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Can Technology Fix the Health Care System?
I was surfing through my usual tech sites for the latest news when I came across an article on Wired News. It turns out Steve Case is not alone in the quest to fix the health care system. I guess I don't get what the big attraction for these guys are.... I know the US's health care system is messed up, but I'm not sure technology can fix all of the aches, pains and dysfunction in our current system. I don't get why they don't just join a major company's board or start a hip/trendy start-up....
But I'd suggest that proper application of game theory is key. Making a system that is hard to manipulate (i.e."game") is a very challenging problem, and frankly, I find it a lot more interesting one than the submitter seems to.
Those who care only for themselves, and have no consideration for the world around them, depress me.
Sometimes we pay to help those who need it. That's the way a community functions. As a Canadian, while I maybe don't have the health care that I need the instant I need it, it's still pretty damn good -- especially when there's an emergency. I pay for it, but I also live in a healthier society as a whole. Perhaps if you had better national helath care, you'd have fewer working poor, who can't afford health care, but make too much for subsidy, and get caught in the nightmare treadmill of constant debt because of a trip to the hospital.
Libertarians make me sad.
What does it mean to wake out of a dream
and be wearing someone else's shorts?
BNL, Born on a Pirate Ship (1998)
... and a strong believe in suvival of the fittest. Look to Europe: Afordable, reasonable healthcare for everyone is not a dream. Many countries have it. For example in Swizerland everybody has health-insurance, you cannot be without it, whether you have money or not.
However it is not possible with a free market, since that will charge customers whatever they still can pay and will let those that cannot pay die or live with problems that could be fixed. At the same time, hugely expensive treatments will be available for those that have the money and single wealthy individuals will be saved instead of hundreds without money. Face it: Despite its lip service to christian values, the US is one of the coldest, inhumane countries on this planet, were cristian values are preached but not practised at all. Instead there is this believe that the market can fix anything. It cannot were infrastructure questions like education, public transportation, healthcare, etc. are concerned, since all of these need a really long-term perspective and the will to make thinks work well instead of turning a profit.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
A collar that shocks it's wearer every time they try to stuff a Big Mac, Twinkee, Slurpee or Hoagie down their gullet.
I mean, come on. People just want a pill to fix their woes. How many times have you met someone that you know have a condition that can be easily fixed through diet and exercise alone?
Besides cancers and other similar conditions, most problems facing the health care industry are caused by lack of exercise and eating the wrong kinds of food, and its a hard thing for people to change. And generally health care professionals are afraid to give definitive health advice because of the opportunity of lawsuits. How many times have doctors told patients that they should "reduce" instead of "eliminate" or "substitute" some offending substance?
There tons of evidence that most medications (some help) have horrendous side effects and yet people continue taking them as if there's no tomorrow. I think that no matter what doctors, tech, or the government does, its gonna take a sea change for Americans to wake up and smell the coffee and start taking their own health in their hands.
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Huh? I don't get it. How is technology going to fix anything? Sure, it's true that there are inefficiencies in the system, like being asked for your health history over and over, as described in the article, but you're not going to wring any major change out of this dysfunctional system just by digitizing people's health histories.
Technology is part of the problem. Technology costs money, and part of the problem with the US system is that it encourages people to spend inappropriately large amounts of money.
The fundamental problem is that it's a positive feedback system that's doing what positive feedback systems always do: wig out exponentially. If you really want to see something scary, look at an itemized hospital bill that includes the costs of things like bandages. The bandages cost 10 or 100 times more than they would at the drugstore. The reason they cost so much is that insurance companies are willing to pay it. Why are insurance companies willing to pay it? Because everything else is ridiculously expensive too, and anyway the insurance companies can raise their rates to cover it. Once the insurance companies raise their rates, the health-industrial complex smells money, and raises their prices.
If you like government regulation, one very simple, sensible thing to do would be for the government to penalize people who are affluent, but have a low deductible compared to their income. If my annual income is $150,000, then they should use tax incentives to browbeat me into not buying insurance that has a deductible any lower than, say, $40,000/year. That would make me treat all these expenditures like real money, not like other people's money. All of a sudden I'd be complaining bitterly about the overpriced bandages. When a nurse pulled out one of the hospital's bandages, I'd say, "No no no-- wait, don't open that! My wife went and got some bandages from CVS. Here, use one of these."
Find free books.
The US healthcare system has two choices to get better: either socialist free health care, or divorcing health insurance from employment. Right now we have the worst of both worlds. If people were free to shop around for health insurance like they shop around for car insurance, I'm confident that a host of problems currently plaguing our health care system would be solved.
Unfortunately, although I think government regulation may well have been the cause of employment and health insurance being conflated, I don't think that deregulation will successfully disentangle the two.
~ roscivs
I was in the emergency room for a few hours because I got suddenly very sick after a tooth extraction to the point that I was going to die. They ran a bunch of tests and gave me a saline iv and then sent me home shivering with a 102 fever.
So I got the bill a few weeks later. It was astronomical. Luckily the insurance covered it but it was of course filled up with all kinds of obscure bizarre codes that only insurance billers know anything about. What I'd like to see is some auditor look very closely at how the money flows around the medical system and find the $3000 toilet seats that I'm sure are lurking somewhere in their. I wouldn't be surprised if there were a few dirty HMOs that were taking kickbacks from hospitals for over-billing. Hospital over-billing would also be a perfect way to launder money I'm sure because everybody expects the costs to be unreasonable.
I think the best course of action would be for hospitals to sell their own insurance. Having the HMO and the hospital separate creates all kinds of incentives for fraud and over-billing not to mention many different sets of books to take care of.
My friend and I just had a conversation about this last night. The fundamental problem is that your health is my responsibility, no matter what.
Let's say we went to a world where only private doctors existed and no one accepted insurance. The rich will be able to afford most care (although they're pretty much dead if they need something big like an organ transplant). With insurance so expensive these days, this isn't too far off from reality today.
Now, pretend that you're poor, and you come down with melanoma, despite your best attempt to avoid the sun. You can't afford care, so you wait until the last minute to get care at the ER. By then, your disease is probably advanced and much more expensive to treat, and the ER can't turn your away legally.
The ER charges you some really high price that you can't pay. They repossesses your car and foreclose on your home so you can pay for it. Maybe you can find a lawyer to declare bankruptcy. Meanwhile, the ER is still waiting for their payment, and the doctors have to be paid to pay off their student loans. So what do they do? They charge the rich people more to offset the cost.
Now you're now homeless, without a car to get to work, unemployed, and you're still in debt. Where do you go? Perhaps you turn to a life of crime and end up in prison. You definitely end up on welfare and Medicaid, probably living in a homeless shelter that is likely funded by tax-payer money.
This isn't some theoretical story. It happens to people all the time.
So, all of you who are terrified of having your tax dollars pay for "socialized health care," you're really missing the point. You're paying for it already. You're paying it in your hospital bills as cost shifting. You're paying for it via Medicare and Medicaid. You're paying for it in the prison system (which is the new mental health system). You're paying for it in terms of treating STDs by county clinics and through federally-qualified health centers.
Socialized health care is inevitable because it's already here, albeit in a horribly disorganized and inefficient state. If we kept everyone healthy, the cost of health care would drop for everyone. The question is, how can we do that while balancing quality care?
> Libertarians make me sad.
As a libertarian, I must say that as long as your hand is out of my pocket, I don't give a flying frak about how happy or sad you are.
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The US medical system is definitely sick. US citizens spend drastically more on medical care than other countries. If you are poor you cannot get decent medical help. If you are a visiting tourist and you get sick then you are in for bills that will make your eyes water.
... The list is far too long, guys - you come below Ireland in the Human Development Index. It's about time to pull your socks up America.
If you are in a job it HAS to pay medical insurance. People are terrified, not so much of losing their jobs, but losing their medical cover. (Yes, I do know that ruling a frightened people is much, much easier).
Why?
It isn't true in the UK, or Australia, or Europe. So it doesn't HAVE to be so.
But then the USA is one of the most unbalanced countries on Earth. By unbalanced, I mean the rich-poor gap is horrendous. Here we have the richest country in the world, and yet it has large numbers of poor illiterates, sick and dying. It is very, very sad.
I think it is amazing how the USA has gone from being perhaps the most admired country on the planet - say after the 2nd world war, to one of the least admired - say now - in barely a single generation. Quite an achievement.
I think it's time the USA started doing things that the world could admire, instead of steadfastly serving its own interests. In the medium to long term, being greedy and acting like a spoilt, petulant child tends to result in nobody liking you.
What could they (you) do?
* clean up your own backyard
* Institute a decent national medical system. Increase taxes to pay for it. Kill off the medical insurance companies, push back the tide of wealth in the medical profession
* Fix the schools. Put money into the system (gosh, there's tax again) especially in the poor areas. You NEED those scientists and business folk who drive you economy - and if they don't get a decent education because they were born poor, black, Hispanic, Muslim, female (or any of the other sins of America), you won't get them
* stop messing up the world. Stop starting wars (USA has started more than any other country since the 2nd world war ended). Try to do some good - but not with soldiers
* start doing thing that need to be done. How about really, really investing in sensible power generation (and stop giving tax breaks to oil and coal companies - maybe that would save you some of the tax). Do some decent research. Put some people on the moon. Make the world proud! You've done it before - do it again
Mind you, a good start would be just stop driving those horrible little trucks (called truck so they can break their own rules on fuel consumption - I mean really, guys).
Sweden is a far easier country to admire. Finland
And getting a fair and equitable medical industry would be a good start.
"Cats like plain crisps"
Why is it whenever someone blasts the negative role of government control, somebody has to remark about the person being "cold" or "indifferent" to the poor? Where did he say that the unfortunate should be left to die? He didn't, did he? Are some people seriously this programmed to believe that giving the State control is automatically more humane? If there is a solution more efficient and more effective than the State, then that is what should be.
The money doesn't go towards $3000 toilet seats. It goes towards $3000 worth of treatment given to an uninsured person, as the hospital is required by law to do. They make up for unfunded charity care by sticking it to anyone who has good insurance.
Over 75% of health care expenses (total) are at the beginning and end of life. I have no problem having Fed sponsored maternity wards, but I do have a problem with $5000-a-day geriatric care. Sure we have the tech to prop up a body that wants to die, but after the first 60 years I don't think we should. My parents are getting close to that age, and my remaining grandparents are well past it. When my grandfather was diagnosed with lung cancer, leukimeia, and alzhiemers with-in one year, he made his peace and died in his own bed at home. When we as a culture accept that growing old and dying are natural and that "fighting to the end" is not always the best choice, then the costs of health care in this country can begin to return to reasonable levels.
We are all just people.
I've spent most of my life living under socialized health care systems. (Canada, Europe).
These are very good for routine situations when the population is very healthy and the society (and hence government) is wealthy. They are ok for catastrophic situations when everything is well-funded.
They are, I grant, dreadful in other circumstances.
That said, the idea that 'federal regulation' is the only problem with US healthcare is decidedly simplistic -- with respect to the parent.
To simply pick one problem that doesn't have an easy left/right solution -- lawsuits (and threat of same) are a serious problem in the US. Legal compliance costs and malpractice insurance eat up a huge percentage of a good physician's income.
You want to ban lawsuits against physicians? Very bad idea for obvious reasons.
And yet looking at political manipulation of the health care situation: right-wing protection of drug patents MAY drive innovation, but definitely drives up drug costs. Left-wing protection of trial lawyers drives up the cost of certain procedures and the practice of medically irrational procedures (e.g. C-sections), though it in turn MAY protect some people.
On simple public health grounds a purely freemarket solution seems imprudent (consider what a pay for treatment approach would do to a poor person with some contagious plague?).
Yet the statists don't have it right either. All I can say is that this area merits considerable thought and care.
libertarianism is nothing but a code word for selfishness, dressed up in political signals and philosphical portents. but if you dress up a cheap whore in a fine dress, she's still a cheap whore. so it is with libertarians and anyone who spouts that nonsense
i put it this way: human nature is both altruistic and selfish. any political philosophy you present to the world has to address both sides of this coin, or you have built a political philosophy which is a nonstarter in the real world, because it doesn't jive with the nature of the humans you are attempting to impose it on
we all understand why communism doesn't work: it depends upon altruism, and doesn't address human selfishness. in a communist system, selfishness still exists, in the human beings in the system, but unaddressed by the system imposed upon them, and so selfishness eats communism apart from the inside
if you will, if a whole country suddenly went libertarian, you'd have the exact same problems as a communist country, in reverse along the axis of human selfishness-altruism. it would fail. as miserably and as surely as communism did. for the same reasons, in mirror image reverse
libertarianism appeals to earnest but naive college students with too many philosophy books under their belt, but without any real life experience, who build castles in the sky in their minds about how the world should or would or could work if people just started behaving in ways people have never behaved in any culture or time period since the dawn of mankind
it also appeals to rural folk, who don't understand how they fit into the larger world, and firmly believe themselves to be islands completely owing nothing to anyone else. what they are of course is coccooned within a larger country and system upon which the relative peace and quiet of their worlds depend. but it is hard to see that from the hinterlands until madness marches across the countryside, which it does, unfortunately, in societies that have abandoned the simple common human responsibility we have to take care of each other
and it appeals to 40 something selfish assholes behind on their alimony payments, corrupt and personally bankrupt about any give and take in their lives. nothing more needs to be said of such people. we understand them, and we understand why libertarianism appeals to them on a deep level
libertarianism is a gem of modern foolishness, and you are a glorious fool if you swallow the pap called libertarianism
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
An interesting anagram of "BANACH TARSKI" is "BANACH TARSKI BANACH TARSKI"
I don't know about anyone else but if I can "fight to the end" and wring out an extra 30 years of life from this body, I have every intention of do so. Just because someone is 60 doesn't mean their life is less valuable or that they have no more to contribute to this society. Your assertion that we "prop up" bodies wishing to die is assinine in the extreme. If we had taken that stance 100 years ago, or even 50 years ago, we'd never have extended the average life span by 20 years + and made the advancements in medicine we have.
Life is precious and until someone proves otherwise, we only get one shot at it. I don't see how you can put a price tag on that. Maybe your family puts such a low value on each others lives but mine certainly does not. I valued my grandmother and great grandmother all the way up till the end and would have paid any costs asked of me to keep them alive longer.
ah, the peachy kean usa of a hundred years past, where racism was considered common sense, monopolistic robber barons controlled industry with pinkerton's men and bully clubs, and a war was started with spain to grab territory
clearly, the founding father's dream, right?
ever hear of a fancy word called "progress"?
libertarianism has nothing to do with what the founding fathers were getting at. the founding fathers were getting at liberty and freedom... freedom from things like disease and lives shortened by infirmary. things a little socialized medicine will fix. what will you lose? some money from your paycheck? you'd prefer to have people die in the streets? if a guy falls down and breaks his arm, do you walk by him and ignore him? no, you take care of him. here's a fancy phrase for you from the founding fathers, who you obviouslly adore, and SHOULD adore: "life, liberty, and the pursuit of happiness." hey genius. what's that first word in there?
LIFE
the fact is, i am more in tune with what the founding fathers wanted than you are
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Now many people reading what I just said are probably thinking, "That's inhuman." These are people's lives, not cars. Well, I'm sorry but this is exactly why health care costs are spiraling out of control. Just like the United States being a debtor nation because people cannot say, "No."
I worked in health care as an analyst and application developer for 3 years. For one: it's a nightmare to use technology to do anything because the systems are hugely complicated and entangled in an enormous amount of rules, regulations, qualifications, exceptions, and so on. For two: we have all the statistical information necessary to classify diseases and injuries by cost and come up with a budget that says, "We can treat that, but the cost is too great given the statistical occurrence of the problem, so we can not treat you."
The outcry against that would be tremendous. But I can tell you for a fact that this is exactly what happens on a battlefield. Any battlefield: a corporate takeover, war between nations, etc. People make brutal choices that have a huge negative impact on peoples' lives all the time. A company buys another because it is expedient and then they let go of 50% of the workers. We don't like that, but we accept it.
But if someone says to most people, "I'm sorry but we cannot treat 30% of these problems. We have the money on hand in the short-term, but in the long-term it will break the system for all of us." People are not altruistic. People will not accept the fact that they have cancer and are going to die because the treatment is available but too statistically expensive. People will not accept the fact that they need some expensive heart surgery because they have been pouring fat and sugar into their bodies for years and now it's time for someone to pay for that abuse.
Many people don't take responsibility for themselves, because we don't have a system that requires it. We put people in prison and relieve them of the responsibility of food and shelter and making adult ethical choices. We provide expensive treatments for people that need emergency treatment because an emergency has occurred as a result of years of abusing themselves. And so on.
We're not going to fix a damn thing until we get better at saying, "No" in the short-term when it is absolutely necessary for a sustainable long-term. And that's true in all aspects of society. Health care, the environment, economics, education, whatever. It's all the same single cause. Most people can't make personal short-term sacrifices for long-term gain. Debtor nation. The one's that can, don't spend much time talking about these things because it goes nowhere. They can't solve other people's problems. People need to take responsibility for themselves or the few that already do have to carry everyone else.
As long as you use any taxpayer funded service, good luck getting my hand out of your pocket. The thing is (and I'm sure you hate to admit this) to participate in any society, you need people's hands in your pocket. Suck it up.
but like most difficult problems in life, the choice is between two infringements on your liberty: taxes, or the infirmary of your community
the bite taxes take out is easy to see and quantify and immediate in effect
a community that doesn't take care of itself is more difficult to quantify, sparse and slow in effect
you are part of a community, you derive your riches from it. taxes are an investment you make to guarantee the health of your community, so that you derive more riches from it. do you think the money in your paycheck is yours by inception from god? no, you worked for it, you provided something to your commuity, and they paid you money
now, in a vacuum, taxes are obviously evil. but in the context of the reality you live in, taxes are a SMALLER imposition on your life than a sick community is
and in life, it is about difficult choices, not simple propagandistic choices presented in a vacuum without any context
do you understand?
there are plenty of things that infringe on liberty in life: sleep, eating. why do i have to sleep? seems like a horrible imposition on my freedoms. of course its a silly statement, because we understand why that imposition on my freeodm occurs
it is also equally silly to think you can live in a community without being taxed, and yet continue to think you can derive financial benefit from a community that you won't take care of
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Something like 80% of medical costs are incurred in the last year of life. However, we can't necessarily make decisions based upon this, because that's a retroactive evaluation. Some 80-year olds with cancer will burn through $250,000 in treatment and die inside of the year, making that a huge amount of expenses for nothing. Others will pull-through, living another 5-10 years in good shape, then dying of something different and unrelated. For the latter, the $250,000 was no doubt reasonably spent, for the former, we wasted resources.
The fact is you can't separate when the treatment is extreme and unreasonable, and when it was reasonable until after they go.
That said about the longer lifespans, the modern entitlement complex is a disaster. Social security solved two problems, getting the elderly out of the workforce (lowering the unemployment rate, we creates a drag on the economy beyond the fact that those people aren't working), and preventing the sickly elderly from being indigent, something reasonable to avoid.
If the retirement age was raised to be the equivalent in terms of life expectancy as it was when social security was created it would be 89 today. That's right, MOST PEOPLE didn't live to collect it, it was to help the helpless elderly. We decided that we were entitled to stop working at 65, while others were responsible for it. I'm not sure why that's an entitlement (I don't begrudge anyone that lived below their means and saved up for retirement), but because we didn't raise it continuously, there is no clean solution now.
I'm not suggesting the people should HAVE to work until their death... but retirement, like vacations, is a luxury that is expensive, and it's not clear why one has a right to ask others to pay for it. The true tragedy is the mythical trust fund, an accounting shell game, has given people the mistaken impression that their have "paid into the system" and therefore are entitled to social security, which is why the system is collapsing on itself.
Note that it's called social security, not a national pension, it's not a reward for payment into the system, it's a safety blanket for the disabled, orpaned, and elderly that need it, and never should have become a way of life.