We Get the System We Incentivize

The System Isn’t Broken. It’s Doing Exactly What It’s Paid To Do.

During my conversation with Halle Tecco, she said something that has not left me.

The most profitable IVF patient is the one who does not get the outcome.

In fertility medicine, a patient who requires cycle after cycle generates more revenue than the patient who gets pregnant quickly. No doctor wakes up intending to fail women. No clinic builds its culture around disappointment. But the incentives inside the system do not prioritize the outcome. They prioritize the procedure.

Incentives shape outcomes.

The more I have thought about that line, the more I realize this is not just about healthcare. It is about every marketplace.

In healthcare, insurance resets every twelve months. Employers and payers think on annual timelines. Meaningful health interventions often take years to show results. So what gets optimized is not long term health. It is short term cost recovery. If you are enrolled on an annual cycle, the system is incentivized to recoup its investment within that year, even if the intervention that would truly change someone’s life requires patience.

We do not have a healthcare system designed around sustained wellness. We have one designed around billing cycles.

That is not a moral judgment. It is a structural observation.

I learned this lesson firsthand at TaskRabbit.

Early on, we wanted tasks to be accepted quickly. We knew that if someone posted a task and waited hours for a response, they would not come back. So we set a goal. We wanted response times under thirty minutes. And we did not hope for that behavior. We incentivized it.

We adjusted ranking algorithms. We gave visibility to Taskers who responded fastest. We structured notifications to reward speed. We nudged behavior through policy and product design. Within weeks, response times dropped dramatically.

The Taskers did not suddenly wake up more motivated. The marketplace did what we told it to do.

Policies and incentives in any marketplace determine behavior at scale. They do not just influence it. They control it.

This is true in gig work. It is true in venture capital. It is true in healthcare.

Venture capital operates under similar dynamics. We talk about long term thinking, but our structures often reward velocity. Ten year fund cycles, quarterly board reporting, markups, and exit timelines create a gravitational pull toward growth and liquidity. If your compensation depends on liquidity events, you will naturally lean toward decisions that create liquidity. That is not a character flaw. It is human behavior responding to incentives.

The same pattern shows up in healthcare pricing. Two people can stand in line for the same prescription and pay wildly different prices. Cash pay patients, often the least able to afford it, sometimes pay the most. That is not random chaos. It is the result of layered incentives, opaque negotiations, and institutional habits that reward certain outcomes over others.

Good people inside misaligned systems will still produce distorted results.

When I was building TaskRabbit, I felt this tension constantly. We were trying to expand the definition of work and create flexibility and opportunity. At the same time, we were operating inside an ecosystem that optimized for short term milestones. The pressure was not malicious. It was mechanical.

Once you see systems through the lens of incentives, it becomes impossible to unsee. The question is no longer whether people care. The question is what gets rewarded.

If the IVF clinic makes more money when you fail, if the insurer benefits from churn, if the fund profits most from fast exits, and if the board is compensated on quarterly performance, then we should not be surprised when the outcomes reflect those incentives.

We get the system we incentivize.

If we want different outcomes, we can’t just demand better behavior. We have to redesign what gets rewarded.

This is where leverage lives. And increasingly, it’s where AI can help realign incentives at scale. Look at Conceivable—the company recently covered in Bloomberg—using AI and robotics to offer 100% guarantees on embryo formation at a fraction of the traditional cost. That’s not just a technology breakthrough. It’s an incentive shift. When the economics change, behavior follows.

This isn’t new.

It’s true in healthcare today.

It was true in a scrappy two-sided marketplace in 2008.

It’s true in every boardroom and every policy debate happening right now.

The lever is not outrage.

It’s alignment.

Change the incentives—and behavior follows.