Dr. Gooby and Our Health System is a Sick-Care, Profit-Maximizing System

David Caldwell

Okay, uh, imagine this. You’re, you’re up in the mountains. There are mosquitos like everywhere, real bad, and instead of, I don’t know, swatting them away, you pull out your phone to make an announcement to the world.

Sofia Ramirez

But not just any announcement. About six months ago, a highly successful MIT-educated, Duke-trained neurosurgeon stood there, on camera, with swarms of mosquitos attacking him and—

David Caldwell

Like literal swarms.

Sofia Ramirez

Yes, literal swarms. And he announced that he was quitting medicine.

David Caldwell

Wait—quitting? Just, just like that?

Sofia Ramirez

Just like that. And you know what? That video exploded. Fifteen million views, David. It became this huge online moment.

David Caldwell

Okay, I gotta ask, why do you think people watched it? Like, yeah, okay, mosquitoes, drama, but why would that go viral?

Sofia Ramirez

Well, it wasn’t just the spectacle. It was what Dr. Gooby—I know, unusual name—what he said in that video really hit a nerve. He didn’t just quit his job, David. He called out the entire healthcare system.

David Caldwell

Oh wow. Just, like, straight up?

Sofia Ramirez

Exactly. He explained that the reason he was leaving wasn’t only burnout, though he certainly struggled personally and emotionally. It was because he believed that our healthcare system wasn't designed to actually make people more healthy. Now he's focused on mental well-being, enjoying nature, and a healthy diet.

David Caldwell

Ouch. That’s, uh, that’s pretty harsh. But honestly, I mean... is he wrong?

Sofia Ramirez

That’s exactly why it resonated. It wasn’t just some random critique. This is a neurosurgeon, someone who reached the very top of his field. And here he was, walking away, saying the system we trust with our lives is, fundamentally, broken.

David Caldwell

Okay, so this isn’t just one guy being dramatic. This is, like, systemic, huh?

Sofia Ramirez

Completely systemic. And his story… well, it highlights the cracks in a way that’s hard to ignore.

David Caldwell

You know, Sofia, what Dr. Gooby said—it’s hard to shake, right? I mean, when someone like him, with all his credentials and experience, just walks away like that, it really forces you to confront how deep these systemic cracks go.

Sofia Ramirez

Exactly. And the truth is, David, his story isn’t isolated. For every Dr. Gooby, there are thousands of healthcare professionals—nurses, doctors, paramedics—facing similar frustrations. The system, as it stands, is driving many of them to the edge.

David Caldwell

And it’s not just healthcare workers, right? I mean, regular folks like us—we we feel it, too. Trying to navigate insurance, costs, wait times... It’s enough to make your head spin.

Sofia Ramirez

Absolutely. Which is exactly why we’re taking a closer look today, to discuss what’s really driving our health system. Spoiler alert: it’s not the things that should be driving it.

David Caldwell

Wait, there’s a should? Like, there’s an ideal version of this somewhere?

Sofia Ramirez

Oh, definitely. And we’ve talked about it before, remember? In the first couple of episodes, we outlined some crucial ideas that should shape every part of healthcare, from policies to research to how we even think about health itself.

David Caldwell

Okay, yeah, I remember, but maybe give us a quick recap. You know, for listeners who might’ve jumped in late.

Sofia Ramirez

Of course. So first, we talked about having a relentless shared vision of health for all—where everyone, regardless of their background, has access to what they need to live the healthiest life at the lowest cost to society.

David Caldwell

I I love that idea. It sounds so—what’s the word?—aspirational. But also, how realistic is it?

Sofia Ramirez

Well, that’s the challenge, isn’t it? But it’s not impossible. The second concept we discussed is key to making it work: shifting from a rigid, linear mindset to what we call a complex adaptive systems paradigm.

David Caldwell

Complex adaptive systems, huh? Sounds... complicated.

David Caldwell

But I guess it means the system has to, like, adapt to what people actually need... instead of giving the same one-size-fits-all solutions?

Sofia Ramirez

Exactly! And that requires more than just technical changes—it needs leadership, or as we’ve called them, systems stewards, who understand and advocate for this perspective.

David Caldwell

Okay, cool. So that’s two. What’s the third again?

Sofia Ramirez

The third was the idea of connection and mobilizing people to act for change—targeting those high-leverage points where small shifts can lead to big, systemic impacts.

David Caldwell

That definitely sounds like a tall order. But also kinda... exciting? Like, real change could happen.

Sofia Ramirez

It can, David, and it has before. But before we get into that...

David Caldwell

Alright, Sofia, before we dive deeper into those ideas, I know you’re always digging up the most fascinating insights. What’s caught your attention this week?

Sofia Ramirez

Oh, well, I’m almost done reading something pretty remarkable—"The Doctors Blackwell." It’s this biography about the Blackwell sisters, Elizabeth and Emily, who were the first women to become formally trained physicians in the United States. It’s such a poignant reminder of how what seems impossible at the time—like women breaking into medicine—can actually change the world.

David Caldwell

The first trained female doctors? That must have been... what? Late 1800s?

Sofia Ramirez

Exactly right—Elizabeth Blackwell earned her degree in 1849, which feels like a lifetime ago, but you start realizing history has this way of echoing back.

David Caldwell

Okay, but tell me—what’s the hook? Like, what keeps you turning the pages on something that’s, what, nearly 200 years old?

Sofia Ramirez

The hook is how much their struggle still resonates today. They faced incredible resistance but pushed forward because they believed women belonged in medicine. And, ironically, you see parallels in modern healthcare—what it takes to challenge entrenched systems.

David Caldwell

Wow. Challenging systems seems to be the theme of the show. Okay, but, uh, let’s step away from old-timey biographies for a second. Podcasts! What do you have for podcasts?

Sofia Ramirez

Oh, I’ve got a great one for you: it’s an episode from Dr. Zak Kohane, on the New England Journal of Medicine AI Grand Rouns podcast and all I’m going to say is—David—AI is here to stay.

David Caldwell

Wait, wait... AI? Like artificial intelligence? In healthcare?

Sofia Ramirez

Absolutely. He dives deep into how AI is fundamentally changing medicine right now—not someday, not in the distant future—but here and now. Dr. Swanson says the same: it's a total game changer.

David Caldwell

Okay, I’ve gotta listen to that. But, uh, before I interrupt again, what else is on your list?

Sofia Ramirez

There’s also an episode from Dr. Robert Pearl's “Fixing Healthcare” They talk about how our winter viruses, vaccine skepticism, and, of course, the broken healthcare system are all colliding in America right now. It’s a perfect storm.

David Caldwell

Sounds like a lot... but honestly, also super relevant. Like, shockingly so.

Sofia Ramirez

Relevance is definitely the key. It makes you wonder—what kind of conversation we could be having if we all took a step back from the noise and actually talked about the real incentives, about why people do what they do every day in our health system.

David Caldwell

You know, Sofia, what you just said about understanding the real forces in our health system—it’s really sticking with me. I mean, these foundational drivers you mentioned—are they the ones we should even have? Like, how did the system get shaped this way in the first place?

Sofia Ramirez

Well, it’s a great question, David, because when you really think about it—what should drive a healthcare system? You’d hope it would be, you know, the health of people. Making sure everyone has what they need to stay well, and at the lowest cost possible. But that’s, uh—that’s not our reality right now.

David Caldwell

Okay, but if it’s not health, then what? Like, what’s at the wheel pulling all the strings?

Sofia Ramirez

The healthcare system as it stands is being driven by what I’d call the wrong incentives: short-termism, individualism, profits, and elitism. These aren’t just random buzzwords—they’re deeply baked into how the system works. And they, uh, they didn’t show up overnight.

David Caldwell

Wait. What do you mean—they didn’t show up overnight?

Sofia Ramirez

I mean, these drivers have historical roots. They trace back to how modern medicine evolved—especially in the late 19th and early 20th centuries. We inherited these values, David. And now we’re stuck with them unless we consciously push to change them.

David Caldwell

Okay, wait, let’s break this down. Short-termism... that’s like, focusing on immediate results instead of long-term solutions, right?

Sofia Ramirez

Exactly. It’s about what looks good now—on paper, in quarterly reports—but often at the expense of long-term health outcomes or sustainability.

David Caldwell

And, uh, individualism? What’s that about in healthcare? Like, people wanting to just do their own thing?

Sofia Ramirez

Pretty close. It’s this idea that instead of seeing health as a shared, collective responsibility, we treat it as an individual burden. You get sick? That’s your problem. Can’t afford care? Figure it out yourself. And it’s all, well, tied into this myth of, you know, pulling yourself up by the bootstraps.

David Caldwell

Yeah, but health doesn’t work that way... right? I mean, if someone in your community is sick, doesn’t that, like, affect others? Isn’t it kinda connected?

Sofia Ramirez

It is. Completely. And that’s what makes individualism potentially so damaging—it ignores the interconnectedness of health. But let’s not stop there. Let’s talk about profits.

David Caldwell

Ah, profits. Here we go. Okay, lemme guess—money over morals?

Sofia Ramirez

That’s one way to put it. Profit motives aren’t inherently bad, but when they take precedence over health outcomes, people suffer. You see it everywhere—from pricing life-saving medications astronomically high to prioritizing lucrative procedures over basic preventive care.

David Caldwell

So basically, the system’s makin’ bank by keeping people less healthy longer than it has to?

Sofia Ramirez

That’s, uh, brutally put, but yes. And then there’s elitism. It’s this underlying belief that certain people—because of their wealth, education, or status—are better or more deserving.

David Caldwell

And those barriers are everywhere—like those insurance approvals that take forever, or hospitals that won’t even take you unless you can front the money.

Sofia Ramirez

Exactly. And the thing is, these aren’t fringe issues—they’re systemic. They’re built into how the machinery of the health system runs. And unless we recognize these drivers—and work to shift them—we’ll keep perpetuating the same inequities, the same inefficiencies.

David Caldwell

So, let’s start unpacking this short-termism you mentioned earlier. I mean, it really does feel like one of those concepts you hear a lot about—but what does it actually mean, in real life, for how healthcare is run?

Sofia Ramirez

It’s a great question, David. Short-termism in health means focusing on immediate outcomes—things like quarterly cost savings or short-term metrics or episodes of treatment or academic publications or public health projects, it's everywhere, really—at the expense of long-term health investments. And here’s the irony: those long-term investments actually save money and improve outcomes over time.

David Caldwell

Wait, wait. So we’re talking stuff like... uh, preventative care, right? Like stopping problems before they even start? But doctors aren't paid to make people more healthy. They're paid to see more patients, right? Fee for service?

Sofia Ramirez

Exactly. Preventative care, public health infrastructure, addressing social determinants of health—all of these are seriously underfunded. For example, the U.S. spends only about 3% of its healthcare budget on public health measures. But it's not just funding. It's also non-financial influences like our collective vision. That’s all despite knowing that interventions like childhood immunizations or smoking cessation programs can return up to $10 for every $1 spent.

David Caldwell

Ten to one? That’s, uh, that’s like a no-brainer. Why wouldn’t everyone jump at that?

Sofia Ramirez

Because the benefits aren’t immediate. The return might not show for years, sometimes decades. And right now, our system is wired to look for quick wins—things that show up on the next balance sheet or performance report.

David Caldwell

But it's not just the government or hospitals or organizations. Personally, I have a hard time sticking to a healthy diet, or my exercise plan. Seems like short-term thinking is built into being human. Okay, but then, what happens when we ignore the long game? Like, what are we missing out on?

Sofia Ramirez

We miss out on healthier populations and more equitable outcomes. Take chronic diseases, for example. They account for about 90% of U.S. healthcare costs, yet most of the system’s response is reactive. Instead of proactively addressing the root causes through community programs, we wait until problems escalate—when they’re harder, and more expensive, to treat. Then people end up in the ERs and ICUs. Or worse, they don't.

David Caldwell

Yeah, but... isn’t that exactly why marginalized communities suffer more? Because the system ignores those, uh, broader issues that cause poor health in the first place?

Sofia Ramirez

Yes, David. Marginalized groups are disproportionately affected by things like poverty, housing insecurity, even environmental hazards. These are systemic issues, deeply tied to health outcomes. But when we focus solely on short-term fixes, we end up widening the gap rather than closing it.

David Caldwell

Okay, so it’s not just bad for health—it’s bad for fairness, too. You solve one problem, but three new ones pop up down the line.

Sofia Ramirez

Exactly. And research backs this up. Think of the work by Sir Michael Marmot—it shows how addressing upstream solutions, like targeting inequality and improving living conditions, leads to better health for everyone. Ignoring these root causes, well, it just perpetuates inefficiency and inequity.

David Caldwell

Wow. And yet... 3%, right? That’s all we spend on prevention?

Sofia Ramirez

Three percent. It’s staggering when you think about it. Public health should be the foundation of healthcare, yet it’s treated more like an afterthought.

David Caldwell

So, uh, what’s the fix? Like, how do you rewire a system that’s so stuck on chasing quick wins?

Sofia Ramirez

It starts with shifting our mindset. We have to recognize—and, more importantly, prioritize—long-term benefits over short-term rewards. But that requires systemic change, David. And, as we know, systemic change is never easy.

David Caldwell

No kidding. But, uh, I guess we’re not quite done peeling these layers back yet...

David Caldwell

Okay, Sofia, so you were saying how focusing on the system’s flaws misses the bigger picture. It’s got me thinking about that “individualism” idea you brought up earlier—are we really blaming people for their own health instead of looking at the system they live in?

Sofia Ramirez

Exactly, David. It’s the idea that if someone’s unhealthy, it must be because they’re not eating right, not exercising, or, you know, making bad choices. And while those behaviors play a role, they’re just a small piece of a much larger puzzle. Almost certainly less than 50%, and probably much, much less.

David Caldwell

Okay, but... like, don’t we have to take some responsibility? I mean, no one’s forcing me to eat a cheeseburger, right?

Sofia Ramirez

Of course, personal choices matter, but they’re deeply influenced by the conditions around us. For instance, if you live in a neighborhood without access to affordable, fresh food, it’s much harder to eat healthy—even if you want to. Or if you’re working two jobs just to make ends meet, when do you have time to exercise?

David Caldwell

Oh, right. Like, the system kinda stacks the deck against you?

Sofia Ramirez

Exactly. And here’s the thing—individualism treats health as though it’s disconnected from those systemic issues, like poverty, housing, or even education. But studies, like the ones by Michael Marmot, show that things like socioeconomic status are huge predictors of health outcomes.

David Caldwell

Wait, wait. So it’s less about what we do and more about where we, like, start?

Sofia Ramirez

Precisely. Health outcomes usually reflect the social determinants of health—the stuff we often can’t control, like whether we have access to safe housing or whether our schools teach us about nutrition. But our system is, well, laser-focused on individual behavior instead.

David Caldwell

Huh. Okay, but isn’t that just how people think in general? Like, the whole “you get what you deserve” mindset?

Sofia Ramirez

That’s exactly it. It’s this deeply ingrained cultural narrative—especially in the U.S.—that health is a direct result of personal effort. But what that ignores is how interconnected we actually are. David, have you heard of the study by Christakis and Fowler?

David Caldwell

Uh, no, but I’m guessing you’re about to blow my mind again...

Sofia Ramirez

I’ll try. So, they found that health behaviors—like smoking or even happiness—are influenced by our social networks. And not just our friends, but our friends’ friends’ friends. It’s a ripple effect.

David Caldwell

Wait, hold up. You’re saying my health could be tied to someone three degrees removed from me? Like, someone I don’t even know?

Sofia Ramirez

Exactly. And that’s the problem with individualism—it completely ignores these connections. Health isn’t just about the individual; it’s about the environments and communities we’re part of.

David Caldwell

So we’re all, like, way more linked than we think. But the system’s out here treating us like we’re all on our own islands?

Sofia Ramirez

Yes. And it’s not just neglectful—it’s harmful. It shifts responsibility onto people for outcomes they often can’t completely control while ignoring the broader factors that actually drive health.

David Caldwell

Wow. Okay, so it’s like—uh—it’s like we’ve been blaming the players when the game itself is rigged?

Sofia Ramirez

Exactly! And if we want a health system that actually works, we have to stop focusing primarily on the individual and start addressing those upstream, systemic issues that affect everyone.

David Caldwell

Alright, Sofia, so if we’re talking systems and how they shape health, I’ve got to ask—how did we end up with a system that seems more about profits than people? I mean, healthcare’s supposed to be about saving lives, not saving... spreadsheets.

Sofia Ramirez

Great way to put it, David. The truth is, in the U.S., healthcare isn’t treated as a basic human right or even as a social good. It’s too often treated as a market commodity. And that means profits—what makes money—become a major driving force.

David Caldwell

Okay, so how bad are we talking? Like, give me the bottom line here.

Sofia Ramirez

Well, the U.S. spends about 18% of its GDP on healthcare. That’s more than any other country, by a long shot. And yet, we have some of the worst health outcomes—lower life expectancy, higher infant mortality rates—compared to nations with universal, non-profit healthcare systems.

David Caldwell

Wait, wait. So we’re spending more... to be worse off? That can’t, like, add up. At all.

Sofia Ramirez

It doesn’t. And the thing is, that money isn’t going toward better care or population health—it’s being siphoned off to fuel the profits of big players: pharmaceutical companies, private insurance, even for-profit hospital systems.

David Caldwell

Alright, lemme guess... big pharma at the top of that list?

Sofia Ramirez

Bingo. A prime example is insulin. In the U.S., insulin prices have been and in some instances still are ten times higher than in comparable nations. It’s a life-saving medication that’s been around for decades, yet we allow companies to jack up prices under the guise of innovation or market freedom.

David Caldwell

Ten times?

Sofia Ramirez

Ten times. And the result? Too many diabetic patients struggle to afford it. Some end up rationing their doses, which is dangerous, even life-threatening. It’s an indictment of how profits often take precedence over people.

David Caldwell

Okay, hold on. I I get businesses wanna make money—fine, that’s... capitalism. But at what point does it just become exploitation?

Sofia Ramirez

That’s exactly the issue. And it’s not just insulin. You see it in how hospitals prioritize lucrative procedures—like elective surgeries or advanced imaging—over basic, preventive care. These are profit centers, David. Preventive care, on the other hand, doesn’t bring in the same revenue, so it gets sidelined.

David Caldwell

So basically, the system’s set up to treat sick people, not keep them healthy in the first place. It’s like... like a fire department that only works if there’s a blaze big enough to bill for. And they get paid even if the fire keeps getting bigger!

Sofia Ramirez

Exactly. And the irony, David, is that prevention saves money in the long run. But when the system is focused on profit-driven priorities, long-term benefits get overlooked.

David Caldwell

Yeah, it’s like we’re we’re building a house of cards here, right? One gust of wind and the cracks start showing...

Sofia Ramirez

Absolutely. And the cracks are already there. The high costs, the disparities, the poor outcomes—it all goes back to this profit-first mentality that undermines health equity and efficiency.

David Caldwell

Alright, Sofia, we’ve been talking about this profit-first system, but it makes me wonder—does this all tie into something bigger, like elitism? How does that idea actually show up in healthcare?

Sofia Ramirez

Elitism is a big one, David. It’s this idea that certain people—because of the color of their skin, their gender, their credentials, where they studied, or their professional titles—are automatically seen as more credible, more important. And it’s deeply embedded in our healthcare system.

David Caldwell

Okay, so you’re talking like... a Harvard-trained doctor walks into a room, they get the mic, but, uh, say a community health worker... doesn’t?

Sofia Ramirez

Pretty much. And it’s not just about who’s talking—it’s about whose knowledge is valued, and who gets to make decisions. For example, consider a highly educated, Ivy League physician compared to a local community health worker. That health worker might not have an M.D., but they’re deeply embedded in the community—they understand cultural dynamics, local problems, even how people access care day-to-day. Yet they’re systematically overlooked because they don’t have the “elite” credentials our system prioritizes.

David Caldwell

But wait, do we have any proof those health workers, uh, actually make a difference? Or is this just like, us saying, “Hey, they’re underappreciated?”

Sofia Ramirez

Oh, we have proof. Absolutely. Studies show that community health workers, or CHWs, significantly improve health outcomes—especially in underserved areas. They help reduce disparities, connect people to resources, and provide preventive care in ways that formal systems often can’t. But despite their impact, CHWs are often poorly funded, poorly supported.

David Caldwell

So they’re literally doing more with less?

Sofia Ramirez

Exactly. And it’s all because we’ve built a system that devalues local expertise. Instead of asking, “What actually works for this community?” the question becomes, “Who has the most impressive credentials?” And that prioritization perpetuates inequities.

David Caldwell

Okay, so the system just decides academic pedigree and... fancy titles win the day. But isn’t some of that valid? Like, don’t you wanna trust someone who’s got all the right training?

Sofia Ramirez

Of course, training is important. But here’s the thing, David—elitism isn’t about recognizing good training, it’s about excluding other types of valuable knowledge. Take a community mother who’s navigated health barriers her entire life. She knows her community inside and out—what works, what doesn’t. That lived experience doesn’t come with a diploma, but it’s just as critical in shaping effective healthcare solutions.

David Caldwell

That sounds... wild, that we’d ignore someone who actually lives the challenges we’re trying to fix. It’s like building a bridge without asking the people who live on either side of the river.

Sofia Ramirez

Exactly. And it’s not just hypothetical. Look at global community health worker programs. In nations like Rwanda and Brazil, CHWs have made an incredible difference. They’re integrated into healthcare systems and given real support. The U.S., meanwhile, keeps sidelining these workers.

David Caldwell

So we’re talking, like, a lesser effort to fund or even trust them here?

Sofia Ramirez

Yes. And that lack of trust ties back to this point about elitism—it’s almost as if we can’t recognize the value of contributions from “non-traditional” sources, like rural health advocates or individuals with disabilities. It keeps the healthcare system from being as effective as it could be.

David Caldwell

Ugh, it’s frustrating. It’s like, we have so many tools to fix the problem, but we’re using... only the ones that look good on a résumé?

Sofia Ramirez

That’s a good way to put it, David. And until we shift away from elitism—until we start valuing diverse voices and knowledge systems—we’re gonna keep hitting the same dead ends in healthcare reform.

Sofia Ramirez

David, if you think about it, this elitism we’ve been talking about isn’t just a small issue—it’s baked into the entire system. These outdated hierarchies and misplaced priorities are steering the health system away from what it’s actually supposed to achieve.

David Caldwell

Yeah, it’s like... the system’s on autopilot, but the settings were designed for the wrong destination.

Sofia Ramirez

Exactly. And the thing is, it doesn’t have to be this way. Systems, by their very nature, can change. If we can shift our core values—if we start prioritizing health over profit, equity over elitism, long-term thinking over quick fixes—the transformations we’d see would be, honestly, unimaginable.

David Caldwell

Unimaginable? That’s a big word, Sofia. Like, what kind of changes are we talking here?

Sofia Ramirez

Revolutionary ones, David. Picture a world where the focus isn’t on what the system can take from people, but what it can provide—where institutions and incentives align around making health care accessible, equitable, and affordable for everyone, and communities where we can all thrive. It would be a historical shift on par with, well, the invention of modern medicine itself.

David Caldwell

Wow. Okay, so it’s not just about tweaking the system—it’s about completely rethinking it from the ground up?

Sofia Ramirez

Exactly. We’d need new stories—stories that center around collective well-being. We’d need institutions willing to hold themselves accountable to those values. And we’d need leaders who prioritize collaboration and trust over competition or status.

David Caldwell

It’s exciting, but also kinda terrifying, right? Like, how do you even start something that big?

Sofia Ramirez

One step at a time, David. Change happens in those small moments, those high-leverage points where decisions ripple outward. And that’s why conversations like this matter—because they plant the seeds for what could come next.

David Caldwell

Alright, well, I think you’ve officially given all of us something big to think about. And maybe, just maybe, some hope too.

Sofia Ramirez

Hope is where it all starts. And that’s all we have for today. Thanks for diving into this with me, David—and thanks to everyone listening out there. The future of healthcare is in our hands.

David Caldwell

Couldn’t have said it better myself, Sofia. We’ll see you next time, everyone.