Is For-Profit Healthcare a Scam? (An Insider's Take)

Sean Weisbrot: Welcome back to another episode of the We Live to Build podcast. Technology and COVID-19 are forcing health care to change at a rapid pace. From the rise of wearables to telehealth and beyond, healthcare tech is shaping up to be a very interesting industry in the next few years.

Sean Weisbrot: Our guest today is Blair Hirst, a biomedical engineer by trade. The founder of Digital Health Review, a platform for people to educate themselves about what's going on in the world of health care, including product services and more. She is also the senior engagement manager at Acorn AI Labs, a company focused on medical data solutions. In this conversation, we talked a lot about health care and somehow we ended up mentioning the role government, politics, lobby groups, insurance companies and big pharma affect how it all works. More specifically, we spoke about what is the current state of the healthcare tech industry. How do you think COVID-19 has impacted technology and health care? Do you think people will learn anything from Covid 19 and adapt so it doesn't happen again?

Sean Weisbrot: Should health care be for-profit or nonprofit? Should pharmaceutical companies be able to promote directly to consumers? Should there be insurance companies? What are the pros and cons of getting into the industry right now? What are some barriers to entry? What are some regulatory hurdles? What do you think are the major shifts occurring as it concerns consumer usage? What are some examples of interesting companies coming out in the last few years? What are some types of products and services coming up soon, and what is going to define the growth of technology adoption in health care over the next 5 to 10 years? So, let's give Blair a warm welcome and I hope you enjoy the show.

Sean Weisbrot: Why don't you tell everyone what it is you're doing right now and a little bit about your background that makes you the right person to talk about healthcare and tech?

Blair Hirst: Right now, I'm building out a wellness marketplace that's focused on consumer technology products. So, what we're doing is we're really on a mission just trying to increase the access. To care for everyone, regardless of your socioeconomic status. We really see digital health as a way to democratize health care, so health tech products are a great way to give access to folks who previously may live in healthcare deserts, who may live in places that they don't have easy access to primary care, who may have chronic conditions that need a lot of management, as well as a multitude of other needs.

Blair Hirst: My background itself. I'm a nerdy geek biomedical engineer by training. I've spent the last ten-plus years in health care doing everything from clinical research to backend development, product management, project management, innovation management, building out things for large employer systems, new tech tools, and telehealth and mobile design. I also currently thinking about, you know, what's the next stage of digital health. So, I've been in this space for quite a bit. I've been thinking about health care and technology for many years, so that's a little bit about my background.

Sean Weisbrot: Thanks for the introduction and definitely sounds like you have a tremendous wealth of knowledge from different aspects. I'm really excited to pick your brain about this now. So, let's start with what is the current state of the healthcare tech industry. And let's ignore Covid because I'm going to ask you about that a little bit later.

Blair Hirst: The current state of health care is it's very interesting. It's going to be very hard to ignore Covid, but healthcare right now is seeing a massive paradigm shift. And by that, I mean traditionally healthcare was something or a place that folks went to. You're sick. You go see a doctor, something's happened to you. You try and get it taken care of. What's changing in health care right now is people's mindsets are trying to prevent illness, trying to increase wellness. It's less about once I have something happening to me, what do I need to do?

Blair Hirst: And more about what can I do to keep my body whole, to make sure that I stay healthy? And so, there's a huge shift in the way that folks are thinking about their health care. It's increased engagement. And that increased engagement is the catalyst to a lot of the technology shift that we're seeing in healthcare, because patients or consumers, or which people are normally called in every other industry, are demanding certain quality of healthcare and certain aspects of healthcare that they're getting in every other field they're experiencing as a consumer.

Sean Weisbrot: I've been saying for a long time that the problem with health care, at least in America, is that it's too focused on treating symptoms rather than preventing sickness. And I think that's because of the pharmaceutical company and the lobbying that they do. That makes America one of the most unique countries in the world I've ever experienced, which is that they can directly advertise on TV and radio their medications that people can have, like advertisements for Xanax and all these kinds of sleeping pills and whatever you name it.

Sean Weisbrot: I have never seen this outside of America, and I was having this conversation off-air with someone the other day. We were talking about future technology. I actually I've decided to interview him probably in the next few weeks, and we were talking about how the pharmaceutical industry and the hospital industry have no incentive to really make it possible to prevent illness because then they would be out of business. Do you agree with that?

Blair Hirst: I think the incentive has not been there in the past fully. I think a lot of the folks that work in health care are incentivized to make people better. I hear your stance on sort of the commercialization of pharma and drugs that you see. But I think something that is also changing in healthcare that I don't think a lot of like layman folks know is that the government and hospitals are now shifting the incentive model to value-based care. So, what that essentially means is we're not just going to pay for services, which has been the traditional model of health care. You come in, you get a hip surgery, you pay me X amount of dollars. Whether that was a good hip surgery or a bad hip surgery, I still get that fee.

Blair Hirst: Now we're talking about value-based care, which is you come in with an issue. And we are incentivized to make sure that we treat that issue, that you're better for it and that you don't come back for that same issue. And we get paid based on how well we're treating folks. So, hospitals are starting to adopt that more because there's more regulatory pressure to have a value-based model. It's slow. It's just starting. It's not ubiquitous. It's getting there. But I think that's also something that can be accelerated by folks like you and me who are consumers.

Blair Hirst: Are patients demanding that? Right. So, the more education we have around value care models and how we can demand that as consumers and say, I'm going to go see this hospital, I'm going to use this service. What has been their results in the past? You know who's working there? The same questions that you think about when you say, I want to buy the next Bluetooth headset. What are the reviews for it? How well has it worked? What's the range? The same things that we do for every other purchase and every other by consumers and patients. If they start doing that in the health care, it's going to help increase the movement. So, I hear you on that. I think it's changing and I think it's for the better.

Sean Weisbrot: So, I've been to Europe and Central America and Asia, and I've experienced health care in probably ten countries. I hurt myself a lot. I'm prone to injury. Let's just say that it seems to me like the best experiences I had were out of America because those countries don't make health care for profit. So, what do you think about that? Do you think health care should be for profit or should it be non-profit?

Blair Hirst: You know, I think there's value in the consumerization of healthcare because I think there's value in the average person demanding value from the healthcare system. So going back to that value-based care model that we talked about, if we're comparing America or US health care systems to non-US health care systems, I think, you know, there is a difference between not-for-profit or for-profit models. But I think one of the larger issues, too, is just infrastructure. The healthcare system in America has very, very, very poor infrastructure. No one talks to anyone. And so, I think, you know, what that causes is just a breakdown. A lot of non-US US healthcare systems are usually government-run, the silos, while they may still be there have more connectors. And so, you as a patient or as a consumer probably have a more seamless experience and a more consistent experience.

Blair Hirst: Whereas if you're if you're getting healthcare and the US, depending on what kind of healthcare coverage you have, what state you live in, what happened to you, you know, there's a variety. So, I hear your statement around that. I think there is value and pushing for a consumerized model for health care, because once the incentive is around how well we're taking care of patients and how well we're taking care of people, and people have a voice in that, and they can demand that, and they can put their efforts and dollars behind things that are actually working. Then the incentive is going to change. And I think health care is going to improve.

Sean Weisbrot: Let's expound on what you just said by talking about how Covid-19 has impacted the healthcare systems and the technology that healthcare systems use.

Blair Hirst: Covid-19 has basically smacked everyone in the face, right, a couple of times over, including the healthcare system. So, a lot of the literature and a lot of the newsreels are coming out and saying that the impact and overload of Covid 19 to the healthcare system is basically pouring water into a bucket that has lots of holes. So, you're seeing where everything is falling apart. I think Covid 19 is putting stressors on the system and that is showing where we are weak, but that's also showing where there's a lot of opportunity. So, there's an uptick in folks now that they have to stay at home wanting to get their care, their regular care, their mental health, their chronic care, PCP care, care for their children, pediatric care right from their home when we were previously traveling to a facility.

Blair Hirst: Now we're needing the doctors and the health care systems to meet us where we're at. And so, Covid, I think is shedding light on all of that. And you're seeing a lot of, you know, investment dollars, venture capital in the health care industry because there's a lot of tech companies that are coming in trying to fill those gaps and trying to take advantage of all the opportunities that are being shown or all the holes that are being shown in the health care system.

Blair Hirst: So, I think Covid-19 has really just put a light on to we need to shift how we think about or how we've thought about a stagnant system to make it more dynamic and make more options for consumers. And it's also increased a lot of investment, and you're seeing a lot of entrepreneurs raising their hand and saying, you know, hey, this is an area I want to tackle. Hey, this is an area I want to tackle, and I'm personally excited about it. I can't wait to see what Covid has done in ten years from now. I think there's been a lot of tragedy around Covid, and I don't want to understate that at all. But I think there's also, in that tragedy, a large opportunity for folks to take a good, hard look and say, we can do better and then go build and do better, that I'm extremely excited for.

Sean Weisbrot: So, I'm torn because I want to go into the pros and cons and the barriers of entry for the industry. I also want to follow up on the COVID-19 thing first. So, the question is, do you think governments and hospitals and people will actually learn anything from COVID-19 and adapt so it doesn't happen again, because Bill Gates just recently said, if you think this is bad and look, I predicted this, but if you think this is bad, the next one is going to be worse.

Blair Hirst: I hope so. I'm not a fortune teller. I can't predict the future. I think, like I said before, you know, Covid has been a slap in the face. We see the response and the recovery rate and the impact of Covid and countries in Africa who have been exposed to contagious viruses like Covid, like SARS, like MRSA before, and who at first also felt that response but learned put procedures into place and have had a great response to Covid 19. And so, I'm hoping that that learned experience that we saw in countries in Africa and other countries in the world, we can. Wake up and see how well that helped them.

Blair Hirst: And we do the same here. Yeah, I'm hoping in this new administration that we will have a task force that is going to deal with health care in the different vulnerabilities that we have as a country around our system and around any huge major impacts like Covid or any other virus that could come out in the future. So, Bill Gates is right. COVID's one thing. The next thing is going to be worse. Viruses mutate. This isn't going to be the only thing that we see. So, I hope that we learn and hope that we have the right people in place to help us.

Sean Weisbrot: I've been following Biden's administration, and he seems to be surrounding himself with intellectual people who are experienced and capable of actually providing valuable insight and backing that up with creating a budget that allows for implementing change. I'm cautiously optimistic that Biden's administration will be able to do something that's different. So, what are the pros and cons of getting into the healthcare tech industry right now?

Blair Hirst: Pros? Capital there's just so much capital out there. I think there's capital. And I think, you know, these days starting a company or tech company, the barriers to entry are a little bit lower because of the ubiquitous nature of the internet, especially since everyone's home to there's a lot of eyes on the internet. There's a lot of folks hoping to help solve or prevent the next Covid outbreak or the next pandemic. And there's a lot of folks out there hoping to fill up the gaps that have been revealed in the health care system. So those are the pros that I see.

Blair Hirst: Some of the cons that I think a lot of entrepreneurs are going to face and have a hard time reconciling, especially if they're not from the industry or if they're more on the tech side rather than healthcare side, is really grappling with the regulatory challenges of healthcare. It's one thing to build a tech product, it's another thing to build a health tech product. And I think that's the beauty and the uniqueness of digital health and health. Tech is that what could be something that is straightforward and easily put into consumers hand? There's different considerations for health care. There's privacy concerns that everyone should be tackling head-on from the start.

Blair Hirst: There are consent questions that you know we need to make sure are clear and readily available and understandable to consumers when they're signing up for this, for these new tech products as well. As, you know, accessibility is a huge thing that I think no one, the conversation hasn't hit it quite yet. Or has it been in the spotlight as much as just building out new health tech products? But the accessibility of these products is going to be really important. So, there's a lot of challenges I see. Or maybe being sort of looked over right now in the early stage. I hope that they're addressed later on. But the regulatory challenge, I think, is going to be the biggest challenge in trying to get into digital health and health tech.

Sean Weisbrot: So, why don't you speak to some of these hurdles like I know of HIPAA? What are some of the other things that maybe most people haven't heard of, these specific agencies or things you have to do to be compliant with government law in order to be able to offer services and products, like what exactly are we looking at?

Blair Hirst: You know, we have state regulations, um, that we have to be aware of. There's also federal ones. So, you mentioned HIPAA, which is basically if you are dealing with someone's personal health information or their private information, such as, you know, their name, any conditions that they have, any personal information that can identify them, that can potentially be used to discriminate them for employment or any other thing like that. You need to be very, very cautious about how you're handling, storing and sharing out that data and making sure that the partners that you're working with, the vendors that you're working with, also have robust measures.

Blair Hirst: Cyber-attacks are no longer a thing of will it happen? But it's more of a question of when it's going to happen. I think if you take that mindset, then you know that you're going to be targeted because you have key data that malicious people are after. And so, it's important for you to maintain that safety. The other thing that it's coming up in state law, it hasn't quite come up yet at the federal level, but it's the question of data ownership. So, if you're using a health tech tool and you're putting in your health information or your partner's health information or your family's health information, who owns that? Is the company or the product that you're putting that information in, then going on and further profiting off of it? Do you have access to that health data easily? If you wanted to pull your information or erase it or share it with your health provider, those are considerations that companies need to, I think, address head-on, rather than wait down the line and figure it out because it's going to bite them in the butt.

Blair Hirst: And that's really because one of the larger issues in health tech and technology is consumer trust. It's something that I'm extremely passionate about because there's been several stops and starts in the healthcare industry, with tech companies coming in and making promises about what they can deliver and asking for the public's trust and dropping the ball on that in a major way and breaking that trust. And, you know, with COVID-19 and the vaccine, especially in the black and brown community, there's already huge trust issues. And so, when we're talking about people's personal information and we're talking about access to that information and sharing it out and making sure that everyone knows what's going on, that's a big thing that companies need to figure out because what's on the line is the trust. Once you break that, it's really hard to get that back.

Sean Weisbrot: I was going to ask you about the major shifts, and you kind of covered the data privacy and all that. I was involved in the blockchain industry for several years, and what I noticed even five years ago was a bunch of blockchain companies trying to develop a means to allow the user to be in complete control of the data that's generated from healthcare so that they could decide who sees it when they see it, and if they're going to charge for people to see it. And so, the whole point of the blockchain was basically the hospital or whoever is buying your data, you'll be paid back in our token, and you can redeem that for dollars or whatever you want. Bitcoin if you want. Do you think that's the future where even without a blockchain, people will be kind of in control of their data and even paid for giving access to their data about healthcare?

Blair Hirst: I don't know if it's the future. I can definitely say that I've seen quotes around how much is someone's EHR record worth. You know, I think I've seen quilts around $15K or something like that.

Sean Weisbrot: What is the EHR?

Blair Hirst: It's an electronic health record. So, I think it's a question I think it needs to be answered. I've also looked into blockchain as a way to help, um, shift ownership to the consumer for their health data and also benefit from the, uh, monetization that is happening in the industry. It's not unique to healthcare. You know, you're using Instagram, Facebook, Twitter, you're shopping at your local grocery store, your data is out there. People are monetizing on it already,

Sean Weisbrot: But none of the consumers are making any of that money.

Blair Hirst: And none of the consumers are making any of that money. Yeah. So yeah, I think it would be interesting to see if there is a way for the monetization of someone's healthcare data to help subsidize their healthcare costs.

Sean Weisbrot: If only we had a government that provided healthcare for all, you know, like almost every other country in the world, then we wouldn't need to have that conversation, would we?

Blair Hirst: Well, now we're talking about Twilight Zone stuff. Yeah, no, that'd be awesome. That would be awesome. That'd be preferred, you know, that'd be preferred.

Sean Weisbrot: I'm sorry, I have to just say this because it pisses me off that America claims to be the strongest, best country in the world, but it is the only Western democracy that doesn't have health care for all. It's just mind-boggling how ridiculous that is, because it's socialist, which is not far from communism. Uh, the boogeyman!

Blair Hirst: If you brought it down to a base level. America is a capitalist nation. And the people of America are essentially its workforce to build up that capital. Anyone who's running a tight ship would want to make sure that that workforce is healthy, so they can work so they can build more capital, whether it's socialist or not. Whatever label you want to put onto it, I really don't care. I think at a selfish level there's value to it. But more importantly, at a human level, there's value to it. The point being, there's value to giving people health care. It's a right.

Sean Weisbrot: I was just feeling really frustrated and I had to get that out. So, what are some examples of interesting companies, products, and services that you've seen come out in the last year or two, let's say pre-COVID and as a result of Covid?

Blair Hirst: In the last year or two pre-COVID and during Covid, there's been an uptick in mental health, um, startups. I love it because it's helping with the stigmatization of mental health and it's increasingly accessibility. And a lot of these companies are also working with insurers, which is a big issue in the mental health space so that the coverage is there. And so that more people are taking advantage of it. So that's something that I'm really excited to see.

Blair Hirst: And the differentiation that's happening in that field of mental health for working parents, mental health for the LGBTQ community. Mental health for other subcommunities, I think are really interesting and I think a right way to sort of break down the barriers of trust and stigma. That's one area I wanted to highlight. Telehealth actually has been around for many years, actually decades at this point, about two decades.

Blair Hirst: But I think the adoption of it in Covid is really showing new variations of it. I foresee, like a hybrid model, not just fully virtual, you know, some in-person, some hybrid. I've recently seen also on call urgent care, you have an emergency, and instead of calling 911 or going to your local emergency room, you have an urgent care team come to your home Covid safe. They treat you and assess you in your home and then escalate as necessary. So that is something that I thought was really pretty cool to see.

Blair Hirst: You know, one thing that I also saw was really cool. I forget the name of it right now, but it's an at-home cardiac care wearable. So, folks who have heart health issues, you're able to basically pull out a full EKG machine that's about the size of this, and it monitors your heart, your heart, and pulse. I think that's really cool, especially since AFib is very common and there's a lot of folks that are living with chronic heart disease and chronic heart conditions, being able to monitor it on a real-time basis rather than on an incident basis is something that is really going to change the cardiac care sector.

Sean Weisbrot: So, those are all interesting observations. I know my dad to talk about the EKG stuff. My dad had to have his aorta replaced about two years ago. And right after the surgery and for the first month after, they had him wear something that was reporting data back to some third-party company that was then giving the data back to the doctors. And so, they were making sure that, like, he wasn't going to have a heart attack or anything just to make sure, like his, his body was able to accept the aorta. And I thought that was really cool. It was like $600 or something.

Sean Weisbrot: And with telehealth and at-home treatment about a year ago. When the virus first started, I think it was like February or March 2020. I wanted to go to the hospital that was next to my house because I normally just do like, you know, a checkup once every six months. Basically, the hospital I live at has this thing, it's like $85. They'll do like your ultrasound, uh, they'll do X-rays of your chest like they do this whole panel of tests and blood and all of this for like $85. It's fantastic. And I have no, I don't have health insurance. So, it's just, you know, paying cash. So, the fact that one it's so cheap is ridiculous and awesome, but the fact that you could do it on demand, I don't have to make an appointment. I just show up and like, yeah, all right, come on. No problem is also pretty cool. But because of the virus, they stopped accepting otherwise healthy patients. Right. So, if you don't have the virus, we're not going to serve you. This is a hospital specifically for treating Covid patients.

Sean Weisbrot: And I discovered a local app that allowed me to arrange for a nurse to come to my house. She took my blood. And then a day later, a doctor came to my house with the results and talked with me about the results. And that was like, I think $100. And that was really cool. I liked it because they spoke English as well. And then with mental health, I definitely see that mental health is a huge problem, and that's one of the reasons why I started the podcast specifically focused on entrepreneurs. But because mental health, especially now, is extremely important for people to talk about, and just the mere expression of what you're thinking and feeling makes people feel better. Although it's not the perfect solution, it's at least better than nothing.

Sean Weisbrot: And so, if people can hear me talking about my issues so I don't talk about it in every episode, obviously, but when I have the chance, I do talk about it. And I think that makes it easier for other people to talk about it. Right. You're talking before about stigmatization. So, there's apps like Headspace and Calm that are specifically focused on helping you to get into meditation, which is fantastic. So, what do you think is going to define the growth of technology adoption in healthcare?

Blair Hirst: I think really it's going to be how well tech companies, traditional healthcare companies, and the government work together. I don't think one body is going to be able to solve the healthcare issue without the other.

Sean Weisbrot: So, which of those three bodies are the ones holding back the others?

Blair Hirst: I think it's more complicated than saying one of them is holding back general adoption. I think what is happening or has happened is that healthcare is a dinosaur industry, and I think it just needs to grow up. I think technology is the way to go. I think it presents the most opportunity to democratize healthcare across a vast majority of people, regardless of socioeconomic status, improve health equity.

Blair Hirst: And I think the federal government needs to do its job in helping to create guardrails to protect consumers and guardrails to ensure that these products are built and tested in a safe manner, especially if they're doing things that are including diagnosis, especially if they're doing things that are sharing out very personal information, genomic information. So, I think I don't want to say that it's one body or another, but I think that each one has an opportunity to bring their expertise to the playing field. And I think they just all need to work in concert together.

Sean Weisbrot: Fair enough. I'm going to go out on a limb and say government regulation is holding things back.

Blair Hirst: It's like the internet, right? No one knew Facebook was going to do what Facebook was going to do, or Twitter was going to do what Twitter did because they didn't know there weren't guardrails in place. Health, tech, and digital health is growing so fast. There aren't any guardrails in place. The federal government FDA is just now, in the last few years, starting a digital health task force and digital health body. So, it's less that the government is holding back with. The government is trying to catch up and learn and find the best entry point to help. If anything, you know, it's sort of an open market right now and probably the next ten years we're going to see some tightening of it.

Sean Weisbrot: Okay. So, I'm glad that you said ten years because I really wanted to ask you next, what do you think the healthcare tech industry looks like and what kind of products and services we might expect to see emerging in the next five years, and then ten years?

Blair Hirst: Yeah, the next, the next five years. We're definitely going to see. Easier access to telehealth. That's the major one that I see. Wearables also are going to be a huge thing in the next five years. You just mentioned how you were able to go into, you know, your local hospital and get a variety of tests done and then have someone come to your home during Covid, right? So, imagine that you get a tool kit, right, that your doctor gives you at the beginning of the year. If you start working with your own primary care and it has something that can take your blood, it has something that can track your heart. It has something that can look at your nutrition and you integrate it into your everyday life.

Blair Hirst: And so instead of going to your doctor and having them review you in a point of time, they're able to see how your health is going across, you know, a longitudinal view. Um, and so they're more accurately going to be able to prevent disease, improve your wellness, take better care of you. You're going to be able to have more insight into and take better care of yourself. So, I'd say telehealth and wearables are definitely in the next five years. AI is entering the space. I think the thing there and why it's going to be something that is going to be more on the ten-year maturation cycle is because it's going to be diving into a lot of data lakes, and it's going to be needing a lot of learned experience for some of its predictive modeling cases out there. And that's something that you can only get. Over time and you can only perfect over time. So, I think the cases are going to come out now, but I think the maturation is not going to happen until ten years.

Sean Weisbrot: What's something I haven't asked you that you wished I would ask?

Blair Hirst: What can you, as a consumer, do to help the healthcare industry or to better take care of yourself? That's something that I think everyone should be asking.

Sean Weisbrot: Again, it goes back, unfortunately, to the politics where if there was universal health care, it would be more affordable for people to go to the doctor more often for wellness checkups rather than for being sick and needing to solve a problem. And that would then actually lower the cost of health care over time because people would get sick less, because they have a better understanding of what's going wrong before it gets bad.

Blair Hirst: And that's what you know. And that's why I built DHR because I think if people had the opportunity to know what's out there and to be able to shop for health tech tools that they can use to better manage their care themselves or connect with their providers, things that can be used for preventative care across like the spectrum of all their needs mental, physical, emotional. Then we will have a healthier nation, a healthier people. And there's only upsides to that.

Blair Hirst: So, the benefit of using digital health review is you're able to go on and you're saying, I need to look at pediatric care tools for my child, and you look at senior care tools for my aging parents. I live across the country. I need to look at mental health because. Covid is kicking my ass. I need to look at nutrition because I've been sitting all day and I've got a little few pounds in the middle that I, you know, I want to address. And maybe that's some connected fitness tools and I can pick all those categories and I can see like what's out there and I can see what's going to be covered by my insurance or what can be covered by my FSA funds.

Blair Hirst: And I can also validate if they've been proven to work clinically, if they've needed FDA approval and if they've gotten it, you know, and so when consumers can see that and they can make better choices for themselves, then I think there's a lot of value in that. And I think as that process becomes more commonplace, we're going to see that paradigm shift that we were talking about in health care more. And I think people need to start shopping for their health care and their health as much as they shop for, you know, winter sweaters and the latest shoes and the latest tech and the latest in my case, you know, new washing machines and, you know, other household items. Yeah, they'll see an improvement in their lives that it's going to be a value that they can't put into words or money.

Sean Weisbrot: If someone wanted to come in and start a company now, what gaps do you see that people could try to fill?

Blair Hirst: Senior care is actually something that is definitely a vertical in the digital health industry. That should get a lot of attention and people should be asking questions around that. We have an aging population right in the US that's going to be pretty big. We also have a distressed health care system and a younger generation that's going to be responsible for taking care of their parents. So, a lot of caretaker elder care tools are going to be needed. And so that's something that I think people should be thinking about and figuring out how those tools can connect to all the different players in the health care system.

Blair Hirst: So that will probably be the second idea that I would say, is any company that's coming in, if they don't want to focus on a vertical like mental health or a vertical like senior care if they're able to figure out how to connect all the pieces and all the folks that are in health care together, that's going to be invaluable. Because one of the issues with health care and why it's so slow and so expensive is because the infrastructure sucks. So, if you're able to connect the patient to the primary care, to their care team, to their at-home care team, to the pharmacy, to, you know, the insurance company. If you're able to have a seamless experience across all of those and you're solving a huge issue, if you're able to do that, then you can sort of insert yourself in any vertical after that.

Sean Weisbrot: You want to know how you can simplify the equation for the connection of patient and all of those things you're just mentioning. Get rid of insurance companies.

Blair Hirst: Well say more.

Sean Weisbrot: Well, if an insurance company has an in-network doctor roster right, then you have to find the doctor that takes that insurance company. If there's no insurance company, then every doctor is a network, which means you can go to the doctor you like, not the doctor that takes your insurance. And then you can also find the pharmacy that doesn't care about your health insurance, because they will take your money. They'll take everybody's money.

Sean Weisbrot: So, there's another piece which is most countries, the governments will do collective bargaining with pharmaceutical companies for the cost of medication. And then that cost gets absorbed by the taxpayer dollars and all that. But in the US, the government has no incentive to bargain on behalf of the entire population, because every single insurance company is dealing with different pharmaceutical companies. And the reason why medication in America is so expensive and very cheap outside of the outside of the US, despite being made by the same dam companies from the same dam factories.

Sean Weisbrot: Is that because the government doesn't bargain on behalf of the population, they can charge whatever they want and insurance companies will say, well, we don't care. It's not my responsibility to pay for it. It's really the responsibility of the individual consumer to purchase this thing and consume it. So basically, the pharmaceutical companies charge incredible amounts in the US in order to not have to charge higher amounts outside of. So again, the government and politics and insurance companies are the reason why health care is so goddamn expensive.

Blair Hirst: I think you're pointing out the fact that, you know, the bargaining power in a fractured system is next to no. Right. So, if you're working, if you're working with one, with one body who has a large amount of consumers or users and the bargaining power is quite high. If you're working with individual hospital systems and insurers and payers, then the bargaining power is pretty low. That's an economic question also.

Sean Weisbrot: Well, yeah, I mean, if you want health care to work and not be broken, things have to be affordable. Health care, like getting a surgery with health care in America, is like trying to get a four-year degree. By the end of it, you're $50,000 in debt, but it's not your fault. Probably that you needed that surgery. It's your insurance company not negotiating with the hospital and the pharmaceutical companies to make sure that it's affordable. Because the insurance company doesn't care. They have no incentive to care because profit is all they care about. So, okay, we've paid for your stuff. Now pay me back.

Blair Hirst: This goes back to the question around like how is health care incentivized? What are the incentives?

Sean Weisbrot: The incentive is profit for shareholders.

Blair Hirst: Yeah. For-profit companies are responsible for the shareholders period. So, whether that's health care, whether that's the car industry, whatever industry that is, it's they're responsible now how they go about that responsibility I think is. Questionable in some cases, but should be questioned in all cases. And I think if we take the time to really break it down, I think there's definitely ways for us to revamp the health care system, to have the patient come first, no matter what.

Blair Hirst: Think about it this way. Right. So, we had recently, um, in America, the opioid crisis and several drugs, especially insulin. Let's talk about insulin that were marked up so high that people were dying because they couldn't afford it. So, a drug that was discovered and made and given for free, you can look that up was then later up priced so much that people were shorting their dosage because they couldn't afford to pay for it.

Sean Weisbrot: Didn't Martin Shkreli go to jail for increasing the price of the drug that his company was making by like 7,000%?

Blair Hirst: I mean, yeah, and that's the going back also to our conversation around how can the federal government work with the healthcare industry to create guardrails to make sure that there isn't ridiculous fraud and there isn't exploitation of consumers? You know, wouldn't it be a wonderful world if all drug discovery and making was subsidized by the government, so that pharmaceutical companies were not shelling out thousands of dollars in research and development and marketing, and instead we're able to make these drugs at cost? And I think that's some of the beauty of technology in healthcare and some of the things that we saw with the Covid vaccine, when we're able to use technology, we're able to expedite certain processes to create certain efficiencies that could lower costs. Which should be getting translated down.

Blair Hirst: Now we need to have oversight that that's happening, that those savings aren't just being pocketed and given to the shareholder, but they're also trickling down into the cost of drug and the access of that drug, not just been a more marketing dollars elsewhere. So, there's a bunch of stuff that we can get into about what's going right and what's going wrong in the healthcare industry. I gotta say, though, being in the health care industry and knowing folks who've worked in pharma, knowing folks who worked in hospital and other large systems and insurance companies, most people are working there not for profit, but for personal reasons and for a really true sense that they want to help and that they want to help improve people's lives.

Sean Weisbrot: Oh yeah, I have no problem with the doctors and the nurses and the surgeons. The administrators, like they're all just doing their jobs. They went into the industry because they wanted to help people. I can respect that.