Poster here -- I do understand why it's broken, that's why I've set out on this journey over the past few years. I've been the CEO of a tech company that had $800M of borderline fraudulent healthcare claims processed in 2015 on our software (Yes, the FBI & OIG are aware of this). I had a bird's eye view into many PBMs and their shady business practices. I've watched corrupt doctors milk millions out of insurance companies. I've seen the problem firsthand and now I have the solution.
It comes down to how we pay for healthcare. When you put for-profit corporations in the middle of the healthcare experience, perverse incentives and negative influences take place on both sides of the equation. For these for-profit corporations to make a greater profit, they reduce the amount they want to pay doctors and reduce the amount of procedures they will cover for patients. Whoever thought this was a good idea?
And the answer out of this mess involves a whole lot of techno fixes. Have you seen how fast AI is progress in healthcare? 250,000 people die each year from human medical errors. Doctors prescribe the wrong meds, nurse types the wrong orders in, someone doesn't check for drug interactions, etc. -- this can all be backed up and verified by an AI. That's just one techno fix.
Where the real fix comes into play is with blockchain technology. This is something I've been following since bitcoin was $0.02 so it's not new to me. My idea is for a decentralized, crowdbased funding & governance platform built on the blockchain that pools money together to pay health providers directly and instantly. I'm taking the direct care model and applying it to all of healthcare. (If you don't know about direct primary care, please google it for more info. I would call it subscription-based healthcare and it's sweeping the nation.)
I won't get into detail about the blockchain's promises, and I know there is a long way to go before this all happens, but I will say that I truly believe blockchains will transform the underpinnings of societies.
Not everything will be solved by tech, though. There are social dynamics in play with my idea. Just like Uber became the largest taxi company without owning a vehicle and Airbnb became the largest accommodation provider without owning any real estate, my idea will be the largest health organization without owning a single hospital. The sharing economy has been resurrected into a better alternative to our current corporate structure.