I agree with you that they can, but I think the point of this essay is that startups can't solve these problems on their own, using only technology and chutzpah. In order to solve "health care recordkeeping" you have to get governments and large companies on board with the process. You can lead a horse to water, and all that. There are going to need to be a lot of people at the table, and for the most part a startup isn't going to have the political juice to make it happen.