Good Morning [%first_name |Dear Reader%],

Before we talk about today’s episode, I need your help with something important.

My co-host Rohin has created a survey asking subscribers of Two by Two what episode they’d like to listen to, and who they’d like to see as guests. It’s not just any regular survey—he also has a list of episodes he’s currently working on and would love your feedback. (Spoiler: VCs are not going to be happy about what he has in store.)

You can take the survey here:

https://theken.typeform.com/to/EMZN4rxJ

And now, today’s episode.

This is an episode of Two by Two I’ve been excited about for a long time. 

Sometimes there’s an amazing feeling you get when you know you have three things that come into place that make a great episode—a topic that’s sharp, timely, and relevant; guests who are smart, accomplished, and…candid; and above all, a conversation that makes the time fly by. 

And this episode has all of the above. 

First, there’s the topic.

We all have a hospital story. It usually involves long waits, opaque billing, confusing instructions, and a lingering feeling of being just another number in a long, broken queue. The experience is often so frustrating that it adds to the stress of being unwell. But what if we could start over?

That’s the question we tackle in this episode. What are the most fundamentally broken parts of our healthcare system, and what would it look like to build a hospital from the ground up in 2025, free from the legacy systems and misaligned incentives that plague it today?

It’s a critical question. Healthcare is a fundamental need. Yet, in India, an estimated 55 million people are pushed into poverty every year because of healthcare costs. The system, as it exists, is failing too many. 

And in today’s episode, we discuss why pricing feels random, why hospitals seem incentivised to treat sickness rather than promote health, and how a new generation of founders is trying to build a better model—one that is smaller, smarter, and puts the patient back at the centre.

Then there are the guests themselves.

Varun Dubey is the founder and CEO of Superhealth. With a compelling background in Indian healthcare, including roles as the Chief Revenue Officer at Apollo Hospitals and CMO at Practo, Varun has seen the system’s flaws from the inside. He describes Superhealth as “India’s first zero-wait, zero-commission hospital”, built on a model of smaller, hyper-local facilities with transparent pricing.

Mayank Banerjee is the co-founder of Even Healthcare, which he started with a mission “to eliminate the burden of hospital bills for every Indian”. It is built on a managed care model that combines health insurance with healthcare delivery, creating a system where the incentive is to keep patients healthy. And guess what the company is also building? That’s right…a hospital. 

It’s not often that we get two guests who are both solving the same problem but from different directions. They’ve converged independently on some fundamental truths of how we can reimagine hospitals. 

To kick off the conversation, I asked everyone a question: “What’s the dumbest thing about hospitals that people still tolerate in 2025?”

And well, the answers revealed just how deep the frustrations run.

For Varun, the absurdity starts with something as basic as pricing. He pointed out the nonsensical way costs are structured, making it impossible for patients to understand what they are paying for.

Mayank argued that the problem is even more basic. The entire economic model of a traditional hospital is built around treating illness, not preventing it. This creates a deeply misaligned incentive structure.

For Rohin, the most glaring issue is the one every patient faces the moment they walk in: the terrible user experience, starting with the queue. 

He even compared it to a classic sitcom moment.

And then, finally, there’s the conversation itself.

Two By Two • EPISODE 64

How do we reimagine hospitals from scratch?

Healthcare vs. sick-care

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I’ll let you listen to the entire podcast, but here are some of the interesting things we found out:

It’s easy to blame hospitals or doctors for the system’s flaws, but Varun argued that the root cause is economic. In his words, the enormous upfront cost, or capex, of building a large, traditional hospital forces the management to adopt a revenue-maximisation model, which inevitably leads to behaviours that aren’t patient-centric. The system itself forces good people to make bad decisions.

Mayank agreed with him.

A core flaw in the current system is that most senior doctors work as consultants, often with incentives tied to the volume of procedures they perform or patients they admit. Both Varun and Mayank are building their hospitals around a full-time, salaried model for doctors. By removing commissions and sales targets and instead offering salaries and even ownership (ESOPs), they align the doctor’s success with the company’s long-term goal: better patient outcomes.

Everyone talks about preventive care, but it rarely happens in practice because the financial model doesn’t support it. However, when the entity providing care is also the one bearing the financial risk (like an insurer), the incentive flips. Mayank explained how Even Healthcare’s model of proactive check-ins, which patients are often initially skeptical of, helps build trust and catch issues early, saving both money and lives.

If there’s one clear thing I learnt from the conversation, it’s that fixing healthcare isn’t about making incremental improvements to the existing system. It’s about building an entirely new one.

The path forward, as envisioned by Varun and Mayank, seems to be a move away from massive, centralised hospital complexes toward smaller, hyper-local facilities that are more accessible and less intimidating. By breaking the high-capex model, it becomes possible to focus on patient experience and quality of care rather than just volume and throughput.

Furthermore, aligning incentives is key. Whether it’s by making doctors partners in the mission through full-time employment or by integrating insurance with care delivery, the goal is the same: to create a system where the provider profits from keeping patients healthy, not just from treating them when they are sick.

The challenge is immense, and as Mayank aptly put it, “it’s really hard.” 

But the experiments being run by entrepreneurs like him and Varun show that a more efficient, affordable, and humane model for healthcare is not just a fantasy—it’s actively being built, one patient at a time.

You can listen to the entire episode here.

Regards,
Praveen Gopal Krishnan

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