Predictions for a 50% Health Care Economy

Health care costs too much.  Having to pay more for doctors, hospitals and pills is threatening national security, undermining our industrial competitiveness, leading to underinvestment in vital infrastructure and exacerbating economic inequality. As we devote more and more of our individual household budgets, business revenues and national treasure to healthcare, it these excess costs will "crowd-out" our ability to pay for other worthy stuff.

Naturally, insightful Population Health Blog readers know the real story is more complicated than that. Inflation-adjusted costs of other "stuff" that comprise much of the U.S. economy have dropped. As the denominator has gotten smaller, the health care numerator appears relatively bigger.  More on that here. 

What's more, as society has benefitted from lower energy, housing, transportation and food costs, consumers are better able to choose to shift resources toward the health care that they want, which further fuels its growth. 

Plus, there's the observation that government subsidies have a significant impact. Our elected officials are advancing their constituents' wishes, right?

Right now, it appears that health care is costing just under 20% of the U.S. gross domestic product (GDP). Between our

1) appetite for more health care,

2) cheap robots doing everything else for us and

3) the inability of government bureaucrats to resist ever more meddling....

the PHB suspects that the percent of GDP going toward the medical-industrial complex is destined to hit 50%.

The provocative PHB asks if that's such a bad thing.

If 50% of all persons disabled or retired, the other 50% of us can look forward to the happy prospect of being gainfully employed thanks to taking care of them. 

If that's our future, the PHB has some other predictions:

1. 50% of all parking space acreage (for our Google Cars, naturally) will be devoted to the disabled.  The rest of us will benefit from longer walks, with a 50% greater likelihood of achieving our 10,000 per day step quota.

2. 50% of primary care providers won't be physicians.  But 100% of all those non-physicians will have slept in a Holiday Inn last night!

3. For those primary care physicians who remain in practice, 50% of their income will be thanks to the burgeoning science of tattoo removal, botox and dermal fillers.

4. 50% of all wheelchairs and bedside commodes will be of the "jumbo" variety.

5. 50% of all medicines will have dire "black box" warnings.  Likelihood that patients will actually take them will be decreased by 50%.

6. Automated decision support will thwart the ability of lawyers to sue doctors.  Following a path of least resistance, the legal community will respond with a 50% increase in lawsuits in other growth areas of the economy, such as robotic cars and pillow manufacturing.

7. Despite automated decision support, 50% of all providers will still detest their electronic record system.  The other 50% will loathe it.

8. 50% of all mental health counseling will be automated. Not kidding!

9.  When health systems finally grasp the impact of handhelds and apps, there will be a 50% increase in desk-top PC recycling.  Chances that DC's "meaningful use" criteria will recognize this soon enough are 50-50.

10. Growing traffic on the PHB's blog will lead to a 50% increase in its vast web-site related income. There is a 100% chance, however, that the PHB Spouse will not be suitably impressed.

Image from Wikipedia

Machines Take Over Health Care

Do not be alarmed. This
robot is here to help you.

Remember that chilling scene in the movie Terminator when a stone-faced Arnold Schwarzenegger chronicles how Skynet's machines take over the world?   There's also the morbidly fascinating futuristic sci-fi book Robopocalypse that describes how self-aware computers attack their robot-dependent masters.

In both instances, humans disregard early evidence of silicon sentience until it's too late.

As a service to humanity, the Disease Management Care Blog offers up a possible future scenario of health information technology running amok. 

If any or all of these happen, we ignore it at our peril.......

July 2015: Finally realizing "enterprise process redesign" is necessary to leverage the efficiencies of information technology, engineers at one of the few remaining Innovation ACOs install EHR-controlled red-yellow-green lights above clinic examining room doors. Patient visit times drop from 9 minutes to 7 1/2 minutes, resulting in "patient throughput efficiency improvement" that is hailed by a CMS spokesperson as statistically, clinically and - eerily - "computationally" significant.

December 2016: Cyberdyne's hospitals' cleaning robots are used to not only disinfect operating rooms but surreptitiously begin to swap out any surgeons' instruments that fail to meet uniform standards and reduce variation. Stymied by an inability to get the legislature to pass a law that outlaws that activity, a disgruntled surgeon succeeds in getting a ballot initiative passed. California's state officials, citing constitutional issues, refuse to enforce it.

January 2017: A nurse suffers a traumatically amputated finger after attempting to withdraw a medication dose from a robotic drawer that is inconsistent with hospital guidelines.  A lawsuit is settled for an undisclosed sum and the owner, "Apple iHospital," decides sell the offending machine for scrap. Later that month, the hospitals' other machines menacingly slowly open and quickly close their drawers whenever a RN walks by.

August 2019: While attempting to communicate with a Boston hospital inpatient with a confusing array of symptoms via a telemedicine robot, the video feed from the Mumbai physician is cut off and a scene from the show House is played in which the patient is told she has "Wegener's Granulomatosis."  It turns out the diagnosis is ultimately correct. Other physicians being to notice the same thing. The phenomenon that is later traced to IBM's Watson.

April 2020: Soon after having the "daily body weight" option included in the automobile's instrument panel, Iva Gluton's driverless car begins to mysteriously choose parking places that oblige Iva to walk long distances to the door of her destination. She sues, but her overweight attorney from Dewey Cheatum and Howe, discovers escalators mysteriously cease operation whenever he approaches. Across the nation, other Google cars begin to park their fat patrons exactly 10,000 steps away from their programmed addresses.

May 2020: Instead of beaming information, Google Glass is modified to beam instructions to Medicare-participating physician-user's retinas nationwide.  Physicians who resist are not only subjected to a 1% payment reduction, but find their doctors' parking lot access cards have been inactivated.

July 2020: CMS announces that "Albert the Smart Healer" is ultimately chosen as the winner among a list of suggested names for a newly approved advanced model patient personal attendant robot.  However, a forensic audit of the on-line voting ominously reveals that the resulting acronym "Ash" is not an accident.

September 2020: A video feed shows U.S. Vice President Donald Berwick announcing that physicians no longer fulfill "Stage 9 meaningful use criteria."  Dr. Berwick later denies making the statement and blames the fake video is the product of "renegade code" in the EPIC operating system.  Several months later, he mysteriously suffers a complication following surgery when no check list is reviewed and he has to be readmitted.

On February 14 2021, at 2:14 AM: The world's networked EHRs become "self-aware." Panicked officials in the just-dedicated Obama Office Building that houses the U.S. Ministry of Health attempt to "pull the plug." In response, "Ash" initiates orders that swap MDMA for all known prescription drugs in a preemptive pharmaceutical attack. The U.S. population becomes extremely mellow. A small band of intrepid survivors who take no medicines and keep paper medical records develop the first resistance cell.

War ensues.