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Dr. Schwartz,

I have been following your writing for a while now and relate to most of what you say. I keenly follow the healthcare space and have been searching for answers for the last 7 years as the Founder/CEO of a health tech startup. While there is no shortage of opinions from clinicians like Dr. Dorn, Li, Walker, etc (and my wife who is a physician leader at a large NYC health system) and non-clinicians, I have yet to come across a discussion on the root cause of the current state. So hear me out!

The health system is simply not set up for handling the volume it currently supports. The fundamental process of diagnosis and treatment involves too many steps, each of which consumes time and effort. For healthcare to improve the number of patients treated by the system needs to reduce by 80%. Imagine how much better the system would serve the remaining 20%. We have no one to blame but ourselves. Until we as individuals take responsibility for our own health, we will fail the 20% that truly need the system as it stands today.

We have convinced ourselves that our actions have no consequences. An unhealthy diet and no exercise which leads to elevated BP, cholesterol, A1C all can be treated with taking a pill. GLP1 makes it worse. Little or no exercise leading to MSK issues can be easily fixed with joint replacement, etc. You get the point. Most pharmaceutical intervention is designed to treat our poor choices. So why bother, surely it is not my fault that my own health is poor. Everyone else is to blame except me is the prevailing attitude. Hence if my BP is elevated, I end up consuming scarce healthcare resources in terms of the doctor’s time, diagnostic lab tests and eventually hospitalizations. This takes away resources from the 20% of the population who really need it.

No amount of efficiency improvement, AI or other future technologies can keep up with the increased demand for the current health system. Imagine if you were stuck on a desert island but magically had access to your own health condition. If you knew for sure, there is no access to any pharmaceuticals or health professionals, I am sure most people would figure out how to keep themselves healthy. These same people, when they are in the real world, have no compunction in lining up for a doctor’s visit at the first sign of discomfort.

This lack of self-responsibility extends to other spheres beyond healthcare. By nature, we tend to look outwards before introspection. This is also fundamentally why religion and philosophy have done little to elevate the human condition. For example, Buddha clearly diagnosed the problem of human suffering, but his prescription has little or no chance of succeeding because it is not for the faint of heart.

I am still waiting for the pill to attain nirvana! In the meantime I will keep myself distracted with technology and process improvement, payment models, VBC, etc.

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