Time To Change Course on Health Care Reform
Published on: February 4, 2010
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  • I feel it would be better to get the idea of universal, or near universal, coverage through now and then tackle the problem of cost containment. The alternative I fear is a racially stratified class society with Malthusian competition at the bottom. Health insurance reform is a way of cementing us together as one people.

  • Anda Olsen

    I would be interested to hear your thoughts on Rep. Paul Ryan’s healthcare proposals. At first gloss it seems to mesh with your long term prediction.

  • Norm

    Alas, I think the Burkean “little platoons” will trump the “one people”. What been manifest in the last year is that current administration proposals get to the nearly last person in the country by putting the current health care arrangements of the rest of us at risk. One doesn’t have to buy every last bit of evolutionary biology to see the logic that people will optimize the benefit for their immediate families over the welfare of unknown individuals across the country.

    I think Dr. Mead is onto something in looking for re-engineering medicine to capture “Moore’s Law”. Back decades ago, the single biggest volume/weight category that I hauled to and from college was the stereo, speakers, and vinyl records. Now that fits in my pocket.

    If a “Doc in a Box” increased a doctor’s productivity by 10x, then you have real “curve bending” cost reductions and maybe extending coverage to all is an affordable piece of charity and not a risk one’s own family’s immdiate welfare. It changes the politics dramatically.

  • Chris

    Medicare will go the way of welfare.

    Eventually, if workers are paying 10% of their income for other people’s healthcare bills, there will be a social stigma for that free ride.

    I don’t think our government system has the will to do a Paul Ryan reform. So it will happen on the social marketplace where people on Medicare will be lumped in with those poor folks who have to buy their beer and cigarettes using food stamps while the other shoppers in line watch.

    People get real testy when they see a direct connection between their taxes and the wasteful personal choices of those around them. It is hypocritical, but true.

  • Leslie Goldstein

    And what is supposed to fuel this health care renaissance? Some malcontent, sluggish government employee perhaps? Or, is it more likely to emanate from old fashioned greed and capitalism. The answer is rhetorical.


  • Luke, the writer here is saying that a diverse system with a wide variety of organizations providing health care is better for innovation than a one size fits all system like traditional Medicare.

    That means no universal healthcare, since that would regulate our whole health system into one size fits all, without any chance for innovation.

    Like the writer of this article, I have a big problem with our current system. if it costs $8,000 a night to have someone in the hospital for tests (which is how I was billed a year or two ago), then there is something extremely out of kilter in our system. The tests I had shouldn’t have cost more than a few hundred dollars. And what’s strange is that I don’t see the hospital, the doctors or nurses as making a particularly huge amount of money. I am frankly puzzled as to where the money goes. (Admittedly the bill was settled for $3,000 by insurance, but that’s still about $2,800 more than I think it should have cost.)

    I’m not sure if I like the author’s idea of a totally impersonal system where expert decisions are made by computer. I would like to still see the human element in our health care. But if you consider that a doctor’s time is worth, say, $200 an hour, and you see him for an average of 15 minutes per appointment (and I’m being generous in a lot of cases), the time actually seeing doctors is not a driver of enormous costs.

    What I would like to see answered is, why is health care so expensive, and what can be done about it? I have asked this question every time I wind up visiting a hospital, and the only answer I get is that nobody monitors their own costs because insurance always pays for it. So the more we force insurance on people, the higher our costs are going to be. This seems logical to me and is an excellent reason to run far away from any of the “insurance reform” efforts I have seen.

    Finally, I have something interesting to toss into the equation. A lot of our sicknesses nowadays are due to lifestyle diseases like diabetes. People get diabetes, and their situation worsens, because it is very difficult in today’s society to limit food intake.

    I believe the solution is simple. Right now, fat accumulation is programmed by mechanisms deep in our unconscious that tell us that we might run out of food at any time and so we need to accumulate fat to be consumed during lean times.

    This is no longer true. Food is always available today. So what if we simply add a microchip to our bodies that would reprogram us to only absorb nutrients we currently need? That would solve the entire problem, and people could eat anything they wanted.

    I believe in solving problems, instead of living with or managing diseases. Why can’t treatments be oriented towards solutions like that? Then people would no longer get diabetes and billions of health care dollars would be saved.


  • Robert Speirs

    People get far too much health care today, most of it wrong-headed and in many cases positively dangerous. Until the system is rationalized costs will keep being exorbitant and health will not improve. Universal health care would just raise the number of casualties. The wisest thing you can do is stay away from doctors completely unless you’re bleeding or have distinct physical pain or a broken bone.

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  • Health care should be for all, just like it is in the UK with their NHS program. It is not fair for people, citizens or immigrants to not be given access to health care just because they do not have insurance cover or have a pre conditioned illness. What are the taxes Americans pay for?

  • WRM writes:

    > We have to learn to do health care in fundamentally new ways in the next twenty years. The changes needed are much more radical and sweeping than anything envisioned in the current legislation — and it will take a very different mindset to make them happen.

    From Cancering:
    Listening In On The Body’s Proteomic Conversation by W. Daniel Hillis

    > Instead, what we’ll do is we’ll go in, we’ll measure you by imaging techniques, and taking it off of your blood, looking at the proteins, things like that, build a model of your state, have a model of how your state progresses, and we’ll do it more like global climate modeling.

    We’ll build a model of you just like we build a climate model of the globe, and it will be a multi-scale, multi-level model. Just as a global climate model has models of the oceans, and the clouds, the CO2 emissions, and the uptake of plants and things like that, this model will have models of lots of complicated processes happening at lots of different scales, and the state variables of this model will be by and large the proteins that are moving back and forth, sending the signals between these things.

    There will be other things, too. But most of the information is in the proteins. There will be a dynamic time model of how these things are signaling each other, and what’s being up-regulated, and down-regulated, and so on. Then, we will actually simulate that under lots of different treatment scenarios; we’ll simulate for your cancering, how we can tweak it back into a healthy state, having it guided back toward a healthy state. It will be a treatment that’s very specific. We’ll look at those and see which ones are most likely to bring you to a healthy state, and we’ll start doing that, and we may treat you in a very different way than we’ve ever treated any other human before, but the model will say that for you that’s the correct sequence to treat it.

    Right now this would be a huge change in medicine. For instance, the way we pay for medicine is dependent on the diagnosis. You pay a certain amount for prostate cancer, and you pay a different amount for lung cancer. That determines what part of the hospital you get routed to, which doctor sees you, what the insurance company will pay for. If you take that out of the system right now, it’s a completely different kind of a system. I don’t think this will be an easy switch and I don’t know what the sociological/economic processes will be. But it will happen because it will start working better.

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