Will solutionism save American healthcare?
In the chaos of healthcare technology offers the illusion of certainty
We’re coming to believe that technology will solve healthcare. If you don’t believe me, look at the money pouring in to health tech startups. $28 billion of venture capital poured into healthcare services in 2021.
But despite this staggering level of investment, Silicon Valley hasn’t solved healthcare yet. The game, of course, is to sell us (literally) on the idea that they’ve got an app for that.
So they make a tool that shows some kind of downstream savings. Those desperate to demonstrate even marginal improvement acquire the tool. Our new empathy chatbot delivers a frictionless end-to-end patient experience.
Solutionism promises certainty
This kind of solutionism thinking captures the mindset that everything in the world is now a problem to be solved.
Mark O’Connell in To Be a Machine: Adventures Among Cyborgs, Utopians, Hackers, and the Futurists Solving the Modest Problem of Death captures the dichotomy of the solution mindset:
The word “solve,” in this context, seemed to me to encapsulate the Silicon Valley ideology whereby all of life could neatly be divided into problems and solutions—solutions that always took the form of some or other application of technology.
From the Hedgehog Review :
Technosolutionism is a way of understanding the world that assigns priority to engineered solutions to human problems. Its first principle is the notion that an app, a machine, a software program, or an algorithm offers the best solution to any complicated problem. …Technosolutionism speaks in the language of the future but acts in the short-term present. In the rush to embrace immediate technological fixes, its advocates often ignore likely long-term effects and unintended consequences.
Technosolutionism alleviates widespread anxiety by promising certainty when uncertainty prevails (my emphasis). It offers efficient responses to complex problems while eliding thorny questions of ethics, politics, or justice. It gives us the how without forcing us to ask the why.
American healthcare is a chaotic space right now. The idea that we can build or buy certainty is central to the appeal of healthcare solutionism. Some startups offer real solutions, for sure. But others sell the illusion of certainty. And this whiff of certainty is just enough to exit with a warm slice of that $28bn health tech pie.
A problem to be solved: Children who can’t get medicine
Over the past several months our clinic has been crushed by a growing onslaught of third party payers denying medication for kids with crohn’s and colitis. It’s some kind of perverse new initiative to put the squeeze on patients with inflammatory bowel disease where treatment can be costly. And beyond those patients who are underinsured are those reasonably well-insured middle class families going broke from sky high premiums (and still having to fight treatment denial). This problem is playing itself out across all ages and disease states beyond inflammatory bowel disease.
And last week while the HLTH community wined and dined in Vegas to the rhythm of beat boards and laser stage displays, I was back on earth addressing prior auths and an endless stream of denials. Lots of selfies with shiny solutions but I’m not sure how many of these folks really know what it’s like at the ground level.
So how about a little Silicon Valley hustle to help these kids and their families? A little exponential thinking on a Sand Hill Road whiteboard to get patients their meds. Or how about a chatbot that handles the endless prior authorizations and denials on behalf of my patients?
The truth is that none of my families will ever see a $100 million exit. Their journey of trying to make ends meet and keep insurance with a chronically ill child never really ends. But the fantasy that more technology will somehow save American healthcare lives on.
For those who celebrate, I hope you have a healthy and restful Thanksgiving.