A $5.3 trillion system designed to treat disease, not heal people. What's failing, what's been suppressed, and the architecture that could replace it all.
How a $5.3 trillion machine optimized itself for extraction — not healing
The American healthcare system does not fail despite its design. It fails because of its design. Every incentive — from how doctors are trained to how insurers are paid to how drugs are approved — points toward the same outcome: treat symptoms, never resolve causes, and extract maximum revenue at every node.
In 2024, U.S. healthcare spending reached $5.3 trillion — 18% of GDP, or roughly $15,474 per person. This is more than any nation on earth spends, by a wide margin. The return on that investment? Americans live shorter lives, suffer more chronic disease, and report lower satisfaction than citizens of countries that spend a third as much. Administrative costs alone consume roughly $1 trillion per year — 22% of total healthcare spend — a figure that dwarfs the entire GDP of most nations.
This is not an accident. This is the system working as designed.
Modern American medicine is organized around organs and symptoms, not people. A patient with depression, chronic inflammation, gut dysfunction, and insomnia will see four different specialists — a psychiatrist, a rheumatologist, a gastroenterologist, and a sleep specialist — none of whom communicate with each other, and all of whom prescribe separate pharmaceuticals targeting separate symptoms of what may be a single root cause.
Medical education reinforces this fragmentation. Physicians train in silos — cardiology, neurology, endocrinology — each with its own journals, conferences, and treatment paradigms. There is no "Department of the Whole Person" in any major medical school. Functional relationships between body systems — the gut-brain axis, the immune-endocrine connection, the role of circadian rhythm in metabolic health — are acknowledged in research but systematically ignored in clinical practice.
The result is a system that manages chronic conditions rather than resolving them. A diabetic patient receives metformin, not a metabolic reset. A depressed patient receives SSRIs, not investigation into inflammation, gut health, hormonal imbalance, trauma, or nutritional deficiency. The system doesn't ask why — it asks what drug.
Pharmaceutical companies are not in the business of curing disease. They are in the business of managing it — permanently, profitably, and at scale. The business model is elegant in its perversity: identify a chronic condition, develop a drug that suppresses symptoms without eliminating the cause, secure patent protection and FDA approval, and create a patient who must take (and pay for) that drug every day for the rest of their life.
The incentive structure makes this inevitable. A cure is a one-time sale. A chronic treatment is a subscription. When compounding pharmacies began offering peptide alternatives to branded GLP-1 drugs at a fraction of the cost, Eli Lilly and Novo Nordisk didn't compete on price — they deployed legal teams, lobbied the FDA, and orchestrated regulatory crackdowns that restricted compounding pharmacies from producing BPC-157, TB-500, CJC-1295, and other widely-used therapeutics.
The FDA's January 2025 peptide restrictions arrived not because of demonstrated harm, but because pharmaceutical revenue was threatened. State attorneys general launched enforcement waves against compounded GLP-1 distributors. The pattern is consistent: regulators intervene when alternative channels threaten branded pharmaceutical revenue.
The physician incentive structure is broken at every level. Insurance reimbursement models — driven by CPT codes and procedure-based billing — reward volume over outcomes and intervention over prevention. A doctor who spends 45 minutes understanding a patient's full history, lifestyle, emotional state, and root causes earns less than one who runs a 7-minute visit and orders a battery of tests.
Insurance companies compound this by restricting what conditions can be treated and which treatments are covered. Integrative approaches — nutrition counseling, stress management, functional lab testing, acupuncture, mind-body interventions — are rarely reimbursed even when evidence supports them. The insurance formulary determines treatment, not the physician's clinical judgment. Conditions that cross systems — a patient with autoimmune symptoms spanning dermatology, gastroenterology, and rheumatology — fall through the gaps because no single specialist "owns" the problem and insurance won't pay for the kind of comprehensive investigation required.
The structural problem accelerates when you examine who controls the system. Healthcare in America is not a market — it is a series of vertically integrated monopolies disguised as a market.
UnitedHealth Group — through its Optum subsidiary — now employs or contracts with approximately 10% of the U.S. physician workforce, operates the third-largest pharmacy benefit manager, owns the dominant claims clearinghouse (Change Healthcare), and insures tens of millions through UnitedHealthcare. It is simultaneously the insurer, the PBM, the data platform, the analytics provider, the employer of the doctors, and increasingly the operator of the clinics. CVS Health owns Aetna (insurer), Caremark (PBM), MinuteClinics (provider), and Oak Street Health (primary care). Cigna owns Express Scripts.
Three PBMs — OptumRx, CVS Caremark, and Express Scripts — process nearly 80% of all prescription drug claims in the United States. A 2025 FTC report found these three PBMs marked up specialty generic drugs by thousands of percent at their affiliated pharmacies, generating more than $7.3 billion in excess revenue between 2017 and 2022.
As of this week, Senators have introduced legislation to break up these vertically integrated insurers — the first serious legislative acknowledgment that "horizontal and vertical consolidation in healthcare has not produced the efficiencies and consumer price reductions Americans were promised."
The federal government finances the largest share of national health spending — 32% directly, with state and local governments adding another 16%. Through Medicare, Medicaid, the VA, and other programs, government is the single most powerful buyer in American healthcare. This should give it leverage to demand efficiency, outcomes, and accountability. Instead, it perpetuates the very system that fails.
Medicare reimburses based on procedure codes, not outcomes — incentivizing more procedures, not better health. Medicaid reimbursement rates are so low that many physicians refuse Medicaid patients entirely, creating a two-tier system. The FDA approval process — designed for safety — has been captured by the pharmaceutical industry, which funds the agency through user fees and populates its advisory committees with industry-connected researchers. The result is a regulatory apparatus that protects incumbents from competition while failing to fast-track genuinely innovative therapies.
The government's role as payer without reformer creates a perverse equilibrium: taxpayers fund the system, conglomerates extract the value, patients receive suboptimal care, and the incentive to change is distributed across too many actors for any single one to act.
The treatments, knowledge, and approaches suppressed by the incumbent system
The healthcare behemoth doesn't merely fail to innovate. It actively suppresses alternatives that threaten its revenue model. This is the intermediation pattern at work — and healthcare may be its most consequential domain.
There is a pattern so fundamental to power consolidation that it repeats across every domain of human activity. It is the progression from direct experience to institutional control, from source knowledge to intermediated access, from autonomy to dependence.
Community healers — overwhelmingly women — possessed direct knowledge of herbs, birthing, wound care, nutrition. Their knowledge was empirical, passed through generations, refined through practice. People understood their own bodies.
Healing knowledge spread through apprenticeship and demonstration. Midwives trained midwives. Herbalists shared formulas. Communities developed sophisticated medical knowledge without institutions.
Medical knowledge was codified into standardized curricula. The Flexner Report of 1910 formalized medical education — and simultaneously delegitimized alternative traditions including homeopathy, naturopathy, and herbal medicine.
The AMA, FDA, state medical boards, and insurance companies became necessary intermediaries between patients and healing. Credentials required. Licensing mandated. Direct access to therapeutic knowledge — including your own lab results — restricted behind institutional approval.
The system optimizes for institutional survival, not patient flourishing. Direct access to therapeutics is criminalized. Recurring revenue models replace cures. The focus shifts from healing to perpetuating institutional control. The patient moves further from source while becoming more dependent on intermediaries.
Psychedelic-assisted therapy — psilocybin for depression, MDMA for PTSD, LSD analogues for anxiety — shows clinical efficacy that rivals or exceeds any pharmaceutical intervention. MindMed's MM120 achieved 65% response rate and 48% remission from a single dose in generalized anxiety disorder. Helus Pharma reported 100% responder rates and 71% remission with psilocybin. These substances were used safely for millennia before being criminalized in the 1970 Controlled Substances Act — not because of safety data, but because of cultural and political suppression.
Peptides like BPC-157 (tissue repair), thymosin alpha-1 (immune modulation), and various GLP-1 analogues were widely used by integrative practitioners with strong safety profiles. The FDA's 2025 crackdown restricted compounding — not because patients were harmed, but because branded pharmaceutical revenue was threatened. The peptide market was worth $39 billion in 2022 and growing. The incumbents wanted it.
Decades of messaging have trained Americans to distrust natural approaches and trust only FDA-approved pharmaceuticals. Herbal medicine, nutritional therapy, bodywork, energy medicine, and traditional healing modalities have been systematically marginalized through a combination of regulatory restriction (you can't claim health benefits for supplements), media dismissal ("pseudoscience," "quackery," "woo"), and insurance exclusion (if insurance doesn't cover it, doctors don't recommend it).
The irony is lethal: pharmaceuticals are the fourth leading cause of death in America when adverse drug reactions and medical errors are included. The treatments the system labels "dangerous" — herbs, acupuncture, fasting, meditation, movement — have safety profiles that pharmaceutical companies would kill for.
Technologies connecting consciousness, bioelectricity, and frequency-based healing have been dismissed for decades. Yet ARPA-E is funding Low-Energy Nuclear Reactions research. The U.S. Navy assembles research teams on phenomena mainstream physics considers impossible. Google publishes results on technologies careers were destroyed for investigating. The pattern from M31's Suppressed Technologies research is unmistakable: ideas mocked for decades are quietly being rehabilitated by serious players.
Consciousness research shows the maximum suppression signal — career risk for researchers, institutional dismissal, funding denial. If consciousness is fundamental, this inverts the materialist paradigm with massive implications for medicine, AI, and human potential.
Perhaps the deepest loss is the erasure of whole-person health from medical education. There is no mainstream training in how the spiritual, emotional, mental, and physical dimensions of a human being interact to produce health or disease. The physician who treats a patient's depression without investigating their relationships, trauma history, sense of meaning, sleep quality, gut health, and nutritional status is not practicing bad medicine — they are practicing the only medicine they were taught.
The paradigm-shifting treatments, technologies, and frameworks that could replace the entire system
Despite suppression, a convergence of scientific breakthroughs, cultural shifts, and technological capabilities is producing genuine alternatives. These aren't incremental improvements to the existing system — they are structural replacements for it.
The clinical evidence is now undeniable. More than 80 companies are developing psychedelic compounds. Phase 3 trials are underway. FDA Breakthrough Therapy Designations have been granted. The first major pharmaceutical collaboration arrived when Otsuka partnered with AtaiBeckley on R-ketamine for depression. Psilocybin, LSD analogues, MDMA, DMT, and ketamine are demonstrating efficacy in treatment-resistant depression, PTSD, anxiety, addiction, and end-of-life distress — often from a single administration.
The mechanism matters: psychedelics don't suppress symptoms. They appear to catalyze neuroplasticity, enabling the brain to rewire dysfunctional patterns. This is medicine that treats causes, not symptoms — and does so in sessions, not subscriptions.
Peptides represent a middle ground between pharmaceuticals and supplements — targeted biological molecules that modulate specific systems. GLP-1 agonists have already proven that metabolic disease is modifiable. The broader peptide landscape — tissue repair (BPC-157), immune modulation (thymosin alpha-1), growth hormone optimization (CJC-1295/Ipamorelin), neuroprotection (Semax, Selank) — represents a toolkit for proactive health optimization that the pharmaceutical model cannot accommodate because it threatens the chronic-management revenue stream.
Aging itself is being treated as a disease. Altos Labs ($3B+ from Bezos and others) demonstrated that partial epigenetic reprogramming extends lifespan in mice. Retro Biosciences, backed by Sam Altman, achieved a 50x improvement in reprogramming efficiency by partnering with OpenAI. The first AI-discovered, AI-designed drug completed a successful Phase 2a trial (Insilico Medicine). CRISPR-based gene editing is producing one-time interventions — Verve Therapeutics' cholesterol-lowering gene edit was acquired by Eli Lilly for $1 billion.
The human body is not merely chemical — it is electrical. Every cell maintains a voltage potential. The heart generates the body's strongest electromagnetic field. Neurons communicate through electrical impulses. Emerging research in bioelectricity — pioneered by Michael Levin at Tufts and others — demonstrates that electrical signaling governs development, regeneration, and potentially cancer. Pulsed electromagnetic field (PEMF) therapy, transcranial magnetic stimulation (TMS), and bioelectric manipulation represent a frontier that mainstream medicine barely acknowledges but that patients report dramatic results from.
The challenge: this space is rife with unvalidated claims, poorly manufactured devices, and inadequate dosing protocols. Legitimate science exists alongside outright fraud. No governing body separates them.
The deepest paradigm shift may be the recognition that health is not purely physical. Trauma research (Bessel van der Kolk, Gabor Maté) demonstrates that psychological and emotional states directly produce physical disease. The ACE (Adverse Childhood Experiences) studies showed that childhood trauma predicts adult disease with startling specificity. Meditation, breathwork, somatic experiencing, and psychedelic-assisted therapy all operate at the intersection of consciousness and biology.
Addressing the whole person — spiritual, mental, emotional, and physical — is not "alternative." It is what medicine should have been doing all along.
AI models trained on comprehensive patient data — labs, genetics, symptoms, lifestyle — can identify patterns that siloed specialists miss. AI drug discovery is compressing 10+ year development cycles into months.
Micro-sampling and at-home phlebotomy tech removes the clinic visit from routine monitoring. Enables continuous optimization rather than annual snapshots.
Patient-owned, immutable health data stored on-chain. Cannot be lost, cannot be altered, cannot be controlled by any single institution. Enables data portability and AI analysis.
Telehealth enables practitioner access regardless of geography. Combined with AI triage and remote monitoring, reduces the need for in-person visits by 60-80% for routine care.
Scams, contamination, and the absence of standards in the emerging space
Here is the uncomfortable truth: the emerging alternative healthcare landscape is a mess. The absence of institutional gatekeeping that enables innovation also enables fraud, contamination, and confusion. Both the establishment and its critics are partially right.
This is the argument from M31's Coordination Without Extraction research — we need the legitimate coordination functions of institutions (standards, quality control, fraud prevention) without the extractive rent-seeking that corrupts them. The question is not whether we need coordination, but whether that coordination requires opacity, extraction, and suppression of alternatives.
The supplement industry is largely self-regulated. Third-party testing is voluntary. Labels are frequently inaccurate. Heavy metal contamination, underdosed active ingredients, and outright fraudulent products are common. A consumer purchasing "turmeric extract" has no reliable way to verify potency, purity, bioavailability, or safety without expensive independent testing. There is no trusted, accessible, incorruptible registry of verified supplements and manufacturers.
The frequency healing space is particularly vulnerable. Devices ranging from PEMF machines to "scalar energy generators" to "frequency therapy" units span a spectrum from clinically validated (TMS, certain PEMF protocols) to complete fabrication. No governing body certifies which devices work, which protocols are effective, and which manufacturers are producing reliable equipment. Consumers are left to navigate marketing claims, anecdotal reports, and pseudoscience.
Even where individual treatments are legitimate, no system exists to synthesize them into a coherent protocol for an individual patient. A person dealing with chronic fatigue might benefit from a combination of peptide therapy, nutritional optimization, sleep protocol adjustment, stress management, gut restoration, and hormonal balancing — but no single practitioner, institution, or AI system currently connects these into a personalized, evidence-based protocol with monitoring and adjustment over time.
The practitioner landscape is equally fragmented. Naturopaths, functional medicine doctors, integrative practitioners, health coaches, herbalists, acupuncturists, and energy healers operate under different (or no) licensing frameworks with wildly varying levels of training and competence. A patient seeking "alternative" care has no reliable way to assess practitioner quality.
This chaos is exactly what incumbents point to when they argue against alternative healthcare. And they're not wrong — the chaos is real. But their solution — "come back to the pharmaceutical system" — is the equivalent of arguing that because the new world has pirates, we should return to the prison.
The real answer is to build the coordination infrastructure without the extraction layer.
Protocols over institutions. Transparency over gatekeeping. A proposed system for healthcare that actually heals.
What follows is a structural proposal — not a business plan, but an architecture. A system design that addresses every failure identified above while preserving the legitimate coordination functions that patients need. The principle: transparent protocols with aligned incentives outperform opaque institutions with misaligned incentives.
Create an independent, decentralized standards organization — operating on blockchain so its records cannot be altered, lost, captured, or suppressed — that performs the legitimate quality-control functions currently absent from alternative healthcare.
This body is staffed by functional medicine doctors, integrative practitioners, researchers, pharmacologists, and patient advocates — not pharmaceutical executives. Its records are on-chain: every certification, every test result, every protocol revision exists permanently, transparently, and immutably. No bureaucrat can suppress a finding. No lobby can bury a result. The standards evolve based on evidence, not politics.
Patients upload their complete health data — lab results, genetics, imaging, wearable data, symptom logs, treatment history — to a blockchain-based health record (platforms like Blue Nexus or similar decentralized health data infrastructure). The data belongs to the patient. No institution controls access. The patient grants permission for analysis.
This inverts the current model entirely. Today, your health data is scattered across 15 different EMR systems controlled by 15 different institutions, none of which talk to each other, all of which charge you to access your own records. Tomorrow, you own your data, store it immutably, and decide who analyzes it.
AI models — trained on the on-chain standards body's evidence base, protocols, and outcomes data — analyze the patient's complete health profile and generate a personalized, multi-modal protocol. This isn't a drug recommendation. It's a comprehensive plan that might include:
Specific supplements from verified vendors, peptide protocols, nutritional adjustments, exercise prescriptions, sleep optimization — all dosed and sequenced based on the patient's labs, genetics, and goals.
Neurofeedback protocols, meditation practices, cognitive behavioral techniques, psychedelic-assisted therapy referrals where appropriate — addressing the brain as an organ that can be optimized, not just medicated.
Somatic therapy, EMDR, breathwork, journaling protocols, community connection — acknowledging that unprocessed emotional material manifests as physical disease.
Purpose exploration, nature connection, contemplative practice, consciousness work — the dimension of health that modern medicine ignores entirely but that research shows profoundly impacts outcomes.
The AI-generated protocol is reviewed and approved by a licensed telemedicine practitioner — credentialed through the on-chain standards body, trained in integrative and functional approaches, and legally authorized to prescribe. For straightforward cases, this is a teledoc review. For complex cases, the system routes to a diagnostician or multidisciplinary team.
For patients who feel the system has failed them — complex, multi-system conditions that no specialist has been able to diagnose or treat effectively — the architecture includes a diagnostic escalation pathway. AI flags cases that don't fit standard patterns. A team of diagnosticians (think Dr. House, but as a distributed network) reviews the full data set. The on-chain record means nothing is lost between providers. The patient doesn't have to repeat their story for the 15th time.
Once the protocol is approved, the patient receives a monthly box containing their personalized supplements, peptides (where legal), and therapeutic materials — all from verified vendors through the on-chain standards body. At-home blood draw kits enable regular monitoring. Labs are uploaded automatically. The AI adjusts the protocol based on results. The cycle continues: data → analysis → protocol → fulfillment → monitoring → adjustment.
This is where the paradigm tips. Forward-thinking insurance companies — Oscar Health (2M+ members, tech-first), Garner Health (physician quality transparency), Pearl Health (value-based primary care enablement) — are already aligned with the principle of paying for outcomes rather than procedures. If the on-chain standards body can demonstrate that its protocols reduce emergency visits, hospitalizations, pharmaceutical spend, and chronic disease burden — and the data will show this — then insurance coverage becomes an economic inevitability, not a political negotiation.
The pitch to insurers is simple: pay $200/month for a protocol that prevents the $50,000 hospitalization. Value-based care economics already prove this works. The architecture simply extends it to integrative and alternative modalities with the evidence base to support them.
Six layers — from standards to insurance — operating as transparent protocol, not opaque institution
What needs to happen — research, infrastructure, partnerships, and phased deployment
The architecture above is achievable — but not overnight. It requires deliberate phasing, foundational research, strategic partnerships, and regulatory navigation. Here is what needs to happen, and in what order.
The American healthcare system is a $5.3 trillion machine that spends 18% of GDP to produce outcomes worse than countries spending a third as much. It treats symptoms, not causes. It suppresses alternatives that threaten revenue. It extracts through vertical integration while delivering fragmented care. It is the most expensive intermediation system in human history.
The emerging alternatives — psychedelic medicine, peptide therapeutics, longevity biotech, functional nutrition, bioelectric medicine, consciousness-based approaches — are not fringe. They are scientifically grounded, clinically tested, and suppressed specifically because they work.
What's missing is the coordination layer — the standards, protocols, quality verification, and insurance integration that enable these alternatives to operate at scale without the chaos, fraud, and inconsistency that currently plague the space.
The architecture proposed here — on-chain standards, patient-owned data, AI protocols, teledoc verification, monthly fulfillment, insurance integration — addresses every identified failure. It preserves coordination without extraction. It enables direct access to healing while maintaining quality control. It treats the whole person. It is transparent, immutable, and incorruptible.
Could a ton of what is currently treated by medication actually be treated more proactively and outside of doctor's offices? The evidence overwhelmingly says yes. Depression, anxiety, metabolic syndrome, chronic pain, autoimmune conditions, sleep disorders, and many more are conditions where root-cause integrative approaches produce equal or superior outcomes to pharmaceutical management — often with a single intervention rather than a lifetime subscription.
Could we help people connect to and address their spiritual health, mental health, emotional health, and physical health — the whole person? Not only could we. We must. The separation of these dimensions is an artifact of institutional fragmentation, not biological reality.
The question is not whether this is possible. The question is whether we build it before the incumbents co-opt the language of "wellness" and "whole-person care" while preserving the extractive architecture underneath.
The paradigm is shifting. The only question is who builds the infrastructure for what comes next.
This research brief synthesizes analysis from M31 Capital's Investment Thesis ("The Healing Shift"), Sector Deep Dive (Alternative Healthcare), Suppressed Technologies Research, The Architecture of Intermediation, Coordination Without Extraction, and the Five Forces Paradigm Dashboard.