September 14th, 2009 by Edward Miller

The healthcare debate is shockingly narrow. We have the do nothing crowd, the privatize it more crowd, the single-payer people, and the public option folks. On the more radical end of the mainstream debates are those calling for more general practitioners, preventive care/incentives, and co-ops. Of the bills pushing through congress now, I have a feeling the public option is the only one with any teeth, but there are a million other non-mutually-exclusive ideas which could be implemented.

Image by: Kristina Hoeppner
Image by: Kristina Hoeppner
If we shift the focus to not just prevention but an anti-aging paradigm, we can delay death, improve productivity, and enhance wellbeing. Unfortunately the short term bias of individuals, corporations, and the government collectively shifts the focus towards lucrative disease-specific research. Most diseases are merely a symptom of aging, which is the root problem. There is no excuse for the NIH to fund disease-specific research when the money could be spent so much better on fundamental aging research which the market is not already providing. The SENS Approach has already laid the roadmap for what needs to be studied, yet funding is grossly insufficient, and as with all things regarding aging, time is of the essence.

Setting aside genetic engineering for now, even simple things like vitamin deficiencies cause an inordinate amount of medical problems, and this is especially sad in a country like the US which, despite being the wealthiest in the world, still has vitamin D deficiency among the majority of the populace. Unfortunately this is part and parcel with our overall short-term bias.

Unintended consequences of current government policies are wreaking havok on us. Red meat, corn syrup, and many other American dietary staples are heavily subsidized by our government. Eliminating those subsidies, and maybe even taxing these to cover the externalities of their unsustainable production, would do as much to improve our health as just about anything that is being proposed. Additionally, banning the use of antibiotics on healthy farm animals, as the Obama Administration has openly supported, would prevent the outbreak of antibiotic-resistant diseases.  Furthermore, promoting local farmer’s markets would improve the quality of our food and our communities.

Libertarians often rail against the FDA,  as the Life Extension Foundation does effectively, and much of the complaints are absolutely justified, but what is often overlooked is the archaic patent system. Not only are patents granted too frequently, and there is actually much to be said for dismantling the patent system entirely, we have a sort of tragedy of the commons when it comes to corporate patents. Although having the freedom to grant your patent to someone else in theory seems like a good idea, in practice what happens is all the researchers end up ceding their patents to their employers and the end result is a sort of medical servitude and reduced incentive to innovate. Yet if corporations, which shouldn’t be legal persons anyways, were not legally entitled to hold patents, they would still have incentive to hire researchers who could use their facilities and license back the discoveries at fair rates (standardized to a certain percentage floor).

The NIH should not fund any research which will go toward patented research, ever. All research which is conducted with public money must go towards the commons or else it is corporatism plain and simple. Open Source Medicine would enhance innovation and reduce costs.

Also, as Kevin Carson argues, there is plenty of room for small low cost community clinics staffed by general practitioners or even the sort of “barefoot doctors” described in the article. Seriously, you don’t need to waste the time of an MD for a simple ear infection, and such things constitute a huge proportion of healthcare.

As Robin Hanson notes here, we simply spend too much on healthcare. True, a huge amount of that is a result of waste, fraud, abuse, and the problems mentioned above, but some of it is a result of simply spending too much money on ridiculous experimental treatments and so forth that we shouldn’t be doing at all since there really isn’t any evidence that they help. One way many countries deal with this issue is rationing, but in fairness, this article was mainly arguing for a reorientation of our priorities and an elimination of subsidies, tax breaks, etc for healthcare providers. While I disagree with the argument that the quantity of treatment itself is a problem, I think it is useful to think about just how much we value healthcare, and how effective each extra dollar really is, because too often this issue is ignored completely.

Lastly, one area in which significant gains could be made is via automation. If we could fund research of automated systems and robots to assist care-providers, we would be able to spend less on care-providers. More would be able to live at home without the need for medical supervision, and for those who live at the hospital, there would be less need for nurses and nurses’s aides to take care of the dirty details, and more time to look after their social and emotional wellbeing. I’m not just talking about robots like ASIMO or R2D2 to fetch you things, though there is certainly a place for that. I am also thinking on a very practical level. There are already motorized wheelchairs, machines which aid people in the bathroom, or help them up the stairs, or shift them around to prevent bedsores. There are even robotic exoskeletons being developed. These sorts of things which can not only maintain the health of the elderly and disabled, but actually give them back lives of relative normality, but most of the machines are patented and the designs are secret. Open innovation and government funding could speed this up immensely.

Please, think outside the box guys!

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2 Responses to “Thinking outside the box on Healthcare”

  1. Thanks for the link. There are all sorts of artificial scarcities built into the system, and I have no doubt that someone attempting to reverse engineer it from a hacker’s mindset could achieve factor four or more cost savings.

    Aside from patents and professional licensing issues, which your mentioned, there’s the extent to which conventional corporate culture is legally mandated on the cartelized insurance and healthcare delivery industries. Even the organizational trappings of faux-corporate “quality” are mandated (e.g. ISO certification, JCAHO certification, even mandated bureaucratic “quality improvement” committees). Any attempt to create a small, cooperative hospital at the urban neighborhood level, using “outside the box” approaches, would — I have no doubt — be met with all sorts of licensing problems (including the requirement to “show need” for another hospital to exist at all).

  2. Excellent points, that is absolutely true. Unfortunately, the way the current system works boosts the profit margins of all these companies so that they can lobby even harder for the next batch of artificial scarcities. We can either strike at the root or get some more lessons in futility, as all this stuff will just sprout right back up otherwise.

    Many of the barriers to entry are clearly unjustifiable. I wonder how effective reputation systems would be for healthcare as a substitute for many of the certification requirements? I mean clearly if you died you could not check “thumbs down” anymore. Perhaps there could be a way to track this anyways.

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