The System Works

For the last 20 years or so I've thought about what retirement might look like. 

In retirement, I'd go back to school and write a thesis on... I didn't know what to call it. The "Medical Industrial Complex?" Much of this was due to the many, many, many interactions as it relates to Kate. 

"I'll go back to school, do the research, get my PhD." Mostly so I could participate in Spies Like Us shenanigans: Doctor. Doctor. Doctor. Doctor.

I had this gut feeling that something was...broken; none of it made sense. 

When I didn't have insurance, $115 copay. When I did have insurance, $400. 

As a consultant/contractor, I understood how we measure things in time; n dollars/hour. 

OK, so Doc is $115 x 4 (because it may have been 15 minutes, I'm being super generous here), how is it now $400 x 4/hour? How in the hell does handing over a piece of plastic turn a $460/hr rate into $1,600/hour?

I'm (often) told I need a hobby. Outside of work. What many don't realize is that I'm one of the fortunate ones; what I do for a living is not work.

Choose a job you love, and you will never have to work a day in your life. Or whatever that phrase is. 

So, one Sunday, a few weeks back, I set Antigravity (Gemini) loose on my idea. I just told it: "I have an idea I want to explore."

I didn't expect a book. I expected a conversation. But what happened over the next few hours was the mechanical equivalent of defining the schema for 20 years of observations. I threw two decades of "gut feelings" at the machine, and it started mapping the plumbing. Before I knew it, I had a 23-bullet outline and links to 50-75 outside sources.

"Fully fleshed out, how long would this be?"

"350-400 pages."

"OK, let's pare that back"

Gemini proceeded to suggest serializing it on Substack or just going with an abbreviated manifesto.

I chose the manifesto. We pared it down to 8 dense chapters. It wrote the Intro. 

What...do I...OMG...this is...wow. 

If you spend enough time listening to patients, doctors, or politicians, you will hear a single, unifying complaint spoken across every demographic and tax bracket in America:

The healthcare system is entirely broken.

It is the one rare diagnosis found across every boardroom, breakroom, and waiting room in the country. They point to the soul-crushing administrative bloat that forces practitioners into eight-minute volume appointments. They point to the labyrinthine "prior authorization" processes where algorithms deny life-saving treatments.

And yet, this frustration is born entirely from a profound paradox.

If you strip away the billing departments and the insurance mandates, the actual clinical engineering of the American medical system is nothing short of miraculous. If you are diagnosed with a rare leukemia, or require an unprecedented cardiothoracic intervention, there is quite literally nowhere else on earth you would rather be. The United States produces the most advanced, precision-engineered medical science in the history of human civilization. The people executing that science—the physicians, the bio-engineers, the surgical staff—are elite.

That is not the original, but you get the idea. I spent time reading and editing that introduction, changing the tone, the focus, where I ended up creating a GUIDING_PRINCIPLES.md file to keep it inline:

• Dissect the Maze, Don't Indict the Mice
• Empathy for the Inheritor
• No Emotional Accusations, Only Systemic Mechanics
• Labels are "Pre-Written Baggage"
• Bypass Over Bureacracy

Super cool. A few iterations later, I had an Intro. On to Chapter 1. Same process. Edit for tone and clarity, but otherwise let it loose. Chapter 2, same. After Chapter 2, I just let it rip. By the end of that Sunday session, maybe 5 hours, I had a 40 page "book."

Over the next couple of days, I'd spend 30-60 minutes creating cover and chapter art (with Gemini web).

On Wednesday I had reached my quota for the month, the $20/month plan would reset on 4/11 (Saturday). 

I was exploring publishing options, I've always wanted to be a published writer (as I type that, I realize there are north of 800 articles here, so...). 

But like that, that specific itch was gone. I did not revisit on Saturday. I did share with friends and colleagues. I solicited feedback. I began to incorporate feedback and also track who provided what feedback. 

Fast forward a month, and I came head to head with this system again. It was unpleasant to say the least. 

Now, however, I was armed with new tools. The system hadn’t changed, but I could finally see how it moved; where the paths were, and why people kept ending up in the same places.