Too Many Small Steps, Not Enough Leaps

I was driving home the other day, noticed all the above-ground telephone/power lines, and thought to myself: this is not the 21st century I thought I'd be living in. 

When I was growing up, the 21st century was the distant future, the stuff of science fiction.  We'd have flying cars, personal robots, interstellar travel, artificial food, and, of course, tricorders.  There'd be computers, although not PCs.  Still, we'd have been baffled by smartphones, GPS, or the Internet.  We'd have been even more flummoxed by women in the workforce or #BlackLivesMatter. 

We're living in the future, but we're also hanging on to the past, and that applies especially to healthcare.  We all poke fun at the persistence of the fax, but I'd also point out that currently our best advice for dealing with the COVID-19 pandemic is pretty much what it was for the 1918 Spanish Flu pandemic: masks and distancing (and we're facing similar resistance).  One would have hoped the 21st century would have found us better equipped.

So I was heartened to read an op-ed in The Washington Post by Regina Dugan, PhD.  Dr. Dugan calls for a "Health Age," akin to how Sputnik set off the Space Age.  The pandemic, she says, "is the kind of event that alters the course of history so much that we measure time by it: before the pandemic — and after."  

In a Health Age, she predicts:

We could choose to build a future where no one must wait on an organ donor list. Where the mechanistic underpinnings of mental health are understood and treatable. Where clinical trials happen in months, not years. Where our health span coincides with our life span and we are healthy to our last breath.

Dr. Dugan has no doubt we can build a Health Age; "The question, instead, is whether we will."

Dr. Dugan head up Wellcome Leap, a non-profit spin-off from Wellcome, a UK-based Trust that spends billions of dollars to help people "explore great ideas," particularly related to health.  Wellcome Leap was originally funded in 2018, but only this past May installed Dr. Dugan as CEO, with the charge to "undertake bold, unconventional programmes and fund them at scale."  Dr. Dugan is a former Director of Darpa, so she knows something about funding unconventional ideas.

Leap Board Chair Jay Flatley promised: "Leap will pursue the most challenging projects that would not otherwise be attempted or funded. The unique operating model provides the potential to make impactful, rapid advances on the future of health."  

Now, when I said earlier that our current approach to the pandemic is scarily similar to the response to the 1918 pandemic, that wasn't being quite fair.  We have better testing (although not nearly good enough), more therapeutic options (although none with great results yet), all kinds of personal protective equipment (although still in short supply), and better data (although shamefully inconsistent and delayed).  We're developing vaccines at a record pace, using truly 21st century approaches like mRNA or bioprinting.  

The problem is, we knew a pandemic could come, we knew the things that would need to be done to deal with it, and yet we -- and the "we" applies globally -- fumbled the actions at every step.  

We imposed lockdowns, but usually too late, and then reopened them too soon.  Our healthcare organizations keep getting overwhelmed with COVID-19 cases, yet, cut off from their non-pandemic revenue sources, are drowning in losses.  Due to layoffs, millions have lost their health insurance.  People are avoiding care, even for essential needs like heart attacks or premature births.  

Our power lines are showing.  The the hurricane that is the pandemic is knocking them down at will.  We might have some Health Age technologies available but not a Health Age mentality about how, when, and where to use them. 

Dr. Dugan thinks she knows what we should be doing:

To build a Health Age, however, we will need to do more. We will need an international coalition of like-minded leaders to shape a unified global effort; we will need to invest at Space Age levels, publicly and privately, to fund research and development. And critically, we’ll need to supplement those approaches with bold, risk-tolerant efforts — something akin to a DARPA, but for global health.

Unfortunately, none of that sounds like anything our current environment supports.  The U.S. is vowing to leave the World Health Organization and is buying up the worlds's supply of Remdesivir, one of the few even moderately effective treatment options.  An "international coalition of like-minded leaders" seems hard to come by.  Plus, only half of Americans say they'd take a vaccine even when it is here.

If COVID-19 is our Sputnik moment, we're reacting to it as we did Sputnik, setting off insular Space Races that competed rather than cooperated, focused narrowly on "winning" instead of discovering.  We will, indeed, spend trillions on our pandemic responses, but most will be short-term, short-sighted programs that apply band-aids instead of establishing sustainable platforms and approaches.  We're reacting to the present, not reimagining the future.

Credit: Darpa

Darpa's mission is "to make pivotal investments in breakthrough technologies for national security," and it "explicitly reaches for transformational change instead of incremental advances."  Her background at Darpa make Dr. Dugan uniquely qualified to bring this attitude to Leap, and to apply it to healthcare.  

The hard part is remembering that it is not about winning the current war, or even the next one, but about preparing for the wars we're not even thinking about yet.  

Most of our population are children of the 20th century.  Our healthcare system in 2020 may have some snazzier tools, techniques, and technologies than it did in the 20th century, but it is mostly still pretty familiar to us from then.  If we truly want a Health Age, we should aspire to develop things that would look familiar to someone from the 22nd century, not the 20th.

Every time I read about the latest finding about our microbiome I think about how little we still know about what drives our health, just as our growing attention to social determinants of health reminds me how we need to drastically rethink what the focus of our "healthcare system" should be. 

Not more effective vaccines but the things that make vaccines obsolete.  Not better surgical techniques but the things that make surgery unnecessary.  Not just better health care but better health that requires less health care.  If we're going to dream, let's dream big. 

That's the kind of Leap we need. 

Healthcare Needs Some #GoodTrouble

As hopefully most of you know, Rep. John Lewis, civil right icon and longtime member of Congress, died this past Friday.  Rep. Lewis was often described the "conscience of Congress"  - perhaps a low bar in today's Congress but important nonetheless -- for his unwavering commitment to social justice.  I have always been struck in particular by one of his quotes:

Rep. Lewis must have been heartened by the fact that, in 2020, plenty of people are, indeed, making noise and getting into good trouble, necessary trouble over issues that he cared deeply about, like Black Lives Matter and voting rights.  There are others who are better able to write about those people and that trouble.  So I'd like to talk about his call to action with respect to healthcare.

If you are working today in healthcare -- especially in the United States -- or, for that matter, someone getting healthcare or having a loved one get it, then you should be making some noise and getting into good trouble, because our healthcare system most definitely makes it necessary.

It should come as no surprise that we're not very happy with our healthcare system, rating it lower than do citizens in most other developed countries.  And for good reason: it's the world's most expensive while delivering sub-par health results and leaving tens of millions without financial protection.  Even our physicians don't like it.  Even our latest, best effort for improving the sorry state of our healthcare system -- the Affordable Care Act  - is under risk of repeal due to a lawsuit brought by 18 states and backed by the Trump Administration. 

Every day, too many of us suffer in the healthcare system, ranging from waits to indignities to critical mistakes, and some face financial ruin due to the care -- whether good or bad.  Most of us suffer in silence, or only complain to our friends and family.  We don't see a lot of mass protests about the pitiful state of our healthcare system, and I have to wonder why. 

We have to stop being so passive.

For those of you working in healthcare, here are the first two things I'd urge you to get into good trouble about:

• Stop doing stupid stuff
• Do simple better

Credit: FreePik

The first admonition comes from a movement developed by Melinda Ashton, MD at Hawaii Pacific Health.  She started asking front-line workers to identify things that were "poorly designed, unnecessary, or just plain stupid," and -- not surprisingly -- there turned out to be a lot.  Someone just needed to ask and to promise some action.

Why every healthcare system/organization does not have such a program is beyond me, because those front-line workers see those kinds of things every day.  They probably do make some noise about them, but many may not be willing to get into good trouble over them, nor are they usually supported by their leaders to do so.  

But, still, they should be trying.

The second comes from advice that Dan Gingiss gives about improving customer experience.  Our healthcare system is the world's largest Rube Goldberg machine, complicated beyond understanding and with much of that complexity not achieving intended goals.  "Complicated" isn't the same as "sophisticated," much less "better."

Yet we continue to add complexity, layering new technologies onto old, inserting new layers and new types of intermediaries, all of which adds costs.  Even things that aren't inherently stupid are usually more complicated than is absolutely essential.  

Before we make things even more complicated, we should focusing on making the simple things better.  Who is getting into good trouble about that?    

I'll give some other examples.  The Commonwealth Fund and Manett just put out a report about transforming primary care for women, and one of the recommendations was the recommendation to expand women's leadership in healthcare.  As one of the authors, Lisa Suennen, wrote in her blog:

In a field where only 4% of all healthcare company CEOs are women and only 19% of hospital CEOs are women (a subset of the other number), policy is made by men. Physician education is also designed by men, who make up 2/3 of active physicians and 84% of the deans and department chairs at the 154 member medical schools in the United States. 

It shouldn't just be about primary care, nor even just about women.  If the leadership at your healthcare organization doesn't resemble the workers in it, or, equally important, the people receiving care from it, then you should be making noise.  That's worth getting into good trouble about.  That's necessary trouble. 

Or take prices.  As expensive as our healthcare system is, we've known for a long time that our problem isn't getting too many healthcare service as it is the prices we pay for them.  If you're working in a healthcare organization that charges the people without health insurance much more, you should be making noise.  If your organization is also suing those patients to collect the resulting debts, you should be getting into good trouble to try to stop it. 

And, of course, if you are working in a healthcare organization where you see patients getting services they don't actually need, or, worse yet, delivering substandard care, then you really should be making noise and getting into good trouble.    That is definitely necessary trouble.

But it's not only those working in healthcare.  If you or your loved one is receiving care, you should be making noise when you aren't treated with respect, or when you don't get the information you need.  Standing up for your rights, especially the right to make informed decisions about your care and your health, is worth making good trouble about.  It is necessary. 

All of us should be getting into good trouble about the shameful health disparities in our nation, which reflect the equally shameful socio-economic disparities we have allowed to persist.  All of us should be getting into good trouble about the fact that a healthcare episode can wipe out a families' savings, even if they have health insurance.  All of us should be making good trouble about how much our nation spends on healthcare for such a poor health return. 

We can't be afraid to make some noise about healthcare.  We must be willing to make good trouble about the many, deep, and pervasive problems in our healthcare system.  If that isn't necessary trouble, I don't know what is. 

Virtually Better

The COVID-19 pandemic couldn't have come at a better time for virtual reality.  It has caused many workers to work remotely, introducing many workers to collaborative tools like Slack or Microsoft Teams and even more to video platforms like Zoom or Skype.  But we're just beginning to understand what collaboration could look like -- such as virtual reality (VR).

As CNBC noted: "Virtual reality is booming in the workplace amid the pandemic."  Even a pre-pandemic Perkins Coie survey, done for the XR Association, predicted an explosion of immersive technologies like VR, augmented reality (AR), and mixed reality (MR).   Elizabeth Hyman, President of XRA, said: "We are at the precipice of an integration of XR technology that will transform businesses and society for the better.”  

The report expected healthcare to be the industry most impacted by immersive technologies (outside of gaming/entertainment).

Spatial virtual meeting.  Credit: Spatial

Take VR-start-up Spatial, which thinks it has a better mousetrap.  Chief Product Officer described their solution to MIT News:

Spatial is a collaborative, holographic, augmented reality solution.  You can teleport to someone’s space, work as an avatar sharing that 3D space, and use it instead of a screen to manage a project, present an idea, and more.

Don't you love the "and more," as though the teleportation wasn't enough? 

Spatial has been around since 2016, but in the wake of the pandemic Spatial made its enterprise version of the platform free.  It works on most virtual reality headsets, although there is a web browser version that can be used without a headset.  Design and engineering companies have been the biggest users, but that is changing.  "After coronavirus, interest went up 1,000 percent," Dr. Lee said, "and a big part of that was from smaller businesses, hospitals, schools, and individuals."  

In the shared workspace, people -- or rather, their avatars -- can use whiteboards, share sticky notes, build and use 3D models, even give each other high fives.  Here's a short promotional video:

Dr. Lee points out:

There’s a lot of Zoom fatigue right now, and I think the biggest reason why is because the video format really forces you to be 200 percent focused when you’re presenting or listening, but you can’t do something together.  You can’t be in this space, looking at things together and pointing at things. This feeling that we’re in the same space can only be achieved through a 3D physical office, and that’s some of what Spatial is trying to achieve in virtual form.

Microsoft, for one, is not sitting idly.  It just introduced a "Together Mode" to its Teams platform, which "uses AI segmentation technology to digitally place participants in a shared background, making it feel like you’re sitting in the same room with everyone else in the meeting or class."  It is supposed to allow participants to pick up on faces, body language, and other non-verbal cues.

Here's Microsoft's promotional video:

Marissa Salazar, Product Marketing Manager, told TechCrunch's Frederic Lardinois: "you’ll notice the way that we’re looking at each other is obviously very different than something we’re used to, not only are we out of the grid, but we’re looking at this, ‘mirror image’ of ourselves."  Microsoft's research suggests that, based on monitoring brain activity, participants using the Together Mode exerted less mental effort than in the traditional grid mode, thus reducing meeting fatigue. 

Currently, the shared space is an auditorium, but additional views are expected to be available soon (including a coffee shop for smaller meetings).  Famed VR pioneer Jaron Lanier, who worked with Microsoft on the new tools predicts: “We’ll see people make the space their own, just like they do the workplace, for the type of social dynamics that may exist.  I think where this is headed is a lot more flexibility and customization.”

At the same time, Teams is introducing Dynamic View to "dynamically optimize shared content," allowing more control over how users see content and other participants.    

Mr. Lanier says: "In a sense, it’s just a simple design strategy.  In another sense  it’s a design strategy that benefits from many years of studying mutual perception, particularly in virtual reality."  

Take a look, for example, of what Imperial College (London) claims is the first virtual ward round for medical students, using HoloLens.  The attending physician sees the patient in person, and streams the visit to literally hundreds of medical students.  The Guardian reports: "Teachers are able to pin virtual pictures to the display, such as X-rays, drug charts or radiographs, or draw lines to highlight something they want to emphasise."  

One medical student gushed: 

Despite the ward round being virtual, it felt far from it – we were expected to ask questions and think about clinical problems in real time.  It was really helpful to be able to access investigations like X-rays and blood tests in an instant, and the way the information was projected felt natural.

Now imagine what that experience could be like using Spatial. 

Last year I suggested that EHRs needed a new metaphor; instead of just being digital versions of paper records, they should be collaborative tools like Slack or Teams.  Now I'll go further: they should be a "collaborative, holographic, augmented reality solution,"  Oh, wait, that's Dr. Lee's description of Spatial's solution. 

Spatial's slogan is "How Work Should Be," but it's not how healthcare is.  Healthcare is full of telephone calls, long waits, 1-on-1 meetings, incomplete or incomprehensible data, even faxes.  It is a maze we navigate anxiously, and sometimes get lost in.

For many, perhaps even most of us, our healthcare journey is a team effort, not just with our healthcare professionals but also our support system.  We need better ways to visibly present, interpret, and use our data, and to get that data to the right people at the right time. 

We need XR healthcare.

I don't want to live in the metaverse (as Neal Stephenson termed it thirty years ago) and I certainly don't want to live in our current pandemic world any longer than I need to, but the pandemic is helping us discover new ways to do things.  The shared, collaborative world that companies like Spatial or Microsoft are working towards is one that I hope we keep, especially in healthcare. 

Goodbye Glasses, Hello Smartglasses

It's been a few months since I last wrote about augmented reality (AR), and, if anything, AR activity has only picked up since then -- particularly in regard to smartglasses.  I pointed out then how Apple's Tim Cook and Facebook's Mark Zuckerberg were extremely bullish on the field. and Alphabet (Google Glasses) and Snap (Spectacles) have never, despite a few apparent setbacks, lost their faith.   

I can't do justice to all that is going on in the field, but I want to try to hit some of the highlights, including not just what we see but how we see. 

Apple smartglasses Credit: idropnews/Martin Hajek

Let's start with Google acquiring smartglass innovator North, for some $180m, saying:

We’re building towards a future where helpfulness is all around you, where all your devices just work together and technology fades into the background. We call this ambient computing. 

North's founders explained that, from the start, their vision had been: "Technology seamlessly blended into your world: immediately accessible when you want it, but hidden away when you don’t," which is a pretty good vision.

Meanwhile, Snap is up to Spectacles 3.0, introduced last summer.  They allow for 3D video and AR, and continue Snap's emphasis on headgear that not only does cool stuff but that looks cool too.  Steen Strand, head of SnapLab, told The Indian Express: 

A lot of the challenges with doing technology and eyewear is about how to hack all the stuff you need into a form factor that’s small, light, comfortable, and ultimately something that looks good as well.

Snapchat is very good at taking something very complex like AR and implementing it in a way that’s just fun and playful.  It really sidesteps the whole burden of the technology and we are trying to do that as much as possible with Spectacles.

Spectacles 3 Credit: Snap

Snap claims 170m of its users engage with AR daily -- and some 30 times each day at that.  It recently introduced Local Lens, which "enable a persistent, shared AR world built right on top of your neighborhood." 

And then there's Apple, the leader in taking hardware ideas and making them better, with cooler designs (think iPod, iPhone, iPad).  It has been working on headset-mounted displays (HMDs) -- including AR and VR -- since 2015, with a 1,000 person engineering team. 

According to Bloomberg, there has been tension between Mike Rockwell, the team's lead, and Jony Ive, Apple's design guru, largely centering around if such headsets would be freestanding or need a companion hub, such as a smartphone, that would allow greater capabilities.

Ive won the battle, having Apple focus first on a freestanding headset.  Bloomberg reports:

Although the headset is less technologically ambitious, it's pretty advanced.  It's designed to feature ultra-high-resolution that will make it almost impossible for a user to differentiate the virtual world from the real one.

Apple continues to work on both versions (especially since Ive has now departed). Bloomberg predicts Apple's AR glasses will be available by 2023.

Not to be outdone, according to Patently Apple,  "Facebook is determined to stay ahead of Apple on HMDs and win the race on being first with smartglasses to replace smartphones."  

Example of Plessey microLED technology

For example, earlier this year, Facebook beat out Apple in an exclusive deal with AR display firm Plessey.  The company's goal is "glasses form factor that lets devices melt away," while noting that "the project will take years to complete."  It continues to generate a variety of smartglasses related patients, including one for a companion audio system.  

Just to show they're in the game too, Amazon is working on Echo Frames and Microsoft is still trying to figure out uses for Hololens.  

But what may be most intriguing smartglasses may be indicated by some recent Apple patents.  As reported by Patently Apple:

The main patent covers a powerful new vision correction optical system that's able to incorporate a user's glasses prescription into the system. The system will then alter the optics to address vision issues such astigmatism, farsightedness, and nearsightedness so that those who wear glasses won't have to them when using Apple's HMD.

It's worth pointing out that the vision correction is not the goal of the patent, just one of the features it allows.  The patent incorporates a variety of field-of-vision functions, including high-resolution display needed for AR and VR.  But vision correction may be one of the most consequential.

Apple vision correction patent.  Credit: Patently Apple

Two months ago, technology author Robert Scoble explained that Apple should be more interested in AR than VR because:

60% of people wear eye glasses.  So, if Apple can disrupt the eye glass market, like it disrupted the watch market, it can sell 10s of millions. So, the teams that are winning Tim Cook's ear are those who are showing how Apple can disrupt eye glasses. Not teams that are disrupting VR.

Doug Thompson elaborated, "If it can grab 13% of the market for glasses, that’s an $18B market, nearly double the current Apple wearables business to date." Although he believes AR is coming, he also believes: "The point of Apple Glasses won’t be to ‘bring AR to the masses’. It will be to create a wearable product that’s beautiful and that does beautiful things."

And this was before the news broke about Apple's new patent.  

I've worn glasses since elementary school, and it's a bother to have to periodically get new lenses.  If I could buy smartglasses that automatically updated, I'd be there. Warby Parker, Lenscrafter, and all those independent opticians should be pretty worried. 

Thirty years ago, if you predicted we'd all be glued to handheld screens, you'd have been scoffed at.  I think that in perhaps as little as ten years it is going to be considered equally as old-fashioned to be looking at a screen or even carrying a device.  Anything we'd want to look at or do on a screen we'll do virtually, using the ubiquitous computing power we'll have (such as through Google's ambient computing).  

Mr. Scoble told John Koetsier: "This next paradigm shift is computing that you use while walking around, while moving around in space,”  Mr. Koetsier believes it is "the next major leap in computing platforms," called "spacial computing."

We should stop thinking about AR as a fun add-on and more about a technology to help us see what we need/want to see in the way that best presents it, and smartglasses as the way we'll experience it.

Baby Bonds Are Anything But Childish

We are, as you probably know, in the midst of the worst pandemic in a hundred years.  It has caused the worst economic crisis since the Great Depression, and, oh-by-the-way, the George Floyd murder has triggered a wave of protests for social justice unmatched since the turbulent 1960's.  The thing that each of these is exposing is how already disadvantaged populations -- particularly people of color -- are the hardest hit. 

Minorities are disproportionately catching and dying from COVID-19.  They're more likely to have lost their jobs and, if not, to not be able to work from home.  And, of course, the Black Lives Matter protests center around how our law enforcement and judicial systems treat people of color much more harshly. 

It's easy to attribute these problems to systemic racism, and there is certainly some truth to that.  But it may be more accurate to attribute them to the vast wealth gap that exists in our country.  The good news is that, while racism has proved difficult to get rid of, the wealth gap may -- surprisingly -- be easier to address. 

The solution may be something called Baby Bonds.

Now, unless you were paying close attention to Cory Booker's Presidential campaign -- and, let's admit it, too few of us were -- you may not have heard about Baby Bonds. 

Simply put, the idea is to give every child a certain amount of money to be invested (either a lump-sum or a series of annual payments), with the money able to be redeemed when the child becomes an adult.  The amount invested is inversely related to family income, so that poorer children get more money.  The accrued amounts could only be used for specific purposes, like education, buying a house, or perhaps to fund a start-up. 

Economists Darrick Hamilton and William Darity are the thought leaders behind the Baby Bonds concept, proposing it in 2010).  

It is worth noting that Baby Bonds are not racially-driven, advantaging one race or ethnicity over another.  They are a function of income, advantaging all children of low incomes in the same way.  It is only the inherent racial inequalities of our existing wealth gap that would help more people of color.

Senator Booker's proposal gave each baby $1,000, with annual deposits of up to $2,000 based on family income.  He estimated that someone born in a family under the federal poverty level would have $46,000 by the time he/she reached 18, versus only $1,700 for those over 500% of FPL.  It wouldn't wipe out the wealth gap, but it'd help put a dent in it. 

A more radical version, put forth by Naomi Zewde of CCNY, would give poor babies $50,000 and rich ones only $200.  Her analysis indicated it would close the wealth gap between young white adults and young Black adults to "only" 40%, versus some 1600% currently. 

Let's look at why this matters so much.  The Pew Research Center found that:

• "Economic inequality, whether measured through the gaps in income or wealth between richer and poorer households, continues to widen."
• "The wealth gap among upper-income families and middle- and lower-income families is sharper than the income gap and is growing more rapidly."
• "The richest families in the U.S. have experienced greater gains in wealth than other families in recent decades...the wealth gap between America’s richest and poorer families more than doubled from 1989 to 2016."

Of particular note, a Brooking Institute report found: 

A close examination of wealth in the U.S. finds evidence of staggering racial disparities. At $171,000, the net worth of a typical white family is nearly ten times greater than that of a Black family ($17,150) in 2016.

Perhaps even more confounding, Brookings pointed out: "the racial wealth gap remains even for families with the same income."  Their report quotes Professors Hamilton and Darity that the largest reason for this are inheritances and other intergenerational wealth transfers; even equal incomes do not offset such lump sum advantages.  For example, The Urban Institute estimated that Blacks and Latinos were five times less likely to receive large gifts and inheritances.  

Baby Bonds are, in a way, society providing an inheritance to help counterbalance these inequities.

In her related story for The Atlantic, Professor Hamilton told Annie Lowrey: "At the root of the racial wealth gap, and wealth inequality in general, is capital itself.  Baby bonds are specifically aimed at giving people that seed capital, that asset that passively appreciates over their lifetime."  

Senator Booker estimated the cost of his proposal at $60b annually, while Professor Zewde calculated hers at $80b.  Neither is trivial, but are still much less than the preferential tax preference on capital gains, while mostly benefits wealthy people.  As Senator Booker told Vox when he introduced his bill, "A lot of aspects of our tax code, the benefits are usually used by the wealthy.  It’s time we start to give less-wealthy families the same opportunity."

It is way past time.

Some are calling for reparations as a different approach to bridge the racial wealth gap.  It is a worthwhile topic for discussion, but gets tricky in the details.  If we're doing reparations for slavery, what about reparations for the many legal and other barriers Asian immigrants faced?  More to the point, there is perhaps no group more deserving of reparations than our indigenous peoples. 

Baby Bonds at least have the advantage of not requiring the debate about how we got to our sorry state of affairs, or deciding who has suffered the most.  They simply require us to look at families' current financial situation.  They won't solve all of our existing disparities and injustices, but they could be a good investment towards lessening them.

There are many things about Baby Bonds that could prove problematic.  Many low income people are unbanked, so where would the money be invested?  There would be tremendous opportunity for fraud or excessive fees.  And there's no assurance that accumulated funds would be spent wisely once available.  

The biggest problem, of course, is that it will take a generation for the funds to accumulate, and our problems are now.  But, as the old saying goes, the best time to plant a tree is twenty years ago; the second best time is today.  

Baby Bonds are a way of planting that economic seed.