Wednesday, July 1, 2009

Putting some soul into health care

My previous three posts have all been about health care. I'ld like to briefly summarize them here and then finish. In the first one I define a governmental agency, like the National Institute of Health, that would act as a transactor for every payment that can be considered a health care expense or a purchase of health care insurance and why I think it is such a wise approach to health care reform. In the second one I outline how that change would affect the basic components of our present health care system and better motivate them to focus on on their specific role, and not just any old way they might increase profits. (And assumed that the present practice of allowing employers to pay the health care expenses of their employees with pre-tax dollars was on its way out.)

In the third one, the previous post, I brought your attention to a particular node or place in cyberspace that would hold all of your medical information and suggested it should exist inside the transactor's databases because that is the most private information about us and that should be very important to our government to protect. The goal is to create an environment where that node actually becomes a personal life advocate for us. A sort of virtual personal assistant that remembers everything about us, has a nearly perfect knowledge of our health history, diet, habits, and myriads of other information that it can use to detect the sorts of things that correlate with opportunities for preventative medicine and make us aware of those choices.

Building a soul for ourselves in cyberspace

Health isn't just being physically fit. It's being educated enough to at least make informed health choices. It's having the infrastructure a person needs to function. Those things are just forms of preventative medicine. The real medicine we'd need by neglecting them is more expensive than the non-medical preventative medicine we need to treat them. If citizens are so important to their governments, how is it no government has even thought to create a computer program that looks for the people it can easily find, would benefit from help, and that it can easily afford to help? That's what this is. Nothing more than a task running on some server in cyberspace with no more to do than be there for you. It's job is to keep you as happy and healthy as you, and it, can figure out how to do.

Think of it as a crude attempt to create a soul for humanity designed to help us be us. We create this computer program that knows a lot about everyone, and uses that information to help us make wiser decisions. If, for example, your behavior changed in some way that correlated well with people who later had a medical problem, this little advocate will make you aware of it. Have a pain you don't understand? It might save you a visit to the doctor or direct the ambulance to where you're lying. If you wanted to change something about yourself, it could be of help since it could look for what worked for others like you that wanted the same thing and got there. If you wanted to learn something, same deal. It will be capable of whatever we are clever enough to teach it. As computers grow in power and software in sophistication I wouldn't be surprised if it renders the field of psychology utterly obsolete in just a few years by doing a much better job of helping us see ourselves clearly and make the changes we want.

The idea is to create a focal point, like the iPhone did, where everyone is invited to deploy their solution to help us be better people (or get more out of the device). Does this imply that I consider people devices? Yes, I suppose it does. Why is that a problem? Doesn't an actor want to get the most out of their instrument? I'm not suggesting we look for ways for others to get more out of you. Just how we can enable you to get the most out of you. No one is going to use an iPhone application that they find annoying. It's the same thing here. If the sort of software that emerges from a system like this was a nuisance, who would use it? Okay, I suppose masochists would love it. But they can almost certainly find devices already that are better suited to amuse them.

Creating the incentive to empower us

Like the iPhone, I'm advocating a standardized forum where anyone can deploy software they believe would be useful helping people become better. We will be the ones to decide how we interact with the data made available this way, and the developers of the software we choose to use will be paid a tiny amount per user by the transactor. The first applications will most likely be electronic patient advocates that help people avoid treatment mistakes (like taking a drug while you are using a different drug that is incompatible,) follow progress, and be sources of information, encouragement, and a connection to supporters. But I would expect lots of stuff to emerge, from software that helps kids do well in school or learn an instrument, to ones that teach adults how to eat more wisely or cope with tragedy.

I see these things as going a long way to lowering the level of overall uncertainty and stress in our lives. I think collectively they'd lead to substantially lower health care costs and healthier longer lives for most people. I also think they would push many other boundaries that limit the opportunities that appear to us and thereby increase the growth rate of our economy.

But most importantly, I see this as a solution we can adopt very quickly and without undue immediate impact (other than starting to phase out employer paid health care.) We can even delay the flow of insurance premiums through the provider to give that industry time to come up with standardized contracts, computer procedures and the other infrastructure needed for a smooth transition. The providers should be routed that way as quickly as possible because there is simply no reason not to. The limiting factor there is to standardize the format of medical information and design and deploy equipment well suited for error-proof collection and delivery of it. All of that should happen regardless of what we do because we need that information for so many things--from better evaluating the efficacy of treatments to the competency of practitioners.

I should also note that I've pretty much avoided any discussion of funding mainly because this suggestion is actually independent of how health care costs are ultimately reckoned with. This is just about how we might get the most out of whatever we do decide to spend.

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