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By the side of the road in Boston, I see the future of health for the first time as a real thing, already enacted in the present. Quite unselfconsciously, a shopfront declares that here they provide ‘healthcare the way it should be’ – without any further explanation beyond a generally sleek exterior. The way things should be has apparently something to do with the high-end environment of the mall in which the shop is located, right next to expensive parfums, internet-enable home exercise equipment and high-end yoga apparel. The pared-back interior of the healthcare shop centres around a glowing pedestal not dissimilar to the transporter platform of the (highly fictitious) Enterprise. Around this white wall-mounted scanning unit, everything else in the shop suggests the modern yet minimalist style of an upmarket living room or low-key cocktail bar, minus the cocktails of course – they would surely mess with the heart rate scan results. What I am describing is not just an oddity or a funny new trend, but a real place answering to a serious issue challenging the healthcare system of the US and also that in many other countries: the classical model of doctor’s surgeries with specific opening hours is becoming increasingly unsustainable in a world that needs two breadwinners per family. And quite often the digital health tech solutions that are being trialled in the US can become a reality for the rest of the world as well.

Modern technology can theoretically address the growing gap between traditional models of healthcare provision and the lived reality of many patients that increasingly requires more flexible arrangements - but most of the promise of digital health has not yet resulted in a comprehensive overhaul. Yes, of course there are digital health applications on mobile phones now, there are wearable measuring devices for certain biomarkers such as heart rate and blood oxygenation, but there is generally no integration of these devices (yet) within the wider framework of national health services. This place in Boston’s Prudential centre now shows us what may be one of many possible futures of this type of healthcare delivery: an integrated yet separate concept located in shopping centres that measures and monitors, and also refers patients for consultations within its own network of medical professionals. This effectively ties medical consultations into a business model based on service delivery, aided by digital automation and remote consultation. The vision of this health future does not look out of place next to the high end stores in the mall not far away from subscription-models coffee shops and luxury fashion brands. But even amongst all this expense, there are reminders that not all is as golden as it seems - the cardboard signs held out by a small number of passing homeless people invoke existing divisions within societies. These divisions are of course also already a reality within healthcare, especially in the highly stratified system of the USA, with all of its drastic consequences. The stark effects of healthcare (in)accessibility still often seem alien to my comparatively naïve European eyes, and need to be kept in mind when we discuss the future direction of change: once privatised, there is no clear way back to universal coverage.

The step-change contained in this digitised and personalised subscription-funded model is in the end not entirely down to the use of digital technology – it is much rather contained in the concept of an entirely separate and integrated environment provided for its subscribers. This is no longer a half-way house somewhere between universal coverage and privatisation of healthcare, but a separate space for a select few, complete with a medical team on call 24/7 (at least as far as the company’s online material claims). As I take the online test on my mobile phone to see whether I would qualify for this service, the programme also promotes genetic scanning for individualised ‘genetic risk reduction’ and a personalised plan to ‘help protect from a severe case of COVID-19’ – both of which make me wonder where these consultations may lead in case of (for instance) specific high-risk factors such as the BRCA sequence. Would something like this render the applicant no longer eligible for membership, or would the services included in this model run to the full extent of preventative treatment, including surgery? Further advice could be anything from medication to nutritional guidance, backed up by tracking software and ‘mini-scans’. The envisaged reality probably lies with neither extreme, but the sheer existence of this model certainly raises more questions than it answers. How we should deal with health – on an individual or a collective level; on a pay-as-you-go or a basic provision level – is clearly one of the most challenging questions of our contemporary unequal and ageing societies. The future is already here, and it is both shocking and appealing in its cool sleek lines that make me grip my paper cup just a little bit harder as I hustle past, already late for the first session of the gene therapy conference held nearby.