Truly transformative healthcare companies often solve "boring" but fundamental problems. Instead of tackling surface-level symptoms (e.g., appointment booking), the best founders dig deep to fix the complex, underlying infrastructure issues of the healthcare system, creating a durable competitive moat.

Rising premiums and deductibles are pushing people away from traditional insurance. This isn't an abandonment of healthcare, but a market response to a product that no longer provides adequate value, forcing a shift towards cash-pay and alternative models.

In a striking irony, Los Algodones' street promoters are almost all individuals deported from the U.S. Their fluent American English and cultural familiarity—traits from the country that rejected them—are leveraged as key assets to build rapport and trust with American dental tourists, making them ideal for their roles.

To overcome tourist skepticism before formal oversight, Molar City's founders established an amateur judicial system: the "Office of Defense of the Tourists." This allowed patients to file complaints against dentists, who could be forced to issue refunds for bad work, thereby building a crucial reputation for accountability.

The rise of cash-pay proactive health creates a two-tier system. One group can afford to defect from insurance and build their own health stack, while another cycles through the traditional system, relying on charity care, exacerbating inequity.

The idea of a single, equitable healthcare system is often a myth. Regardless of the official structure, a cash-pay system for faster or better care will almost always emerge for those who can afford it, a reality policymakers must acknowledge.

The business model of Los Algodones highlights a stark border reality. Americans cross into Mexico with ease to spend money, while local workers like Alberto, a deportee, can see their former U.S. homes but are permanently barred from crossing back. This illustrates a profoundly unequal, one-way economic and social flow.

Los Algodones was deliberately transformed from a party town with 48 bars into a dental tourism hub. The founding dentist, upon becoming mayor, strategically closed most bars, recognizing they undermined the town's potential as a premier healthcare destination and reshaped its economic foundation.

To combat American fears about Mexico, clinics in Los Algodones engage in "performative safety." This includes creating an overwhelming smell of sanitizer, hiring American English speakers to sit in waiting rooms, and ensuring a visible police presence—all to make foreign tourists feel comfortable and secure.