{"id":12426,"date":"2026-04-01T17:56:00","date_gmt":"2026-04-01T17:56:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=12426"},"modified":"2026-04-01T17:56:00","modified_gmt":"2026-04-01T17:56:00","slug":"oh-another-moonshot","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=12426","title":{"rendered":"Oh. Another Moonshot"},"content":{"rendered":"
\n<\/div>\n

By KIM BELLARD<\/p>\n

If all goes well, in the next couple of days NASA will be sending astronauts on their way to the moon, for the first time since \u2013 gulp \u2013 1972. They\u2019re not landing, mind you, they\u2019re just doing a fly around, something Apollo 8 first did way back in 1968. Given the advances in microchips, computing power, AI, a robust private space industry, and Elon\u2019s grand plans<\/a> to inhabit Mars, it doesn\u2019t really sound all that ambitious, hardly a \u201cmoonshot\u201d in the sense that we\u2019ve come to use that term, but I guess we should be glad that NASA hasn\u2019t entirely <\/em>conceded space to the billionaires.<\/p>\n

The Artemis II<\/a> mission will send four astronauts \u2013 including, if you are counting (and many are), the first person of color, the first woman, and the first Canadian to reach the moon \u2014 on a ten day, 230,000 mile trip that won\u2019t actually orbit the moon but just loop around it, not getting closer than a few thousand miles. \u201cThings are certainly starting to feel real,\u201d Christina Koch, one of the four, said during a news conference Sunday morning.<\/p>\n

Last week NASA unveiled<\/a> its \u201cIgnition\u201d strategy that Artemis II is part of. It includes not just the fly-by, but also a follow-up mission in 2027, a manned landing in 2028, and a permanent moon base in the 2030\u2019s, committing $20b<\/a> over the next seven years to accomplish the latter. \u201cNASA is committed to achieving the near\u2011impossible once again, to return to the Moon before the end of President Trump\u2019s term, build a Moon base, establish an enduring presence, and do the other things needed to ensure American leadership in space,\u201d said NASA Administrator Jared Isaacman.<\/p>\n

He added: \u201cToday, we are providing a demand for frequent crewed missions well beyond (previously announced moon landings in 2028). We intend to work with no fewer than two launch providers with the aim of crewed landings every six months, with additional opportunities for new entrants in the years ahead. America will never again give up the moon.\u201d<\/p>\n

I knew Elon and Jeff were going to get something from all this.<\/p>\n

<\/span><\/p>\n

I hope the mission goes according to plan. I hope I live long enough to see a successful manned landing on the moon and even that lunar base. Then again, President Obama launched the Cancer Moonshot<\/a> in 2016, aiming to \u201cend cancer as we know it,\u201d and there still seems to be plenty of cancer around. Sure, much progress has been made, but we\u2019re still seeing disturbing trends like \u00a0\u201cskyrocketing<\/a>\u201d increases in colorectal cancer rates in young adults. \u00a0<\/p>\n

You might call Operation Warp Speed<\/a> a moonshot, developing effective vaccines against the global COVID pandemic in a matter of months, but it has had the paradoxical result of a new wave of vaccine hesitancy generally<\/a>, aided and abetted by the MAHA team heading up HHS in the Trump Administration. You wouldn\u2019t consider our measles outbreak<\/a> as what we\u2019d expect from a vaccine moonshot.\u00a0 \u00a0<\/p>\n

Similarly, Alphabet has a whole \u201cMoonshot Factory<\/a>\u201d aimed at big breakthroughs, but none of its successes have revolutionized society or even been the Next Big Thing for Alphabet. \u201cWe have a 2% hit rate,\u201d CEO Astro Teller told<\/a> a conference last fall. \u201cMost of the things we try don\u2019t work out, and that\u2019s okay.\u201d Waymo and Wing are considered its big successes, but, I don\u2019t know about you, neither is in my market yet.<\/p>\n

A couple weeks ago I wrote<\/a> about the U.S. military seems to have failed top learn the lessons of the way in Ukraine, continuing to rely on expensive weapons systems that are ill-equipped to deal with flights of AI-driven drones. A couple days ago Simon Shuster wrote in The Atlantic<\/em><\/a> about his visit to Rheinmetall, the German arms manufacturer. He told his guide about how tanks in Ukraine had changed from being killing machines to being easy drone targets, and so had been modified to have nets and other anti-drone protections. His guide was abashed. \u201cNo,\u201d he said. \u201cWe don\u2019t have something like that.\u201d<\/p>\n

The Rheinmetall CEO was dismissive of Ukrainian innovation: \u201c\u201cIt\u2019s Ukrainian housewives. They have 3-D printers in the kitchen, and they produce parts for drones. This is not innovation.\u201d<\/p>\n

I beg to differ.<\/p>\n

I think of all this in the context of an updated KFF analysis<\/a> of hospital concentration. The key takeaways:<\/p>\n

\u201cOne or two health systems controlled the entire market for inpatient hospital care in nearly half (47%) of metropolitan areas in 2024.<\/p>\n

In more than four of five metropolitan areas (83%), one or two health systems controlled more than 75 percent of the market.<\/p>\n

Nearly all (97% of) metropolitan areas had highly concentrated markets for inpatient hospital care when applying HHI thresholds from antitrust guidelines to MSAs.<\/p>\n

Most hospital markets in metropolitan areas (80%) became less competitive from 2015 to 2024 or were controlled by one health system over that entire period.\u201d<\/p>\n

I first wrote<\/a> in 2015 about how hospitals were the biggest source of health care spending \u2013 as they had been in 1960, and as they are today. KFF says they accounted for 40% of our national health care spending growth from 2022 to 2024. With such concentrated market share, it\u2019s easy to see why.<\/p>\n

This is not innovation. Those are not the result of any moonshots. That is not the future.<\/p>\n

Hospitals, to use an overworked analogy, are the health care system\u2019s tanks (or aircraft carriers). Powerful but hugely expensive, relatively slow, steeped in traditions of prior wars. They should not be the mainstays of 21st century medicine.<\/p>\n

21st century healthcare should not be \u201cfought\u201d with big, expensive, slow-to-produce assets. Even aside from hospitals, I mean, how long does it take to train physicians, at what expense? And once they are practicing, how long does it take to bring the new clinical findings into their actual practice? It\u2019s ridiculous, especially in an AI era.<\/p>\n

Similarly, how many billions does it take to develop new drugs, leaving how many years of patent protection? \u00a0With genetic manipulation, AI-assistance, and 3D printing, why aren\u2019t we in the era of inexpensive, more effective prescription drugs?<\/p>\n

We need the kind of innovation that Ukraine has brought to 21st century warfare. Those<\/em> are the kind of moonshots I want to see.<\/p>\n

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented\u00a0<\/em>Tincture.io<\/em><\/a>, and now regular THCB contributor<\/em><\/p>","protected":false},"excerpt":{"rendered":"

By KIM BELLARD If all goes well, in the next couple of days NASA will be sending astronauts on their way to the moon, for the first time since \u2013 gulp \u2013 1972. They\u2019re not landing, mind you, they\u2019re just doing a fly around, something Apollo 8 first did way back in 1968. Given the…<\/p>\n","protected":false},"author":0,"featured_media":12423,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-12426","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/12426"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=12426"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/12426\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/12423"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=12426"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=12426"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=12426"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}