Admittedly, I am older than the assumed modal user as a seven year Medicare Advantage veteran (though one way or another, my 76 million rapidly deteriorating boomer age-peers will be the test bed for a lot of these ideas). However, my 2015 experience with head and neck cancer really sobered me about the level of trust required by the advent of a serious medical problem. The central question I wrestled with was: who do I trust to diagnose me and rid me of my cancer? Had a similar problem with the impending loss of my mobility and the ability to type that led to a 5 vertebra cervical spinal fusion in 2017. I have trouble figuring out how a virtual first model would have worked here. In both cases, I wanted to hold a real live human responsible for both framing my problem and solving it, and was lucky enough to find both. I do realize that roughly 20% of our US population do not have a physician or regular source of care, but the last time I looked at it, that percentage skews sharply toward the young and healthy. Sadly, it is “events’ that drive us to use healthcare. Absent the events, we don’t think very much about medicine or our need for it.

I strongly believe we need a fundamentally re-architected and differently financed care model (and argued for it in my 2003 Digital Medicine book)- one which funds and supports relationships rather than care events. It won’t be the dreaded “incumbents” that stop this from happening, but the complexity of medical issues themselves. I think “virtual first” will be the latest in a long succession of tech-driven fantasies into which billions of LP dollars will disappear without a trace. Would dearly love to be proven wrong, Matthew. Just not sure I will live long enough to be able to say ‘I told you so!”