healthcare is having its top deck of the titanic moment what happens in the next year will define the next century of american healthcare, and basically everyone is ignoring it. here’s the real story: View Tweet
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Healthcare has been defined by four factors:
- Extremely limited supply (MDs are scarce and costly).
- Principal-agent problem with payments (your insurance pays, not you).
- Inelastic demand and high trust (you need it and have confidence in it).
Regulatory capture. View Tweet
this has allowed the industry to behave in incredibly weird ways cost can constantly grow, patient experience can constantly degrade, and clinics will still fill up with waitlists. because patients trust it, need it, aren’t paying for it, and have no choice. View Tweet
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In the last years, we’ve seen all four of these factors shift
Supply is expanding. Its hard to imagine a world where 90%+ of care isn’t LLM assisted within the decade— after years of getting brutalized by EMRs, we’re close to MDs having technology leverage View Tweet
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As commercial insurance degrades, patients shift from a payor/PCP-centered model to an army of online telemedicine services for each and every condition they might have. This ends with Amazon being your doctor and pharmacy (cash please, no insurance welcome here) View Tweet
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Patients have lost trust in the system. This begins with the medically assisted gutting of America with opioids, continues through the pandemic, and the horrible experience in clinic today. The answer is not patients demanding better, its patients exiting entirely. View Tweet
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FDA continues to be slow to regulate new methods of care that blur the line between medical/non-medical. Pill mills and other online cash for Rx schemes are allowed to operate for years, while patients increasingly ask for non-medical “health optimization” View Tweet
The pieces of the stack that have existing regulatory entrenchment (EMR, etc.) are even stickier than they’ve ever been. When the agency moves slow, it has the effect of allowing capture to persist and entrench to absurd degrees. There is no world where we untangle these. View Tweet
Yet, I just spent the last month bouncing between various healthcare conferences and the party goes on. We have free, physician quality, artificial intelligence inbound and the most interesting question the industry can ask is how can this automate the fax machine View Tweet
No one seems to /actually/ believes that change is coming— the most confident seem to believe that physician scribing will get more efficient if we pour another billion dollars into it. No one is reckoning with the fact that the fundamental patterns of care will change View Tweet
In every case, technology excels at making new firms more efficient than incumbents, setting a higher standard for them to catch up to. Technology struggles to elevate legacy firms to a level that exists beyond their industry. Failure becomes the default and expected outcome. View Tweet
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Technology has been a mess in healthcare because:
- Technology firms overpromised/underdelivered underbaked solutions without understanding pre-existing workflows.
Healthcare firms saw their peers trying to adopt and failing with technology, so they safely ignored it. View Tweet
In a world where there is no supply side competition (no net new entrants)— this is a perfect strategy. the issue is this is no longer the case, patients are now building an alternative medical system to the side of the traditional one with incredible demand. View Tweet
In the next 24 months, we will see hundreds of novel care schemes pop up that look unlike the healthcare system we are used to. These will be cash pay, often legally gray, and likely mostly LLM assisted. They will provide a better, cheaper, and faster option. View Tweet
