I find myself thinking about the future a lot, in part because I’ve somehow accumulated so much past, and in part because thinking about the present usually depresses me. I’m not so sure the future is going to be better, but I still have hopes that it can be better.
Two articles recently provided some good insights into how to think about the future: Kevin Kelly’s How to Future and an except from Jane McGonigal’s new book Imaginable: How to See the Future Coming and Feel Ready for Anything―Even Things That Seem Impossible Today that was published in Fast Company.
I’ll briefly summarize each and then try to apply them
to healthcare.
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Mr. Kelly – a founding Executive Editor of Wired
(and now “Senior Maverick” there), editor/ publisher of Cool Tools – posits that futurists need to
look at the past, present, and future. “They look carefully at the past because
most of what will happen tomorrow is already happening today,” he
notes. “The past is the bulk of our
lives, and it will be the bulk in the future.”
As for the present:
It is often said that most futurists are really predicting the present. It turns out that the present is very hard to see…So a good futurist spends a lot of time trying to decipher the present and to try to see it through the mask of present-day biases…I sometimes think of “seeing the present” as trying on alien eyes; looking at the world as if I were an alien from another plane.
Mr. Kelly suggests trying
to picture the “history” of an imagined future, the steps required to get to X
in year YYYY, so that we can understand “What kinds of technology and laws
and social expectations needed to be in place year by year in order to
arrive at that state.” However, he warns: “Most important, the main job
is to think about the consequences of X arriving. What would we do if X was
true? How do we manage it? How do we regulated it? How does it change us as
humans?”
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Dr. McGonigal – a game designer, Director at The
Institute for the Future, and co-founder of health app/game SuperBetter – shares five tips for imagining
the future:
Take a Ten Year Trip to
the Future: “Ten years because that is enough time for society,
and your own life, to become dramatically different. It’s enough time for new
technologies to scale up and achieve global impact. It’s enough time for social
movements to achieve historic victories. It’s enough time for big new ideas to
take root, gain traction, and change the world.”
Be Ridiculous – At First:
“Any
useful statement about the future should at first seem ridiculous…We need to
prepare our collective imagination for “unimaginable” possibilities…If
something feels unimaginable, that’s the tip-off that it is an essential future
to start thinking about.”
Look for Clues:
“To find future clues, you need to develop a way of observing the world in
which you spot weird stuff that others overlook. You must constantly home in on things you
haven’t previously encountered, things that make you say, “Huh…strange,” and “I
wonder why that’s happening.”
Turn the World Upside-Down:
“If your imagination feels stuck in the present, then rewrite the facts of
today. Make a list of up to a hundred things that are true today, then flip
them upside-down…Turning the world upside-down can help clarify what changes
you want in society and your own life.”
Build Urgent Optimism:
“Urgent optimism is a highly motivating, resilient mindset made up of three key
psychological strengths: mental flexibility, realistic hope, and future power.’
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In healthcare, the past is, for better and for worse, always
with us. For example, the central role of
hospitals and doctors is certainly over a century old, that of pharmaceutical
companies almost that old; the pervasive presence of employer-provided health
insurance goes back to the 1940’s and that of Medicare/Medicaid to the 1960’s. None of them seems likely to go anywhere
anytime soon.
The present of our healthcare system is, as Mr. Kelly
warns, is harder to see. It has proved dangerously
fragile in this pandemic. It never has
offered equal care, or even equal access to care, to everyone. And, most scary of all, in 2022 it turns
out that we still don’t know if most medical treatments work, much
less cause harm.
So we need to think of ridiculous futures, filled with
impossible things. We need to turn
healthcare upside-down, as Dr. McGonigal might say. Ten years isn’t going to be enough; we need
to be thinking about 2050, or 2100.
In my upside-down healthcare world, we don’t have
doctors and hospitals. Care is done at
home, supported by assistive/supportive technology and overseen by artificial intelligence. Health is monitored in real-time and any
necessary adjustments are made almost as quickly, such as through the nanobots
swimming within us or in the medications/devices we 3D print at home. Care decisions and treatments are based on
evidence, collected and analyzed on an ongoing basis, not on intuition,
tradition, or personal preferences. Technology
has lowered costs so much that insurance is not necessary.
We acknowledge that health starts with how we live – what
we eat, where we live, what we breathe, how much income we have, how we earn
our living, to name a few. We need
massive savings in healthcare to invest in those.
Where are all the healthcare workers in this future? I don’t know, but healthcare isn’t supposed
to be a jobs program. It’s supposed to
be about maintaining/improving our health.
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Sound ridiculous?
Good; that’s how we know we’re trying hard enough.
I’m going to keep looking for clues to that future, be
they improvements
in AI, turd
robots, or RNA
computers – “weird stuff that others overlook,” as Dr. McGonigal says. I want to be open to the possibilities that
healthcare can become, not limited by our expectations about what it is now.
We need more urgent optimism about fixing healthcare.
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