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Monday, May 8, 2017

#HealthIT and the American Sickness

Elisabeth Rosenthal:

In the last twenty-five years, nearly every aspect of our day-to-day lives has been made easier by digital technology: banking, watching films, traveling, communicating with loved ones near and far away, purchasing a new home. But healthcare is an exception to the rule.

That’s not because of a lack of investment. Silicon Valley is hot on healthcare. Even though tech funding in general has fallen off lately, digital health funding went up 13 percent in the first quarter of 2016, with investment for the quarter reaching nearly $ 1 billion. Every week I get more than a half-dozen pitches from start-ups touting new machines or claiming that their algorithms and apps will empower consumers and solve the healthcare cost crisis.

The problem is that these huge investments and the products they spawn are of highly variable benefit to patients. Health technology can be deployed for enormous patient good, but often all it offers up are useless, but profitable, services. If a company exists to untangle or parse the data in our convoluted system, the real answer is not to add another layer designed by entrepreneurs looking for profit, but to make the system simpler.

Consider the five largest healthcare start-up deals in that first boom quarter of 2016: $ 175 million for a start-up that describes itself as a “clinical intelligence platform for cancer care providers” (funded largely by drug companies that want to mine the data for faster approvals); $ 165 million for a company that develops and sells wearable wrist monitors that provide “personalized insights into how [users] sleep, move and eat; $ 95 million for an (or “another”) online platform that offers “intelligent health information” to patients; $ 70 million for a company that promises to “warehouse” healthcare data; $ 40 million for an outfit that developed a kiosk to deploy in drugstores and malls that can screen for blood pressure, weight, pulse, and body mass index. (Automated measurements are notoriously inaccurate; there are simpler ways to measure these parameters and no medical reason to regularly monitor some of them anyway.)

With our purchases and our votes, we should make sure that new technology serves patients before investors’ profits...

Rosenthal, Elisabeth (2017-04-11). An American Sickness: How Healthcare Became Big Business and How You Can Take It Back (pp. 321-322). Penguin Publishing Group. Kindle Edition.
Hashtag #anamericansickness.

She goes on to discuss in more detail the relative (and sometimes dubious) merits of digital stuff such as "wearables," "telehealth," and "interoperability/patient data access." She also brings up the still-contentious federal "Meaningful Use" initiative, which gave birth to this blog in 2010.

apropos of all of this, excellent interview with the author:
Why are American health care costs by far the highest in the world? Journalist and former practicing physician Elisabeth Rosenthal chronicles how we got here in her new book, "An American Sickness." Economics correspondent Paul Solman talks with Rosenthal about the forces driving high prices and what could be done to bring costs down.

Again -- and particularly given the recent narrow House passage (by a 1-vote margin) of the controversial "AHCA" bill -- I find this book a must-read (though I have to admit to my concerns going to the viability of her "How You Can Take It Back" assertions, in light of the powerful forces aligned against patients).


I tweaked the crude little "Health Care UTIL" graphic I'd rendered.

Click to enlarge. Again, what am I missing?
Every health care stakeholder on the provider side -- physicians, clinics, hospitals, pharma, biomed, insurors, etc -- claims to be losing money and needs higher prices, or it will exit its respective market space. Yet, to our "Repeal and Replace" "conservatives," the ostensible beneficent magic of (inexorably margin-minimizing) "free market competition" will somehow leave them better off and happier (The Monopolism Wisdom of Peter Thiel notwithstanding) -- accepting lower returns in order to "bend the cost curve" significantly and durably down for the benefit of patients (and our chronically ballooning NHE). I'm not sure we're ever gonna get coherent, productive consensus dialogue on this maddening perplex.
On the subject of UTIL and costs, see my prior post "Rationing by 'Price'."

On health care "pricing,"

Ahhh... the lovely buzzword "transparency." My phrase above, "inexorably margin-minimizing" could not be more apt. Margin is inescapably to a significant degree a function of opacity (plus, of course, barriers to entry of competitors). "Conservative" politicians love to bloviate euphorically regarding the ostensible unalloyed virtues of "free markets" and "competition" until transparency erodes (their donors') margins, at which point they invariably whine and stomp about "predatory competition."
Again, read An American Sickness.

More to come...

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