Dear Readers,
As you’ve probably heard me say before, healthcare is broken in America. As with many other broken systems, there’s an amazing opportunity in 2025 to fix it — both with policy and technological improvement. At 8VC, where we invest in and build companies, including many in healthcare and therapeutics, we see every aspect of the system and the way government affects it: the types of care that is prioritized or discouraged, the innovations that are slowed, the crooked incentives and outrageous spending.
Sebastian Caliri is my partner at 8VC who works on healthcare. He’s one of the best systems thinkers out there, especially on the system he’s devoted his career to improving. Sebastian himself is on extended leave from the Stanford MD program, and holds degrees in molecular biophysics from Yale.
His piece, shared on our 8VC blog, summarizes our view, and gets into specifics about what we are suggesting to the new administration for federal policy changes. You can read the whole piece for the detailed plan, but here’s a teaser:
1. Reform healthcare payments
2. Eliminate barriers to market entry
3. Liberate healthcare data
4. Accelerate scientific inquiry
5. Address fraud and abuse
There are some great people going into the administration to lead the Dept. of Health and Human Services and Center for Medicare and Medicaid Services, among other entities. Very smart, and very bold is the name of the game. My old friend Jim O'Neill will be RFK Jr's deputy at HHS; we and talented friends we admire are also close to Mehmet Oz (CMS), Jay Bhattacharya (NIH), Marty Makary (FDA), and more.
We’re lucky that they’ll have great advice from innovators like Sebastian as they work to fix this critical area for our civilization.
Here’s the piece. — Joe
In 2023 the United States federal government spent about $1.5T on healthcare. It is the single biggest component of the federal budget: double the $817B allocated to defense, sixty times NASA’s $26B budget, and about 100-fold more than the $16B spent on securing our borders.
Our healthcare system is not making us healthy
For $800B a year, America boasts the strongest military force on planet Earth. How much health does $1.5T buy us? One answer is “not enough”. Despite astronomical spending, by a number of measures America is actually getting sicker every year:
Obesity: Chronic disease like obesity in American adults has gone from 13.5% in 1980 to over 40% today.
Maternal mortality: Vastly more American mothers are dying in childbirth today than in the Reagan era, despite advances in medical technology and investment in modern hospital facilities.
Drug overdoses: Drug overdose deaths have grown by more than tenfoldsince 1980. And in just the last decade, the rate of alcohol use deaths is up 70%.
Cancer in young adults: The incidence of cancer in young Americans has alarmingly climbed by 35% since the mid 1980s.
Life expectancy: Life expectancy has barely improved over a forty year period.
Now pick five friends at random and give them each a call. Ask each of them if they have had a bad experience with our healthcare system: a confusing bill, a primary care visit cut short by a busy doctor, or a situation where they have had to repeat, for the thirty-fourth time, their detailed medical history. You don’t need to make the calls, you say? You know the answers already?
Doctors don’t have it much better. Physicians leave medical school holding $265k in debt before beginning years of earning less than minimum wage during residency. Endless documentation and compliance requirements drive many healthcare professionals to burnout.
Joe: Why not extend COBRA from 18 months to up to Medicare eligibility age?
You mentioned the few questions to ask anybody and I have asked many times why it is so complicated and obtuse. It never made common sense why my medical history has to be repeated in nauseating detail with every new provider. A hospital CFO told me that healthcare systems want to be siloed to form a barrier to entry. Seems like a prevailing theme that the federal government also provides those barriers, the big systems can afford the expensive lobbyists.