So Let's Talk About Health Care

A few things keep popping up everywhere, such as the current US argument about whether to create a more socialized medical system or not, which is largely a debate along partisan lines, and of little interest to this bureau because either it will pass and thus doom healthcare in the US or it won't and thus keep us locked in the slow, painful death of our current system.

The bureau is simply against a single-payer healthcare system because, like all socialist systems, it will pretty much end any innovation in health care. Of course, our current system has channeled 'innovation' into ways not particularly helpful to the rest of us, leading to ever more expensive tailored prescription drugs with ever odder side effects that may or may not be effective at treating the actual problem. Seriously, let's not get started on how broken medicine is.

Above, I did, indeed, mean to say 'more socialized'. The system we have now is already pretty much socialized. Hospitals are subsidized out of public funds. Much of our current research is funded by public funds. Bureaucrats control what remedies can and cannot be used.

One problem, so they say, is that poor people cannot afford expensive procedures, and a single-payer system would ensure this was fixed. Poor people can afford catastrophic insurance. What most of the poor can't afford is the current PPO/HMO plans. Catastrophic insurance is pretty much what it says on the tin; if you break your arm, they will cover it. If you get laid up with cancer, they will cover it. If you want to go to the doctor for the sniffles, they won't cover it.

Believe it or not, catastrophic insurance is actually lots cheaper than a PPO because these things don't happen that often. Regular doctor's visits and simple procedures are to be covered out of pocket, but since catastrophic insurance is so cheap, it is easy to save quite a bit of money to cover the high deductible the plans tend to have.

Now, were the health care system deregulated, further savings could be seen. For instance, most instances of a doctor's visit are for some form of a communicable disease that can be dealt with on an outpatient basis. Believe it or not, your local pharmacist is a very good resource for these sorts of problems because he knows the drugs and what they do better than the average doctor.

As an anecdote, I used to go to doctors to get medicine to deal with my allergies. Invariably, they'd prescribe something like Zyrtec, at that time prescription only, and not properly covered by my insurance. The cost of a month's supply of Zyrtec was $66. My copay was $60. Hardly worth the paperwork, methinks. I got 'downsized' and ended up working for far less money, and no longer had the cash to cover $100 for a doctor's visit followed by $66 for Zyrtec, so I went into a local drug store. The pharmacist asked if he could help and I said I needed a cheap, powerful antihistamine. He directed me to chlorpheniramine, which is so cheap it can be had online for $5 for 1000 pills.

I took chlorpheniramine four times a day until Zyrtec went over the counter. It saved me great wads of cash. However, I probably would have bought the Zyrtec if I could have avoided the 'doctor tax' of $100 per visit.

One other problem with health care is that the average doctor simply cannot be acquainted with every possible syndrome. It is very easy to miss the markers for an underlying condition, leading to vastly more expensive treatment at a later date. This problem has been solved in the engineering field with something called an expert system.

An expert system is a large collection of rules in a computer, although it can be done by hand as well. When a problem crops up, the technician opens the expert system, enters the initial parameters, then conducts the tests the system directs. As each parameter is entered, the system processes the rules to eliminate the ones that do not apply. It then displays the necessary diagnostics to proceed based on the rules that still apply. If the system is well-designed, it can narrow the problem down in a hurry and will provide the same diagnostic solution for every instance of the same disease. Believe it or not, this repeatability does not happen now.

Also, a proper expert system will spot cross-discipline blind spots. It is an old adage that if you tell your doctor what you think you have, you will be diagnosed with that, but there is a corollary that says that if you go to a specialist, you will be diagnosed within his speciality. An expert system would easily spot this sort of problem, as any specialist can run the whole system and the system will, through diagnostic rules, lead the specialist to conclude the disease is in another speciality.

The resulting medical system would be in tiers, with technicians doing most of the actual day-to-day work, with researchers and doctorates responsible for tracking down diseases the system failed to identify and fashioning rules for them. I expect early on there will be a lot of rules that say 'see a specialist in '. The specialist would be expected to craft acceptable rules based on his diagnosis, and would be expected to take a significant amount of time making sure he got it right.

The resistance to this idea the bureau has found falls into a few different categories. I will deal with them each, one at a time:

What if it is wrong?

This is an interesting question. As the system is being developed, it will be wrong rather often, so will require the oversight of an experienced doctor. However, after a period of time, even though the system will still make mistakes, it will begin to be more accurate than the average doctor, whose accuracy is lots lower than any of them like to admit. Further, as time progresses and the system is elaborated upon, it will begin to spot rare and exotic disease earlier than humanly possible. In other words, this sort of thing will eventually be right far more often than a human could ever be.

I don't like being treated by a machine.

The machine won't treat you; medical technicians will do that. They will just do it with far less wasted time in school and with far greater accuracy than any human ever could. Actually, for some people, this sort of thing could be a boon because the average person can self-diagnose most common problems and self-treat using an expert system, which would save even more money and give these people a degree of freedom unheard of before.

I trust my doctor; he's a very intelligent and confident man who seems to know everything.

Doctors do, indeed, have a god complex, which is why they absolutely must not be allowed any real political power. So certain are they of their beliefs, they are prone to having massive blind spots and to being completely unaffected by rhetoric, facts or glaring fallacies. As far as many of them are concerned, if it is in a book or a drug pamphlet, it is correct. They are confidence men, as nobody would let a mere human anywhere near their bodies if they did not act with supreme confidence. However, the dirty little secret none of them want out is that more people are killed by mistakes made by doctors than are killed by handguns in this country. Look it up. Seriously.

Your system would allow people access to valium/painkillers/narcotics/etc.

Sure it would. There's no reason for them to not have access to those things at this time. As a simple aside, almost anyone can get any of those drugs with relative ease despite well over forty years of drug prohibition. Just like alcohol prohibition, drug prohibition has created a criminal element with a strong control of much of the country. This is really fodder for another essay, but banning something is a sure way to make it extremely profitable to criminals.

That being said, once knowledge is out there, it would be easy for the average person to understand what they're doing, and if they have a concern about it, they can check themselves into a clinic.

However, by far the most pernicious facet of the control the doctors exert on medicine is the cost. Drugs are expensive enough, but the average person has no way of determining if the drug they were given was appropriate, or whether or not it was the cheapest option. With the availability of an expert system, such information could be obtained, meaning that, with free availability of medicine, the average person can make an informed decision, either to follow the advice of their medical professional or to go with some other solution.

I won't go deeply into it, but cannabis is clearly in this category. Very expensive drugs exist to deal with the lack of appetite for those under chemotherapy or suffering from AIDS, but few are as cheap and effective as cannabis. Despite that these people are essentially going to die, they are not granted what little comfort cannabis can provide and instead are given drugs whose side effects can often be horrific and whose price is rather stratospheric.

What about all the doctors?

Lots of medical doctors would find themselves being nothing more than medical technicians, as that is what they are now. Initially, lots of trained doctors would be needed to refine the system, but, in the end, most of the doctors are going to have to find something else to do or accept that they will merely be technicians. On a positive note, they ought to be able to handle patients at a higher capacity due to the ease and speed with which an expert system can diagnose problems.

Also, the good diagnosticians will be 'kicked upstairs' to work on the rules. There will be lots of work streamlining the system. If the thing is left to market forces, there will be as many as three competing systems, providing an impetus to develop improvements and refinements to both increase efficiency and accuracy.

So, the monopoly exerted by the doctors' cabal is seriously inflating the price of medicine as a legal monopoly almost always does. Couple that with the economic issues facing insurance and the general decline in real income in this country, and you have the problem in a nutshell, well, a large basket, anyway.