Sunday, May 02, 2010
Where Do We Go Now...
The healthcare reform bill has been signed into law, and the iron triangle is hard at work formulating the regulations that will be put in place to enforce the law.
Already several states are joining in a class-action suit against the Federal goverment on the grounds that forcing people to purchase health insurance has nothing to do with interstate commerce and so exceeds the authority of the Federal government. Personally, I agree with the governors, but it will be an interesting court case, none the less.
So where do we go now? I still believe that market forces, the forces of disruption are the key to making health care more affordable for everyone. We need drastic changes in how we manage clinical trials and in how we diagnose desease. We know now that what we used to call "breast cancer" is actually over twenty different types of cancer. It isn't that we don't have good medicine, it is that we don't have the best diagnosis. A bad diagnosis will ruin a clinical trial faster than a fatality.
On top of that, the charlatans have hit the streets pawning off "electronic medical records" the way peddlers use to hawk "snake oil" out of the back of wagons. What a lot of people in the medical profession haven't learned is that nothing comes for free and it takes years or decades to implement a truly successful electronic medical system.
So now we have errors cropping up where there should be no errors and it is costing people their lives. That means the Federal government is scrambling to come up with a system of checks and counter-checks to make sure the EMR you purchase is the best.
This has good points and bad points. On the good side it makes sure some of the charlatans are caught and dealt with. On the bad side it makes those who are not charlatans jump through additional, costly hoops to get their product to market.
Make no mistake - EMR's do not save money, but when implemented correctly, they save lives and improve the efficiency of health care. The biggest thing they do is provide the clinician with the information they need to correctly diagnose a problem. That correct diagnosis, when it happens often enough, allows the care and treatment of that disorder to be passed down to a technical based care solution, such as a PA or an RN - this saves you money, and it frees up the time for the MD to do what he does best - find answers to questions that haven't been asked before.
Case in point - what used to take a trained medical professional to diagnose (a pregnancy) is now the venue of an over-the-counter $15 test you do at home. If you still want to pay $75 for an office visit you can, and the doctor is going to hand you one of those sticks and tell you to visit the bathroom; or they will get the RN to do it, and still charge you for the office visit.
Flu shots are another example. What used to take a trip to the doctor is now being done in most pharmacies across the country. And in-house clinics at chain pharmacies are set up to see a specific type of ailment for a specific cost structure. This is the future of medicine and the answer to the high cost of healthcare. It isn't forcing everyone to buy health insurance, any more than forcing people to purchase life insurance will guarantee their families won't grieve when they pass away.
I want to recommend two books as I have in numerous places. "The Innovator's Prescription" by Clayton Christensen; and "The Healing of America" by T.R. Reid. I think both of these should be "must reads" for anyone sitting in Congress, or who desires to sit there.
Already several states are joining in a class-action suit against the Federal goverment on the grounds that forcing people to purchase health insurance has nothing to do with interstate commerce and so exceeds the authority of the Federal government. Personally, I agree with the governors, but it will be an interesting court case, none the less.
So where do we go now? I still believe that market forces, the forces of disruption are the key to making health care more affordable for everyone. We need drastic changes in how we manage clinical trials and in how we diagnose desease. We know now that what we used to call "breast cancer" is actually over twenty different types of cancer. It isn't that we don't have good medicine, it is that we don't have the best diagnosis. A bad diagnosis will ruin a clinical trial faster than a fatality.
On top of that, the charlatans have hit the streets pawning off "electronic medical records" the way peddlers use to hawk "snake oil" out of the back of wagons. What a lot of people in the medical profession haven't learned is that nothing comes for free and it takes years or decades to implement a truly successful electronic medical system.
So now we have errors cropping up where there should be no errors and it is costing people their lives. That means the Federal government is scrambling to come up with a system of checks and counter-checks to make sure the EMR you purchase is the best.
This has good points and bad points. On the good side it makes sure some of the charlatans are caught and dealt with. On the bad side it makes those who are not charlatans jump through additional, costly hoops to get their product to market.
Make no mistake - EMR's do not save money, but when implemented correctly, they save lives and improve the efficiency of health care. The biggest thing they do is provide the clinician with the information they need to correctly diagnose a problem. That correct diagnosis, when it happens often enough, allows the care and treatment of that disorder to be passed down to a technical based care solution, such as a PA or an RN - this saves you money, and it frees up the time for the MD to do what he does best - find answers to questions that haven't been asked before.
Case in point - what used to take a trained medical professional to diagnose (a pregnancy) is now the venue of an over-the-counter $15 test you do at home. If you still want to pay $75 for an office visit you can, and the doctor is going to hand you one of those sticks and tell you to visit the bathroom; or they will get the RN to do it, and still charge you for the office visit.
Flu shots are another example. What used to take a trip to the doctor is now being done in most pharmacies across the country. And in-house clinics at chain pharmacies are set up to see a specific type of ailment for a specific cost structure. This is the future of medicine and the answer to the high cost of healthcare. It isn't forcing everyone to buy health insurance, any more than forcing people to purchase life insurance will guarantee their families won't grieve when they pass away.
I want to recommend two books as I have in numerous places. "The Innovator's Prescription" by Clayton Christensen; and "The Healing of America" by T.R. Reid. I think both of these should be "must reads" for anyone sitting in Congress, or who desires to sit there.
