgot) 

Here’s the part that often gets missed: PL/SQL has always been the API. 

A PL/SQL procedure returning a ref cursor isn't some low-level implementation detail. It’s a contract. It’s the database saying, “Here is a defined shape of data. Consume it as a set.” 

That distinction matters. 

A result set is declarative. It’s complete. It has no behavior, no lifecycle, no implied navigation path. It just is. Objects, on the other hand, carry all this baggage about how they want to be used. They imply traversal, ownership, and state transitions. 

One is about truth. The other is about interaction. Most APIs were designed by app devs, so they expose objects. Not data. 

It's probably why I loved APEX so much. It didn't ask me to pretend my data was a "user object," it just asked me for the query.

AI Is the New Translation Layer 

What finally broke the barrier for me wasn't some breakthrough in REST design. It was AI.

Today, I don't waste my life manually mapping JSON payloads into structures. I don’t read API docs line-by-line trying to guess where the edge cases are hiding. I just hand the spec to the machine.

My workflow is now dead simple:

1. Grab the API key. 
2. Stash it in the system keychain. 
3. Give the spec to the AI and let it do the grunt work. 

Pagination, retries, flattening, normalization; the machine handles all the deterministic boring stuff. What I want on the other side isn't an object model.

I want result sets.

Give me the rows and columns. Give me something I can join, constrain, and reason about at rest. 

From OO Friction to Set-Based Speed 

Once that API output is normalized into a set, the friction evaporates. 

I stop worrying about endpoint "shapes" and start thinking about data quality. I stop writing glue code and start defining truth. This is where PL/SQL shines. It doesn't want you to think in objects; it wants you to think in operations over sets. It wants logic close enough to the data that violating a business rule is actually difficult.

APIs that dump object graphs on you fight that model. APIs that deliver result sets fit into it like a glove. 

APIs Are Just Addresses 

If you look at it the right way, APIs aren't applications. They're just addresses.

A table is one physical address. A view is another. A remote API endpoint is just a slightly more annoying address. The "brain"—the business definition—doesn't live at the address. Neither does the "brawn" (the execution).

Those belong in a stable, declarative core. For me, that’s still the database.

With AI translating API specs into tabular, set-friendly forms, external APIs finally behave like first-class data sources instead of OO intrusions. 

The New Era of Data Integration

For a long time, integrating with external APIs felt like a chore because it forced us to abandon our set-based mindset. We were stuck parsing hierarchies instead of querying data. 

That manual struggle is over. 

With AI acting as the translation layer, we can finally overcome that old "impedance mismatch" between objects and sets. We can normalize the world's objects into the sets we need to build real applications. The "API barrier" has turned into a bridge. We can stop worrying about the shape of the payload and get back to what we do best: defining the truth of the data.

AI Didn’t Know the Law. It Made the Path Visible.

How I finally appealed a denied insurance claim

Kate (now 21!) had dental surgery on 12/01/2025, a 4-5 hour procedure.

I don’t pay much attention to insurance stuff because it’s overwhelming. Before I joined my current company, it was also genuinely hard and expensive. Every day I’m grateful for my employer's coverage and, by extension, the generosity that makes it possible.

Kate has had 3–4 major dental surgeries over the last couple of years. She doesn’t technically qualify as “hillbilly” yet. Her dentist says that’s eight or fewer teeth. 😆

Kate also requires general anesthesia. 

Dental surgery is not cheap, which means I know the exact limits of our dental coverage: $2,500 per year. Her most recent surgery came in just north of five figures. Thankfully, Kate has Medicaid as secondary insurance. Less thankfully, her dentist, who is excellent, no longer accepts Medicaid. 

About a month later, another bill arrived. This one was for anesthesia. It was roughly half the cost of the surgery itself. Sigh. 

I called the anesthesiologist’s office and learned they didn’t have Kate’s current insurance information. I gave it to them and asked them to resubmit the claim. They did. Denied. Denial code: 001. 

This is classified as dental work, so medical does not cover anesthesia. I think. 001 isn’t super descriptive, it says:

We denied this service. Your benefits don't cover this kind of care. You can check your plan documents or go to the Benefits section of our website for a searchable list of what's covered.

Not super descriptive. AI (Gemini CLI) to the rescue. I downloaded the EOB and asked Gemini to scan it. It did and came back the above so I asked if it there were any other reasons possible?

While the document itself doesn't provide a specific medical rationale beyond the generic reason code 001 ("Your benefits don't cover this kind of care"), we can infer a highly likely explanation based on Kate's profile and typical insurance practices. Given that Kate's diagnosis is Developmentally Disabled, the most common scenario for an automatic denial like this is:

The Underlying Procedure was Dental: It is very common for special needs individuals to require general anesthesia for routine dental work that a neurotypical patient might do awake. Because routine dental care is generally excluded from medical plans, the automated claims system will automatically deny the associated anesthesia as "not covered care," even though the anesthesia itself is medically necessary due to her disability.

“Kate’s profile.” That’s a reference to other AI work I’ve been doing trying to make my life just a bit easier handling all the bureaucracy surrounding her (Guardianship, SSI, etc). My next prompt was, “How do I appeal?”

This is where it gets super fun and unexpected. With that other context, “Kate’s Profile,” Gemini’s first response was:

I will research Florida's specific legal requirements for anesthesia coverage for individuals with developmental disabilities and provide the exact steps to file the appeal with the insurance provider.

It came back with this:

✦ To appeal this denial, you need to challenge the automated determination that the care is "not covered." Because Kate has a developmental disability, Florida law likely requires them to cover the anesthesia and facility charges, even if the underlying procedure (like dental work) is not normally covered. 

The Strategy: Use Florida Law
Florida law mandates that health insurance policies must cover general anesthesia and associated hospital/facility charges for dental procedures if the patient meets specific criteria. Since Kate is over age 8, your appeal will rely on:

Statute: Fla. Stat. § 627.65755

The Argument: Kate has a developmental disability (as noted in her profile.json) that creates a "significant or undue medical risk" if dental or minor medical treatment were performed without general anesthesia in a controlled environment.

This isn’t an example of AI “knowing the law.” It’s an example of AI making a path visible that was previously opaque enough to stop me from trying. 

This is the second time in as many weeks that it has helped me overcome a bureaucratic hurdle that usually stops me from pursuing a thing. The last time, it helped me transfer Kate’s Conservator Payee (SSI) from my mom to myself. My mom handled it previously because I would not engage with that labyrinthine system. She’s retired. It took her 10 months. I’m ridiculously grateful and lucky. 

If you’re looking for ways to utilize AI, here’s another. 

*Editor's Note

I posted this internally a few weeks back. I'm slowing making my way back out into public waters. 

It's Been a Minute...

 

Hi.

It's been a while. 

Not sure if this is a one-off or not, but I'm going to give it another go. I miss writing (publicly).

Like, this is super awkward. "What do I say?"

"How are you?"

"Things are good."

"How are you?"