America Cannot Afford More “Cost Saving” Medical Initiatives
Incremental Agglomeration, Creative Destruction, and the Impending Forest Fire of the American Medical Establishment
Part 1: Introduction
The great promise of every modern medical initiative has been “cost savings.” Indeed, what magnanimous medical aspiration in print or powerpoint could preclude a fast-fact stat about the alarming overspending in American healthcare? Yet, we continue to realize these “cost saving” health initiatives, and health spending inexorably grows despite marginal improvements in care.
Electronic records, evidence-based medicine, patient-centric care, personalized medicine, universal coverage, and genomics —sure, they all sound good, but can America afford another revolutionary “cost saving” medical industry initiative? No, because revolution is destructive, and what institution willfully destroys itself? Not institutions that still exist. So like the non-directive flaws of biological group selection theory, the drastic improvements promised by revolution are beyond the incremental and self-sustaining mechanisms of institutionalism —as intellectually unaesthetic as that may seem.
Every new medical initiative purports revolution by some combination of better education, savings, standards by implementing some new discovery, invention, or idea. But there’s no grand medical conspiracy inhibiting the potential of these ideas; the mundane simplicity is that change is hard work, people are busy, and everyone stakes in the status quo. Only outside competitors are willing and able to metabolize the medical establishment, and while these well-minded initiatives may snuff immediate needs, rather than sparking significant change, they continue to agglomerate like a thicket. Thus the longer revolutionary fire is procrastinated, the more dead wood accumulates, and the greater the inevitable conflagration in healthcare will be.
But today, two decades of information technology has made healthcare revolution imaginable. First, medicine has matured from scholarly practice to information science, and science needs no priesthood. Next, decades of accumulated initiatives choke American healthcare in waste information, a problem information technology solves well… too well. From problems like “pager tag” to communicate simplistic information like blood pressure and on-calls to “governance by bureaucratic harassment” like insurance coding and liability threats outside strict procedure, the revolutionary solution destroys the existing systems and their vested interests. But, destroying useful systems is locally suboptimal, and institutions can act for their own immediate growth and survival. Thus, revolution is fundamentally unachievable by insider initiatives despite theoretical feasibility and best intentions. So finally, a willing and able outsider is necessary to imagine revolution, and the elite groups behind information technology giants like Google have announced their revolutionary intentions with ventures like 23andMe and Google Health. However, revolution is unpredictable, and by the power of the Internet, the eventual leading health revolutionaries could be anybody.
So manifests the quintessential American pragmatic hypocrisy: all tout the wealth-building virtues of creative destruction until the torch of change is under you. Then, change is “unethical.” Only law is more artificially sustained by its own ethical sophistry and willfully abstruse erudition as is the gross establishment of American health. America hates its healthcare, revolution is coming, and no insider medical initiative can stop it forever.
This is a four part serialized essay which will discuss what a revolution in health will and will not look like, why revolution is possible today, and why direct-to-consumer genomics is sparking our imaginations. Subscribe to Think Gene to be notified when new sections are published.
[1] Introduction
[2] Picture of Revolution (coming soon)
[3] Why Revolution Today (coming soon)
[4] The Spark of Direct-to-Consumer (coming soon)
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