Our guest today is David Johnson, CEO of 4sight Health and author of the new book, The Coming Healthcare Revolution: 10 Forces that Will Cure America’s Health Crisis. Prior to starting 4sight, a think tank promoting market-driven healthcare reform, Dave spent 28 years of his career in healthcare investment banking. This background and his Harvard public policy experience give him the unique ability to provide commentary on the nuances of healthcare, which he does so in an almost prophetic way in this landmark book. There is a reason we are kicking off the 2025 season of Creating a New Healthcare with his insights.

Where did the idea of revolution come from? Building on the realizations from his first two books*, Dave realized that there can’t be an incremental fix to US healthcare. It has to be exponential, so we, as consumers, shouldn’t be looking for evolutionary change. We should demand revolutionary change.

In our conversation, Dave describes the post-revolution system as “democratized and decentralized distribution of whole person health.” He goes on to explain that the two movements needed to get us to that end goal are care redesign and care migration – basically, care that integrates the whole person and can be delivered in the patient’s home, community, or location of choice. Add to that the advantage of aggregators, organizations that put all of the pieces together in a way that makes it easier for consumers to access. And finally, empowering caregivers to harness and realize their full potential. The shift to this new reality has been happening gradually for the past decade, but Dave feels like gradually is about to shift to suddenly.

Much of Dave’s work echoes my own feelings expressed both in Reframing Healthcare and, most notably, in Beyond the Walls. But I can’t say that I have been as convinced that the revolution is imminent. Talking with Dave gives me hope that it’s just over the horizon. That’s how I’d like to start this year…with hope.

* Dave is also the author of Market vs. Medicine: America’s Epic Fight for Better, Affordable Healthcare (2016) and The Customer Revolution in Healthcare: Delivering Kinder, Smarter, Affordable Care of All (2019)

Chapter 1 Part 2 - Gene Wolfe's Return to the Whorl