HealthCare

I have an ongoing interest in healthcare.

• I was first CTO for Living Independently, using motion sensors to monitor senior citizens so they could safely live alone longer.
• I was going to join a Complementary Medicine (Alternative Health) startup in 1999, but they failed to get funding.
• I helped start Medscape, 1994-2000.
• I worked for SCP Communications, a medical journal publisher and events manager, in 1992-93.
• I was an internal consultant (Management Engineering) for New York Hospital in 1988-89.
• I did some WorkProcess consulting for Glendale Adventist Medical Center in 1985.

2005: I'm still tempted at times to start a narrow-topic (probably something psych-oriented) healthcare content/community website. I may do it as a side business some time in the future. Might take a Nono Publishing approach of combining a WebLog and a Vertical Search Engine.

• looks like HealthLine beat me to it! :)

Some factors:

• demographic shifts (increasing age) will significantly increase costs
• increasing Chronic Condition-s will significantly increase costs
• US system is optimized for hospital-based care of acute problems
• this doesn't fit with growing areas of demand
• increasing care by lower-skilled professionals, Amateur-s, family-members, and self will be increasingly important
  • Trade Guild forces are fighting against this

Some things broken:

• employers get to deduct their expenses of providing Health Insurance, but individuals can't deduct the cost of insurance they buy themselves. (Tax Deduction)
• the prices to buy Health Insurance as an individual Free Agent are obscene. Does risk-averaging really provide a benefit to insurers handling a corporation? That just doesn't smell right. (Group Purchasing)
• if as a Free Agent you focus on a Catastrophic policy (because, after all, it's pretty silly to buy "insurance" to cover standard physician visits), then you pay a ridiculous fee for doctor visits (if you're an HMO member, you pay $15 and the HMO pays maybe another $45; go alone and you pay over $100). (Group Purchasing)
• we focus on benefits for SeniorCitizens, yet they have much more wealth than children - I think we need Means Testing for Social Security, Medicare, and everything else.
  • just because medical technology makes certain interventions possible, that doesn't mean it's a good idea for the individual. While I'm OK with letting them make that choice for themselves, I'm not convinced the rest of us need to pay for it.
  • many late-life health issues are a direct result of personal Life Style decisions: Smoking, excessive alcohol (Drink Ing), sedentary life (Obesity), super-fatty diets, etc. Why should the rest of us bear the burden of bad Physical Fitness choices?
    • last-year-of-life expenditures account for over 25% of Medicare costs
• Arnold Kling on using Reputation Management instead of Paternalism - he notes Drug Regulation issues, I think Malpractice would be interesting.
  • Oct'2004 update - applying it to Trade Guild WorkRules. Although medical work rules serve primarily to carve out economic rents for health care providers, they are not sold that way to the public. Instead, these regulations ride in under the banner of "consumer protection."
• I think EHealth systems (e.g. EMR) are being mis-designed as overly-scoped messes, rather than be focused on specific areas of problem, like Medical Error-s, that can be attacked by specific behavior changes (e.g. Online Prescribing).

http://www.nlm.nih.gov/nichsr/ihcm/hsrchist.html

http://www.panix.com/~dhenwood/Paying-for-health.html

books on the future:

• http://library.wellcome.ac.uk/doc_WTL038922.html

covered by MedBlog-s