I Was Wrong – The Health Care Blog


The New York Occasions had an fascinating set of op-eds final week below the theme “I Was Unsuitable.”  For instance, Paul Krugman says he was improper about inflation, David Brooks laments being improper about capitalism, and Bret Stevens now fears he was improper about Trump voters.  No person fessed up about being improper about healthcare, so I’ll volunteer.  

I’ve been writing usually about healthcare for over a decade now, with some sturdy opinions and infrequently with some fairly speculative concepts.  I’ve had quite a bit to be improper about, and I hope I shall be improper about a lot of them (e.g., microplastics).  A few of my ideas (akin to on DNA storage or nanorobots) may be nonetheless too quickly, however there are undoubtedly some issues I’d thought, or at the very least hoped, would have occurred by now.

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I’ll spotlight three:

I assumed we’d care extra about our well being  

Twenty plus years in the past I used to be an evangelist for what we’d now name digital well being.  Give individuals extra, higher well being info and a few helpful well being instruments, then actually they’d  use them to enhance their well being. If I’d recognized about smartphones or wearables I’d have been much more certain.

However, it seems, not a lot. Sure, we’re all fairly good about googling well being info, many people have well being apps on our telephones, and wearables are cool, however we’d be laborious pressed to pinpoint precisely how our well being has improved, usually talking.  Our epidemics of weight problems, diabetes, and different continual situations proceed to develop, and our mortality charges have been a humiliation even earlier than the pandemic’s results. 

The pandemic exacerbated, however didn’t trigger, well being disparities that fall alongside racial, ethnic, and socioeconomic strains, ones that almost all nations can be embarrassed about however which the U.S. appears to tolerate with out a lot political will round addressing them. ACA helped, however it was solely a finger within the dike, and that dike is cracking.

Even worse, the pandemic proved that we care extra about politics than our well being, to the purpose many resist taking vaccines which were confirmed secure and efficient, or following easy public well being measures like masking or social distancing. Even worse, many states are weakening public well being departments’ powers usually.  How did taking good care of our well being develop into a political litmus check?

We’ve additionally proven that faith additionally trumps well being, as evidenced by abortion restrictions. Some individuals’s non secular views {that a} fetus is an individual, even at conception, outweighs a lady’s rights to her personal physique, and even her personal life. And people so-called “pro-life” believers solely appear to care in regards to the fetus throughout the being pregnant.  

I assumed we’d care extra about sufferers than earnings

Foolish me.

Twenty and even ten years in the past looks as if such a less complicated time.  Hospitals hadn’t, for probably the most half, consolidated, franchised, or gone abroad.  Doctor practices hadn’t been purchased up in massive numbers.  Non-public fairness didn’t see specialists, air ambulances, nursing houses, or ER docs as big revenue alternatives.  Pharmaceutical corporations hadn’t absolutely mastered how you can lengthen their patents virtually indefinitely with a view to maintain costs excessive.  Well being insurers have been completely satisfied if they may eke out margins within the low single digits.  

The healthcare system has gone all Martin Shkreli, discovering earnings wherever and in all places, the extra the higher.  There’s no proof that hospital consolidation improves affected person care and loads of proof that it raises costs. Medical faculty college students see the revenue differentials and are more and more opting to enter specialty fields.  Everybody has horror tales about prescription drug costs, but Congress appears powerless to behave, little doubt as a result of pharmaceutical lobbying clout. Nobody thinks that personal fairness is trying to do something however line their buyers’ pockets. Well being insurers have develop into so diversified that they’ve extra income streams than we are able to depend.

We’re closing in on well being care at 20% of GDP. I keep in mind individuals being alarmed when it hit 10%; how far more does it must get earlier than we acknowledge we’re chasing the improper issues?

I assumed somebody would determine how you can wreck healthcare 

Mark Zuckerberg’s well-known motto was “transfer quick and break issues,” and Fb did each, considerably to everybody’s chagrin (and, but, we maintain utilizing Fb…).  That perspective has by no means caught on in healthcare, ostensibly as a result of it’s too harmful for sufferers. However, I’ve come to suspect, it’s extra that it’s too harmful for healthcare’s many vested pursuits.

I’ve been in search of a number of years for healthcare’s Uber, the entrant(s) that don’t care about how the {industry} has been structured (or regulated) and need to introduce a brand new, higher client expertise.  Massive Tech was going to come back in (particularly Amazon). Walmart was going to come back in.  Different retail corporations, like Greatest Purchase or online game corporations, have been going to come back in. Effectively, they’re in, however I’m not seeing that a lot disruption.

We’ve acquired scores of digital well being corporations getting ridiculous quantities of cash, and lots of of them are doing fascinating issues, however I don’t see many industry-wreckers amongst them.  They’re extra within the “if we are able to simply get 0.x% of healthcare spending, we’ll all be wealthy” mindset.

Once more, Uber didn’t come alongside to enhance the taxi {industry}’s know-how and even its rider expertise. It mentioned, the taxi {industry} is a 1950’s mannequin, with very restrictive rules, so we’ll invent a brand new {industry} that replaces it. There’s quite a bit to criticize Uber for, however many of the “innovators” I see in healthcare are within the “enhance taxi {industry} know-how” class, not the blow-up-the-antiquated-healthcare-industry-model(s).

I’m satisfied there’s a healthcare system on the market that’s less expensive, far more efficient, far more handy, and far more equitable.  However persevering with to graft on to our healthcare system’s present edifices isn’t going to get us to that.   


Barring some kind of miraculous life extension know-how, I’m not going to stay lengthy sufficient to see what a 22nd century healthcare system appears like.  I’ve excessive hopes for it, and none of these hopes embrace it being much like at this time’s system.  

I hope that’s barely seen to us and that we don’t even essentially consider it as a well being care system (or, at the very least, a medical care system), as a result of well being is so woven into our lives.  I undoubtedly hope that well being is not a perform of your revenue, race/ethnicity, gender, or location.  

I simply hope I’m not improper about all that too. 

Kim is a former emarketing exec at a serious Blues plan, editor of the late & lamented, and now common THCB contributor.

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