A former GLP-1 telehealth startup founder analyzes how customer acquisition costs consume roughly two-thirds of patient payments, with Meta and Google capturing ad spending from primarily uninsured, low-income patients. The business model mirrors failed DTC subscription companies like Blue Apron and Casper, but telehealth faces unique structural barriers—regulatory restrictions on drug marketing, commodity products, insurance gatekeeping, and short retention—that eliminate traditional escape routes from the acquisition cost trap.