An Upside-Down Future for Healthcare

I find myself thinking about the future a lot, in part because I’ve somehow accumulated so much past, and in part because thinking about the present usually depresses me. I’m not so sure the future is going to be better, but I still have hopes that it can be better.

Two articles recently provided some good insights into how to think about the future: Kevin Kelly’s How to Future and an except from Jane McGonigal’s new book Imaginable: How to See the Future Coming and Feel Ready for Anything―Even Things That Seem Impossible Today that was published in Fast Company.

I’ll briefly summarize each and then try to apply them to healthcare.

Mr. Kelly — a founding Executive Editor of Wired (and now “Senior Maverick” there), editor/ publisher of Cool Tools — posits that futurists need to look at the past, present, and future. “They look carefully at the past because most of what will happen tomorrow is already happening today,” he notes. “The past is the bulk of our lives, and it will be the bulk in the future.”

As for the present:

It is often said that most futurists are really predicting the present. It turns out that the present is very hard to see…So a good futurist spends a lot of time trying to decipher the present and to try to see it through the mask of present-day biases…I sometimes think of “seeing the present” as trying on alien eyes; looking at the world as if I were an alien from another plane.

As for the future, he says, “I find it helpful to unleash the imagination and trying to believe in impossible things…there is an art to believing in impossible things well. It’s more like being open to possibilities, to listening to what is possible.”

Mr. Kelly suggests trying to picture the “history” of an imagined future, the steps required to get to X in year YYYY, so that we can understand “What kinds of technology and laws and social expectations needed to be in place year by year in order to arrive at that state.” However, he warns: “Most important, the main job is to think about the consequences of X arriving. What would we do if X was true? How do we manage it? How do we regulated it? How does it change us as humans?”

Dr. McGonigal — a game designer, Director at The Institute for the Future, and co-founder of health app/game SuperBetter — shares five tips for imagining the future:

Take a Ten Year Trip to the Future: “Ten years because that is enough time for society, and your own life, to become dramatically different. It’s enough time for new technologies to scale up and achieve global impact. It’s enough time for social movements to achieve historic victories. It’s enough time for big new ideas to take root, gain traction, and change the world.”

Be Ridiculous — At First: “Any useful statement about the future should at first seem ridiculous…We need to prepare our collective imagination for “unimaginable” possibilities…If something feels unimaginable, that’s the tip-off that it is an essential future to start thinking about.”

Look for Clues: “To find future clues, you need to develop a way of observing the world in which you spot weird stuff that others overlook. You must constantly home in on things you haven’t previously encountered, things that make you say, “Huh…strange,” and “I wonder why that’s happening.”

Turn the World Upside-Down: “If your imagination feels stuck in the present, then rewrite the facts of today. Make a list of up to a hundred things that are true today, then flip them upside-down…Turning the world upside-down can help clarify what changes you want in society and your own life.”

Build Urgent Optimism: “Urgent optimism is a highly motivating, resilient mindset made up of three key psychological strengths: mental flexibility, realistic hope, and future power.’

In healthcare, the past is, for better and for worse, always with us. For example, the central role of hospitals and doctors is certainly over a century old, that of pharmaceutical companies almost that old; the pervasive presence of employer-provided health insurance goes back to the 1940’s and that of Medicare/Medicaid to the 1960’s. None of them seems likely to go anywhere anytime soon.

The present of our healthcare system is, as Mr. Kelly warns, is harder to see. It has proved dangerously fragile in this pandemic. It never has offered equal care, or even equal access to care, to everyone. And, most scary of all, in 2022 it turns out that we still don’t know if most medical treatments work, much less cause harm.

It’s not a “system” in any meaningful way, and I’m honestly hard pressed to think of for whom it works well; even the people getting ridiculously compensated by it complain. “Alien eyes” looking at it might not even recognize it as health care, especially considering we keep paying more and more yet are increasingly in worse health.

So we need to think of ridiculous futures, filled with impossible things. We need to turn healthcare upside-down, as Dr. McGonigal might say. Ten years isn’t going to be enough; we need to be thinking about 2050, or 2100.

In my upside-down healthcare world, we don’t have doctors and hospitals. Care is done at home, supported by assistive/supportive technology and overseen by artificial intelligence. Health is monitored in real-time and any necessary adjustments are made almost as quickly, such as through the nanobots swimming within us or in the medications/devices we 3D print at home. Care decisions and treatments are based on evidence, collected and analyzed on an ongoing basis, not on intuition, tradition, or personal preferences. Technology has lowered costs so much that insurance is not necessary.

We acknowledge that health starts with how we live — what we eat, where we live, what we breathe, how much income we have, how we earn our living, to name a few. We need massive savings in healthcare to invest in those.

Where are all the healthcare workers in this future? I don’t know, but healthcare isn’t supposed to be a jobs program. It’s supposed to be about maintaining/improving our health.

Sound ridiculous? Good; that’s how we know we’re trying hard enough.

I’m going to keep looking for clues to that future, be they improvements in AI, turd robots, or RNA computers — “weird stuff that others overlook,” as Dr. McGonigal says. I want to be open to the possibilities that healthcare can become, not limited by our expectations about what it is now.

We need more urgent optimism about fixing healthcare.