GRAND RAPIDS, Mich. — Medical technology that seemed relegated to science fiction is at hand, but fast-moving innovations are threatened by established interests and government regulations, said a panel of medical and academic experts at the State Policy Network’s recent annual meeting in Grand Rapids, Mich.
Health care in America is the classic case of the fortress and the frontier, said Robert Graboyes, senior research fellow with the Mercatus Center at George Washington University in Arlington, Va., who made the same case earlier this year during a presentation at the John Locke Foundation.
The “fortress” is paternalism and protectionism, as those blocking reform “imagine every terrible thing that could ever happen … and focus all of [their] efforts on protection,” Graboyes said. The “frontier” mentality says, “If you want innovation, you’ve got to let people take risks,” and don’t protect insiders against revolutionary thinkers.
“The question is, how do we get health care out of the fortress and into the frontier?” Graboyes asked.
Doing so will require looking beyond the system of third-party payment by health insurers, Grayboyes said. Replacing Obamacare with conservative ideas about high-risk insurance pools and selling insurance across state lines, “is about as useful a device as buying and selling haircuts across state lines,” he said.
“We need to get away from the debate about insurance, because for 70 years that’s all we’ve talked about,” Graboyes said. Responding to insurers’ interests simply redistributes resources and attention from one patient to another.
One concept Graboyes finds promising is a compact of nine (and potentially 11) states, that has asked the federal government to release them from some regulations of the Affordable Care Act, Medicare, and Medicaid.
And yet all of those states, except Utah, have “absolutely terrible state restrictions on the practice of medicine” that limit consumer options, Graboyes said.
These states don’t maximize personal choice and individual liberty by denying competition in telemedicine and allowing nurse practitioners and other nonphysicians to perform some functions that state law limits to doctors. They also have restrictive certificate-of-need laws that impede the opening of new specialty hospitals or purchasing medical equipment.
Dr. Jason Hwang, chief medical officer of Icebreaker Health, a San Francisco-based company, said the current health care model continues to pack all of the expertise and technology into hospitals and insurance providers. These institutions stand as hurdles to less expensive technological advances, he said, thwarting “the democratization of health care” seen in consumer-driven products and services — including Uber, TurboTax, consumer banking, online trip booking, car sales, and real estate purchases.
“The question is what is that iPhone equivalent in health care,” Hwang said. Sophisticated tools with diagnostic software can be built into a cell phone to conduct an electrocardiogram or ultrasound. Qualcomm is offering a $10 million prize to the first company that designs a device that can diagnose 12 different conditions simultaneously, similar to a tricorder that “Star Trek” fans would be familiar with.
Hwang compares the current “synchronous” mode of telemedicine of talking to a doctor on the computer screen to having to go through a bank teller to use an ATM.
His company developed the “asynchronous” LEMONAID app that asks a health care consumer to answer all of the questions a doctor would ask, and puts the answers into a software program that guides the patient through the interview process.
“The heavy lifting is done by the computer program” with such self-directed care, and allows the physician to spend more quality time with the patient, Hwang said. In the United Kingdom, doctors can see 300 patients orders per hour. “We actually have aims to see 1,000 patients an hour” at far less cost using that technology.
Aaron Dallek, CEO and cofounder of Opternative, created a smart phone application that allows consumers needing eyeglasses or contact lenses to perform eye examinations at home using a computer and a phone.
“These systems won’t forget to ask the right questions,” which are based on accumulated health science data, Dallek said. “I think that this can be replicated across health care.”
Doctors will continue to have a role in providing health care “long into the future,” he said, but inexpensive, home-based technology frees a doctor to provide higher quality care by cutting down on paperwork.
“The doctor shouldn’t be your secretary,” Dallek said.
“We know that we’re going to have a fight on our hands” from legacy providers, Dallek said.
Consumers should “challenge your legislatures to open up the frontier” by removing regulations and controls that protect incumbent interests, Dallek said. “This is what health care needs.”
Dr. Darcy Nikol Bryan, a practicing OB-GYN, said it is imperative to innovate in medicine, and technology is expanding access, lowering costs, and treating and curing diseases.
As an example, she said, a do-it-yourself finger stick is being developed that can run blood through a machine to analyze personal risk factors for things such as diabetes and heart disease.
Advances in science allow personalized health care instead of government-regulated, one-size-fits-all, population health delivery models, Bryan said.
“There is a huge disjunction where science is taking us and where policy seems to be taking us,” she said.
She said public policy should include a safe harbor against devastating legal repercussions for entrepreneurs and innovators that had a problem with a product, so long as they performed due diligence, followed published standards and procedures, and were not negligent.
While there are amazing advances with bionic prostheses, biochips, and bio-implants, Bryan cautioned about “pretty scary” movements to expand definitions of disease to include people who are unhappy with their DNA or the body that they were born with. Other concerns include a possible resurgence of eugenics, and the non-reproductive manipulation of genes.
“Let’s not give up on the idea that human beings are worth something regardless of their deficits and flaws,” Bryan said.
Dan E. Way (@danway_carolina) is an associate editor of Carolina Journal.