I have a problem envisioning a bright future for Haven Healthcare, a collaboration between the founders of Amazon (Jeff Bezos), Berkshire Hathaway (Warren Buffet and Charlie Munger), and JP Morgan (Jamie Dimon) plowing money into a venture led by Atul Gawande, MD.
Entrenched
I have not read a single article and saw not a single pitch by Atul regarding the approach he sold to his funders, but I did my own analysis of the health care business.
Last year, I spent a couple of months dissecting the healthcare business with an MD running her practice, looking to partner with a big hospital. After an extensive deep-dive into the business model, I concluded no suboptimization of the current processes with massive, entrenched “power lines” will yield the disruption needed to change healthcare’s highly corrosive cause.
Even when you are Kaiser Permanente in California and attempt to shave off and combine a few layers in the highly fragmented care process, you will find enormous resistance in other states adopting the same model. Kaiser Permanente is moderately successful in creating a more monolithic and integrated stack of care. Still, its approach does not solve why Americans need so much care in the first place.
Developed
When I came over from Europe some twenty years ago, I could not believe the amount of medicine available for everyday consumption in the supermarket. Especially coming from The Netherlands, where medicine could not be advertised on television, and only aspirin was available over the counter. I still do not take medicine of any kind.
In contrast, Americans now spend 18% of GDP on healthcare, 70% of Americans have one chronic illness, and many have two from the cascading effects of obesity and depression. We are now the second most obese country in the world after Mexico, which must make us question a so-called developed country’s evolutionary integrity.
In implementing healthcare comporting with evolution, a developed country should require less, not more care. For a developed country, spawning human excellence would reduce the need for care.
Statistics
The question is not whether technology will play a supporting role in the current health care processes. It does already, and the use of technology will increase dramatically. For the simple reason, technology, such as telemedicine, helps doctors squeeze more billable hours in a day. Finagling more billable visits per hour charged to health insurance companies is the game all doctors play to make a decent living by virtually any means possible.
These days, being a doctor is not easy nor fun by my definition, as I witnessed from close by. Depending on the service provided to the patient, to get doctor payouts to rise above $100/hour, a doctor must deploy a staff of four people to deal with the necessary ancillary services earning less, deploy scribes to log the diagnoses accurately and deploy administrative staff to comply with insurance company protocols.
The efficacy of using more technology benefits the operating model of doctors, not the patients. Indeed, the fragmentation of service and lack of dedication causes patients to become even more of a number, a statistic, with optimizations designed to increase the billing frequency and increase the number of visits.
I have seen the insurance companies’ payout reports, with about half of all billings, and thus medical care, issued by a doctor eventually paid out.
Theory
Even when we change the theory of the health insurance company that determines what can be discovered (in the words of Einstein), meaning, we change the standard of care by which the doctors get paid, the cause of why people are seeking care in the first place remains lodged in higher-order causal societal issues ballooning the consequence of how we collectively pay for health care.
No improved efficacy of a consequential healthcare system can reliably revert to and resolve the causal reasons for the excessive need for care as a cause leads to a consequence, and by the law of entropy, not the other way around.
Hence, we must do the opposite of what we do today and address why we need so much care to begin with, which will then address the ability to pay for it.
Wellness
In the vast majority of cases, the accountability of health is related to how we take care of ourselves, what we do to our mind and body to keep them both in shape as we age. In the early stages of humanoid development, both would be challenged continually in the quest for survival. No longer, for our existence is not challenged by a brutal, vile maxim of pillage and plunder that could get one killed.
Indeed, some 70% of healthcare cost is now spent on people 70 and older. While those people do not deserve to be neglected, technology can help prevent the new generation from ending up in the same or worse predicament of chronic dependence on care.
Indeed, technology can help facilitate a health care meritocracy by establishing and recording the responsibility of personal wellness and fitness that staves off the cascading medical waterfall of apathy.
Bigger Fish
Giving people more personal responsibility for the development of their health must have financial ramifications. We can easily conjure up a meritocracy where people who, measured on a trajectory of long, take good care of themselves and are rewarded, reverse insurance of sorts. Technology can play a role in establishing and recording records to evaluate the merit of health.
Not all problems related to health come from the personal responsibility of wellness and fitness. For example, extreme poverty in the U.S. of 15.8% causes children to have limited brain development, up to a third less, which leaves them and their parents with limited comprehension and capacity to develop and manage oneself.
Society as a whole has a solemn responsibility to ensure we dramatically reduce poverty, especially in a developed nation the world looks up to, where we could deploy advanced operating-systems for humanity to offer everyone a respectable lifestyle.
Today, 40% of Americans cannot come up with a $400 emergency expense. A large part of the American population is, in essence, enslaved by jobs that barely pay their cost of living, let alone health care related expenses. The obvious example was on display when Jamie Dimon was interviewed in Congress about a female clerk working for his company, JP Morgan, barely making ends meet in California. Many people with decent jobs are forced to eat cheap fast-food as the poison that wrecks their bodies.
The state of health in the United States is very much related to the socioeconomic fallacies of the “systems” on top of our health care system that leak their exhaust into the healthcare system.
Change From Within
Improving our personal responsibility to health must be paired with improving the collective interest in health.
Technology companies should stay away from attempting to optimize the convoluted system of care currently in play. Technology can and should play a pivotal role in wellness aimed to prevent the need for care. For no suboptimization of the current health care system induced by technology will provide any meaningful long-term cost reduction or operating efficiency to society.
Instead, we must address the cause of health. Our state of health derived from the evolutionary strengthening of human renewal derived from an improving understanding of evolutionary biology and anthropology technology companies know nothing about. Saliently, neither do most doctors, as more than 87% of doctors in the U.S. are not educated in evolutionary biology to investigate a disease’s cause rather than patch it up.
The best way to improve the state of health and reduce the cost of care is to improve health and preventive care. So that health care is only used and needed for non-chronic aberrations in human development. The best way to prevent care is to build a new operating system for humanity that no longer leaks its significant manmade exhaust into a health care system and instead seeks to systemically expand the fractal of human ingenuity and capacity using principles innate to human evolution.
Hence, to fix health care, we must move upstream, address cause, and begin to implement nature’s principles to which our health will always be subjugated.
Real change is that simple.
