It’s entirely clear to me now that healthcare reform will not happen in any real way via the current system. With too many cooks in the kitchen — all having a vested interest in the dish being served to customers — we’ll never get anything done. I fully believe Obama will get some version of reform passed, but it’s mostly a matter of how watered-down it is and how many politicians and citizens he upsets in the process.
My opinion is reform MUST come from the bottom-up. Somebody who will change the paradigm as much as possible. I also believe this business is going to have to be scrappy, with little funding (compared to the rest of the industry). Here are my thoughts on one way this should work (and like my two posts about the power grid, this is an extremely uninformed opinion and I welcome reasons why things like this would/wouldn’t work):
It all starts with this assumption: Americans generally believe (conciously or not) that their own health is out of their control. We believe in order to be healthy we must generally be “made healthy” by someone else.
This is obviously false. In fact, according to studies, medicine has very little to do with health. On the other hand, diet, exercise, and lifestyle contribute greatly to health. Those three things are fully within the control of each of us. Note that I’m certainly not claiming doctors aren’t useful at all. Far from it! I’m simply arguing we rely on doctors for too much, rather than focusing directly on the root of many of the problems (our lack of control over of our health). We also spend too much on the treatment of diseases, rather than the prevention and early detection of diseases.
Knowing that being healthy is really in our own hands (and not a doctor’s), why do we frame “health care” in terms of how much medical coverage (doctors visits, hospital stays, etc)? Why don’t we frame “health care” in terms of how you choose to live your life and keep yourself healthy?
This is how I would change the paradigm. Rather than buying “health insurance,” I would instead offer a much stricter definition of “medical insurance.” I believe doctors are both necessary and amazing mostly for the things we can’t control ourselves, like being hit by a bus, or — in many (but not all) cases — cancer. Let’s focus on lowering the probability of ever getting many diseases rather than focusing on increasing the care after those diseases are already in place.
And as a software guy (as well as a fan of libertarian paternalism and choice architecture), of course I think there are many ways technology can help. I would create my “medical insurance” firm with a great web-based interface. Think of it as Mint.com for your health. You’d keep track (maybe via things like an iPhone app?) of everything dealing with your health: how much you’re exercising, what you’re eating, etc. Every time you do something good, you earn “points.” For example, going for a three-mile run nets you +250 points. Every time you do something bad, you lose “points” (e.g. smoking would cost you -100 points per cigarette, while eating McDonalds would cost -75).
Next you turn points into currency. You can either rollover points and use them for the cost of your insurance later, or even — for the uber-healthy — you could turn them into a rewards program (much like credit card points). In effect, you get paid to be healthy.
By providing the points system, you’re essentially providing nudges to keep the country healthy. And, with scale, you achieve a healthier population, the ideal goal in the first place. Then, with a healthier population, you can reduce much of the costs of health care by removing much of the unnecessary parts and bureaucracy.
Perhaps this is the kind of paradigm shifting idea that the health care industry really needs? Again, I am extremely uninformed on this topic, so please help me understand what major flaws there are in this idea?
