Can AI Move Us From Incremental to Exponential Progress in Healthcare?
Forward CEO Adrian Aoun has thoughts.
The healthcare industry has made significant strides in the past 20 years… or has it? In this episode, we sit down with Adrian Aoun, CEO of Forward, an AI-based healthcare system combining world-class private doctors with new technology to enable proactive, data-driven primary care, to discuss how artificial intelligence (AI) can help us achieve exponential improvements to human health.
Prior to founding Forward, Adrian was the head of Special Projects for the CEO of Google/Alphabet, where he founded one of the Alphabet companies, Sidewalk Labs. Adrian arrived at Google upon the acquisition of his previous startup Wavii, and spent his first year at Google helping to create and build their AI division.
Topics covered:
What exactly is AI and how will it change healthcare
How ChatGPT is the worst of the new world
Why humans are so bad at thinking expontentially
Why healthcare only improves incrementally
Why Adrian hates health insurance companies
Listen
Transcript
Halle: Adrian, thanks for being here.
Adrian: Not at all. I'm excited to be here. Thanks for having me.
Halle: So just to level set for this episode and for all listeners, I wanna talk about what AI is and how you would describe it to, say your grandparents or the average grandparent. I don't know, maybe you have very savvy grandparents.
Adrian: Somehow I think I do. Okay. So if you take a step back and you just think about like what is a human like, what are we, we're a bunch of different things. We're this body, we're this, we're these people who love, we're these people who have empathy. But in some ways, like AI is really focused on just kind of two core pieces, which is the part of us.
That reasons and the part of us that computes. Now, the fascinating thing is if you look over, you know, last kind of, let's call it 20, 30 years, you and I have been living in this like information revolution, this computing revolution since the integrated circuit was created, and really what we're saying is, The computing part has kind of been there, right?
We've got these fancy processors that do trillions of little processes per second, but the reasoning part hasn't been there, right? In fact, you know, if you go to your phone right now and you talk to Siri and you say, Hey, Siri, you know, can you find me a, can you find me a dinner reservation? Or can you order me some pizza?
Like, Siri's pretty fucking bad at that, right? Siri's like, I don't even know what you're talking about right now. I can just do something super, super simple like turn the lights on or set. And so what you realize is that the reasoning part is kind of what I don't know in some ways has made us really special as humans over the last few decades because that's the thing we feel like we can do and, and, uh, and computers can't.
And now what you're starting to see is we're starting to enter a phase where actually, you know what, computers are getting pretty good at this reasoning thing. Now we're kind of at the beginning of this new phase. But we're definitely, uh, we're definitely entering a new phase and the trend lines are looking, uh, looking pretty strong.
So in some ways, I'd say if you were to sum up ai, it's like a just really fancy calculator that actually knows what the hell it's talking about, as opposed to just showing you numbers.
Halle: Yeah. So AI has been around for a long time, but it feels like ChatGPT has kind of pushed us into this inflection point. It's part of the zeitgeist. Do you think that it's, or I guess not. Do you think that, is it a breakthrough AI technology compared to the other things we have, like Siri and Alexa and all the other AI tools that you know of?
or is this just like a really good marketing and PR moment for them?
Adrian: Well, I maybe, I might say that it's absolutely both, and I'm not sure that, I'm not sure that those are discordant with one another. So on one side, like if you break down what is ChatGPT, there's a few things going on, right? There's this notion of using these. Things called transformers, which let's just call those pretty fancy calculations, right?
A pretty fancy calculator. Then there's this notion of feeding it in, feeding into those transformers, what we call LLMs large language models, which is again, a way of like almost educating the algorithm. Here's a whole bunch of language on the internet. Now you can go ahead and it's almost like you read every single book.
Well, of course you're gonna be pretty damn smart. . And then the third thing that chat g p t is doing is they're giving you this like natural language interface, right? You can literally just type in normal sentences, just normally kind of the way that you, and I think we don't really, like, it's more natural for us to have a conversation like this as opposed to go and write Excel formula as one communicating with each other.
Right? So, so it's more kind of, yeah. Thank God. Right? so it's, it's more normal for us. So there's kind of three things happening and you need to think of these things as actually being separable. C. Because it turns out that you can use, let's say, transformers and LLMs, but not use them for, uh, for natural language interface as an example.
Some people are using them to help them write code or help them build Excel sheets, et cetera. Now you asked this question of like, well, I don't know. Is this just a PR gimmick? . Yeah, it kind of is. And I don't mean that in a bad way. I mean that almost in the best way, which is you've now seen the future, you've now seen where the world is going, but maybe our kind of old technology that's the best of the old world and cha, e b d is the worst of the new world now.
It's almost like, you know what? It turns out that the best of the old world is still pretty fucking good. You know, Google's pretty damn awesome. I'm not going to chat G B T and trying to get it to, to do everything today, because you know what? It's gonna make more mistakes than, uh, than Google. But on the other hand, you kind of see where it's going to go.
So think of this as the world's best demo. Yeah. But that doesn't mean it's not real. You just gotta give it time. So one of the things that I think we're really bad at as humans is, is predicting the future. When the future is exponential. We're really good at it. When the future is linear and really bad at it.
When the future. Pal and the rate of compounding right now that's happening as we pile these technologies and these algorithms upon each other is pretty incredible. So if I tell you, Hey, this thing is gonna double in performance every 60 days or every six months, you gotta don't really know how to think about that intuitively until you realize that really what it means is this thing's gonna be like super intelligence, you know, before, before you and I make a trip around the sun.
And that's kind of the, the direction we're going.
Halle: So, uh, just on that note of being able to envision a world when it's a little bit more linear than exponential, do you feel like that's a, a problem unique to adults? Because I feel like children are able to , like even teenagers are able to like, have these really grand ideas of what the future could be.
Whereas I feel like as adults we're just pessimistic about everything.
Adrian: Yeah. You know, it's funny that you take that. I, I'm gonna give you why I think it happens, by illustrating something and maybe it relates to this. So let's pretend that I, uh, that I put a chess board in front of, you know what, you know what a chess board looks like, right? It's about eight squares by eight squares, so about 64 squares.
And, and I play this little game where in one corner of the chessboard, on one of those squares, I put one grain. And then on the next kind of square, right next to it, I double it. So there's two grains of rice on the one next to it. I double it. So there's four grains of rice, and I do this until I go through all of the chess board.
Now at the end, you have to ask, how much rice do I have? Do I have enough to fit in my hands enough to fill a car or enough to fill a house? Which do you think the answer is?
Halle: Uh, I'm gonna say house
Adrian: Yeah. So let's go with house. Okay. So it turns out that the answer is actually that you have seven quintilian tons of rice. Let me be clear, that's more mass than exists in the entire.
Fucking known universe, like, holy shit, you weren't off, Allie. You weren't off by a little, you were off by literally the known universe. You know what I mean? Okay. So now, now let me ask you a different question. The last time you were headed to your friend's house for dinner, were you five minutes late?
Five days late or five months late,
Halle: I, I'm never late. My husband would be five minutes
Adrian: Yeah. Your husband would be 30 minutes late, so we'll put that aside.
Halle: Yeah.
Adrian: Now, what do you realize? You, you, you've never once shown up five days later, five months late, but when something is exponential math, you're off by orders and orders of magnitude. And what you're exposing right now is actually that there's a flaw in the human brain.
There's a flaw in how we compute things. We, our brain intuitively understands linear. and uh, or incremental math and not exponential math. Now, what you might be seeing in kids, and now I'm purely speculating, what you might be seeing in kids is that they aren't bound by the constraints of what they've seen.
So it's easier for them to imagine a new world every single day. And you can see this empirically, your neuroplasticity is decreasing, right? You're not forming newer and newer connections. As such, when you're given a piece of information like, well, I don't know, humans are black and humans are white, and humans are Asian.
Well, you know what? Your kid's gonna draw a human who's orange or green or blue? And you're like, no, no, no, but I've seen all the humans and the kids like, yeah, but I haven't seen all the humans. Maybe. Maybe there's a blue person out there. And so maybe that's, maybe that's what's playing in. But I, but I don't know.
You'd have to ask an expert.
Halle: I love that. well, so we've recently seen the headlines that, these algorithms are passing medical licensing exams and everyone is shocked and surprised. What was your reaction when, when you learned this
Adrian: Okay, I'm gonna, I'm gonna sound super like, like Michaela not impressed kind of thing, but I just don't give a shit and lemme tell you why. Lemme tell you why don't give a shit. And, and so, okay, let's just ask ourselves. What is like the state of of healthcare? You're saying, fine, you can beat a doctor. Sure.
But how good is a doctor in the first place? So average life expectancy today, on this planet is somewhere in kind of the, the mid seventies, right? If you go to literally countries that do not have doctors, it decreases by about two to three years. And if you go to countries that have what you would argue.
Best healthcare system. Again, it increases by two or three years. So what you're telling me is the difference of no doctor and the difference of a doctor is at best a few years. I just don't care. Literally, you know this, right? Let, let's pretend, let's pretend somebody you love most in the world. Your husband walks up.
To you and he is like, Halle, I didn't go get my checkup this year. Do you go, oh my God, Jeff, I, oh my God, you're gonna die. No, you go, I'm not sure it fucking matters. Like, go to the doctor. You really should, but you don't think he's gonna drop down dead. And everybody in society is kind of iterated to the exact same notion.
Think of how many people around you are like, Hey, you know what? You know what Holly? I'm gonna go ahead and drink organic smoothies and buy methods soap to prevent cancer. It's like, are you fucking kidding me? Your solution to cancer is drinking a smoothie. You kind of know that the healthcare system is done roughly fuck all.
And so take a step back and let's just think about like, how has evolution of the healthcare system developed over the course of, of, let's say, human, modern humanity. But before we look at, before we look at the healthcare system, let's give it something to compare it to. So I wanna start by comparing to transportation.
Let's pretend you're gonna, you're gonna allow me to be philosophical for a minute, but let's pretend that, that we're walking around in, uh, in the Bronze Age about 5,500 years ago. Well, you know what? We're walking on our own two feet. We don't have shoes, we don't have, we don't have anything. So the average, the average distance you could travel in a day is roughly about, I don't know, let's call it about five miles.
We did that for about a thousand years. And you know what? Our feet got tired. We said, let's go ahead and build this thing called shoes. We invented sandals that got us to about 10 miles. We did that for a thousand years. Then we tamed horses. And you know what, we did that for about a thousand years, and horses were awesome.
Cuz now you could get up to about, you know, maybe. 50 or even a hundred miles per day. But then in the last 200 years, think about what we did. We invented river boats to take us hundreds of miles. We invented trains, automobiles, planes to take us across countries or even continents. And then NASA said, you know what?
We got this. We're going 125,000 miles to the moon. And then SpaceX said, hold my beer. 125 million miles. We are going to Mars this decade. Think of what that literally 25 million x in the last 5,500 years. Now let's look at how healthcare has developed. So if I go back to the Bronze Age, you have to ask yourself what was life expectancy?
And it turns out that in the Bronze Age, you know, first off, things were pretty bad. If you were born, you had roughly a 15 to 20% chance of mortality right there in infancy. Okay, that sucks. That's not good. But that also means you had a 75 to 80% chance of. Now the interesting thing is, let's say you did survive what was average life expectancy?
Turns out it was about 43 years old. Now remember what I told you earlier? I said today it's mid seventies. We went from 43 to let's call it 75, in 5,500 years. So, Less than 0.5 x. What the hell happened? Like one was 25 million x one was 0.5 x. You have to ask yourself like, where's my spaceships? Where's my rockets?
Where's my future world? And it has never hit the world of healthcare. And now you have to start asking yourself. Why was the world of transportation able to innovate so rapidly over the last few hundred years and the world of healthcare was not? And if you can answer that question, now we can start getting healthcare to a world where it's truly doing something that matters, where it's truly saving lives on a regular basis.
Halle: What do you think are kind of some of the biggest barriers to innovation in healthcare and why we haven't seen the progress that we've seen in other industries.
Adrian: Okay. So you and I are unfortunately old enough that we remember a world pre iPhone. So let's think about what happened when, when the iPhone came out, when the mobile computing revolution took off literally overnight. You went from this, like this phone in your pocket to millions of apps. Why? Well, it turns out that the rate of innovation went through the rip.
Think about. This 22 year old at Stanford named Kevin Systrom sits down, has an idea. Boom, 12 hours later, there's this photo sharing app on every single person's phone all around the world. And what happens is when we build the tools to help us innovate, the rate of innovation takes off. Now, Kevin's Syms app was not the only app.
You and I know that there were thousands and thousands, if not million. Photo sharing apps. But if you think about it, in the world of healthcare, we would just call these all clinical trials. We would call them experiments, and we're learning rapidly what works and what doesn't because the cost of experimentation has gone down.
But think about what it is in the world of healthcare today. It's frankly a fucking disaster. You have an idea. What do you do? You go recruit a, a patient population to be your clinical trial. Hopefully you get IRB approval, and that takes less than six months. Then let's say you run your trial. A year, and then you sit there and you say, okay, now I've got my idea.
It is better if we do this. So what do you do? Well, first off, you know, one path is go through the FDA and age about 20 years before it comes to market. The other path is write a paper. Hope that doctors in school now learn about your most recent research and 20 years from now are actually practicing it.
I mean, literally the cost of one single innovation. Is at best years and at worst decades, whereas the cost of innovation in the world of mobile computing is at best hours and at worst days. It's a, it's a night and day difference. And you remember from that class they taught you in fourth grade about compound dangerous.
That when you can compound your gains, They go exponential. So remember what I talked about? I said that, that today healthcare is living in the world of incremental and mobile computing is living in the world of exponential. So now you have to ask yourself, what will it take to get healthcare to live in the world of exponential?
Halle: Wow. I mean, what about the fact that these are human lives? We have to , you know, we can't experiment, we can't move fast and break things. Isn't that something that you hear often?
Adrian: Maybe, but maybe I'd reframe. Would you rather, would you rather have, uh, would you rather have a technology that's gone through 10,000 iterations or live in technology that's centuries and centuries old? I, uh, I think it's pretty obvious at this point that we're killing more people by not innovating than we are.
Uh, then we are by innovating. In fact, this is, this is the whole argument. This is the whole argument against self-driving cars. And I'll tell you right now. The data's pretty damn clear. Self-driving cars, they do move fast, they do iterate, and they're doing just fine. They are not killing millions of people out there, but it turns out the normal cars are.
And so the way to think about it is we haven't invented even the, the seatbelt in healthcare, much less the self-driving car because we're so afraid to change things and this is terrible.
Halle: Yeah. Well, I mean, in so many clinical trials aren't even repeatable, so we have a lot of issues within that. So what are some low-hanging fruit use cases for AI in healthcare?
Adrian: Yeah. Yeah. Well, it ironically, the, the low hanging fruit is super interesting. If you go look, if you go look at like, what are the number one killers? We're talking about self-driving cars, and we're talking about ai. Well, it turns out that the number one killers are still in the cruise control and seat belts phase, right?
Number one killers. Heart disease. You know what, how many people in the United States know that they've got, whether it's high blood pressure or high cholesterol, and are even managing it with the things we have today, like the statins like that about, it's like, like we're literally not even going down, the, the correct path in the world of healthcare with the technology that we have.
So what you have to do is you have to start with realizing, that the product of healthcare is actually worse than the science of healthcare. What does this mean? Well, if it takes me three weeks to schedule an appointment and I walk into a room, I mean, imagine describing what going to the doctor's like to your kids one day.
Wait, you mean to tell me, mom, that you walked into a room and there was this person there wearing a white coat? You tell what was going on. They, and they divined. What was wrong with you? I like, wait, mom, did you go to a to a fortune teller? Doctors are the fortune tellers of our time. No, no shit. People don't wanna use them.
No shit. People aren't going to the doctor. Right? So step one is we have to make a product that makes sense to, people have to put that product in their hands and put them in control as opposed to putting it behind the gate of this person that went to, went to med school for 10 years, charges, you know, $250,000 a year and you at best get 10 minutes of their time.
Like that's an absurd. Once we do that, then we're gonna solve the low hanging fruit. Getting people to manage their blood pressure, getting people to detect that that mole on their skin might be cancerous. Right. And then the second part that you need, is you need that foundation the same way that the, uh, that iOS has become the operating system for mobile computing.
You have to ask yourself, where is the operating system for healthcare? We sit around and we say, Hey, we've got ai, we've got algorithms, but they're doing fuck all in healthcare. Well, why? It's almost like healthcare is in the, if you remember the Sharper Image era, as I like to call it, it's like when you and I would go to Sharper Image, we'd buy these like stupid little gadgets that, I don't know, the smart barbecue and the smart lights.
We'd use them for 30 days and we'd throw them away. Well, That doesn't happen today. Why? Because all these gadgets now connect to my phone. They have the operating system. They make sense. Well, in healthcare, you're buying smart rings and smart glucose monitor, and where are they going? Who are they phoning home to?
There is no operating system of healthcare. So what we need is we need that consolidated core where everybody is building on top of. Because if you get that, the weight of innovation is going to take off. The network effects will.
Halle: Yeah. What could go wrong? Like when you think of, you know, 10 years from now, if, if AI has not been helpful in improving healthcare, what happened?
Adrian: So there's two phases that you have to look at this, right? So the first phase is, let's call it, all ai. I hate calling it ai, I'm just gonna call it all algorithms, all machine learning, pre, uh, pre, I don't know, super intelligence, singularity, whatever the hell you want to call that. So in that first phase, like any technology, right, there's, there's gains, but there's also losses, right?
You see that, you see that Facebook, uh, connected the entire world and also caused genocide in Myanmar. You see that Google. Democratized information. I mean, think of how powerful this is. Google literally brought information all around the planet to the fingertips of even the poorest people on this planet for free.
I mean, that's amazing. On the other hand, you can go to Google and you can learn how to make a bomb. You can learn to commit suicide. These are terrible things. The, the idea that you're ever gonna create an innovation that only that is super powerful and has, is super impactful, but only has pure upside is absurd On the other.
What you see from history is that you would take those trades any day of the week. Would you rather live a hundred years ago to today? I don't think so. You didn't have food security a hundred years ago. You couldn't even talk to somebody across, across the country. Uh, a hundred years ago. You'd at best see your neighborhood, maybe your village, maybe your state.
You certainly weren't traveling the. The world is a better place today and we know it. And does that mean that there's downside? Of course, there's downside. We should be incredibly thoughtful. We should be incredibly careful. But there will be downside as we go and create a better and better world.
Halle: and maybe this is a good time to ask, uh, what is algorithmic fairness?
Adrian: I tend, I tend not to try and answer questions that don't have a metric. Saying something is fair, is philosophical and you and I can sit here and we can argue back and forth and it's frankly just gonna be bullshit at the end of the day because there's no way to ground an argument. I'm an engineer.
I'm a mathematician. I like science. So at the end of the day I say, well, what's the metric that you want to optimize for? If the metric that you wanna optimize for is that the wealthy don't have substantially longer lifespan than the poor, that makes total sense to me. I'd love to work on that problem.
If the metric you wanna optimize for is that people of certain skin color do not have different life expectancy than others. Fantastic. Let's work on that. But engaging in conversations about what's fair or what's right mostly leads you down a path of having philosophical arguments. And I'm in the business of impact.
Halle: But do you think that can help close these health gaps between the rich and the poor and the underserved?
Adrian: Absolutely. If you, if you wanna predict the future, the best way to do it is just to look at the past. And if you have to ask yourself, if you ask yourself, merely the simple question of was it better to be poor a hundred years ago or a thousand years ago than today? Without question, the answer is today, the literally the richest person, the richest person of one or 200 years, Has a worse life than the poorest person of today.
Think about that rate of progression. Think of that, that that rate of progress, that's the world that you wanna live in. When you look at ai, when you look at machine learning, merely think about it. As just a better and better calculator, and we've seen what the calculators have given us. They've allowed that farmer in Rwanda to farm.
They've allowed the person in Nairobi to trade, they've allowed that person in the middle of India to educate themselves. It has lifted us all up and it will continue to do so.
Halle: So tell us about how you're using AI and technology to completely rebuild the healthcare system.
Adrian: So if you actually think about kind of the structure that I said, it turns out that before you can use ai, you need that operating system and you need that operating system to collect the data and be able to assert the actions. It turns out that. These algorithms like chat, G B T only work because there's this thing called the internet with a bunch of data.
It turns out that all these apps on your smartphone only work because Apple went to the effort of creating that smartphone that's in now, I don't know, 1.6 billion pockets around the planet. But it turns out nobody has created that structure and that foundation that the, let's call it the scaffolding of hair of healthcare.
So what forward's doing is really. . We started with this core notion that we said, you know what? We've made a mistake in healthcare, and the mistake is that we treat healthcare as a service. Let me take a step back. There's about 8 billion people on the planet. Less than 2 billion of them have access to anything that you and I would call a real.
Form of healthcare. You're like, what? It's in the year 2023. How did we end up here? And you ask yourself why? Well, it's pretty obvious healthcare is based on doctors. And it turns out that if I told you I wanted to get doctors to the whole planet, to those 8 billion people, to the middle of India, the middle of Rwanda, to every single person, you are gonna say, Adrian, where are you gonna get all these doctors?
And who the hell's gonna pay? . On the other hand, if I told you I wanted to get smartphones to the whole planet, to billions of people to the middle of India, the middle of Rwanda, you'd say, Adrian, not only do I think it's possible, I think it's kind of already happened. So what do you intuitively know, Halle?
You intuitively know that humans don't scale in a way that technology does. Another way to say it is doctors don't scale in a way that hardware and software. So at Ford we had this one key realization. We realized that healthcare should be a product, not a service. We should just take every single thing that doctors and nurses are doing and just migrate it over to hardware and software.
Now, think about what I told you earlier. I said, you wanna get healthcare to the whole planet? Well, of course you want to do it as hardware and software, but also think about what I told you earlier. I said that for healthcare to be able to. We need an operating system. You know what looks a lot like an operating system is hardware and software.
If we convert healthcare to hardware and software, if we convert it to a product, now the world's smartest minds, all these people going to med school, taking that 10 years of education at 10 years of knowledge are not sitting there standing in front of a patient. Here's how to fix your flu, and then telling the next patient, here's how to fix your flu, and then telling the next, damn the exact same thing.
Here's how to fix your. Instead, they can write the algorithm. They can write the app that fixes the flu for the planet. We've seen the flu billions of times. Why haven't we just solved the damn problem? This is the world that we need. We need a world where we're all collaborating together to build the world's best product.
The reason that you and I use an iPhone, Is because millions, if not tens of millions, maybe even hundreds of millions of co of people have come together to invest their time, energy, data, you name it, into this one platform that has been a runaway success. So you have to ask yourself, where is the runaway success for a healthcare?
Where is that consolidated product that's gonna take us into the new.
Halle: You guys aren't replacing doctors. In fact, you guys offer your patients three times more time with their doctor every visit.
Adrian: Yeah. So this is really fascinating. So we don't want to replace doctors. Think about what I said. When, when, when, you know, I'm an engineer, when I sit down to work, I sit down at this thing called, called a laptop. It's like the some culmination of all human advancement in this beautiful two bound device.
In my prior job, I was at Google. and I worked on the search engine. I literally wrote code that later that day went out to 3 billion people. Why? Because I have a laptop. Because my tools were built for me. And they're amazing. And doctors are seeing people one at a time because they don't have the tools that are equivalent to what engineers have.
So we afford said, let's build them the tools to have more and more impact. So our doctors sit here and they don't just see, see our members. But they also write the algorithms that allow all of our members to be seen whether or not they have time with the doctor. So we actually don't, I wanna correct something you said.
We actually don't say let's have three times as much time every single visit. No, no, no. Three times as much time when you need it, when the algorithms aren't doing what you need. Yes, your doctor's there, but most of the time that's not what you need. It turns out that your blood pressure is not any different than the other person who has high blood pressure is your rash isn't different than my rash, and your cholesterol is not different than my cholesterol.
So let's get doctors out of dealing with the rote routine bullshit, and let's get them doing the things that are truly, truly.
Halle: So from the patient perspective, are you finding that they are becoming more engaged with their health on a daily basis and in between these visits?
Adrian: Absolutely. In fact, the visits, uh, you, I would, I would change it. So we don't start thinking of the visits as where the healthcare happens, but almost think about it as in between. The visit is where healthcare happens. Your body does not say, Hey, 99% of the time, I'm not thinking about my health. I'm not developing.
I'm not developing that cancer, that cholesterol, but yo, now we're going into the doctor. Here's where, here's where everything happens. That's just not how it works. It's a continuous process, right. Uh, doctor's offices have become these repair shops for human as opposed to us dealing with you at all times.
So yes, our members are way more engaged. In fact, about 50 times more engaged is what we see, but, but it's almost like we're cheating. Of course, they're engaged because they're able to just do something as simple as. , open their phone and engage their health or swing by whenever they want, and use anything from a skin sensor to a body cancer or get a blood test.
Again. When you don't gate things behind doctors, and instead you use doctors where they're needed most. On the truly most complex cases, all of healthcare becomes way more accessible.
Halle: So I'm afraid to go here and I feel like there might be some swearing in your answer, but why don't you take, why don't you take health insurance? Tell me what you really think about health plans.
Adrian: Uh, health insurance is the root of all evil. Fuck them. They should go to hell. I apologize. Uh, but really I don't
Halle: knew that was coming.
Adrian: But, but let's think about, let's think about why, right? First, first problem is really simple. The health injuries literally do not care about your health. Think about the entire healthcare system that we've created.
What did I describe earlier? So I, before this, I worked at Google for a bunch of years, okay? When I was at Google, Google came up to me every year, Adrian, time to get your flu shot. Time to get your flu shot. Time to get your flu shots. Okay. Let me ask you, Halle. . Do you know anybody who's died of the flu?
Can you name a single person who's died of the flu? Is there something huge rash of flu deaths going on that I don't know about? On the other hand, how many people that you can name have died of cancer or heart disease? plenty, right? So what the hell is happening? Why is Google coming up to me saying, you know what we wanna talk about Your, your, your, your, uh, uh, your flu, but we don't wanna talk about your cholesterol or your heart disease.
Well, easy. The average tenure of an employee with an employer in the United. States is two and a quarter years. So think about it, you get the flu, you're gonna be out. Some work, they're out, some money, maybe you take somebody else with you, it's a little worse for them. But cancer, heart disease, you're not gonna develop that for 20, 30, 40 years.
So they're thinking, you know what? It's the next guy's problem. And so the entire healthcare system, the entire I. System is attached to the employer, and because of that, they don't care about your long-term health. They care about your short-term health. You see this in everything you do. Go get a checkup.
Just go to a primary care physician and go get a checkup, and you know what they're gonna say. Say, Halle, you're great. You're fine. You're okay. You're good. Well, hold on, doc. Hold on. What's my probability of. A hundred percent. I promise you. A hundred percent. So what the fuck are you telling me that I'm good.
Imagine if you got your house. I inspected before buying it. Building inspector comes by, they say, ah, your house looks great. Two years later, five years later, it blows down in a, in a windstorm. You call up that building inspector, you're like, what the fuck? And the in building inspector and, no, no, no, no, no.
I met, it was great that month. I didn't mean it was great for good. You're like, what the fuck are you doing? What did I pay you for? And this is the healthcare system that we've created. We created a healthcare system that's focused on keeping you at work, not keeping you alive. It's utter bullshit and it needs to stop.
Halle: Yeah. So I, I assume you also think that your health insurance shouldn't be tied to your employment.
Adrian: I believe you shouldn't have health insurance. Health insurance is, is a vestige of the past. Think about why you have insurance even as a concept, right? It's because you have these outlier events that cost you a lot of money. Oh no, I could get hit by a car and need open heart surgery. Oh no. I could get cancer.
But now Ali, let's say I walked up to you and I said, Hey Allie. do you have Gmail? I. , you're like, no. What do you mean Gmail insurance? Why the fuck would I have Gmail insurance? But hold on, Allie, I could send you like 10,000 emails tomorrow and you can't do anything to stop it. Or do you have, do you have Instagram insurance?
No, but whatever. I could tag you in 10,000 photos tomorrow. Well, why? Why does insurance not make sense here? And what you quickly realize is because those outlier. Don't particularly cost much more money, right? The marginal cost of that is almost nothing. Well, now ask yourself, remember what I said? I said I believe healthcare should be a product, not a service.
So now ask yourself when you go get open heart surgery. And it cost, I don't know, 50 grand, a hundred, a hundred thousand dollars. Why did it cost a hundred thousand dollars? I tried to understand this. I was like, well, clearly they must have used a $3 million machine. No, no. It was some, some dude, some. You know, dude, that, that kind of is just sitting there cutting you open.
Okay. Well, clearly they must be using some, some, I don't know, some gold, some, some titanium. Nope. Nope. It's cotton swabs and some needles. You know, it's like, imagine describing, imagine describing open heart surgery to an alien that just landed on this planet. It's like, . Okay. On one hand I've got this thing called open heart surgery.
Kind of looks like when you're eating a, a steak dinner, you know you got a fork and a knife. I mean, they're a really clean fork. They're a really clean knife. I mean, you've got a tablecloth in this place. The tablecloth is blue. I don't know why, but it is. Okay. And on the other hand, you've got this thing called an iPhone, right?
It's, it's can connect you to the entire world's information under a second. It has AI processors, it's got a photographic memory. It can call all the way to China. It's made in a clean room by. And I literally tell you one of these things costs $400 and one of these things cost a hundred thousand dollars.
Well, you know what? The alien from Outer Space is gonna say, I don't know how to tell you this Adrian, but clearly the iPhone is a hundred thousand dollars. You're like, no, that's $400. Why the fuck does a guy who looks like he's like having a steak dinner cost a hundred thousand dollars? There's no material cost to this.
You know what you're paying for? You're paying. The first thing you're paying is the damn healthcare system. The insurance companies, they want their cut, and the second thing you're paying for is the education of that doctor. You're paying Harvard, Stanford, and Yale, and that's gotta stop. Now, let's go back to this healthcare system bullshit.
Imagine that instead of having a healthcare system like you just got hit, you just got into an accident, got hit by a bus, and you need to get to the hospital. . So, uh, you, you open up your Uber app, right? And, uh, Uber X is $20, Uber Black is $40, and Uber ambulance is $3,000. You're like, what the fuck? How did we end up here?
Why do, what does an ambulance ride always cost two or $3,000. If Uber made it, it would be $60, right? It's not that expensive a vehicle. You're not paying the guy in there any, like, any material cost, like what the hell happened? And that's what you. The difference between $60 and $3,000. That's the bloat of the insurance system.
That's them taking their rake. Now think about why makes total sense. You can't negotiate it. If you get that hospital bill, you can't do fuck all about it. So if Verizon and at and t say, you know what? We wanna raise your bill. What's the first thing you do? Fine. I'm going to T-Mobile. And if the local hospital says, we wanna raise your bill, what do you.
Well, I just gotta pay it. And this is the problem. So every single year they're Costco up and they're literally giving us less and less value while charging us more and more. It's gotta stop. It's literally the number one problem in this country.
Halle: So what's next for you in forward? What's like the grand vision?
Adrian: My, my vision is very, very simple. There's 8 billion people on the planet. They don't have healthcare. The vast majority of them don't have healthcare. I wanna build the. First healthcare system that truly scales to planet scale. The first healthcare system that scales to 1 billion users. And if you think about what I told you earlier, really all this means is you have to build the first healthcare system that can go exponential.
The same way an iPhone's going x. Exponential has gone exponential the same way the internet has the same way Tesla's now getting cars to go exponential and deliver 'em to the whole planet. I want healthcare to look the same way, which means taking every single thing. So you, you talked about our clinics, it's really simple.
We just watch everything that's happening inside of our clinics. You come in, you sit in an exam chair, you talk to your doctor about the flu. We say, great, why'd you come in? Why not build that into the mobile app? Next person comes in, they sit in the exam chair, they talk to their doctor about their heart issue.
We build a body scanner. You talk to your doctor about your skin issues. We build the skin scanner solely, but surely we're just migrating every single thing from doctor and nurse to hardware and software because we know that as we do, we can get healthcare to go exponential and be ubiquitous. You me, everybody talks about healthcare as a right.
We want healthcare to be truly democratized. We want it to be equal and fair. Well, you know, It's not gonna get there when it costs 20% of GDP to offer the crap that we have today. It's gonna get there when it's as cheap as Google and as ubiquitous as Android phones in the middle of Rwanda. That's the world we're trying to create in the world of healthcare.
Halle: Amazing. Well, we wish you all the luck and Adrian, thank you so much for being here.
Adrian: You're super kind, but I don't need your luck. I need your talent. So if you wanna join us, join the team, please.