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The doctor-centric medical system is rapidly becoming technologically obsolete. It’s now cheaper to get an MRI with radiology report than a primary care office

by jl2718 6y ago

The doctor-centric medical system is rapidly becoming technologically obsolete. It’s now cheaper to get an MRI with radiology report than a primary care office visit. Lab tests for most common ailments are less than gas to get to the hospital (GSA schedule pricing). Doctors don’t have any more information than the diagnostics tell them. Office visits are a functionally useless exercise. Innovations in private elective procedures have dramatically reduced costs and increased safety compared to procedures controlled by hospitals and paid by insurance. The government pays for drug development and then the FDA grants monopolies charging several orders of magnitude markups and giving kickbacks for prescriptions. Although there is little technological need for most doctors, the administrative demand is greater than any other industry, but don’t expect many H1Bs granted for physicians. Limiting access to the profession through high standards is actually great for innovation, if innovation is allowed, but protecting obsolete functions is probably bad for everybody. I’d like to do some angel funding of new concepts in private consumer healthcare that go around the system. Medical hacker stuff. For instance, you can buy an imaging ultrasound system from China for roughly the cost of a single ultrasound appointment. I think micro-MRI is achievable under $10k, mostly a problem of data analysis. X-rays of course could be very cheap if people could be trusted not to abuse them. DIY blood and urine testing could be nearly free. I don’t want to sound like Elizabeth Holmes here; I’m mostly talking about known existing simple procedures with huge unnecessary overheads, replaced by DIY, community, or AI business models that are aligned with users.

derbOac 6y ago
The worst problem with the AMA is that it's worked to completely distort our expectations about what is possible in a healthcare system. A lot of the comments here are focused on artificial restrictions in supply of physicians and so forth, which are important issues, but the more insidious problem is the way in which licensing and practice laws distort alternative structurings of healthcare delivery. As you point out, healthcare should be more consumer-driven, with providers acting more as consultants, akin to how tax accountants and lawyers work. The problem isn't necessarily that we need more physicians, it's that we need consumers to get more of their healthcare directly, and/or through alternate providers like pharmacists, psychologists, dentists, optometrists, or some other classes of providers we haven't even dreamed up yet because the healthcare system is so centralized and rigid. The discussion of healthcare in the US has focused so much on who pays, with such little attention to how the care is structured, when it seems to me that's a much bigger problem. To me the payment issue is almost an entirely different issue. I have lots of family in healthcare, including physicians in administration, and they're terrified of single-payer not because they don't want universal care, but because they already see the healthcare system overburdened by regulation and red tape, and don't really see how having single payer (as opposed to something like the ACA) will really help a lot. In their minds the only thing worse than what existed 10 years ago, is what existed 10 years ago plus a monolithic government agency controlling payment as well. I see an important role for physicians, but there needs to be a lot more flexibility and deregulation in healthcare. There's so much that could be written about this it's absurd.
wutbrodo 6y ago
> I’d like to do some angel funding of new concepts in private consumer healthcare that go around the system. Medical hacker stuff. For instance, you can buy an imaging ultrasound system from China for roughly the cost of a single ultrasound appointment. I think micro-MRI is achievable under $10k, mostly a problem of data analysis. X-rays of course could be very cheap if people could be trusted not to abuse them. DIY blood and urine testing could be nearly free. The challenge here isn't technological. As you point out, there are a lot of things you could do, but I'm not confident that the relevant lobbying groups won't just pay off the government to ban whatever it is you want to do. Corruption is more or less open the minute it gets too complex for the average person to understand, and healthcare regulation falls squarely into this bucket. Name some protectionist, anti-patient, cost-increasing move the "Patient Protection Act" and half the idiot voters out there will support it. Specifically, the half of the country reflexively inclined to support any positive-sounding regulation instead of those reflexively inclined to oppose it (most voters' brains consist almost entirely of these "reflexes")

by jl2718 6y ago

derbOac 6y ago

The worst problem with the AMA is that it's worked to completely distort our expectations about what is possible in a healthcare system. A lot of the comments here are focused on artificial restrictions in supply of physicians and so forth, which are important issues, but the more insidious problem is the way in which licensing and practice laws distort alternative structurings of healthcare delivery. As you point out, healthcare should be more consumer-driven, with providers acting more as consultants, akin to how tax accountants and lawyers work. The problem isn't necessarily that we need more physicians, it's that we need consumers to get more of their healthcare directly, and/or through alternate providers like pharmacists, psychologists, dentists, optometrists, or some other classes of providers we haven't even dreamed up yet because the healthcare system is so centralized and rigid. The discussion of healthcare in the US has focused so much on who pays, with such little attention to how the care is structured, when it seems to me that's a much bigger problem. To me the payment issue is almost an entirely different issue. I have lots of family in healthcare, including physicians in administration, and they're terrified of single-payer not because they don't want universal care, but because they already see the healthcare system overburdened by regulation and red tape, and don't really see how having single payer (as opposed to something like the ACA) will really help a lot. In their minds the only thing worse than what existed 10 years ago, is what existed 10 years ago plus a monolithic government agency controlling payment as well. I see an important role for physicians, but there needs to be a lot more flexibility and deregulation in healthcare. There's so much that could be written about this it's absurd.

wutbrodo 6y ago

> I’d like to do some angel funding of new concepts in private consumer healthcare that go around the system. Medical hacker stuff. For instance, you can buy an imaging ultrasound system from China for roughly the cost of a single ultrasound appointment. I think micro-MRI is achievable under $10k, mostly a problem of data analysis. X-rays of course could be very cheap if people could be trusted not to abuse them. DIY blood and urine testing could be nearly free. The challenge here isn't technological. As you point out, there are a lot of things you could do, but I'm not confident that the relevant lobbying groups won't just pay off the government to ban whatever it is you want to do. Corruption is more or less open the minute it gets too complex for the average person to understand, and healthcare regulation falls squarely into this bucket. Name some protectionist, anti-patient, cost-increasing move the "Patient Protection Act" and half the idiot voters out there will support it. Specifically, the half of the country reflexively inclined to support any positive-sounding regulation instead of those reflexively inclined to oppose it (most voters' brains consist almost entirely of these "reflexes")