Tag Archives: healthcare

Bridging the Gap Between Doctor and Patient

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According Marty Makary‘s book Unaccountable, over 30% of medical procedures carried out in the United States are unnecessary. There are over 200,000 deaths from medical mistakes a year. Medical mistakes and preventable infections taken together is the #3 cause of death in the United States.

The problem is a lack of transparency in healthcare. I think the debate about healthcare in this country has been missing the main problem: in order for consumers to make a decision about their health, they need to have INFORMATION about the health services they’re “shopping” for. There is a culture of secrecy among doctors, as a result most consumers choose their doctor almost randomly based on factors that do not directly relate to their essential unmet needs.

Here’s my example of a good system… First, I Google the symptoms I’m having to get some basic information about the underlying conditions that could be causing the symptoms. As an imaginary example, say I suspect that I have an abdominal hernia. I look it up online, and it says that normally this requires a hernia repair surgery that costs an average of $5,000. I would like to be able to go online and find doctors near me that perform this surgery often and have gotten good reviews. Also, I would like to sort those options by price of the surgery. This data is out there! But unfortunately it’s not easily accessible.

Instead, as a consumer, we can’t know if the doctor we went to has done zero, one, or one hundred hernia repair surgeries. We don’t know up front what all the options are and what the price of each option is. What are the benefits, what are the costs?

According to Makary, doctors are pressured to hit quotas in the number of surgeries they perform, and maintain secrecy to avoid exposing themselves to lawsuits. I think doctors should be exempt from lawsuits. The only punishment for a screw-up should be whatever the consumer decides is appropriate when that information is made public.

Makary provides a lot of practical ideas for opening the channels of honest communication. For example, he suggests that all patients be provided with the video of their operation.

Check out a C-SPAN interview with Marty Makary where he preaches the message of openness in the medical profession.

Obamacare Requires Disclosure of Calorie Content

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I think too many people know nothing about Obamacare except that the name Obama is in the title, and that’s enough for them to like it or dislike this very complex healthcare legislation.

No matter how you feel about it, I think the law is an attempt at reform that at the very least is inspiring an important public discourse on one of the most important subjects that we face as a democracy.

So, I’ve been slowly chipping away at learning more about this huge 2010 law. One of the interesting provisions is that chain restaurants must list the calories of menu items in the menu. They must also provide detailed nutritional content info (fat, sodum, carbs, sugars, protein, etc) upon request.

I knew that this has been a growing trend in restaurants, but I thought that it was due to laws passed in major cities and not due to a federal law. In some cases, restaurants have until 2014 to start disclosing this info, so there still might be a few hold outs.

I am a huge fan of government forcing information down our throats. That’s where big government does the most good in my opinion: help inform the public, and let the public make their own individual choices.

Where a lot of people start feeling uneasy is when laws start popping up that limit what people can eat or drink. For example, the following video discusses a recent New York City law that bans jumbo-sized sugary drinks in restaurants, theaters, and street carts. I like this specific law, but it makes me nervous.

Like I said, I’m all for government informing the public, even forcing that information down our throats. But consumer freedom is essential to the economic vibrancy of our nation. We should limit this freedom very carefully, if at all.

Centralized Health Care Record Database

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I’m a big proponent of “big data”, of giving people the option of storing anything and everything about their life digitally as long as it makes their life easier, better, more fulfilling.

Unfortunately, too many people are still scared of giving personal information over to “big business” or “big government”. In my view, that’s like being scared of pulling down your pants during a physical exam.

There are areas of our lives, where keeping a centralized database of personal information can have dramatic effects of the quality of life. One such area is the healthcare system, where many records are still not kept electronically, and those that are, cannot be easily synchronized from one doctor to the next.

You could, of course, pass laws that require health care providers to (1) keep all records electronically and (2) to use the same standard that work with the centralized database. My hope is that companies like Google come out with a solution that seems obviously beneficial.

Unfortunately, Google Health tried to do just that and recently closed down. The reason is unknown, there are many suggestions, but the main reason is probably that it was bad PR. People seem scared of putting their health records online due to privacy concerns, and therefore if Google helps them do it, that somehow automatically make Google evil.

The following is a C-SPAN program on this subject from a while back:

Common Sense Reminder: You Will Get Sick and You Will Have To Pay

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The Supreme Court heard oral arguments on the constitutionality of the new health care law’s individual mandate today (hear the arguments on C-SPAN). The individual mandate requires that everyone in America purchase health insurance.

The debate over the morality and fiscal potency of the health care law very interesting, but that’s not what the Supreme Court court is deliberating. They’re simply trying to figure if the federal government has the power to mandate that you buy something, overriding state’s rights. It’s really a debate about the relative power of the federal government relative to state governments.

The constitutional opponents of the law believe that allowing a mandate would remove any identifiable limiting principle. This means that the government can next force you to do anything else because it’s “good for you”.

The best question (in my mind) asked by the proponents of the law (such as myself) is: what happens when an uninsured person shows up at the hospital and can’t pay out of pocket even a small fraction of the cost? In fact, no one is really asking this question fully. It seems everyone assumes that of course we treat the person to the best of our abilities and then the taxpayer has to flip the bill. It seems that the people that are demanding their personal liberty be protected are really operating on the assumption that they will not get sick or will be able to save enough to cover the costs. In their minds, they can do a better job at fighting off sickness than their less-clever neighbor. That assumption reminds of the assumption folks have when they recite the wedding vows. You can’t base a policy that determines the well being of millions on hope.

Just to be clear, whether the health care law is deemed constitutional or not, to me, is much less important than the fact that our current health care system is broken and this law is one of the possible fixes. If it’s not constitutional, then we need to do something else that is, but we can’t afford (literally) to do nothing.

As a side note, I discovered that there are services out there that allow you to hire a person to stand in line for you. The rate I saw was $36 per hour. This came up because people stood in line for days to be able to get one of the 60 seats open to the public for individual mandate hearing.

No Incentive to Cover Preventative Care

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Main point: Insurance companies only have you for a couple years, so it’s not in their immediate self-interest to prevent you from getting cancer in 5 years.

I heard a statistic mentioned during an interview with Dr. Peter Beilenson that the average duration that a person holds an insurance plan in the United States is just 2 years. In other words, an insurance company (acting presumably in its blind self-interest) has no incentive to cover care that is preventative.

So what if a checkup or scan or consultation with a dietician could help reduce the risk of cancer in 10 years? Covering that checkup, scan, or consultation costs the insurance company money, without resulting in any savings, since the patient will be off its plan in all likelihood if they do get cancer.

Of course, this is a very common problem that game theory addresses. In this case, insurance companies need to cooperate to maximize profit and minimize cost. Businesses are rarely good at cooperating in that way however. That, in theory, is the role of government: to “encourage” or downright force cooperation through regulation.

I’m obviously not a healthcare policy wonk, but it seems to me that healthcare should be much more proactive and not just fall back to being “sickcare”.