You should ask the people doing healthcare with blockchain, or whatever it is you're confused about. I agree, oftentimes they just have no idea what they're talking about. Sometimes they do though. It's worth noting that I think a few of them expect to depend on not-yet-completely-implemented "infrastructure" projects (off-chain computation, off-chain storage, prediction markets, private transactions, cheaper transactions). However since these infrastructure projects are still in a research stage I don't think it's reasonable for you to be able to cleanly split the "conceptual user perspective" from the "bitcoin-dev perspective".