The Cure's Consequence: A Brave New World
Editor’s note: I’m honored to present you with something special in today’s newsletter — a guest post by Chris Deacon. Chris is a consultant and attorney who formerly led the health benefits plan for teachers and public employees in the state of New Jersey. She’s brilliant and driven to make health care more affordable and accessible to working Americans.
I’m proud to publish Chris’s short story, “The Cure’s Consequence: A Brave New World.” I love how she takes dystopian currents in today’s health care and envisions them in the future, carried out to their logical extreme. It does what a great short story should do — entertain while provoking us to see our world in a new way.
Enjoy!
— Marshall —
The Cure’s Consequence: A Brave New World
By Chris E. Deacon
Foreword
In this brief narrative, I explore a plausible future molded by the current trajectory of the healthcare industry's influence on our society. It paints a picture of a world where healthcare extends its reach, intertwining with every aspect of our daily lives. As I crafted, revised, and contemplated its publication, I couldn't help but notice the unsettling parallels between the unfolding dystopia and real-world events. The narrative depicts hospitals venturing into education, insurance companies innovating in housing solutions, and healthcare systems assuming the role of primary food distributors for select groups. These scenarios mirror a shifting landscape where essential services and social safety nets, traditionally overseen by government entities, are gradually being entrusted to private conglomerates.
This tale, set in 2084, aims to explore a potential future where the foundational fibers that make up a social safety net, like food security, housing, and the right to an education, are increasingly managed outside the traditional public sector framework. As the boundaries between public welfare and private gain become increasingly indistinct, essential services transform into commodities under the expansive umbrella of healthcare giants.
With this story, I invite you, the reader, to embark on a thought exercise. Consider the contours of the future it presents, observe the parallels with our present course, and ponder the implications of such a world. What future are we steering towards? And what role do we play in shaping it?
The transformation of Villnash into its current state had been subtle and steady, a reflection of the changes that swept across America over the last century. Lamp posts that once symbolized community spirit with hanging flags or community announcements, were now retrofitted with the tools of a new era: cameras, heat sensors, pulse monitors and always available direct lines to automated healthcare services. Sam had navigated this landscape daily on his path home from school, as consistent as the weathered bricks underfoot.
As he walked these familiar paths for what felt like the last time as a kid, Sam's mind wandered to the future laid out before him. Tomorrow, he would trade his after school walk and routine for a journey to a new destination — the prestigious internship that would mark the start of his 'Elevated' career. This evening’s walk felt different; each step was a tangible reminder of the passage of time, and with each block he crossed, he moved closer to a future that promised change but carried the weight of uncertainty.
In Sam's world, the air was a tangible presence, heavy with the warmth of an earth trying to find balance after years of climate extremes. Like most kids his age, he had to wear his Etana issued mask most days, filtering the air that seasons past would have rendered invigorating. While sometimes a nuisance, Sam knew that the mask was for his own good and was not only protecting him from the toxins in the air, it was providing valuable feedback on his health status. Today was one of those days that the mask was mandated and so he walked along with both face and head covered. He always wore his Potum cap, a gift from a cousin in a distant healthcare zone. It had been a token of kinship across boundaries that few crossed anymore.
The town itself was a patchwork of the past and the present. Buildings and streets still bore the architectural charm of an age gone by, yet each was seamlessly integrated with modern monitors that tracked the pulse of the community's health and environmental stability.
For as long as Sam could remember, healthcare control zones divided the country. This was a division born from a decision long ago to treat social wellbeing as an aspect of healthcare management, as opposed to healthcare being an aspect of social wellbeing. The zones were the recommendation of the government's three health zone contractors, as an answer to a complex puzzle — how to distribute care and social services efficiently, using federal funding to meet local needs within each district's budget. Whereas the healthcare system had once taken up a mere 20% of the nations’ GDP, as the industry’s largest healthcare companies grew and consolidated, and the scope of services they were entrusted to provide expanded, they eventually came to swallow over 65% of the federal budget.
The zones were the answer to what seemed like an unsolvable challenge — how to adequately and accurately compensate these healthcare giants for taking care of people that were attributed to them. After years and years of debate, mostly involving the issue of risk and solving for it when people were free to move around to different zip codes, the issue was solved. Once attributed to a specific healthcare zone, mobility would be limited so that the populations being served in that zone could be adequately cared for by the same company over time, cradle to grave. Of course, there were limited exceptions made to permit cross-zone travel, but it was a rare event and required a massive fee to be paid in order to compensate the health zone contractors for the risk involved.
While each zone was run by a different contractor, life within them was fairly uniform given the tools at their disposal to manage the health and wellbeing of all of the people that fell within it. While the zone’s governing healthcare body was responsible for setting the safe health risk parameters, the community’s input was also important and often sought in important matters like dietary guidelines, mandatory exercise duration, and other similar lifestyle decisions that would impact their everyday lives.
Sam actually got to serve on one such community health committee when the dietary guidelines for young people were being revised. He had hoped to have more of a say in what the institutes served for breakfast, lunch and dinner, but alas he did not and was still forced to choke down three daily supplements of vitamin C rather than get actual citrus fruit, which was his absolute favorite treat in the world. Sam often remembers stories his grandmother would tell him about her school lunches — pizza, real fruit, bagels, and even ice cream! He couldn’t believe the kind of food they were allowed to eat, and the fact that they only had one meal provided for them. Of course, that was before the schools had become affiliated with the largest healthcare systems that would eventually commit the resources to multiple meals per day.
“If you didn’t eat all your meals at school, how did they know what you were eating? Did you have to self-report what you ate so that they could manage your nutritional intake?” Sam once asked his grandmother. He got an earful that day, as she launched into one of her diatribes about how different the world once was.
Sam's grandmother had lived through a great change, as she put it, and he would often hear her talking to his parents with great regret in her voice. Initially, these healthcare systems were dedicated solely to addressing medical needs, serving as places of healing and care, even if imperfect. As the world around her grappled with escalating public health crises — from pandemics to the pervasive impacts of climate change — the response from both the government and these healthcare behemoths began to blur the lines of their traditional roles.
One moment in particular was a favorite topic of her reminiscing, and that was what she referred to as the pandemic. A virus had shut down the world for almost a year in the early twenties, and at about the same time a confluence of factors seemed to tip the balance irrevocably. Government strategies, increasingly beleaguered by the mounting pressures of public health emergencies and the social upheavals they engendered, began to pivot. In a bid to harness the extensive reach and resources of these healthcare systems, the government began to delegate more and more responsibility to them, extending well beyond their original medical remit. And private industry supported this shift, perhaps unaware of the massive redistribution of their own wealth that was happening underfoot.
This delegation was not just about managing the immediate fallout of health crises but also about addressing the underlying social determinants that were believed to contribute to these emergencies. Education for example — something once considered to be the backbone of a community and an inherent public good — was gradually absorbed into the ambit of healthcare services. Housing was another example, where both the role of the public and then the private sectors were stealthily replaced by healthcare systems as a social determinant of health. These and many other essential components of daily life were now viewed through the lens of health outcomes, metrics to be optimized, and variables to be controlled in the grand scheme of public welfare.
The largest healthcare systems morphed into quasi-governmental entities, stewards of a new order where the provision of care was inextricably linked with social governance. This expansion was not merely administrative but represented a fundamental shift in how societal well-being was conceptualized and delivered. The very fabric of society was rewoven, with what were once medical institutions now at its core, dictating the rhythm and structure of daily life.
Sam’s walk home usually took about 45 minutes, and therefore satisfied almost half of his quota for the day. But today, he took his time, really trying to absorb the importance of the next few days of first impressions. Sam’s home in Etana Heights was an end unit in a community hailed as a triumph of modern healthcare’s reach into the everyday. The houses, architecturally uninspiring and transient by necessity, were supported by a robust network of amenities. The Etana housing authority, a division now as commonplace as any municipal entity, ensured a continuous cycle of construction and renewal, reflecting the impermanence of the era.
Every residence boasted the latest in health monitoring technology: biometric scanners, community scales, and ambient displays, all designed to ensure the proper health tips were prompted and given to residents, when appropriate, and to ensure compliance with the protocols and recommendations given. These tools served a dual purpose — care and surveillance.
The residents of Villnash had relinquished more than just their data; they had surrendered much of their privacy, their healthcare details, and a measure of their everyday freedoms. In return, they were given the promise of an equitable future — a society where healthcare access and favorable health outcomes were not just aspirations but guarantees. Data had become the currency of this new era, a medium of exchange that they spent willingly, or perhaps inevitably, under the auspices of a system that pledged to transform their sacrifices into societal well-being.
While the system reshaped the landscape of personal liberty, it had also played a huge role in restructuring key aspects of domestic life, including housing. Homeownership, once the cornerstone of personal autonomy and financial security, had withered under the relentless growth of healthcare costs and the prevalence of chronic illness. It was in this vacuum that companies like Etana and their counterparts emerged, not just as healthcare providers, but as architects of community, offering affordable housing as part of their expansive portfolio.
As personal fortunes dwindled under the weight of medical expenses, the once-robust social safety net frayed and retracted, replaced by the large conglomerates that had emerged after decades of consolidation and growth. Grandma’s stories of government-led social programs — programs that were run by organizations unrelated to the healthcare control zone contractors — seemed like fables to Sam, tales from a world that no longer existed.
Yet, for all its faults, the system did bring a semblance of equality within bounds of each zone. Sam, like all residents, was assigned an “R” score at birth — a classification that determined his place in the healthcare hierarchy and was generally consistent with those that had similar attributes and characteristics. This system promised equal outcomes for those within the same group, though he knew that the reality was more complex. This topic, of all the topics, was probably the one that made his grandmother most emotional. Sometimes that meant anger, sometimes deep sadness, but always a heaviness followed by a quick change in subject.
On one particular occasion Sam asked his grandmother why he had never met anyone in his school with an R score above 8. He knew they existed, because he had been taught from a very early age that the consequences of certain risky behaviors and habits could lead to an increase in your R score — and they would use 8s and 9s as examples. He heard a rumor at school that there were no 8s or 9s at school because nobody had been born with that R score since 2034. When Sam asked about the rumor, he heard his mom whisper to his dad, “Wasn’t that the year it became mandatory?”
“What became mandatory, Mom?” Sam asked.
“Stop it! I will hear no more of this and and you will speak no more of this,” Sam’s grandmother spit back.
Sam was about to join an organization that could perhaps help him understand some of the history that seemed so difficult to parse out, and so much more. It had taken all of his focus these last few years to make sure he got the right grades and said the right things in his papers and interviews. The Elevated track was something most young people aspired to early on, but gradually they would lose interest or the stamina to stay in the running for it. He knew the ‘Elevated’ track which could completely change his life.
Those that were part of the "Elevated" cohort would no longer have an R score. They were categorized as the “E’s” and existed in stark contrast to the rest of society. They inhabited secluded enclaves, bastions of luxury and extended life, shielded from the more abrasive elements of the world outside. These bubbles within bubbles represented not just a higher standard of living but a higher state of being — one that Sam was poised to enter if he played his cards right. Of course, it only seemed fair that the E’s would get such treatment because it was the E’s that were responsible for the administration of the healthcare zones. That was a tremendous responsibility and in order to perform those functions well, the E’s had to function at their peak - which justified their higher standard of living.
Sam knew that his tenure at Bill Grist Academy, formerly George Washington High, had been a prelude to this new chapter. The curriculum there — a mirror of the prevailing healthcare-centric worldview — left scant room for dissent or privacy. It was an education that shaped him, priming him for a role in a world where health was paramount, and individuality took a backseat to collective welfare. As a member of the Grist community and the greater Etana community, Sam had played his part well.
It was his sharp mind and steadfast commitment that had distinguished him, leading to his selection for Etana's advanced track opportunities — an internship that promised to elevate his status and understanding of the healthcare system that governed their lives. Though his grandmother harbored reservations about the world that had claimed her past, she supported Sam’s advancement because she knew it would lead to a safer, if not more fulfilling life for her only grandson.
Sam's first day at Etana was etched with the kind of nervous anticipation that accompanies a journey into the unknown. The sprawling campus of the healthcare giant was a microcosm of the world outside, with the same pervasive technology monitoring every step. Yet, it was also different, brimming with the promise of innovation and advancement. Sam, dressed in the crisp, new attire of an intern, felt the weight of opportunity as he passed through the security gates.
After getting all of his scans done and having his vitals taken, Sam’s first assignment was one that required him to spend time in the archives, a veritable vault of history, where the past and present dialogue in hushed tones. He was asked to retrieve a record and as he made his way down the staircase towards the underground archives, he saw pictures lined up along the walls showing all of the past leaders of the companies that would eventually come to make up Etana. CEOs, CFOs, and CROs from the organization were pictured starting at the beginning of the 21st century, and the pictures moved into the late 2020’s and early 2030’s, an additional role was added – that of the Chief Community Officer (CCO).
The CCO would eventually become the most important role within the organization – equal to or greater than the CEO – because they would be responsible for all of the social determinant programs that were to be outsourced from government to the hospital systems. While CEO’s and CFO’s of these healthcare systems used to be responsible for the $5 trillion in spending in 2030, by 2080 the CCO’s were responsible for over half of the federal budget — spending on housing, food security programs, education, and other social service programs funded by government.
Once in the basement, a narrow corridor to the oldest archives, which Sam needed to get to, was lined with a timeline of sorts, which included commentary and photographs from the last century. The early images vibrated with a raw vitality, eyes alight with passion - for social justice, climate justice, equal rights, humanity — it was an intangible quality that seemed to wane in the photographs as the years progressed. The faces grew less animated, the spark dimmed, and a subtle shift in the energy of those photographed was testament to a society in quiet decline. Yet, the timeline accompanying these very images was marked by organizational prosperity: robust market growth, revenue spikes, and the aggressive sprawl of consolidation.
It was in this juxtaposition that Sam's epiphany struck. The narrative celebrated by Etana, captured in markers and milestones of corporate triumph, stood in stark contrast to the loss in faces of those who lived through it. He understood now that the organization's growth came at an unspoken cost to the community it served. Was he going to be responsible for inflicting similar costs?
In that moment, an image caught his breath — a younger version of his grandmother, weary but resolute, captured in a courtroom standoff opposite a healthcare executive. The photograph, devoid of any caption, spoke volumes of her quiet defiance. In her eyes, Sam recognized the same determination that had subtly underpinned all the stories she'd shared with him.
In the silent archive room, with history's weight in his hands, Sam stood at a crossroads. This moment was not just his, but also part of a larger story. A story that I, as the author, have intimately woven from my own experiences.
Yes, I am the narrator of these words, the voice from the past, and Sam's grandmother. My story, told through his eyes, is a legacy of warning and hope, a bridge from my past to his future. As Sam looks forward into the unknown, my message resonates through these pages — a cautionary tale from one generation to the next.
Author’s note:
The following images are not AI generated. These are a small sample of the headlines, stories and pictures that I have gathered over the past year, confirming that my predictions are not so far fetched.
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