Good Quests Nobody Chooses

"Choose Good Quests" asks exactly the right question: why aren't the best founders working on hard, important problems? The framework is genuinely good — good enough that it's worth examining the one assumption inside it that may be reinforcing the very drought it's trying to fix.

What is a 'good quest'? And does that differ from a 'hard quest'? The author argues that repeat founders should pursue hard, good quests — high-risk, operationally complex, society-shaping — rather than easy copycats with well-worn playbooks. The premise is right. Where I'd push further is the definition of hard.

The hurdles in the original framework are those of a technoptimist: cure aging, eradicate cancer, create space colonies, pioneer new energy, introduce new transportation. None of these would be bad. But most of those hard quests everyone celebrates are hard technologically and easy financially. Battery chemistry is genuinely difficult. But the revenue model has DARPA, DOE grants, CHIPS Act, defense procurement, and industrial buyers with government mandates. The money is visible before the product works.

That optimism runs into a wall: 37% of Americans can't cover a $400 emergency — let alone afford childcare, get skilled for work that pays enough to build anything, or plan for a future beyond next month. 

Building technically hard things to meet a funding allocation is not courage — it's a safety net. The team behind a single-dose gene therapy for spinal muscular atrophy rode NIH grants through clinical trials to FDA approval and an $8.7 billion acquisition by Novartis. The drug costs $2.1 million per dose. The science got funded. The delivery didn't.

Yet what about the team that's decoded why hospitals perform 200,000 unnecessary spinal fusions a year — a $1.9 billion charge to Medicare, 18% complication rates, clinical trials showing no better outcomes than physical therapy — and is building a tool to reach patients before they go under the knife? Where is the funding for that quest? That team does not exist. Unlike the gene therapy researchers, there's no pipeline for the people trying to demystify the intended complexity of a system that costs the federal government over a trillion dollars a year. While 100 million Americans carry $220 billion in medical debt. 

Spinal fusion may seem strangely specific. But Luigi Mangione — whose own spinal surgery actually went well — became so radicalized by what he saw in the healthcare system that he assassinated the CEO of the largest health insurer in America. My hairstylist — early thirties, healthy, on Medicaid — was told she needs spinal fusion after a car accident and had no tool, no app, no second-opinion platform to help her evaluate that recommendation. One became a folk hero. The other asked me, a client she barely knows, what to do. Both arrived at the same place: total loss of faith in a system that was supposed to help them. Because of a surgery. That's where we are.

The quests everyone celebrates are hard technologically. The quests nobody chooses are hard structurally — and yet they'd do the most good for the most people. Not in our children's children's future. Now. Healthcare, dependent care, education, housing — the baseline needs most resistant to change, caught in regulatory capture and bureaucratic complacency. What good is Mars if we have people selling plasma to afford their next doctor's appointment?

So why isn't anyone going on these quests? There's no DARPA for eldercare. No CHIPS Act for healthcare delivery. No defense procurement pipeline for skills training. Plenty of funding exists for the moonshots — drug discovery, genomics, biotech. The infrastructure that keeps people actually living healthy lives? That's left to founders with no safety net and no clear buyer. A founder who wants to give workers access to affordable childcare services isn't less ambitious than a founder building battery chemistry — but when she walks into a pitch meeting, there's no $50B government program on the other side of her TAM slide. She's selling into a market where the payer — insurance, Medicare, or the employer — has an optimization function that's actively hostile to what she's trying to build.

When 82% of the most influential startup accelerators' last three cohorts are AI-focused, and the healthcare companies that do get through are building medical billing automation and hospital reporting tools, the pattern is clear. The original framework puts AI crop-yield optimization in the good-and-easy quadrant. Legible problem, legible buyer, legible exit. It's no wonder it gets funded. The issue isn't that easy AI is bad: it's that easy AI is so legible, so fundable, so obviously a yes in a pitch meeting, that it absorbs the oxygen. The hard quests don't lose to bad companies. They lose to easy ones.

In hard quests, you have to face both technical challenges AND markets where the physics and economics will kill your company. Take, for example, Papa - a B2C service that initially started by offering companion visits and light task-rabbit-like duties for seniors. The founders pitched it like DoorDash for seniors. YC and SoftBank Vision Fund backed it. To sustain their growth rate, they pivoted to Medicare Advantage payers as the revenue source. But Medicare Advantage inherits the insurance industry's cost-reduction optimization function. A gig contractor model can't meet healthcare compliance standards for vulnerable populations — and Medicare Advantage payers knew it. The result: 1,000+ complaints, harassment and assault incidents, a Senate inquiry, CMS scrutiny, 36 MA payers declining renewal in 2024, and a misclassification lawsuit.

Or take Forward. Forward Health was the darling of 2021 — insurance-free preventive primary care, $149 a month, no copays, body scanners, genetic testing, 24/7 app access to real doctors. Healthcare as a product, not a service. Founders Fund, Khosla Ventures, and SoftBank believed it enough to push total funding to $657 million and a billion-dollar valuation. But the math never worked — less than $100 million in total revenue against $657 million raised, and a subscription price that couldn't sustain tech-enabled clinics staffed by real physicians. They shut down in November 2024. All 200 employees. Effective immediately.

Papa got caught in insurance’s price-optimization function; Forward couldn't make affordability and investor returns coexist. That's a different kind of hard than battery chemistry.

It’s fear. 

Founders don’t fear ‘hard’. Hard with a legible path - whether it's a mathematical theory or an obscure pool of money hidden away in the bowels of an equally obscure agency - gives plausible deniability. Someone else’s theory didn’t work. The government funding you wanted dried up. People just weren’t ready. If things fall apart, you’re able to retreat back to your moat, dust off your idea, reframe it in a different way, and try again. The economics are there - it’s just your tech that needs to get worked out. 

But hard without a legible path - without a clear way to offset costs by leaning on the government or a deep-pocketed entity that wants your solution - well, that’s scary. Your path is undefined, and you're building in a market where everyone has an opinion about their doctor, their insurance, their kid’s daycare, their parents’ health woes, and their best course of care for whatever ailment it is they think they have. The fear isn't failure. It's looking like you don't know what you're doing in a domain where everyone thinks they're an expert. Not only will your peers judge you, but your family, your community, your loved ones, and anyone who encounters you and your idea will judge you too. And unlike battery chemistry, most people think they understand what you're building — which means your audience of 'experts' has expanded by n = 500.

In Congress, I was tasked with orchestrating a legislative package on childcare costs and paid-leave parity. My job wasn't to write the bills — it was to vet dozens of them across the House and Senate, meet with the staffers drafting them, assess which could muster the votes to pass, which could be implemented, and which would have the intended economic impact. Then package it for leadership to bring to the floor. Basically, bring a policy product to market — the market being the American voter.

I prided myself on being a specialist in technology, tax, and trade policy. What business did I have working on labor policy — let alone anything that touched healthcare? And I could be certain if I touched anything - and by touched, I mean took a meeting, reached out to a staffer, or was seen at a think tank - that any of the ‘experts’ in these policy areas thought was working just fine, I would suddenly have a 5 alarm fire on my hands, complete with lobbyists calling my office asking what I was doing and Members of Congress tracking me down to ask what I was planning. That's the exposure. And that's what a founder in these markets signs up for every day.

To the founders who look around at the here and now and know we can do better — listen to your doorman, your barista, your UPS driver, the people who make your life run every day. Get curious about what they worry about. What keeps them up. What have they given up on. Those are the quests.

Hard doesn't mean technologically complex. It means structurally resistant to change. Good doesn't mean humanity benefits someday in the abstract. It means someone's life gets measurably better now. And the future everyone wants to build? It needs people who can actually afford to live in it.