The greatest obstacle to transforming healthcare is our unwillingness to embrace tradeoffs. Sometimes you have to go backwards to go forwards. In short, It is insanely difficult to disrupt an industry even as you rely on it sustain life.

Example 1: Most people want lower costs and broad access. They typically do not go hand in hand. Providers of services offer deep discounts when they aggregate volumes and can spread fixed costs over greater patient volumes. But patients want choice. Choice costs.

Example 2: There are many new “disruptive” kidney care companies. While they offer innovative dialysis models, they are small—and collectively lack the scale to meet all of the dialysis needs of the country. So even while introducing new models, we must rely on old models.

Example 3: We can all agree we want a healthier society. But healthier people means fewer healthcare services consumed and the revenues of healthcare services providers—now a substantial component of US GDP—will go down, not up.

The notion that everything can get better for everyone without it getting worse for some parts of the healthcare industry is the false logic that holds us back from any real progress.