Let’s paint a picture many of our readers might find familiar.
Let’s say there is a service which can be provided to the public, and let’s say that service comes in a number of different forms. Some forms of that service – the high-end, high-stakes forms of it, to be more specific – are handled by private companies which evolve into some of the most technologically advanced marvels of organizational performance in world history.
But the other forms of that service are…different. In those other forms, the low-end, low-stakes forms, service is provided by the government. Prices don’t fluctuate as a matter of the market; they’re set by Congress. And despite performing a service the public unquestionably needs, the government operation loses money hand over fist as it fails to adapt to changing market conditions.
And over time, the market responds to the government’s inability to serve it by embracing technology. It turns to the digital space to perform many of the typical functions of that service, and before long one can see a day in which the government’s side of the service won’t be needed at all; in fact, much of what the government is currently doing within its performance in the industry in question is regarded as a nuisance by the public.
Sounds like the shipping business and the Post Office, doesn’t it?
FedEx and UPS have emerged as two of the truly outstanding corporations in the world, and their capability to deliver packages practically anywhere on the planet with lightning speed, and for a price that, while it’s relatively high-end, is quite reasonable.
And yet the Post Office’s inability to match that performance in the downscale market, despite a massive and highly-paid workforce, has left it in the dust where the market’s needs are concerned.
The market’s rejection of the Post Office first manifested itself when fax machines became the rage, and shortly thereafter e-mail turned into a standard mode of communication to replace the letter. And increasingly, the public pays its bills online, eliminating even more of what used to be the role of the United States Postal Service.
Give us Obamacare and a few years, and don’t be surprised if that above description doesn’t apply to the healthcare business – already largely gobbled up as it is by government programs like Medicare and Medicaid, which distort the market and largely prevent the efficiencies which would likely result from the free interactivity between consumer demand and industry supply.
Glenn Reynolds had a terrific column at USA Today yesterday which gamed out how much of this could look once Obamacare makes the inadequacies of the healthcare industry much more glaring than they already are…
We’re already seeing things that once took place only in doctors’ offices trickling out into the real world. I thought about this just the other day when reading that schools are stocking auto-injectors of epinephrine to deal with sudden, life-threatening allergy attacks. With these injectors, you don’t have to have any particular medical skill: “The tip of the device is placed firmly against the thigh, which releases a short, spring activated needle that injects the epinephrine.”
With a severe allergic reaction, by the time you got the victim to the hospital it would probably be too late. But with an auto-injector on the hand, you can administer life-saving treatment right away, and the technology makes it easy to store and easy to use.
This phenomenon holds true even for far more sophisticated technologies than just spring-loaded needles. Many schools — as well as malls, airports, and other public facilities — are installing Automated External Defibrillators. These are designed so that almost anyone can use them to administer life-saving resuscitation to someone whose heart has stopped or gone into deadly ventricular fibrillation. A computer in the device reads the victim’s EKG and administers a shock if called for. Voice commands tell the user what to do.
How simple are these gadgets? So simple that you can buy them on Amazon, to install in your home.
The proliferation of these defibrillators is a good thing, since sudden cardiac death is a serious problem, and it often strikes unlikely victims. But this is just the start.
Over time, I think we’ll see a lot more intelligence moving into medical devices covering a wide range of subjects. (And, in some cases, it may do the job better than a human doctor: When my wife had a heart attack at the age of 37, the EKG machine at the hospital flagged her reading as indicating a possible myocardial infarction, but the doctors dismissed that because she was a young, thin, athletic woman. The machine was right, and they were wrong.)
Quite right. Much of what is done in the medical field hardly requires a doctor; we don’t allow non-doctors to perform some of those services largely because (1) the tort law industry’s ability to impose liability on non-doctors infringes on the entry into the market of people without a medical degree, and (2) the doctors hire lobbyists to keep their share of the market where they want it.
But technology has a way of de-mystifying some of the more advanced tasks an economy needs performed. It used to be, for example, that to perform advanced calculations you needed to have an advanced degree in mathematics or be some sort of prodigy; now, people of average intelligence can use programs like Microsoft Excel to process those calculations in minutes.
And since so much of healthcare involves the collection and processing of data, technology is a solution in that business which might well alleviate the economic dislocation of what will be an increasingly dysfunctional public-sector system.
While we’re a long way from the “autodocs” featured in some science fiction stories, the proliferation of devices that can do extensive blood tests and diagnostic workups doesn’t seem that far away. Neither does the creation of freestanding gadgets that can diagnose things such as strep throat and other staples of doc-in-a-box or nurse-in-a-box practices now.
While such devices will be expensive at first, they’re likely to get steadily cheaper and more capable because, as electronic gadgets, they’ll benefit from Moore’s Law, the steady increase in computing power.
A few years ago, Andy Kessler wrote a book predicting just this kind of thing. It seemed plausible at the time, but it seems more plausible now. And while I’ve worried in the past that Obamacare might slow progress in these areas, the high costs (and high deductibles) of the policies we’re seeing under Obamacare make me think that it may instead push people toward this sort of alternative.
The challenge, though, is going to be to keep the technological advances that introduce low-cost “doc-in-a-box” solutions to make for a healthy public that doesn’t need the government healthcare system out of the hands of that system. Defending medical technology from Obamacare might be the final redoubt of conservatives as the current horror show of that program’s rollout progresses toward calls for a single-payer system.
And given the promise of escape that technology offers, perhaps it’s time for the GOP to renew its demand for a repeal of the Obamacare medical device tax. That tax is probably the most important current obstacle to Reynolds’ medical technology revolution. Its repeal could be a key to providing an way out for millions of people desperate to avoid public sector health care.