Thread by @chasedave

On this day celebrating 🇺🇸 independence, 🧵about another kind of "taxation without representation" & how community leaders are ending Wall St's (& their water carriers) colonization of our communities. And, how #web3 can turbocharge return of health sovereignty.

First some background: @JoshuaRosenthal said nations are "imagined communities instantiated by currency and contracts." [PSA: If you are into history, check out Josh's thoughts on how today's situation has remarkable parallels with the Renaissance ]

In #healthcare, state/federal laws matter but the real "laws of the land" are the legal docs that underpin health plans. Regulatory capture* is real but "contractual capture" is at heart of 🇺🇸's hc dysfunction
*HC orgs spend more lobbying $$ than 🏦 ✈️🛰🪖 industries combined

🇺🇸 hc industry now the 4th largest economy in the world. Let's call it' "Healthcareistan" which also wastes* $1.5T "tax"/year which would be the 11th largest economy in the world (larger than Russia). How is that possible?
* @theNAMedicine/@PwC both show 1/3 to 1/2 is waste

Reason #1: Mega carriers/PBMs/health systems have armies of smart lawyers codifying the $1.5T waste
Reason #2: Contract counter-parties (employers, civil servants running state/fed health plans) massively outgunned

Observed results in 5 years since @HealthRosetta launched:
1)Brokers paid by carriers/PBMs (hello, conflict-of-interest!) tell employers these terms are "standard"
2)Most employers treat legal docs like you treat Terms of Service (i.e., don't look at or negotiate)

Example: PBMs (Fortune 50 companies most people have never heard of) create so many revenue streams, they're bigger than pharma & can buy mega carriers. Naive employers join "PBM coalitions" mistakenly thinking it'll save $$ (opposite is true). PBM make more than pharma!

Employers sign profiteering-laden agreements w/o any transparency on data, ability to audit, etc. "One of my mentors often said price is irrelevant. He said he would sell anything for any price as long as he could define the terms of the deal." - @RelentlesHealth's Stacey Richter

Sad result: Working/middle class has had 30 yrs of wage gains stolen. One def'n of economic depression: 2+ yrs of wage stagnation/decline. In other words, 1/2 of 🇺🇸 household in depression 2x as long as 🇺🇸 Great Depression/1930s 🇩🇪. Status quo results: docs.google.com/presentation/d…

That's not all. Thus, why Ch 1 of my 1st book titled "American Has Gone to War for Much Less" listing other "achievements" (i.e., misery) inflicted on avg American. cdn2.hubspot.net/hubfs/481991/A… (PDF of chapter). Opioid crisis, preventable med mistakes 3rd leading cause of death...

Time for some good news: Well, 1st with this image. It sucks so bad that the largest generation in history that has no loyalty to status quo won't let this predicted future happen. In fact, wants to blow it up. Status quo built for greatest gen/boomer/acute care (not chronic) era

5 yrs ago, @HealthRosetta had a hypothesis: If we shared what we found (i.e., outliers who'd sustainably spent 40-55% less per capita on the best health plans in America), other would follow. My TED talk was about one that cumulatively saved >$500 million vimeo.com/615193743

Today: Every corner of the country (rural/urban), in public/private sector, large/small orgs now has world class health plans costing 20-55% less. Some case study examples: f.hubspotusercontent40.net/hubfs/481991/R… (PDF). Not yet mainstream but more widespread than most know.

New laws unnoticed by most require transparency (prices, broker fees, bans on gag clauses). Last key element active as of 7-1-22. Rare Trump exec order supported by Biden polls well across parties, age, ethnicity. Mini-documentary screened at White House. vimeo.com/691154961/8801…

New laws are now unleashing "4th branch of government" (i.e., class action attorneys). Same firm that has saved $billions for retirees (w/ 2 Supreme Court wins) now focused on hc. Wonky ERISA details - cdn2.hubspot.net/hubfs/481991/A… (PDF)

Old: Wall St, toxic*, unsustainable, brittle

Transparent/today: Local, organic (i.e., from grassroots community), sustainable, resilient

Food example (great video!): idea-farmer.wistia.com/medias/fxgr0ex…

*See "financial toxicity" as driver of poor health outcomes jamanetwork.com/journals/jamao…

Community-owned health plan leaders adopting system change model that's lifted 10's of millions out of poverty & remaking most important input into U.S. food system. The Future of Health Will Be Local, Open and Independent f.hubspotusercontent40.net/hubfs/481991/R… (PDF)

Community-owned health plans vision/reality:
f.hubspotusercontent40.net/hubfs/481991/R… (PDF)
Impact example: School district saved more money than entire school levy (that failed). Avoided cutting teachers/schools/programs vimeo.com/681961837/8828…. Employers of all types following school's lead.

So, how does Web3 fit into this vision (assumes familiarity with Web3/crypto concepts)? First of all, @HealthRosetta has been an IRL DAO for years (decentralized & autonomous) convening those who want a future not controlled by damaging behemoth orgs but by a bottom-up movement.

At a macro level, there’s perfect alignment with Web3/crypto’s open & decentralized ethos with community-owned health plans. The following outlines key areas of Web3 applied to the next era of health plans which govern the rules of how healthcare operates:

Smart contracts: 1)The annual $1.5 trillion wasted each year in healthcare is codified in deeply unfair legal documents (vendor & provider agreements plus the plan documents required by state/fed laws) that set the rules of the game.

2)Status quo health plans have “dumb contracts” (in the analog) realm that Health Rosetta makes much smarter and more fair. Once battle-tested, these analog smart contracts can be implemented using ETH-based smart contracts.

DAOs: Health Rosetta is essentially a IRL DAO. Over time, we expect it to become a DAO of DAOs that are governed by geographical & affinity-based communities. 90+% what drives health outcomes takes place at local level. Thus, that's where primary governance resides.

NFTs: 1)As COHPs are formed, they must balance vision & version (i.e., having something that can deliver immediate value). Vision is critical to laying out the values and positive future health ecosystem for a given community. These can be represented in art (visual & musical).

2)Those who invest in the vision development and early community development should be granted NFTs capturing the vision and values. Those early NFT holders can be granted commensurate tokens at a future point in time.

3)Impact certificates (HT @emiyazono @protocollabs @gitcoin) can be granted to orgs such as employers who have health plans delivering on our purpose (transforming waste into well-being) vimeo.com/615193743 vs. status quo, extractive models

Tokens: 1)Fundamental to the Health Rosetta Dividend (our purpose) is breaking down the artificial economic wall present in the U.S. between the sick care system (which consumes 90% of health-related $$) & the items driving most of a community’s well-being.

2)Further, items most driving community well-being are under-resourced & often uncompensated (or at least under-compensated). Creating a local token economy can allow redirecting resources from low to high value interventions. Tokens also enable time-banking for trading services.