Let’s Get started Over – The Well being Care Weblog



After I first learn the reviews about some Silicon Valley billionaires short of to start out a brand new town, I figured, oh, it’s only a bunch of wealthy white guys short of to take their toys and cross to a brand new, higher house. In any case, they’ve observed what’s been taking place to downtown San Francisco (or Portland, or Chicago – select your most popular town).  

Towns nowadays could also be an what one professional calls an “city doom loop” – suffering to get well after having been hollowed out by way of the pandemic. Those so-called elites most definitely figured it’s more uncomplicated to construct one thing new reasonably than to check out to mend what already exists.  And, , they could also be proper.  

Now that I take into consideration it, the similar could also be true of our healthcare gadget.

The crowd, fronted by way of a mysterious entity known as Flannery Mates, has been busy purchasing up land outdoor San Francisco for the previous 5 years, spending a reported $1b for some 57,000 acres in Solano County. The proximity of its purchases to Travis Air Drive Base had already raised issues. Believed to be in the back of the crowd are plenty of widely recognized tech names, together with LinkedIn co-founder Reid Hoffman; former Sequoia Capital spouse Michael Moritz; undertaking capitalists Marc Andreessen and Chris Dixon; Stripe co-founders Patrick Collison and John Collison; Laurene Powell Jobs, Steve Jobs widow.

It doesn’t assist that previous this 12 months Flannery sued dozens of native landowners for colluding to force up costs, or that they’ve been so secretive. John Garamendi, one of the crucial house’s Congressmen, stated: “Flannery Mates has evolved an overly dangerous popularity in Solano County via their general secrecy and mistreatment of generational circle of relatives farmers.” 

The crowd in any case went public with its intentions closing week. “We’re proud to spouse on a undertaking that targets to ship good-paying jobs, inexpensive housing, blank power, sustainable infrastructure, open house and a wholesome surroundings to citizens of Solano County,” stated spokesman Brian Brokaw. “We’re excited to start out running with citizens and elected officers, in addition to with Travis Air Drive Base, on making that occur.”

Lots of the land is lately zoned for agricultural use, so getting permission for residential or different industry makes use of will take some effort, which is why Flannery Mates is making plans to fulfill with native, state, and federal officers. 

The New York Occasions reported that Mr. Moritz spearheaded the trouble in 2017, sending out a be aware: “He painted a type of city clean slate the place the whole lot from design to building strategies and new sorts of governance might be rethought.” A ballot despatched out closing week to Solano County citizens requested in the event that they’d be in prefer of a poll initiative that might “come with a brand new town with tens of hundreds of latest properties, a big solar power farm, orchards with over one million new timber, and over 10,000 acres of latest parks and open house.”

What’s to not like? 

If that is going to be every other enclave of wealthy folks,then I’m hoping it by no means will get off the bottom, after burning off a lot of their cash (no longer that they’d pass over it). In the event that they’re trustworthy about having a various town, all earning and racial/ethnic backgrounds, then I’ll be staring at intently. They’ve an opportunity to construct new infrastructure (trace: come with tough wastewater tracking!), be sure that secure and inexpensive housing for all, use renewable power, design it for walkability, and fill it with quite a few inexperienced house. They might rent the great folks at Construction H to assist “construct well being into on a regular basis lifestyles.” And in the event that they in point of fact need to galvanize me, they may even mirror/extend on Stockton’s common elementary source of revenue initiative.

However what are they going to do about well being care?  What’s the purpose of establishing a 21st century town from scratch best to overlay it with our 20th century healthcare gadget — the notoriously frugal Medi-Cal program, scads of employer well being plans, and ACA person plans, to not point out Medicare/Medicare Benefit for any seniors who occur to finally end up there. There’ll be a lot of hospitals and experts who would possibly see the brand new town as a perfect likelihood to make a lot of cash from all the ones personal pay sufferers. It’s going to be our acquainted mess.

No, in the event that they need to do that proper, they must reconsider well being care too. Right here’s a couple of concepts they must believe:

Common protection: if you happen to reside locally, you’re lined. No exceptions, no opt-outs, no ineligibles.  Bring to mind it as their very own team well being plan.  They could want some Medicaid and Medicare waivers to try this proper, however they must make this the primary neighborhood the place everybody is roofed.

Wealth-based investment: everybody must take part in how the healthcare gadget is funded, however no longer throughout the inequitable top rate gadget we’re used to however via taxes on source of revenue, wealth, and/or belongings.  Nobody must ever be priced out of protection (or care).

Well being, no longer clinical: we at all times say “healthcare gadget” however what we imply is our hospital treatment gadget. It’s constructed round medical doctors, hospitals, and different clinical pros and establishments. They’re all a part of it, however they’ve turn into the tail that wags the canine. Diet, workout, sleep, social improve, and such a lot of different elements give a contribution way more to our well being. Those shouldn’t be ancillary to the brand new gadget however integral to it, with hospital treatment what occurs best when the ones don’t suffice. 

Number one care emphasis: the gadget must focal point on recruiting (and holding) sufficient number one care physicians (together with OB/GYNs and psychological well being pros) that waits are nominal, visits aren’t rushed, and number one care is the principle locus of care. Fail to remember conventional price schedules/salaries; make source of revenue for number one care commensurate with its worth.

Tech enabled: the Silicon Valley other people must love this: the gadget must be designed round the newest tech – e.g., digital care. real-time tracking (e.g., wearables), AI improve, and so forth, along side proactive Giant Information research and proposals. And do higher than Epic!

Hospitals: to be fair, I’m no longer positive there must be any hospitals, no less than no longer first of all. Don’t construct any giant structures that turn into capital sinks. Perhaps let the Johns Hopkins (or different) professionals design a Sanatorium At House program that fits the neighborhood, preserving folks of their properties. Handiest construct bodily sanatorium(s) when the inhabitants warrants it, or even then construct them as small as imaginable. And without a doubt don’t allow them to make use of physicians.

That’s no longer an all-encompassing checklist, however it’s a get started.


I’m no longer keeping my breath that Flannery Mates will construct their new utopia, however, let’s admit it, they’ve a greater likelihood than they do to create a Twenty first-century healthcare gadget. 

Kim is a former emarketing exec at a big Blues plan, editor of the past due & lamented Tincture.io, and now common THCB contributor.



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