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There has been a lot of talk about the failing U.S. medical system. While politicians deeply into denial keep telling us that the U.S. has the best medicine in the world, it is commonly accepted by international reviewing groups that the U.S. has slipped way down the list. The World Health Organization, in 2000, ranked the U.S. 37th among the world's 190 countries. AND, in 2005, the U.S. had the HIGHEST cost vs. GDP except for the Marshall Islands.
When asked how this could be fixed, former senator Tom Daschle presented a 10-point plan. This is pretty much the standard "politically correct" view at this time, most of which has been captured by the "Obama" plan:
1. America’s health care system should be a combination of a private system and the public system now in place through programs like Medicare, the Indian Health Service and the Veterans Administration.
2. Universal access should be a universal goal.
3. Any new system should be based on a model “that we know works,” the Federal Employee Health Benefits Program.
4. Policy-makers should recognize the need for “complete care,” which would include insurance coverage for mental health services and dental insurance.
5. Incentives should shift to wellness and prevention away from expensive disease treatment after a patient is sick.
6. Transparency is needed. Deaths and injuries should be subject to federal review and public reporting such as takes place under the Federal Aviation Administration after a plane crash. Daschle said physicians and others should get safe harbor from lawsuits if they follow best practices.
7. Records should be computerized to avoid the sea of redundant paperwork now in place.
8. Eliminate unnecessary care. Of the $2.4 trillion spent on health care each year, some estimate $700 billion is unnecessary.
9. Shift from a fee for service, which promotes lots of procedures (see Nos. 5 and 8), to payment based on the quality of health of patients.
10. A governing authority, a Federal Health Board, should oversee the system as the Federal Reserve oversees the banking system.
The problem with this is that it TOTALLY misses the point. Fiddling with Medicare and Medicaid, or alternative insurance approaches is a total waste of time. The current approach, even with the inclusion of universal coverage, is just a payment reshuffling diversion. It doesn't do anything to address the major problem: COST! SO! Why is the cost so high? There are two reasons.
First, human labor. While so many other parts of our society have incorporated computers and machines, medicine is primarily done the same way it was done by the Greeks 2500 years ago. With the exception of adding advanced imaging systems to improve diagnosis, medicine is provided by human doctors who interact with patients, ask them questions, perform tests, and then either prescribe medicines or do surgery. Medicine is still focused on curing illnesses and treating injuries just like it was in antiquity.
Second, we do many procedures and prescribe many costly drugs which are not needed.
So, why do we keep doing this? For two reasons.
First, most people are not capable of envisioning any other way to do it. This includes most leaders in government, academia and industry.
Second, the U.S. will never fix the cost problem as long as the people who benefit by high costs control the people in government who determine the structure of business. High costs are due to de-facto business models which hold back innovation to maintain existing power structures and corporate identities. Government, academic and industry leaders are sitting at the top of the food chain. They don't want to risk losing their elite positions. They make a LOT of money with the present system. If major changes are made, they stand to loose a lot. So, since they are the ones in a position to hold back innovation, that's what they do. Major changes are resisted at all cost. They only feed out small changes, which they have already tested and know will continue to improve their financial well being. This is such a tragedy, however, because they are protecting their positions of power and income at the expense of the entire world population.
Here are some specific examples. I, personally, as well as many others, developed medical systems before 1992 that would be described as similar to those seen on "Star Trek". These innovations, which were not just concepts, but were actually built, demonstrated global remote medicine including hospital intensive care unit ( ICU ) level care in the home. The demonstrations, now 20 years past, far exceeded anything in current use or even being currently discussed.
Medical knowledge has exploded. Even the average citizen can see that medical students and practicing physicians are totally overwhelmed with the flood of new information. There are now over 12,000 diseases in the medical books, for which we have over 55,000 drugs to treat them. No human in 4 years of medical school is even capable of reading that much material, never mind studying and understanding it all. Yet, a computer can process it in seconds. Direct computer diagnosis and treatment planning, with accuracy exceeding human ability, has been available since the 1970s. But the old approach persists because medical leaders, in the schools, business associations, and government agencies hang on to the old methods and block change.
The U.S. should NOT be attempting to just "improve" medical care, or even to catch up with other countries in the world. If these gate keepers were not in the way, human society would be able to make huge jumps forward. So, if the U.S. population wants to solve the crisis we are in, we should refuse to be handed small changes one at a time. We should move to "Star Trek" medicine right away! And YES! We do know how to do that. We already know how to do a lot of what was only Hollywood fiction back in the 70s. How do I know? I invented a lot of it. As I said, I was at the leading edge of that technology as were many others. By the early 90's, most of the technologies had been demonstrated. But they were not allowed to see the light of day because they would DISPLACE existing products. None of the companies in a position to introduce them would take them on. The "vulture capitalists" wouldn't fund them either because they were chasing the huge profits expected from "going public" with the "dot com" fads. Great for corporate leaders and investment bankers; bad for world society.
This brings up an obvious question: why does the population let this happen? ENTITLEMENT, COMPLEXITY, and GREED!
Because of TV and medical dramas, people know more about medical care. They see Dr. House solve all kind of difficult problems. So, they expect that level of care for themselves – they feel ENTITLED to it.
What people don't understand is the COMPLEXITY behind delivering such "top level" care. This is the 12,000 disease, 55,000 drug problem I mentioned. To make a correct diagnosis of all the diseases, even one at a time, is already beyond the ability of any human. What happens when two or more diseases occur at the same time? What happens when we bring in the variability of each human body to respond to the disease? The number of combinations goes into the millions. It doesn't stop there. In addition to the medical complexity, doctors have to navigate the legal and insurance complexities. When the symptoms are not precisely specific, the doctor still has to specify a single diagnostic code against which payment will be made. There are thousands of combinations.
And, of course, the practice of medicine is placed in a "conflict of interest" position from square one. If a doctor is paid based on the number of patient visits and the variety of procedures done, then, unless they have a full work load, the incentive will not be there to further reduce the number of patients and visits they have. The same problem applies to hospitals. Their goal is MORE revenue, not less. And if more revenue comes from more patients, they are not going to be innovative, at their own expense, to reduce illness in the community. Remember, the goal of business is MORE revenue. Does the word "greed" come to mind?
So, to address all of these problems, here are 10 things the entire world should do to FIX MEDICINE:
1. Healthcare, as a whole system, which includes every element of society, should move to a wellness-prevention model, rather than focusing on curing illness. This should include a Japanese style "cooperative - continuous improvement" quality model based on six sigma concepts, rather than hanging on to approaches like root cause analysis that were abandoned by industry 20 years ago.
2. Health records should move to an electronic, universal access system.
3. ALL medical practice should move to computer based diagnosis, treatment and follow-up. The role of physicians should change from full-spectrum patient care to serious illness care, public health management and caretakers of the medical information data base.
4. The entire national population should be taught basic medical skills as part of their primary and secondary education, achieving EMT level skills by high school graduation. They should learn substantially improved self-care using automated computer support. Self-care would be given the new designation: ‘primary medicine’.
5. Every home should be equipped with basic medical instruments. These would be simple tools like a scale, thermometer, blood pressure cuff and camera. Things like fevers, colds and bug bites would be addressed through self care, with the ability to diagnose many more serious problems through phone support.
6. For emergencies and questionable symptoms, people would go to ‘rapid care’ centers in drug stores or community centers. This level of care would get a new designation as ‘secondary medicine’.
7. For chronic but ambulatory patients, there would be additional tools in the home like urine test strips, spirometers etc.
8. Surgery should adopt automation methods and robotics. This would redefine surgical teams. Some surgeons would be specialists who could operate remote from the patient, saving the time for them to scrub up for their part of the procedure.
9. The finances for wellness can work using a ‘per person’ model rather than a ‘per procedure’ model, as long as ALL of the elements in the process are included in the model. This must be implemented in a shared way including EVERY element of the healthcare chain: insurance, doctors, hospitals, regulatory agencies, law making agencies, medical schools AND the patients. It must also be extended to those who affect wellness such as food providers, media and industry in relation to working conditions.
10. Medical education should start much earlier. The whole population should be exposed to health right from first grade. Students who have an interest in medicine as a career can start as early as, 6th grade. That way, future docs will have 11 years of basic medical education before they enter 4 years of medical school. Obviously, today’s 4 year pre-med and 4 year graduate medical programs would have to drastically change to deal with the higher skill level of applicants and the absence of skills moved to earlier training.