Presented by Commons Clinic
The healthcare system isn’t broken—it’s operating exactly how it was designed.
This common refrain gets to the heart of why healthcare change and innovation are so difficult. It’s not just a matter of improving efficiency and value, it’s a matter of redesigning processes from the ground up.
Few people understand this better than Health Rosetta’s Dave Chase, our guest for this latest edition of The Surgeon’s Record webinar.
Dave, also Health Rosetta’s co-founder and CEO, is one of the most influential voices in healthcare transformation today. If you’ve spent any time in the world of health benefits, value-based care, or employer-led innovation, you’re probably familiar with his work.
Health Rosetta isn’t just another high-minded ideal, it’s a practical blueprint for designing a new and better system. In our conversation, Dave shares the story behind his journey, the systemic issues plaguing American medicine, and—most importantly—a path forward. What follows are the key insights from our discussion.
Key Insights from Our Conversation with Dave Chase
1. From Microsoft to Mission-Driven Medicine
Dave’s path into healthcare wasn’t necessarily intentional—it began as a consulting assignment and became a calling. His time spent building Microsoft’s healthcare business shaped his perspective on medicine’s weak points. After a 10-year career break from healthcare, a friend’s crushing experience with the healthcare system left Dave thinking there must be a better way. Health Rosetta was born from a desire to realign healthcare with its true purpose: better outcomes, lower costs, and healthier communities.
2. Why Healthcare Is "Working as Designed"—and That’s the Problem
One of Dave’s core insights: our healthcare system isn’t broken—it’s operating exactly as it was built. Today’s approach to healthcare is analogous to using rotary phones and landlines in an era of smartphones and cloud computing. Dave argues that health plans are the “operating system” of healthcare—one that’s in desperate need of an upgrade and a different set of assumptions.
3. Health Rosetta’s Blueprint for Fixing American Healthcare
Rather than focusing on theory, Dave has spent the last decade identifying real-world, reproducible solutions. The Health Rosetta framework is built around community-driven health plans, value-based primary care, and transparent pricing. He shares compelling examples of employers and local governments cutting costs by 30–50% while improving outcomes—proof that transformation is already happening.
4. Stolen Wage Gains: Middlemen v. The Middle Class
Dave succinctly describes how the current system thrives on unnecessary care, inflated prices, and administrative bloat. We talked about how middlemen insert themselves between the patient and care and how health benefit profiteers have stolen 30 years of wage gains from the middle class. True reform means confronting these perverse incentives and creating a virtuous cycle, not a destructive one.
5. The Role of Clinicians in Reclaiming the System
Dave believes clinicians must reclaim their role—not just as caregivers, but as system architects. From direct primary care doctors to orthopedic surgeons rethinking care delivery, the movement toward physician-led models is growing. If doctors don’t lead the transformation, others will—and patients will continue to lose.
6. A More Hopeful Vision of the Future
Despite the dysfunction, Dave is optimistic. He’s seen what happens when smart, mission-driven people get fed up with the status quo and say “enough.” Through companies like Health Rosetta and Commons Clinic, patients and physicians now realize there’s an alternative to the extractive system. By honoring doctors, nurses, and patients, these alternative approaches provide the tools to do what is reasonable—a simple but powerful concept.
I learned a lot from my conversation with Dave. One particularly shocking stat from our conversation: Since 2000, wages have gone up 100%...but insurance premiums have increased over 300%.
But there’s reason to hope. According to Dave, the direct care market is now bigger than the textile industry and outpaces videogame sales. He sees a future where community-owned cooperatives keep care local, open, and independent.
Dave is optimistic about the future of healthcare. He envisions a system that honors clinicians and patients, allowing us to evolve from an extractive system to one that “just does what is reasonable”—a simple, yet powerful concept.
Ben Schwartz, MD, MBA
Editor-in-Chief, The Surgeon’s Record
Commons Clinic Senior Clinical Fellow
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