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You may well be right, but nevertheless, where medical care can be automated, it should be. Because otherwise medical care never gets more affordable. The econo

You may well be right, but nevertheless, where medical care can be automated, it should be. Because otherwise medical care never gets more affordable. The economy doubles in size, wages double in the general economy, and ... doctors wages double. As long as we consider medicine an elite profession (so that we don't train an overabundance of doctors and drive the wages down, which most of us wouldn't want to do) employing medical staff will always cost some approximately fixed multiple of the median hourly wage. And medical care is and has always been too expensive to provide proper care for the entire population. If, for instance, we can automate doctors taking blood pressure readings, by giving patients their own sensor, or automate the drawn out process of step-by-step diagnosis by driving down blood cost prices so that 50%, 5% and 1% diagnoses can be explored simultaneously, or have automated machines which allow frail, elderly patients to bathe without needing a nurse, then we can really start to improve care, and decrease cost (which, in any case, will simply be reallocated to dealing with other ailments). Doctors lose nothing, but, step-by-step, the general population gains immeasurably.

eru 13y ago
> And medical care is and has always been too expensive to provide proper care for the entire population. Which countries are you talking about here? (I agree with your general sentiment, though.)
- Brakenshire 13y ago
  I know there are issues which are specific to the States, but I would say this applies almost everywhere. Almost everywhere doctors are paid 5-10 times the median wage, because they are chosen from the top few percent of students, and that difference in wages introduces an inherent asymmetry in how many hours of work are necessary to buy an hour of a doctor's time. The majority of the population, certainly as people age, have low level health issues which they manage imperfectly. You don't exercise enough because your knee is a bit gammy (perhaps requiring physiotherapy or knee surgery), your cholesterol is high, cancer is spotted six months later than necessary because you thought your dodgy stomach or sore throat was just something minor, etc, etc. And, you know, even in countries with good health provision for the poor, the middle-class still get much better care, because they talk to their doctor friends, know how the system works, research their options thoroughly, and so on. Perfectly reasonable behaviour, but the fact that it is necessary shows up the gap and the inherent limits in provision. The cheaper healthcare is, the higher the baseline and the average can rise.
  - eru 13y ago
    Oh, sure, there's an infinite amount of (generalized) health care people might want to consume if the prices are low enough. You can get there either by lowering the pay of health care people, or by making them more productive per humman-hour, eg via automation or just better business practices.
    - dagw 13y ago
      There are two prices of health care I have to pay. One is the up front cash (or monthly insurance) cost I have to pay, the other is the massive time sink and general pain and inconvenience it is to get it. I live in country where the cash cost is basically zero, yet I consume as little health care as possible due to the high second cost. In fact the times I do need health care I often opt to pay more up front to avoid as much of the second cost as possible. As long as you keep the second high enough the demand for health care won't go to infinity even as the first cost goes to zero.
      - eru 13y ago
        Yes, the demand will only go up in relation to the total cost. (I am not sure making people wait and introducing hassle is a good way to regulate demand, though.)
yeukhon 13y ago
> Because otherwise medical care never gets more affordable. They can be affordable but the problem is largely because of the large number of law suits hospitals might have to face, and plus the cost of buying those technology. Then you go with drugs. Those are expensive. Regulations, license, those are costly too. And salary too, very high. One might argue that doctors deserve to be paid more if they can do the job properly, saving people's life. I won't get into that, but unless you can cut drug $$ down, salary down and law suit down, or at least two of them, you won't get very far from affordable healthcare. You might ask why isn't Chinese medicine expensive.
- Brakenshire 13y ago
  You're right of course that inflated drug prices and lawsuits are significant costs, but, for instance, the NHS analyses all proposed pharmaceuticals for cost-effectiveness, and barters with the manufacturers at a national level, and medical litigation in the UK is almost nil. The system is more efficient, but there is a base-line which is impermeable. The only way to go below that is to train many more doctors, and start paying them something closer to an average wage, but, firstly, they'd just move abroad, and secondly, you would not be able to persuade the candidates to train for ten years if they didn't earn a decent professional wage. The only other option is to move some of the burden onto technology.
bigchewy 13y ago
Almost none of the prescriptions you offer have any measurable impact on healthcare spend. Blood pressure readings -> performed by $18 Medical Assistants Step by step diagnosis -> office visits are < 4% of total healthcare spend etc. Now, what actually costs money is getting your spine surgery at Stanford rather than the outpatient clinic which costs more than getting physical therapy. It takes a person (often a doctor) to help guide a scared patient towards the most effective option, not the most expensive one. We, as patients, are not experts, so we choose the expensive option as the best proxy for quality. Computers can't engage in a meaningful discussion.

eru 13y ago

> And medical care is and has always been too expensive to provide proper care for the entire population. Which countries are you talking about here? (I agree with your general sentiment, though.)

Brakenshire 13y ago
I know there are issues which are specific to the States, but I would say this applies almost everywhere. Almost everywhere doctors are paid 5-10 times the median wage, because they are chosen from the top few percent of students, and that difference in wages introduces an inherent asymmetry in how many hours of work are necessary to buy an hour of a doctor's time. The majority of the population, certainly as people age, have low level health issues which they manage imperfectly. You don't exercise enough because your knee is a bit gammy (perhaps requiring physiotherapy or knee surgery), your cholesterol is high, cancer is spotted six months later than necessary because you thought your dodgy stomach or sore throat was just something minor, etc, etc. And, you know, even in countries with good health provision for the poor, the middle-class still get much better care, because they talk to their doctor friends, know how the system works, research their options thoroughly, and so on. Perfectly reasonable behaviour, but the fact that it is necessary shows up the gap and the inherent limits in provision. The cheaper healthcare is, the higher the baseline and the average can rise.
- eru 13y ago
  Oh, sure, there's an infinite amount of (generalized) health care people might want to consume if the prices are low enough. You can get there either by lowering the pay of health care people, or by making them more productive per humman-hour, eg via automation or just better business practices.
  - dagw 13y ago
    There are two prices of health care I have to pay. One is the up front cash (or monthly insurance) cost I have to pay, the other is the massive time sink and general pain and inconvenience it is to get it. I live in country where the cash cost is basically zero, yet I consume as little health care as possible due to the high second cost. In fact the times I do need health care I often opt to pay more up front to avoid as much of the second cost as possible. As long as you keep the second high enough the demand for health care won't go to infinity even as the first cost goes to zero.
    - eru 13y ago
      Yes, the demand will only go up in relation to the total cost. (I am not sure making people wait and introducing hassle is a good way to regulate demand, though.)

yeukhon 13y ago

> Because otherwise medical care never gets more affordable. They can be affordable but the problem is largely because of the large number of law suits hospitals might have to face, and plus the cost of buying those technology. Then you go with drugs. Those are expensive. Regulations, license, those are costly too. And salary too, very high. One might argue that doctors deserve to be paid more if they can do the job properly, saving people's life. I won't get into that, but unless you can cut drug $$ down, salary down and law suit down, or at least two of them, you won't get very far from affordable healthcare. You might ask why isn't Chinese medicine expensive.

Brakenshire 13y ago
You're right of course that inflated drug prices and lawsuits are significant costs, but, for instance, the NHS analyses all proposed pharmaceuticals for cost-effectiveness, and barters with the manufacturers at a national level, and medical litigation in the UK is almost nil. The system is more efficient, but there is a base-line which is impermeable. The only way to go below that is to train many more doctors, and start paying them something closer to an average wage, but, firstly, they'd just move abroad, and secondly, you would not be able to persuade the candidates to train for ten years if they didn't earn a decent professional wage. The only other option is to move some of the burden onto technology.

bigchewy 13y ago

Almost none of the prescriptions you offer have any measurable impact on healthcare spend. Blood pressure readings -> performed by $18 Medical Assistants Step by step diagnosis -> office visits are < 4% of total healthcare spend etc. Now, what actually costs money is getting your spine surgery at Stanford rather than the outpatient clinic which costs more than getting physical therapy. It takes a person (often a doctor) to help guide a scared patient towards the most effective option, not the most expensive one. We, as patients, are not experts, so we choose the expensive option as the best proxy for quality. Computers can't engage in a meaningful discussion.