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Abundant Healthcare and the End of Scarcity

July 17, 2026

As of 2026, the UK spends £258bn on healthcare, and we are performing worse on almost every metric. Why? Why has everything else in my life gotten easier while access to timely, high-quality healthcare has gotten worse? I can order food from my phone, fly to the other side of the planet, and reach all the world's knowledge, yet I wait three weeks for a GP appointment.

The good news is that I think we are about to enter an era of healthcare abundance, one that hasn't been seen since the early 20th century. It will bring about a new era of healthcare abundance, one that raises the floor for all humanity. I want to answer what healthcare abundance looks like and what the path looks like to get there.

Sewers, sanitation and healthcare demand

Between 1830 and 1850, London grew by 900,000 people; over 60% in twenty years. Its infrastructure buckled under the new arrivals, above all its ability to move sewage. As Britain expanded its colonial power, the increased movement of people and goods also increased the spread of diseases like cholera. The city became a petri dish in the early 19th century. In 1832, 6,000 people died in a matter of months from cholera.

Over the next 25 years, the engineer Joseph Bazalgette transformed London's sewage system: five main lines, 310 million bricks, north and south of the Thames. By 1875, over 800 miles had been built or renovated — the distance from London to Madrid. Before this, Londoners' waste ran into storm drains meant to carry rainwater to the Thames. London rebuilt its sewage network from almost nothing.

The result was beautiful. We eradicated waterborne disease from London. Mortality fell 30-40% over the late 19th century, and infant mortality went from 150 deaths per 1,000 births to under 100 by the century's end. Today, everyone, whether living in a studio flat or a mansion, has access to the same sanitation and clean water.

You could think healthcare in the UK has the same problem: that if only we could radically increase supply, the way we did with sewage, we might avoid an impending crisis. Attlee's government created the NHS in 1948 when the UK population was around 50 million. We have grown to nearly 70 million since and the percentage of people over 65 has roughly doubled. If we could turnaround healthcare on the scale of the 19th century sewers, we would see similar gains. But, the NHS has already had an enormous increase in supply, from 2.5% to 7% of GDP in the last 75 years. We have gone from 9,000 to 188,000 doctors, and it still feels like the system can't cope.

This tells us a couple of things about healthcare as a market. Firstly, it is an industry with effectively unlimited demand. If you are diagnosed with cancer, cutting your wait to see an oncologist from two weeks to one is nice, but you would still see one tomorrow if you could. It's also true that you probably want to chat with your oncologist more than you can currently; more appointments in less time. Increasing supply incrementally only raises expectations about what people should be getting. Rationing is only tolerated because it is mostly free.

Secondly: demand rises exponentially with age. Each person, as they age, picks up a litany of conditions. Someone in their 60s and 70s might carry ten at once, many of them chronic. We also operate a system on specialities so each diagnosis comes with a new care pathway that interacts poorly with your other forms of care. So while supply has expanded, demand is growing faster and the complexity of treating it has grown with it. More conditions to treat and a rising expectation that they are treated faster and better.

The NHS was founded on the principle that if we can provide high quality free healthcare, we would have fewer sick people. This has proven to be wrong, with the opposite happening instead; any new supply of healthcare will be met by demand. In 1949, Antony Bevan, the NHS' mastermind said "I shudder to think of the ceaseless cascade of medicine which is pouring down British throats". So if demand is effectively unlimited, what blocks new supply? Cost. The cost of people, equipment, infrastructure, and process.

To reach an era of healthcare abundance, we need the cost of supply to asymptotically curve toward zero.

Cost curves

On a late Spring day in 1984, Robert Sinsheimer, then chancellor of the University of California, Santa Cruz, gathered a series of scientists to discuss something crazy. A recent telescope had failed to get funding and so Robert wanted a project that would put UCSC at the forefront of its field. The 12 scientists, including one called Walter Gilbert, gathered in a grey meeting room to plant the seeds of one of the century's most ambitious scientific projects.

At the same time, an American virologist, Renato Dulbecco, had an emerging curiosity about the effects of genes on cancer. Watson and Crick had discovered genes in the 1950s, and scientists like Dulbecco had begun to connect diseases to the genes, winning a Nobel Prize in 1975 for his work on Oncoviruses. He would go on to write an essay that popularised the ambitions of a few crazy scientists with the rest of the scientific community.

Finally, in 1985, a scientist at the Department of Energy named Charles DeLisi read a paper on technologies used to detect inherited diseases caused by genetic mutations — a long-standing concern stemming from the atomic bombings of Hiroshima and Nagasaki. He thought it might be possible to help them if we better understood the human genome. What would become one of the great feats of biological sciences started in the department of energy.

1984 and 85 witnessed the genesis of the human genome project. After the meeting at UCSC, Walter Gilbert sent Sinsheimer a memo translating the group's ideas into specific operating plans, and he became the torchbearer, carrying the concept into the power centres of molecular biology through talks at a Gordon conference and elsewhere in 1985. Dulbecco laid out the idea on Columbus Day 1985 and then in a commentary in Science published in March 1986, which was the first widely public airing of the concept. Finally, Charles DeLisi got the project real momentum within the government: getting funding from the department's Office of Health and Environmental Research. $3bn to sequence the first human genome, 35 years after genes were first discovered, all 3bn base pairs.

40 years after the meeting at UCSC, it now costs less than $100 to sequence your own genome. A 99.999997% depreciation in price. Our ability to sequence genomes for ever decreasing costs has meant the following:

This is a wonder of modern biology, government investment, and the power of the free market.

Abundance and its forms

The genome shows what happens when a cost falls far enough. Sequencing did not get cheaper and then progress stopped. The first thing the cheap genome brought was more of the genetic research we were already doing, but faster and for more people. The second was genetics we could not do at any price before: screening a newborn for hundreds of conditions in an afternoon, tracking a pandemic across seventeen million genomes, matching a drug to how one person's body handles it.

This is the promise of technological progress. That some new way of making or doing something radically lowers its cost. At first cheaper just means the same thing for less. But after some time, completely new ways of doing something emerge on top of a new technology; industries are refactored to do the thing in a completely new way and as well as completely new industries emerging. This principle can be applied to healthcare:

Healthcare is currently episodic and AI is driving progress in its current structure. AI scribes remove the need for note taking, AI telephony systems remove the need for appointment scheduling and AI coding automatically tagging diagnoses. We are tagging AI on to the existing system to drive efficiency. The new thing is harder to see, because we keep describing it in the language of the old thing. The very concept of care invokes an idea of healing something that is broken. The NHS is free at the point of delivery; healthcare perpetually reacting to the ailments of the individual. So maybe abundant healthcare is a move towards prevention? But preventive health has always lent on the weak will of the human species to avoid disease – eat better, exercise more, get more sleep. It has always failed to recognize that we succumb to temptation. Maybe the next iteration of healthcare is a movement beyond episodic care to longitudinal, pharmaceutically aided interventions? We have seen glimpses of this with the GLP1s and the emergence of peptides, quelling people's desire to over eat and in doing so, bringing a wave of health improvement not seen for over 50 years. Or maybe it is all of the above? Is healthcare abundance the death of healthcare? One can imagine a new way of managing human health that is continuous with always on monitoring from wearables and AI, personalized pharmaceutical stack tailored to your genetic profile and abundant episodic intervention in emergencies – an army of robots is ready to deliver a series of yet to be invented interventions.

Bryan Johnson, during his tumultuous rise to fame, was excommunicated from the healthcare community for his weird obsession with "Don't die". But I think he has reached healthcare's true philosophical ideal. The hippocratic oath is a standard of a bygone era as we approached an intelligence explosion that holds the promise of eternal life.

So what does healthcare abundance look like? It isn't simply more of the current thing: this is something that has been happening over the last 100 years. It will be a completely new way of managing humanity's health, with some critically important features:

What will truly stop us from delivering a new system of care is ourselves as we hold new ways of doing things to some unrealistic platonic ideal. People in healthcare do this too often: hold a new way of delivering care to a standard the old way has never met. We compare the AI to the best doctor on her best day, rested, unhurried, fully read into your notes, and when it falls short of her we call it unsafe. But that doctor is not the real alternative.

The reason we do this is asymmetry. We forgive harm that comes from doing nothing and we punish harm that comes from doing something. The three-week wait that lets cancer grow kills people every year and no one is blamed, because the system only failed to act. An AI that was right ninety-nine times and wrong once would be a national scandal on the hundredth, because this time something was done, and someone chose to deploy it. It is the same instinct that puts one self-driving death on the front page while the forty thousand killed by human drivers on American roads each year are just the weather. The bar for acting sits far above the bar for standing still, and healthcare, which can kill you either way, holds to that asymmetry harder than anywhere else.

What is healthcare abundance?

When I started writing this piece a month or so ago, I wanted to plant a yard stick in the future; what could we expect from an era of abundant healthcare. As I began writing it, it became clear that doing this on a 2-3 year time horizon is not interesting because everyone agrees and in 10 years + is impossible. Put yourself in 1999 for a second, and at the dawn of the internet, most people wouldn't have said taxis would not be disrupted and yet in 2012, Travis Kalanik founded Uber and built a global transportation giant. I have laid out some features of the system, a direction or trend we are going in but also some of the questions worth asking: I think episodic care will become less and less frequent as the system has to do less rationing. More of human health will be managed by software and computers. Drugs will be more precise and tailored to the people taking them. I think there will be increasing friction between rich and poor as access to "great healthcare" increasingly looks like "access to eternal life".

I think, critically, the technology is not the hard part. It is arriving whether we are ready or not. The hard part is whether we can look at our own system clearly enough to let it help us. That is a choice, and it is one we get to make. The abundance is real and it is close. The only thing standing between us and it is the story we tell about how good we already are. We should tell a truer one.