At the center of this transformation lies a deceptively simple question: what does it mean to be a good doctor in the twenty-first century? Traditionally, competency was understood primarily in terms of medical knowledge and technical skill — the ability to diagnose accurately, prescribe appropriately, and perform procedures safely. Those qualities remain essential. But they are no longer sufficient. Today’s physician must also function as a manager of complex information ecosystems, a coach who motivates patients toward healthier choices, and a critical interpreter of algorithmic outputs that no previous generation of clinicians was trained to evaluate. The role has expanded dramatically, even as the time available for each patient encounter has, in many settings, grown shorter.

This matters enormously for Americans seeking care. The United States spends more on healthcare per capita than any other nation, yet its outcomes — measured in life expectancy, preventable mortality, and the burden of chronic disease — frequently lag behind peer nations. The gap between what medicine knows and what medicine actually delivers to patients remains startlingly wide. Evidence-based guidelines for managing hypertension, preventing cardiovascular disease, and detecting cancers early exist in abundance. Yet research consistently shows that these guidelines are applied inconsistently, risk factors go unaddressed, and patients are too often left without the information and support they need to make truly informed decisions about their own health. Closing that gap is not simply a matter of spending more money or building more hospitals. It requires physicians who possess the knowledge, the skills, and — perhaps most critically — the attitude to harness every available tool in service of their patients’ well-being.

Digital health information technology, and the artificial intelligence systems now embedded within it, represents the most powerful set of tools medicine has ever had at its disposal. Electronic health records can surface hidden risk factors. Predictive analytics can identify patients most likely to benefit from early intervention. Remote monitoring can transform chronic disease management from a series of episodic encounters into a continuous, responsive partnership between patient and clinician. Large language models and clinical decision support systems can place vast bodies of evidence at a physician’s fingertips in real time, helping to reduce diagnostic error and standardize care in ways that were simply impossible a decade ago.

But technology does not heal people. Physicians do. And the physician who lacks the digital literacy to critically evaluate an AI-generated recommendation, or the communication skills to translate complex probabilistic data into meaningful guidance for a patient, or the managerial awareness to coordinate care across a fragmented system, will find these powerful tools of limited use — or worse, a source of new errors. Conversely, the physician who embraces these capabilities thoughtfully, who sees the patient not as a recipient of care but as a partner in it, and who commits to continuous learning in a landscape that will not stop changing, stands at the threshold of a genuinely transformative era in medicine.

The stakes could not be higher. A healthcare system that promotes genuine well-being and achieves optimal outcomes for all Americans — not just the affluent, the well-insured, or the geographically fortunate — depends on a profession that is prepared for this moment.

What follows is an exploration of what that preparation looks like in practice: the specific competencies physicians need, the ways digital technology can extend and enhance those competencies, the barriers that stand in the way, and the path toward a healthcare system worthy of the patients it serves. The conversation begins here.

Mayo Clinic and Microsoft’s June announcement is more than another AI partnership. It signals the rise of branded AI medicine: elite health systems turning their clinical know-how, longitudinal data, and institutional prestige into reusable foundation models that can be distributed far beyond their campuses. That could improve care. It could also harden a narrow, high-cost, institution-centered vision of healthcare just when the field most needs a whole-person, community-centered alternative .

The branded-AI play

A foundation model is a broad, reusable AI system trained on very large datasets and then adapted to many downstream tasks. In healthcare, that means one model might support triage, documentation, risk prediction, patient education, and clinical reasoning across settings (He et al., 2024). Mayo and Microsoft say their new model will combine Mayo’s de-identified clinical data and longitudinal insights with Microsoft’s cloud and AI capabilities; the model will be owned by Mayo and made available through Azure APIs . In plain terms, the hospital brand is becoming part of the product.

The idea has a history. IBM’s Watson was famously “sent to medical school” in 2012 as an earlier attempt to package high-end medical cognition into software for clinicians and health insurers (Wired, 2012). What is different now is scale: today’s models are multimodal, cloud-native, and designed to sit inside every layer of care delivery. The aspiration is not just a better tool, but a platform that can extend an institution’s reach, reputation, and business model.

Why the race is on

The rush is being driven as much by economics as by science. Big Tech and health systems see AI as a way to cut administrative burden, reduce clinician burnout, improve throughput, and defend margins. Reuters reported this spring that Amazon launched an AI platform for scheduling, intake, documentation, and coding; in 2024 Reuters also reported that Suki’s AI assistants had reached more than 300 health systems. That is the market signal: healthcare AI is becoming infrastructure, not a side project .

For elite providers, branded models offer a second advantage: competitive insulation. If AI becomes the front door to healthcare, institutions will want their own protocols, data assets, and brand voice embedded in the machine. But that logic creates a public problem. The more value accumulates around proprietary datasets, cloud contracts, and dominant record systems, the easier it becomes for today’s fragmented healthcare market to harden into tomorrow’s AI oligopoly.

What elite data misses

The central weakness of branded AI medicine is representativeness. Even the best tertiary center does not possess a monopoly on health-relevant data, because health is shaped not only by diagnoses and procedures but also by housing, food access, transportation, caregiving, digital literacy, stress, and trust. Reuters reported in 2025 on a Nature Medicine study showing that large healthcare AI models sometimes changed testing and treatment recommendations based on patients’ socioeconomic and demographic characteristics even when the clinical details were identical. That is a warning sign for any model trained mainly in elite settings .

The Mayo announcement promises to “expand access,” but it does not specify how the model will reach Medicare and Medicaid populations or safety-net settings. That omission matters. If a model is optimized around highly resourced referral care, it may perform elegantly for the digitally connected and commercially insured while offering less help to the people who most need navigation, continuity, and context. Reuters has also reported that Epic controls health data on up to 94% of Americans according to allegations in ongoing antitrust litigation, underscoring how easily AI power can concentrate around a few chokepoints in records and distribution .

Consider one illustrative case: a rural Medicaid patient with heart failure, diabetes, depression, and no reliable broadband. A branded model trained on elite tertiary-care flows might generate an impressive medication and referral plan. A whole-person model would also ask whether the patient can get to the pharmacy, afford healthy food, keep the phone charged, trust the care team, and follow up without losing a day’s wages. That is the difference between optimizing treatment and building health.

The whole-person path

A salutogenic alternative starts from a different question: not only how to detect disease earlier, but how to strengthen the conditions that help people stay well. That requires integrating clinical data with behavioral, social, and community information, and it argues against institution-sized data silos. Reuters reported in 2025 that Truveta’s multi-system data effort brought together 17 health systems, Microsoft, Regeneron, and Illumina to build a large-scale genomic and clinical resource. Whatever one thinks of that project, it points toward a necessary principle: healthcare AI should be built from interoperable, governed, plural data ecosystems, not just elite brands .

The policy agenda follows from that. We should require independent bias audits, public-interest data governance, interoperability across institutions, and community-benefit expectations for healthcare AI trained on clinical data. The educational agenda is just as important: physicians and health systems need competencies in AI critique, whole-person assessment, shared decision-making, equity, community resource navigation, and responsible governance. In the AI era, the highest competence may not be faster pattern recognition, but wiser stewardship of people, systems, and health itself.

Moonshot Press is building toward that future through the Whole Person Health Assistant initiative: tools designed not merely to optimize episodes of care, but to help citizens and clinicians co-create health across the full arc of daily life. If you want AI that serves whole-person flourishing rather than branded scarcity, this is the conversation to join.

The Question That Guides Us

Moonshot Press and Project 2026 approach this historic moment with one orienting question:

How do we build a system where everyone can get the care they need to live healthy, flourishing lives?

We believe the answer lies in Citizenism—the idea that the future of technology and health must be co-authored by the people it serves. AI has the potential to drastically reduce costs, personalize wellness, and free up our doctors to focus on the human connection of healing. But this potential can only be realized if we, the citizens, guide its development.

Join the Effort

We are currently finalizing our team’s response to the HHS RFI, and we want you to be part of this journey. This is a “Moonshot” for the health of our nation, and it requires all of us.

• Engage: Follow our updates as we break down the complexities of AI and health policy into language we can all use.

• Participate: Your voice is the most important data point in existence. Help us demonstrate that the American people want a healthcare system built for flourishing, not just for processing.

• Aspiration: Let’s move beyond “fixing” what is broken and start building what is possible.

The year 2026 marks a milestone for our country. Let’s make it the year we reclaimed our health and used the power of technology to ensure that every American has the opportunity to thrive.

In health and solidarity,

The Moonshot Press Team Project 2026: Toward a Flourishing Nation

And yet we keep having the same argument. Is healthcare a right or a service? Single payer or free market? We’ve staged that debate for decades, and it has gone nowhere. The shouting gets louder; the system gets sicker.

Moonshot Press in collaboration with the Institute for Salutogenesis The Healthcare Initiative — begins from a different premise. The problem isn’t that we lack ideas. It’s that we lack a way to reason through them together. So we borrowed a method from the one field that confronts overwhelming complexity every single day and still manages to act: medicine.

A good doctor doesn’t lead with the cure. When a patient arrives in distress, the doctor takes a history, examines, runs the tests, and names the problem — before reaching for the prescription. Diagnosis comes first. Treatment follows. And then, crucially, the patient is monitored and the plan adjusted over time.

What if we treated the healthcare system the same way? Not as a battle to be won by one side, but as a patient to be understood. That is the idea behind Civic Grand Rounds.

In medicine, grand rounds is a disciplined public forum where a difficult case is presented, the evidence examined, competing explanations debated, and a plan proposed and followed up. Civic Grand Rounds brings that discipline into public life. The premise is simple and a little radical: the patient is the system — not a party, not a CEO, not “the other side” — and the public is part of the clinical team. Your experience as a patient, a parent, a caregiver, or a clinician isn’t an anecdote to be managed. It’s evidence.

Each session unfolds like a case. We present the problem and trace, briefly and without blame, how we got here. We examine the data calmly — what’s actually true, and what we don’t yet know. Citizens testify from lived experience: the denied claim, the delayed referral, the postpartum care that never came. Experts clarify. Insurers, hospitals, and agencies answer for their part of the story. Then we build a problem list, a treatment plan, and — most important — a scorecard that tracks whether anything actually improves before the next round.

Sessions are held in public and livestreamed on Zoom, Facebook, and YouTube, so that a neighbor in the room and a parent watching from a kitchen table can take part on equal footing. Artificial intelligence helps us organize hundreds of testimonies and summarize the evidence — but under one unbreakable rule: AI recommends; humans decide. Always. No person is reduced to a data point. No community is synthesized into invisibility.

Two commitments anchor everything. The first is a floor: can everyone get the care they need across a job loss, a move, a disability, the years of aging? The second is an aim: does the system actually create health — through prevention, mental health, and the first years of life — rather than only billing fastest after harm is done? Universal coverage is the floor. A salutogenic system, one that produces flourishing, is the aim. We hold both.

This is not a town hall built for performance, or a debate built for winners. It is a public diagnostic process with a record and a plan. Behind it stands a wager as old as the republic itself: that ordinary citizens, given real information and real tools, can be trusted to reason through hard problems — and that an engaged, informed, respectful public is not a luxury in a crisis like this one. It is the treatment.

The case is open. The treatment plan is unfinished. And the question it turns on belongs to all of us: How do we build a system where everyone can get the care they need to live healthy, flourishing lives?

The Case Presentation is Being Developed. The rounds are open soon.

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The United States faces a pivotal moment in healthcare—a system strained by soaring costs, uneven access, and disparities in quality. Recognizing the urgency of this crisis, the Institute for Salutogenesis, in collaboration with Moonshot Press, presents "The Case of the United States Healthcare System." This citizen-focused, deliberative initiative leverages the power of media and community engagement to reframe the national dialogue on healthcare. Guided by the salutogenic approach—a paradigm centered on health creation and well-being—we believe that Americans are pragmatic problem solvers, eager to address tough issues within a solution-driven, nonpartisan framework akin to a Medical Case Presentation. By providing the necessary tools and information through Moonshot Press, we empower citizens to engage in passionate and competent discussions that drive meaningful change.

Our Mission

Dedicated to addressing challenges and improving outcomes, this initiative employs the salutogenic model to offer a comprehensive framework designed to achieve optimal health for all individuals. We begin with a clear vision of a desired healthcare system—one that prioritizes accessibility, affordability, quality, and patient-centered care. By focusing on factors that promote health rather than solely combating illness, we aim to shift the paradigm of healthcare in America.

Healthcare: Enhancing Health and Wellbeing​

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

• The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.

• The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest cooperation of individuals and States.

WHO Constitution

Moonshot Press: Catalyzing Citizen Engagement

Moonshot Press plays a crucial role in this initiative by serving as the platform for disseminating information, facilitating discussions, and amplifying citizen voices. As a media outlet committed to exploring bold solutions to complex problems, Moonshot Press provides the resources and outreach necessary to engage a wide audience. Through articles, interviews, podcasts, and interactive forums, we foster a community of informed citizens ready to participate in transformative healthcare reform.

The Salutogenic Approach

The salutogenic model, developed by medical sociologist Aaron Antonovsky, emphasizes understanding the origins of health ("salutogenesis") and strengthening the capacity of individuals and communities to maintain and improve well-being. This approach aligns seamlessly with our initiative's goals, encouraging us to look beyond disease management to foster environments that support holistic health.

An Activist Agenda for Systemic Change

Our approach is bold and transformative. Guided by the salutogenic paradigm and propelled by Moonshot Press's commitment to impactful journalism, we advocate for systemic changes and innovative solutions that consider the complexities and entrenched dynamics of the healthcare system. By addressing powerful barriers head-on, we aim to create a more effective, efficient, and equitable system that serves everyone.

A Roadmap for Reform

Through this initiative, we provide a detailed roadmap for reform, outlining specific actions and strategies to overcome obstacles that have hindered progress in the past. Our plan combines visionary thinking with an actionable agenda, empowering stakeholders—including the private sector, non-profits, government, and citizens—to advocate for change. Moonshot Press facilitates this process by providing a transparent, accessible platform where ideas can be shared, debated, and refined.

The Treatment Plan: A Multi-Stage Salutogenic Strategy

Mirroring the structure of a Medical Case Presentation, our treatment plan offers a multistage action strategy divided into immediate, short-term, and long-term interventions. This framework, disseminated and discussed through Moonshot Press, facilitates a healthy, deliberative political process aimed at realizing our vision:

A sustainable system that provides access to quality, affordable healthcare for all Americans, focusing on the creation of health and well-being.

By reframing the challenges we face, we pose a critical question:

How can we all—including the private sector, non-profits, government, and citizens—best achieve effective solutions that promote health creation in a complex world of escalating needs and diminishing resources?

Engaging Citizens in the Health Creation Process

Central to our initiative is the empowerment of citizens as active participants in transforming healthcare. By adopting the salutogenic approach and utilizing Moonshot Press as a conduit for information and engagement, we focus on strengthening the resources and capacities of individuals and communities to enhance their own health. This perspective encourages collaborative efforts, where everyone plays a role in fostering a system that not only treats illness but also promotes overall well-being.

Why This Matters

The urgency of reform cannot be overstated. The challenges within our healthcare system affect every individual, family, and community across the nation. By embracing the salutogenic model and leveraging Moonshot Press's reach, this initiative aims to bring about meaningful and sustainable improvements. We recognize that collective action, facilitated by effective communication and engagement platforms, is essential to achieve optimal health outcomes nationwide.

Join Us Through Moonshot Press in Creating Health

The Institute for Salutogenesis and Moonshot Press invite you to be part of this critical endeavor. By engaging in a nonpartisan, solutions-oriented dialogue grounded in the salutogenic approach, we can navigate the complexities of healthcare reform together. Moonshot Press offers you the opportunity to:

• Stay informed through in-depth articles and expert analyses.

• Participate in interactive discussions and forums.

• Share your experiences and ideas to shape the future of healthcare.

We encourage you to join us in advocating for change, contributing insights, and participating in the collaborative effort to reshape our healthcare system.

Together, through the collective power of citizen engagement and the amplifying platform of Moonshot Press, we can create a healthcare system that not only addresses illness but actively fosters health and well-being—reflecting our nation's values and ensuring a healthier future for generations to come.

The Case of the US Healthcare System (Google Doc) (Wix Website)

Hospital Watch USA (Wix Website)

Moonshot Press Website