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December 03, 2007


James Drogan

You've long been one of my favorite reads and this post is of the type that keeps me coming back -- thoughtful, comprehensive, easy-to-understand, dealing with a significant issue.

I think it highly unlikely that the leadership you call for will be found at the national level. What then is required is leadership in various niches of the socio-political-economic structure -- companies, states and counties, universities.

This, it seems to me, will require uncommon commitment on the part of rare individuals who command in these niches. This approach invites fragmentation of effort, but perhaps some sort of unifying collaboration can help overcome this issue.

I agree with you that the health system is complex, but I also believe it can be simplified.

What is broken is that most critical part of any system -- the human. Political correctness, obfuscation, special interests, fear of competition need to be overcome. Yes, we need uncommon individuals to take this on.

Chris Ward

It's not just the USA; different countries in Europe have different ways of organising (and funding) health care, and different sets of outcomes.

The 2 significant advances over the last century have been 'public sanitation' and 'antibiotics'; and even 'antibiotics' might go into reverse as bacteria evolve.

Beyond those, the difference between 'healthcare' and 'automobile manufacture' is that with auto manufacture, you're aiming for a stable process and an identical 'product' each time you turn the crank to make another one. You do process experiments and process changes with a view to improving quality, or reducing cost.

But with healthcare, every person is different.

So it's a challenge.

Can you invest to bring a sustainable income stream ? That is, is it a challenge that a capiialist system can address ?

Chris Ward

In the auto industry, it's only the 'manufacturing' stage of the process that has been revolutionised.

As soon as the auto leaves the factory and arrives at the dealership, it's likely to languish on the forecourt waiting for someone to buy it. I believe that the 'benchmark' is 90 days.

Then, after the thing is driven off the forecourt, who knows what is likely to happen to it ?

It's actually quite similar in 'healthcare'. The first stages of a human's life ... up to leaving the mother's womb ... are quite well controlled and predictable, at least in the Western world. The next few stages, too; look at the vaccination schedule, and the proposition that US schools will not accept unvaccinated children.

But after that, the control comes off. Do you look at it as 'loss of quality' ? Or 'diversification and blossoming' ?

DC Martin

The challenge in this industry is the difficult issue of profit margin and the recognition that such profit margins are required for necessary investment in productization of innovation. In other industries the very "best" customers account for the greatest profit margin and actions are taken to increase demand. If that paradigm was followed in healthcare we would expect to see a system that forestalls pro-active, pre-emptive care in favor of intensive, expensive last-minute care.

Interestingly, that is what we experience.

If we wish to change the system we must change the timing of the profit margin, spreading it out over the lifetime of the patient. In addition, we must find ways to increase profit throughout the lifetime of the patient so that a long-life is more profitable than a short one.

In addition, if we wish to see innovation delivered to the majority of patients we must recognize that all such innovations must be routinized through the expenditures of early adopters who are self-motivated to spend on such innovations. We do not enable our seniors to participate in both Medicare and be able to choose physicians who do not participate. While this may appear egalitarian, it limits the ability of those who can afford to pay for those innovations.

So all we need to do is identify the parties who stand the make the greatest profit when people live the healthiest and longest lives possible and ensure that our intellectual property systems deliver compensation to those who provide the innovation that will allow us to achieve our objective.

Anne Johnson

There are at least three points of approach here, all of them large in scale.

1. Irving's Improve Health System Supply Grand Challenge - how to improve the coordination and delivery of health care.

2. DC Martin's Reduce Health System Demand Challenge - how to use the profit approach to compensate innovations which allow the least possible use of the current health care system while promoting healthy longevity.

Both of these require 'big system' development. There is a third approach, which is actually within the reach of almost everyone - for each individual to take responsibility for consuming no more food energy than the energy they expend over a day or a week. In aggregate this is also a hard problem, running into the profit motives of the fast food, sugar and corn industries. Unlike the others, though, it is possible for each individual to do something, right away, which would make a difference to them.

All of these approaches are required.

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