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What Will Finally Fix Health Care - Howard Tayler
Ramblings of a Happy Cartoonist
What Will Finally Fix Health Care
You know what will finally fix health care?


For centuries good health care has not really been about seeing a doctor or a surgeon. It's been about getting the right information to the right person at the right time. Okay, sure, often that person WAS a doctor or a surgeon, but often it was not. And the smarter we got as societies, the longer and better we started living. The pattern still holds.

These days we have ready, free (or as close as makes no difference) access to all the information our doctors do. (Except patient records -- HIPAA says that would be a violation of privacy, and I agree...)

What we, the patient-class, the uninitiated do NOT have free and ready access to is trusted gatekeepers who will filter the good information from the not-so-good. You know, doctors who will tell us that although our Google search on these symptoms was flawed because we left out "night sweats," or something like that.

Assuming we haven't all succumbed to Bird Flu, Swine Flu, Nanocancer, or the Andromeda Strain in the next 200 years, I firmly believe that our descendants are going to look back at our primitive, 21st-century discussions and wonder why we wasted so much time and money when what finally fixed Health Care was information we'd been sitting on for decades.

We will probably always need a select few, skilled practitioners of the dark and arcane arts of medicine, but most of what we need to be healthy is a correct diagnosis, and the alignment of simple treatments with sets of symptoms.

That's just information.

I'm not belittling what my doctor does. He's worked hard to throw terabytes of information into his head so that his miraculously synaptic brain can quickly process my complaint and prescribe the treatments I need (and proscribe the things that are hurting me.)

But it's still just information.

Okay, not when he whips out his scalpel and removes a mass from my forearm (had that done in January. Ouch.) -- that's skill acquired through years of practice. And we'll always need somebody with that skill set to complete certain treatments. We'll also always need other things that cost money, like new medications, fancy devices for irradiating tissue, and diagnostic tools. But those things don't need to cost what they currently do. Not once we fix the flow of information.

I'm not proposing anything radical here. I'm not really proposing anything. I'm arm-chair quarterbacking, only instead of yelling at the television about the choice of plays, I'm yelling about how the game should really be taken into orbit and played in three dimensions by guys in armored EVA suits.
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From: siliconshaman Date: September 10th, 2009 11:44 pm (UTC) (Link)
See, that's the difference between a doctor and a surgeon.

One you could replace with a decent database and halfway good A.I expert system. [perhaps backed up with a human version with intuition for the really difficult cases].

The other you'd need a pretty good robotic arm for as well.
chalain From: chalain Date: September 11th, 2009 12:15 am (UTC) (Link)
Currently, if you replace most any human knowledge worker with a very good database and a top-end AI expert system, you get a very bad knowledge worker. Compounding this with the complexity of the human body and the fact that patient cases are not reproducible just makes the problem that much worse.

I'm only disagreeing with the part where you make it sound easy and already attainable, however. The principle is very good, and backing up human doctors with just such systems is already starting to happen. And it's a very good thing. See, difficult cases aren't the problem. The problem is when a patient has a nonintuitive case, a subtle case, or even a deceptive case. It's not a matter of memorizing the symptoms; that's easy. It's a matter of talking to human beings, which is actually quite hard.

I recently went to the doctor complaining of chest pain. That was caused by indigestion caused by taking too much aspirin caused by back pain caused by a car accident years ago. All pretty much cut and dried, except that my doctor picked up on one odd phrase I mentioned--about the back pain spreading under my arm--and a minute later she found me a barely perceptible rash I didn't even know I had. I was in the VERY first stage of shingles, and we were able to treat it with antiviral meds because we caught it in time.

darthparadox From: darthparadox Date: September 10th, 2009 11:46 pm (UTC) (Link)
The one thing you're glossing over - and in fact, the thing that this whole debate is centered on - is, supposing we've determined the best course of action, how do we pay for it? Like you point out, there are things that cost money. Some of them cost a lot of money. When a guy that makes $20,000 a year needs $500,000 worth of treatment to make the difference between dying in the next six months and living another three decades, how do we as a society want to handle that situation? Managing to lower the cost of that treatment from $500,000 to $200,000 isn't going to change the fundamental debate at hand.
From: ridgerman Date: September 11th, 2009 12:51 am (UTC) (Link)
I'll give you a good example of what you're talking about. I worked for a pharmacy benefits manager for five years. I routinely put in overrides for high cost on a medication for a customer. He was getting a clotting factor as part of his treatment for hemophilia - a thirty day supply carried a submitted cost (what the pharmacy wanted to get paid) of $750,000. The contract cost (what the pharmacy agreed to accept from the company) was $350,000. His copay, each month, was $30.00. The plan paid the remaining $349,970.

My concern is that someone with a chronic illness like this will get dumped at the first opportunity (real or otherwise). And as someone recently diagnosed with a chronic illness (diagnosed in May as a Type 1 diabetic), I have a stake in that concern.
theomni From: theomni Date: September 10th, 2009 11:54 pm (UTC) (Link)
I think I completely agree with this.
42ndblog From: 42ndblog Date: September 10th, 2009 11:57 pm (UTC) (Link)
Something like more retail clinics then?

As for the question regarding how someone pays for $500k of treatments to save their life when they only make $20k/year. There is actually a lot of ways, currently, to get that $500k paid, but it does take cutting through a lot of red tape. Which takes information to know which routes to pursue.
darthparadox From: darthparadox Date: September 11th, 2009 04:59 am (UTC) (Link)
Sure, but what happens if they guy doesn't work at a job that provides health benefits? Or what if he does, but the insurance company comes up with some pretext to deny the claim, or to drop coverage of him entirely?

In the latter case, "red tape" could include years of lawsuits. With six months to live, all the insurance company has to do is wait the guy out, and in fact that's a pretty common tactic for them to employ.

In the former case? The guy's just screwed.
ccdesan From: ccdesan Date: September 11th, 2009 12:01 am (UTC) (Link)
These are very good comments. To that I would add "prevention", which intersects deeply with the concept of information.

If everyone in this country could get their BMI below 25, enough long-term healthcare dollars could be saved to provide cradle-to-grave coverage for everyone in the nation. Again, making that happen is pretty pie-in-the-sky, but it's definitely a factor.

Thanks for the thoughts.
kengr From: kengr Date: September 11th, 2009 12:54 am (UTC) (Link)
actually, there are studies showing that BMI (at least the way it is usually measured (as a height weight ratio)) has no real connection to health. And that much of it is genetic anyway.

Seriously. They get the fact that gaining weight is a *symptom* of some things confused with being overweight is the *cause*.

This is one of those "everyone knows" things that studies are showing to be wrong. Only it challenges prejudices. some entrenched medical "dogma *and* is counter to the interests of the weight loss industry (dieting actually tends to result in weight *gain* in the long term)
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howardtayler From: howardtayler Date: September 11th, 2009 12:01 am (UTC) (Link)
Paying for the big, expensive treatments isn't an issue if the system isn't clogged with diagnosis and prescription. And yes, hypochondria and placebo, addiction and abuse.

The "information" solution assumes that we'll all get better at using the available information. We wash our hands more often, and don't drink from pools of poop-water anymore. There's still hope for curing stupidity.
hopses From: hopses Date: September 11th, 2009 01:59 pm (UTC) (Link)
Don't forget stupidity among the other failings. I have a sister who is a nurse who sees the same patients time and time again because they don't take their medication for diabetes. They are regulars in the ICU not for lack of information but for lack of implementation.
dcrisp From: dcrisp Date: September 11th, 2009 12:06 am (UTC) (Link)

Segway :

Armoured EVA suits??? MEH! Armour is for weenies! :)

(See Australian Rules Football.)

Health System : I don't get how the US system can be so bad. (I know it is) its not Brain Surgery... okay.. maybe it is. I see it and compare it to the Australian system and the NHS system in the UK and I just don't GET IT...
zenkitty_714 From: zenkitty_714 Date: September 11th, 2009 02:09 am (UTC) (Link)

Re: Segway :

In a nutshell, it's bad because the health insurance companies are businesses whose prime directive is to make a profit, *not* to keep/make people well. Thus, if you cost them too much - if you exceed your "lifetime maximum expense" or you develop a chronic disease at some point when you aren't already covered by group (not individual) insurance - you will not have insurance anymore. And even the simplest and most routine medical procedure - say, an X-ray (and really, it's not like X-rays are in limited supply) - is prohibitively expensive for anyone who isn't rich to pay for themselves. So, to sum up, the sickest and poorest people are the ones least likely to have health insurance.
maritzac From: maritzac Date: September 11th, 2009 12:21 am (UTC) (Link)
This doesn't take in account that it's just not a simple matter of symptoms and answers. If that was it, then we'd only need Dr. Google.

The thing is, physical examination is needed, and tests, and x-rays, ultrasounds, palpation, and even surgery.

It'll probably take centuries to perfect our robots enough for them to perform all the doctorly duties, but if that happens then no job will be too complex for a robot to perform.
dcrisp From: dcrisp Date: September 11th, 2009 12:34 am (UTC) (Link)
"I'm sorry Sir, RoboSurgeon Beta2 appears to have accidently sliced your big toe off whilst it was removing your ingrown toe nail. have a coffee on us"
theomni From: theomni Date: September 11th, 2009 01:14 am (UTC) (Link)
You know, as cliche as it is, I really do think that the Information Age will greatly impact and improve society over the long term. Especially now with the proliferation of smart phones that give people almost limitless access to untold amounts of information anywhere they are. And as methods to effectively search, sort and filter that information improve the effect is going to become even greater.

Or maybe I just read too many transhumanist/futurist/singularity articles.
pharaohmobius From: pharaohmobius Date: September 11th, 2009 01:26 am (UTC) (Link)

re: information

Agreed. And IMNTHO a big part of the information that will fix healthcare is the information that will enable healthcare consumers to become more engaged in the process, e.g. "how much does this procedure/treatment/what-have-you cost?" and "will it be cheaper if I pay for it out of pocket?". One of the largest factors in driving up healthcare costs is that people don't know or care the cost because they aren't paying for the bulk of it themselves. I've learned from experience (mainly from losing my employer-provided health insurance) that if you arrange to pay out of pocket for doctor's visits they will charge you less than they would if insurance was picking up the tab. The doctor's office we go to even allowed us to apply for "hardship billing" (my term, not theirs) which gives us an even larger discount on our doctor bills. Knowing the costs also allows healthcare consumers to "shop around" and find the best value for their money.

So yeah, I agree with the points of your post in terms of "preventive care" and home remedies and the like; I just think the "information spigot" needs to be opened up on the fiscal end, too. :o)
pharaohmobius From: pharaohmobius Date: September 11th, 2009 01:33 am (UTC) (Link)

Re: information

Yes, I recognize that some procedures/medications/etc. are too pricey to be paid for out of pocket by most people. Those are the things that health insurance was traditionally intended to help with prior to HMOs got everyone into the mindset that health insurance should pay for every doctor's visit and prescription. Again in my not terribly humble opinion, health insurance should cover only catastrophic health events (i.e. the ones that would utterly ruin one financially if one had to pay it themselves). Limiting what insurance companies have to pay out would go a long way toward making it more affordable.
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zoyx From: zoyx Date: September 11th, 2009 01:37 am (UTC) (Link)
The fundamental problem with the current health care system is that it is money-centric, not patient-centric. Insurance and pharmaceuticals care more about their bottom line and stock prices, than they care about their patients. Doctors are also guilty of gaming the system, to milk out more dollars. All the information in the world won't help you if it is pushed aside to make a buck.

So the resulting system must result in keeping the corporations honest. Both through incentives, and regulations. Move the focus from money to the patient, and the flow of information will improve.

If you ask me, 'do you want the government making your health decisions'? If the alternative is a stock price driven insurance company or a doctor lining his pockets with pharmaceutical money, then definitely, yes the government is the better choice.
tprjones From: tprjones Date: September 11th, 2009 01:45 am (UTC) (Link)
I suspect the final solution for this will best be described in our current familiar terminology as "open source health care". I don't know exactly what form it will take yet, but it seems like a likely long-term possibility.
From: wizarth Date: September 11th, 2009 09:27 am (UTC) (Link)
I'd watch EVA football in 3D. I'm thinking Enders Game.
From: pmthecat Date: September 11th, 2009 07:02 pm (UTC) (Link)
I would definitely watch that! EVA Football in 3D WITH GUNS!(even if they are only laser tag guns)
From: tariq_kamal Date: September 11th, 2009 07:36 pm (UTC) (Link)
All I gotta say is, the management of information is harder than it looks.
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