Why I Spent Ten Years Writing This Book: Relocalizing Health Taking Back Healthcare. Rebuilding Communities.

[00:00:00] Before we start, I want to invite you to Rosetta Fest 2026 in Nashville. This is where employers, unions, and clinicians who are cutting healthcare costs 20-50% while improving care and outcomes share exactly how they did it. Operators learning from operators with patients at the table. Learn more and register at rosettafest.org. Now let's get into today's conversation.

[00:00:25] Hey there. Welcome to a special series within the Relocalizing Health podcast as we count down to Rosetta Fest in Nashville, July 29-31. Each one of these episodes is a quick look inside the book and the communities that inspired it. Real places, real numbers, real people who decided to stop waiting for somebody else to fix healthcare and just built something better themselves.

[00:00:54] You don't have your ticket to Nashville yet. Go grab it at rosettafest.org. This is where people in these stories will actually be in the room with you, very open to sharing their methods and excited to have you copy it and run with it in your community. So let's get into it.

[00:01:11] I want to tell you why this book exists. And it all started with a friend of mine. She was a successful executive, a Silicon Valley leader, the kind of person you'd assume the system would never fail.

[00:01:35] Yet the system failed her anyway. And it was absolutely a preventable failure and the kind that should never happen to anyone, let alone some with every resource. And at the end of the day, she left behind a 10-year-old daughter after being devastated physically, financially and emotionally by a system. And, you know, I really think about her more than almost any statistic in this entire book and really what we do in the broader movement.

[00:02:02] It comes down to the people. And it just wasn't the medical failure, you know, left her in financial ruin. And I saw the emotional devastation that hit her, you know, towards the end. And, you know, really the cruelty of the system, you know, can take your health and your savings in the same stroke. And, you know, I just couldn't unsee it after that. And once you watch it happen to somebody you love, you can't go back to pretending it's somebody else's problem.

[00:02:31] And the way I was raised, you see it wrong. You don't do something about it. You're complicit. And so I owed it to my friend to really do everything in my power to limit the damage from the current system while building a model that replaces this wildly underperforming system. And I didn't know exactly the form that would take. But fortunately, over the last decade, that form has really come into view. And it ultimately is about relocalizing health.

[00:02:59] Your AFROL health starts at home with mom and dad and then fans out from there. It doesn't start in a pill bottle. It doesn't start in a hospital. It starts, you know, right, you know, in our own homes. You know, and here's what the grief turned into for me. I started noticing a pattern that, you know, I've kind of been trained to ignore. You know, we love to blame the system as if it's just kind of the weather that we have no control over.

[00:03:30] It just happens to us. But that's really a lie that lets everybody off the hook that's in the system. And when I started, what I started seeing was that almost every bad outcome traced back to specific, identifiable, fixable decisions made by people inside organizations that put in chosen differently. It was all codified in this arcane legal language in documents we call health plans. You know, after all, what is a health plan?

[00:03:59] It's not a doctor or nurse. It's just a bunch of legal documents that quietly govern everything in health care. And I'd have a front row seat. I'd spent my career inside of health care finance and tech. I'd found in Microsoft's health care ecosystem back in the mid 90s. And I'd built a digital health company that was acquired by WebND. So I wasn't watching from the outside.

[00:04:22] I was in the inside, you know, watching these misaligned incentives drive up cost and, you know, complexity, even when the people involved were good people with good intentions. And that was the part that really just stuck with me. It wasn't there was villains. It was this overall structure, you know, good people trapped inside a structure that produced really horrible results overall. At some point, I just made a decision that changed everything for me.

[00:04:51] I stopped trying to optimize a broken model. For years, the whole industry's energy and attention goes into making a broken thing slightly less horrible. I decided that was a dead end. Instead, I started doing something almost nobody was doing. I went looking for what already works, you know, not pilots, not little innovation theater here or there.

[00:05:17] You know, there were communities, whether they were, you know, communities like the Alaska Native people or, you know, a union or a company. Those are communities as well. And they'd solved this thing. And they'd had years of evidence of that, that most people just weren't seeing. And what I recognize is fundamentally, no matter where you are in the world, people are problem solvers.

[00:05:41] They may not have all the resources in the world, but, you know, the old expression necessity is the mother invention really applies here. And I'd remind myself, you know, how Americans have always done this. You think about rural America and how they got electricity. You know, over a century ago, there were farmers in Iowa that started laying six miles of power line across the prairie before they even secured a power source.

[00:06:08] Each one put in $175 in their own blood, sweat and tears. And their neighbors frankly thought they'd lost their minds, probably a little bit like, you know, people watching Noah build in the ark. But they understood something that when you want something badly enough, you just build it yourself, even before you know how every piece will work. And that's the instinct that I kept finding in health care.

[00:06:36] My friend Chris Brookfield put the principle this way. He called it the local advantage, you know, basically making the impossible possible. The way he put it was by decreasing scale, solutions appear to problems that seem too complicated to solve at the global level. Reengineering the food system or ending poverty are really intractable at the global or even national scale.

[00:07:01] Even the basic atoms of those systems become, you know, like people become invisible. But you dial in the local and new features and relationships emerge. And they were out there and they were hiding in plain sight. You know, I found this hotel company, Rosen, in Orlando. There was a school district consortium in Pennsylvania, a wood products company in Georgia, an Alaska native community.

[00:07:28] And, you know, that frustration just kept me going was pretty simple. I kept watching the same fixable problems repeat community after community because nobody had gathered the proof in one place. And, you know, people would constantly say it can't be done. And I think, well, if it's already been done, you just haven't seen it.

[00:07:49] And our theory of change was if we kept our heads down, prove these successes could be replicated thousands of times in rural urban areas and small and large employers and the public and private sector all over the country sustained for years. And it would be pretty hard to say we just got lucky. And more than that, we'd prove the blueprint for the next 50 years of health care and make it 100 times easier to replicate what these pioneers had had to endure.

[00:08:18] So that's what this book is really all about. Ten years of refusing to accept that nothing can be done. It's not some screed manifesto. I didn't write another book that diagnoses a problem in 300 pages and mostly shrubs about the problems and maybe has five or ten pages about the solutions. It's really the opposite. There's plenty of those books and they have their place for sure. But I wanted to put the proof in one place.

[00:08:46] The communities, the numbers, the names, the playbook. So the next leader who wants to act doesn't have to start from scratch the way that pioneers had had to do. And I'll be honest about the faith piece because it drives me. I believe that to witness a wrong and do nothing is its own kind of failure. And once you see it, you're responsible for what you do next. And that's really how open source comes in.

[00:09:14] Openness wins largely because information networks have coalesced over the last 15, 20 years and exponentially increased the flow of information to local communities. There's no way to transmit proprietary ideas anywhere near the speed and reach that open source ideas move. There was a great book that James Fallows wrote almost a decade ago called Our Towns. And he quoted Professor Phil Zalicow, who said,

[00:09:44] In scores of ways Americans are figuring out how to take advantage of this Europe, often by bypassing the dismal national conversation. There are a lot of positive narratives out there, but they're lonely and disconnected. It would make a difference to join them together as a chorus that has a melody. That's why this book exists. That's why our movement exists.

[00:10:08] And that's why I'll be standing on stage in Nashville at the end of July to launch this. Not because I have all the answers, but because the answers already exist in these communities and somebody needs to carry them forward. And building connections across communities is how you dramatically accelerate the progress. It's not theory.

[00:10:31] It started with a friend and what I'd seen happen with her leaving behind a 10-year-old daughter and the promise I made to myself that I would not let it be the end of the story. So I hope you get a lot out of this book. Everybody who attends Rosetta Fest is going to get a copy of the book. And you can pre-order a copy on Amazon. And it will be available on our website as well. I hope you take a look.

[00:11:01] Well, that's the story for today. If it resonated, the new Relocalizing Health book is going deeper into that. And Nashville goes deeper still. So Relocalizing Health comes out July 29th right at Rosetta Fest. Every attendee will get it. You can pre-order a copy now on Amazon. And if you want to be in the room when that happens, get your ticket at rosettafest.org. See you in Nashville.