What universal healthcare should look like
Looked at through one lens, Forward Health seems like it could be part of the problem: It’s a for-profit Silicon Valley startup with frothy amounts of funding ($225 million in its latest round, including a de rigeur celebrity investment, from The Weeknd). The 12-minute blood tests, as much as they seem to work, remind us of recent blood test-tech huckster Elizabeth Holmes. Forward’s primary care services cost $149 a month, on top of any other insurance you might have, and are currently only available to the usual suspects, the well-heeled citizens of LA, New York, Chicago, SF, and Washington, D.C.
Those of us who worry about a two-tier 22nd century healthcare system, with a sparkling, polished, cancer-vaccinated, gene-edited elite on the one hand and a vast brink-of-bankruptcy underclass on the other, will find much to fear here.
On the other hand, maybe it’s exactly the sort of company we need to help cure America’s addiction to spending on sickness treatment (expected to reach $5.4 trillion, or 20 percent of U.S. GDP, in 2024). Maybe Forward and its ilk can disrupt this $11 trillion industry by being the smartphones of healthcare — getting the masses hooked on treating their health like a video game where the object is to have as few troubling biomarkers as possible.
The $149 a month cost may be expensive now (though it is the same as Medicare Part B, the government insurance we fantasize about making available to everyone, which, in addition to general medical services like diagnostics and ambulances, covers only one major preventative visit per year and one screening for the country’s biggest killer, cardiovascular disease, every five years). That’s the company’s business plan, to keep expanding and driving down the cost and adding more services, like its new purpose-built skin cancer scanner, until the cost plummets well below monthly premiums.
“I want to keep going until Forward is as close to zero fucking dollars as possible,” says Aoun. “That’s not a joke. Not a euphemism. Literally, I would like to charge $0. And we want to keep adding value until we’ve built out the entire healthcare system.”
If preventative care becomes a big enough deal that it eases pressure off the hospital system, then the massive subsidies we’re already spending on healthcare may be able to cover more costs. Insurance premiums, Medicare included, may plummet if they only have to cover the truly unavoidable, like accidents and rare diseases. More preventive care means fewer people on long-term drug regimens. Shorn of big payouts, Big Pharma may be forced to actually innovate again, focusing on smarter drugs and next-generation brain-stimulation tech. Maybe they can figure out how to prevent the antibiotic resistance apocalypse along the way.
It won’t be all sunshine and roses, of course, because this is healthcare we’re talking about: a field where 100 percent of all users die eventually, even if they make it to age 150 first. The employer-based insurance system will probably get worse before it vanishes altogether. Our employers aren’t always motivated to prevent long-term health problems if you’re only going to be with them for a few years on average — well, beyond the WW memberships and fitness trackers they offer in return for discounts on insurance costs — but they are motivated to peek into your genome to see if they should bother keeping you around. As laws loosen on sharing medical data, there will be some life-saving outcomes for patients; there will also be disastrous unintended consequences. The threat of genetic discrimination, like racial discrimination, looms large in many walks of life.
But if any iniquity can make a majority of the U.S. Congress finally, properly bring the health industry and its rapacious cost curve to heel, genetic discrimination will be it. By the time you arrive, 80 years in our future, Americans may finally have what we could have had for the past 80 years: Genuinely universal healthcare, prevention-focused and treated as a human right, for as close to zero fucking dollars out of pocket as possible.