This is not individualized medicine. This is profitable one-drug- for-all medicine heralded as breakthrough innovation.

By 2040, we’ve moved past this expensive theater. Christian Junior’s medications are 3D-printed at his local pharmacy – or more likely, delivered by a drone. Each pill is customized to his exact genetic profile, his current biomarkers, his environmental exposures. Not 50 milligrams or 100 milligrams because those are the only options the manufacturer produces. He gets 73.4 milligrams of the active ingredient, because that’s what his body needs today.

When his DNA indicates his liver will begin failing in his forties, he doesn’t wait for symptoms. At age 38, he receives a stem-cell-grown liver, cultivated from his own cells. It’s preventive organ replacement – analogous, in a way, to how we now remove all wisdom teeth in America because we’ve concluded they cause more problems than they’re worth. Your body came with parts that will fail? We replace them (or remove them) before they do.

The “Easy Button” Principle

Here’s the crucial insight that makes this scenario plausible: prevention cannot rely on behavior change.

Current “preventive” care beyond screenings and vaccinations is mostly ineffective. We tell patients to exercise more, eat less, manage stress, get eight hours of sleep, end toxic relationships. We offer this advice knowing full well that there is no health coach to assist at 11 PM when the ice cream in the freezer beckons. We’re not there when the alarm goes off at 6 AM for that well-intended gym session and we hit the snooze button, patting ourselves on the back for our good intentions. We’ve designed a system that requires sustained willpower from people already exhausted by modern life, then we blame them when they fail.

In 2040, prevention is almost automatic and much more focused on prophylaxis. Christian Jr. takes a single pill each morning – easy enough to become a habit, like brushing your teeth. Inside that pill are vitamins and medications at the right dose. Given his genetic risk for obesity, another pill contains nano-bots that break down carbs before his body can store them as fat. Or perhaps he receives quarterly injections that adjust his metabolism. Or maybe there are medications that suppress the genetic markers leading to his predicted diseases. The specifics don’t matter. What matters is that staying healthy requires no more willpower

than staying alive requires willing your heart to beat.

If a fifteen-year-old must walk 8,000 steps daily to avoid obesity owing to the way his body processes carbs, we haven’t achieved prevention. We’ve just created a lifetime of behavioral burden. True prevention means Christian Jr. eats foods he enjoys, lives the life he wants, and remains healthy through interventions so seamlessly integrated, he barely notices them.

Why This Won’t Happen

Now let me tell you why this beautiful scenario is almost certainly fantasy.

One of my favorite quotes that I use almost every day is by Dr. Paul Batalden, often repeated by Dr. Donald Berwick: “Every system is perfectly designed to get the results it gets.”

Our current healthcare system produces exactly what it’s designed to produce: massive profits from treating disease, minimal investment in preventing it. The scenario I’ve just described would require pharmaceutical companies to dispense 10% of their current medication volume. That’s not a business model adjustment. That’s an extinction event.

But where would research funding come from when you’ve eliminated 90% of revenue? Yes, pharmaceutical companies charge egregious prices and executive compensation is obscene. But even accounting for that excess, the current system does fund the research that creates new interventions. Cut the revenue by 90% and you gut the innovation pipeline.

Next, insurance companies in the United States have no incentive to keep you healthy long-term. In commercial insurance, patients stay for an average of three years. In Medicaid, maybe three to five years. In Medicare, seven years, mostly because people die. Why would an insurance company invest in preventing a disease that will manifest in fifteen years when you’ll likely be someone else’s problem by then?

Compare this to the German healthcare system I grew up in. Germans typically stay with the same insurance company for life. Employers pay 50% of premiums, employees pay 50%, and coverage is mandatory. Insurance companies have every incentive to keep you healthy at 40 so you don’t cost them a fortune at 60 and 80. Prevention isn’t altruism -it’s financial self-interest aligned with patient outcomes.

The American system is designed for maximum extraction of profit from sick people. Keeping people healthy is bad