A lot of U.S. health care is genuinely first-rate, and that’s worth saying plainly. The best hospitals in the world are here and medical innovation moves faster than almost anywhere. That’s the real reason big changes are so hard to make: nobody wants to break what’s working to fix what isn’t.
Well Designed starts with this acknowledgment, then asks: what would it take to lower costs, raise quality, expand availability, and make health care easier to navigate? Every system produces the results it’s designed to get. This is a quest to find a better design, and to test whether it’s one people would actually want.
I've seen the US healthcare system from a few different seats: as a hospital director at a top ten U.S. hospital, as a member of the research staff in the Office of the Chicago Mayor, and inside high profile health tech, including on the initial leadership team at Datavant and leading global business development at Allscripts. That last chapter is where I watched technology make the system faster and cheaper to run, sometimes dramatically so.
I have high conviction that software opens up the potential for lower costs and higher quality, but it doesn’t fix incentives. Good incentives make technology produce better outcomes; bad or mixed incentives make it produce outcomes that are neutral at best. Entrepreneurs build to the incentives that exist, that’s what building a business means, so getting different outcomes starts with asking whether the incentives themselves should change.
Before health tech, I studied public policy and business at the University of Chicago, where I heard plenty of genuinely good reform ideas. Some happened: Operation Warp Speed proved the system can move fast when incentives align. Many still haven’t: ending the tax deductibility of employer health benefits keeps getting proposed and keeps getting shelved.
How a system is organized often matters more than the technology inside it. Netflix didn’t beat Blockbuster with better video technology, they used the same DVD media, but reimagined the experience. I think health care has a Netflix moment ahead of it too, if the industry allows more creativity in how care gets priced and packaged.
Each episode puts one question to a policy thinker, technologist, entrepreneur, academic, system insider, or someone who tracks public opinion: what would it take to ___? Sometimes we’ll zoom in on something already happening. Sometimes we’ll discuss opportunities that need a state or local fix, and sometimes even an act of Congress. A better system will produce a better future. Let’s find out how to build it.
