The Next Revolution in Health Care

By George Lightbourn

No one can argue that there has been too little written about health care or that there have been too few speeches given on the theme.  Yet the contemporary discussion is dominated by a rather slender slice of thinkers and talkers, mainly economists, public policy analysts and politicians.  This is hardly the well-rounded discussion that the issue deserves. 

Where are the physicians, the nurses, the medical ethicists, the venture capitalists?  Venture capitalists? What might they have to say about the state of health care in America?  Plenty.  After all, they are the hearty souls who will provide the money to fuel the future developments in health care.  Already active in the health care sector, these are the men and women who do their homework, put their money where their mouth is, and make the U.S. economy hum.  They are the reason so many of us Johnny-come-lately types made a good deal of money when technology revolutionized the U.S. economy in the 1990s.

So I was interested in what Andy Kessler had to say in his book, The End of Medicine.  Kessler was a fellow who turned $100 million into $1 billion riding the tech wave of the 90s.  He is remarkably inexpert regarding health care and just as remarkably expert when it comes to technology and in turning technology into money making endeavors.   His quirky writing style reveals both a fine mind and a conspicuous curiosity.

Kessler’s is not a book about whether a single payer system is better than a consumer-driven system.  In fact, he writes precious little about health care financing.  His interest is in the technology behind health care and where that technology might be taking the industry.  In his quest, he hopped from lab to lab giving his readers the same behind-the-curtain look at the future of health care that he encountered.

There are a couple of themes that dominate Kessler’s thinking.  First, he is baffled by the imbalance between the amount of money we spend treating medical maladies and the amount we spend detecting them.  Diagnosis and detection have received the short end of the health care spending which has only served to increase the cost and decrease the effectiveness of treatment.

Second, Kessler is convinced that a revolution in health care is just around the corner.  Based on what he describes in the public and private research labs he visited, big changes are coming in the way we Americans interact with the health care system.  He foresees a time when health care consumers do much of their own detection using scanning technology and blood testing that is much more sensitive and advanced than what is currently available to our family physicians.  What’s keeping these advances from coming into wider use is cost, the same cost hurdle that initially kept technology developments out of the hands of all but the wealthy.  Scalability is the elixir in Kessler’s world and based on what he’s seen, scalability in powerful health care diagnostics is not that far away.  And once the cost per unit t comes down, just as it has in every other technological development, let the revolution begin.

Andy Kessler is one of those dreamers that would be easy to blow off if it weren’t for his track record.  As I was reading the book I found myself cringing at how quickly Kessler blew past some of the important applications of technology we have already seen in health care.  Dane County is home to a number of bustling companies including Tomo Therapy which is improving the delivery of radiation and Epic Systems which has become the gold standard in medical record keeping.  While Kessler would see these companies as greatly improving the product, he would not see them as revolutionizing the industry.   Regardless, The End of Medicine is a provocative, inspiring read.

Does Kessler’s message have relevance to the current discussion of how we ought to pay for health care?  I think it does.  We can see a good deal of evidence of the inefficiency of the current health care system, one that is lethargic, internally driven and favors treatment over early detection.  So the status quo is far from ideal, but would a government-dominated, single-payer system be an improvement? 

Experience would tell us that government has a zeal for cost containment and a pathological aversion to risk.  Our government, born of revolution, is anathema to the type of revolution Kessler foresees.  I think Andy Kessler would favor as light of a touch as possible from government.  He would want entrepreneurs free to work with the research community to do to health care what they have done to technology sector of the economy.  In that world, government is hardly a facilitator but rather, a force to work around.