A Glimpse of American Healthcare of the Future (My Talk at Health 2.0)

Thomas Jefferson had a radical notion: When the people are well-informed, they can be trusted to govern themselves. This powerful idea worked to end our rule by the King, but at the time it didn’t apply to slaves; it didn’t apply to women. It STILL doesn’t apply to patients.

I like that he used the word trust, by the way, perhaps the most used word at this conference. It isn’t just something we need to get from people in order to succeed. Trust is a two-way street. So is satisfaction.

In my lifetime, the primary focus of healthcare has moved, first from the hospital to the outpatient visit (“let’s do all we can to take care of people as outpatients”), then from offices and clinics to the home (most health decisions are made at home, often at the home computer). Today health is mobile; it is moving from the home to wherever people are. In other words, we are at the beginning of patient-centered medicine…

We are about at the stage of the Declaration of Independence. A new approach to health has been declared, some people are already living that way, but the old system is still in power.

I predict that in the next four years this will change. By the end of 2012 our healthcare system — and especially the payment system — will be revolutionized. I know this seems unlikely. The current payment system is a deeply entrenched, barnacle-encrusted, labyrinthine system that seems impervious to change. The vested interests are too complex and too well-funded to allow it.

But here’s a secret: the American healthcare system as we know it is a bubble.

At one time, the dot.com bubble of the new economy and the more recent housing bubble looked to many like they would go up forever. The banking bubble grew in the marbled halls of century-old firms. But what looked so solid has quickly changed. There are signs that the healthcare bubble is already weakening. Healthcare costs already consume 16 percent of our GNP, and the percentage is accelerating at an unsustainable pace. Meanwhile, the number of Americans who don’t have access to their doctor on the day they need care has grown to 210 million.

The current system is a burden on our economy (with waste alone estimated at 800 billion dollars every year, more than the banking bailout); it’s a burden on business; it’s a burden on doctors; it’s a burden on people. Healthcare payments are almost reminiscent of taxation without representation. We are ripe for change.

In the American Revolution, the colonies were similar in many ways before and after the transition. The buildings and beauty remained intact. Only unhealthy power and economic chains were thrown off, allowing for new creativity and growth.

On the positive side, computing power will likely double and then double again in the next four years. Exciting new tools for promoting health are rapidly emerging. Rag tag groups of visionaries, including the folks at Health 2.0, e-patients.net, the Ix Center, and others, can be part of a movement that brings about a change that most people would like to see.

How will it happen? Clay Shirky talks about the Power of Everyone. Edelman talks about the power of Health Expertise. I believe the game change comes when these two are brought together, in something people are beginning to call Participatory Medicine.

Heathcare is not something done ‘to’ us or ‘for’ us. Health is something we foster ‘with’ our family, our friends, our community, and with other people dedicated to fostering health. Participatory Medicine is a movement that recognizes the importance of people, their caregivers, and healthcare providers working together as a team to solve our current healthcare problems and promote health for all the people.


Posted in: general | reforming hc | trends & principles




8 Responses to “A Glimpse of American Healthcare of the Future (My Talk at Health 2.0)”

  1. I am a cancer patient and author of Everything Changes: The Insider’s Guide To Cancer In Your 20’s and 30’s. My generation finds it unfathomable that we cannot flip through our medical charts on our blackberries and cell phones. We love the idea of computing power quadrupling in the next four years, however, it takes time and money, both of which the system seems short on. I was diagnosed with cancer at age 27 while living in San Francisco during the opulent, increasing prosperity of the dot com boom, and later during the explosion of the bust. I don’t see the analogy between that and our current healthcare crisis. Roaming the cancer world, I don’t even see the illusion of healthcare prosperity; I only see a downward spiral that is teetering on implosion.

  2. John Grohol says:

    I echo Kairol’s sentiments about medical charts. And the current proliferation of differing, non-compatible PHRs and such is only going to matters worse before they’re better. Hospitals are tied to expensive, enormous legacy systems that do not talk to one another (it’s amazing to walk into a modern medical facility and then find out how their IT system was built 2 decades ago). And while they may try to innovate here and there, it’s more often than not a piecemeal approach (with a few notable exceptions).

    And then try and get one hospital’s medical record to transfer electronically (and instantaneously) to another hospital’s medical record. Today, it can’t be done unless they are miraculously using the same system (and even then, it’s not guaranteed).

    It’s far worse on the small practitioner level. My poor doc complained to me last time I visited him about how his electronic medical system has been in the deployment phase for about 2 years. It’s just him and another doc in a small office-based practice! If it’s this bad for many ordinary docs, you can imagine how long it’s going to take to get us to instant access to our medical records.

    Oh, unless you’re willing to be a data entry person or happen to be involved in one of the very few systems that will put all of the data into a system that you also have direct and immediate access to. While such hospitals are few and far between right now, we’re all hoping they jump on the train within the next few years and open up their records to their patients.

    I’d love to hear more patients direct experiences with this new generation of PHRs and how they are interfacing with their standard medical record. Because I all hear are from the vendors pushing their systems, and the occasional hospital announcing adoption of one of them. So where are the patients in all of this?

  3. Kairol, I’m starting to think that the only solution is for us to start building our own system outside the walls of the current idiotically unworkable systems that John describes.

    I myself don’t use Google Health, but what do you think about it? If you could get all your records into Google Health and access it however you want, would you?

  4. […] the full entry: A Glimpse of American Healthcare of the Future (My Talk at Health 2.0) (No Ratings Yet)  Loading […]

  5. John Krueger says:

    There is an intereesting discussion amongst physicians on this very subject that is on http://www.imedexchange.com. The conversation is only open to licensed US physicians, but the comments are quite candid and very enlightening.


  6. […] talk about Jefferson was great. He recapitulated what he’d said in his October post here, but beyond that, he talked about the “healthcare bubble.” It was superb and powerful; […]

  7. ePatientDave says:

    @tstitt Yes – Jefferson: “When the people are well-informed, they can be trusted to govern.” http://is.gd/mthx #healthcomm

  8. I love reading a post that will make men and women think.
    Also, thank you for allowing for me to comment!

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