Why Don't They Win

There are moments, usually late, usually quiet, when honest thinking can be had. When you zoom out and see the ecosystem around children not as a collection of caring institutions, but as a set of incentive machines. And incentive machines, unlike grandmothers, do exactly what they’re built to do.

MAKE MONEY

Tonight I sat with some difficult thoughts about the state of primary services for children in the United States. The deeper I look, the clearer it becomes that money, not well-being, drives most decisions shaping a child’s life. And the imbalance is not trending in a positive direction.

Children Continue To Lose From My Viewpoint

Approximately two-thirds of a child’s daily nourishment comes from school food programs, which too often rely on ultra-processed, calorie-dense, nutrient-poor products. Outside of school, the dominant food environment is similarly saturated with highly engineered foods that optimize profit, shelf life, and palatability rather than health. Kids are micronutrient starved, but calorically overfed. Biological systems begin to fray early. Biochemistry no longer meets cellular needs. Children develop disease and we are asked to medicate or worse rationalize away that this is NORMAL.

Kids are less attentive nowadays. Kids are heavier nowadays. Kids are mentally stressed nowadays. Kids are metabolically dysregulated nowadays. Kids are just different, a sign of the times.

I do not accept that.

Medical care, while lifesaving in many contexts, increasingly prioritizes speed and symptom control over prevention and root-cause resolution. Children receive large volumes of medications, including antibiotics, often in response to systems that reward throughput rather than long-term outcomes. Children paradoxically need time, love and education that doctors can provide.

Technology and social media platforms compete aggressively for children’s attention, shaping behavior toward short-term reward seeking rather than sustained development. Meanwhile, educational outcomes lag despite ever-increasing expenditures, suggesting that funding alone does not guarantee alignment with children’s needs.

Taken together, these forces form an environment in which a child’s well-being is rarely the primary optimization target.

What would our society look like if we reversed the equation?

What if every institution that touches a child, schools, healthcare, insurers, food producers, technology companies, and government agencies, asked a single guiding question before acting:

If a child does not benefit, should we do this?

For me, the answer is simple: no.

If we collectively said no. Boy, what a world we could have.

The two accompanying cartoons represent this contrast. One depicts the current reality, where competing systems pull resources toward themselves. The other imagines a different future, one in which every surrounding force is oriented toward the child’s flourishing, with well-being as the true north.

This is not a utopian fantasy. It is a design choice.

It is doable!

Zooming out even further, this is basically an incentives problem disguised as a moral problem. Systems behave like rivers: they flow where the terrain guides them. Change the terrain, reimbursement models, procurement rules, metrics of success, what gets rewarded, and the river changes course without needing a sermon.

These cartoons function like a thought experiment in policy physics: same actors, different incentives, radically different outcome. That’s powerful because it sidesteps blame and goes straight to structure, the place where real leverage lives.

Dr. M