Charles Hoskinson, the founder of Cardano and early co-founder of Ethereum, says the American healthcare system isn’t broken — it’s working exactly as designed. And that, he says, is the problem.
“Healthcare is just fucked in America. It’s just fucked. Everybody knows it’s true,” Hoskinson said in an interview with CoinDesk TV at the Rare Evo conference in Las Vegas. “Yet they all try to continue making the system go because it’s just too profitable.”
While it may sound like a harsh criticism, Hoskinson is putting his money where his mouth is: He is pouring $200 million investment into a medical center in Gillette, Wyoming, that now serves about one-third of the town’s population.
His vision for his multi-million dollar investment? “If they can’t pay, don’t charge ’em,” he said.
The ‘Horrible’ problem
So, what are the main issues with the current healthcare system that made him pour millions into a new type of system? According to Hoskinson, it is how doctors are paid.
“All the financial incentives are just horrible and wrong inside healthcare,” he told CoinDesk TV, using an example of how doctors are incentivized to treat their patients all the same, regardless of their needs.
“Let’s say you’re 75 years old and you have a ton of cool morbidities and you’re just not feeling good … Your doctor will be paid the exact same amount of money to see you … as he or she will be paid to go and see a 16-year-old girl coming in for a UTI and just needs like five minutes and some antibiotics.”
That economic structure, he said, discourages coordination, conversation and long-term planning. “They have every incentive to keep you as sick as possible for as long as possible, because they’ve developed chronic treatments for all those things,” Hoskinson claimed.
And what’s the source that built his scathing claims about the healthcare system? “Because my dad’s a doctor, my brother’s a doctor. Grandfather was a doctor, uncle’s a doctor,” said Hoskinson
The patient-centric solution
To fix this, Hoskinson suggests building a facility centered around the patient, not billing codes or bureaucracies and using cutting-edge technologies such as artificial intelligence and blockchain.
“Let’s build a clinic where we put the patient at the center. We build care teams, we use AI and we do everything in our power to try to just make it patient-centered care that’s affordable.”
AI, for this new system, will be used to support — not replace — the physicians. “Every day it can rag in the totality of all medical knowledge, and you can have agents representing each specialty of medicine… and give an updated care plan at the beginning of the day to the provider.”
The system, he said, can catch “subtle cues in the patient history” and help with real-time auditing. He also described plans for AI tools that can flag drug-to-drug interactions, transcribe patient visits and eventually act as an “AI companion” to help people interpret food labels, medications and supplements.
The project’s architecture may also involve blockchain.
Hoskinson referenced selective disclosure and zero-knowledge technology — cryptographic tools that can verify facts (like age or citizenship) without exposing underlying personal details. “You can satisfy the intent and philosophy of those buckets without revealing the underlying customer,” he said.
He also plans to open-source the entire model — including protocols and software — to allow replication elsewhere. “We’re not here to make money off of [it],” Hoskinson said. “The goal is to open source them, open source the software, you know, get that care system out there.”
He’s also pushing for a broader policy reset. “Health insurance should be the same way you buy it in case you get really fucking sick,” Hoskinson said. “It makes no sense to say, well, it’s there for when you get a paper cut or there for when you want to get birth control or something.”
However, Hoskinson claims that this new model of healthcare is facing pushback from the traditional medical system.
“The hospital there is trying to kill us,” he alleges.
“They do everything in their power to make our life miserable. Uh, they won’t credential our doctors. So it takes six months to 12 months to get credentials to have them practice medicine. I bring a world famous surgeon and a famous transplant surgeon. They won’t give ’em credentials,” Hoskinson said.
While Hoskinson’s fight to revamp the health care system might be a David versus Goliath scenario, he sees this as part of his and his family’s legacy. “I put $200 million of my own money into my clinic and we’ve been building for the last three years, and I legitimately wanna solve this problem,” he said.
“I think it’s my legacy and it’s the family’s legacy and it’s also the single most important thing in America.”