Modern tangle


Government insists on creating the Gordian knot to bind our freedom
I just finished reading Andy Kessler's excellent The End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor. I agree with him that we'll need to shift from response medicine to preventative medicine. My stepfather's condition has given me a closer look at how long term medicine in this country operates, whether I wanted it or not.

But I also think Mr. Kessler identifies two of the biggest bottlenecks in medicine today, and those bottlenecks have deep implications for liberty.

It seems that the big insurance companies use the same billing codes as Medicare. That leads to what we had last week. The U.S. House of Representatives passed a bill that promotes the use of IT to handle medical records and expanded the number of billing codes used by Medicare and health care providers.

Can you think of any other industry that had to have Congressional approval to computerize it's records? Not to mention having to use billing codes approved by the government?

Since the insurance companies and medical providers use the same billing codes as Medicare, that means they are only interested in the "approved conditions," and then only in special circumstances. And like most regulations, the folks at the FDA pay closer attention to the people they regulate than they should. This means that most medical research is indirectly approved by the big pharmaceutical companies, even if it's not their money paying the bills.

That doesn't include getting the government to pay for other projects. Stem cell research is one example. Existing law does not ban stem cell research, it just prevents the Federal government for paying for any stem cell research except on certain cell lines which were already in use.

All this is bottleneck number one. Centrally managed chaos.

Bottleneck number two is the doctors themselves. As I have said before, most of what the American public uses doctors for can be done by specialists with much less training.

When your car loses a tire, you don't need to go to a mechanic, and you certainly don't need to go to an automotive engineer. You can go to the local tire store, which has a wider selection of tires than either a mechanic or an automotive engineer. The tire store can offer a bigger choice within their speciality. Except for medicine and other government protected monopolies, there is not another product or service where that is not true. WalMart may have something that works, but True Value will have more of it plus the expertise to tell me how to use it.

Doctors are expensive and in short supply. Why are we using them for every little thing?

Notice how this doesn't even begin to cover things like the availability of drugs.

So is there a general case here, or am I just making noise?

There is a general case. I'm old enough to remember when reengineering hit, and I know what made it work in most cases. There is a Dilbert strip where the consultant tells the company to centralize everything that is decentralized and decentralize everything that is centralized. There is more to it than that.

Decisions need to be made at the lowest possible operative level, and people need to be responsible for those decisions.

When you go to see a doctor, you are not just dealing with that doctor. You are dealing with huge, tangled, bureaucratic webs stretching in all directions over the entire nation.

The doctor is just the visible agent, and he's very low in decision making power.

Medicine is just one set of regulations. Almost every activity is subject to similar tangles. Your job, your groceries, the things you purchase for your child, your credit record, your telephone, even your sex life, it's all subject to approval. In triplicate. Central authority. All for your own good.

What will we do about it?

— NeoWayland

Posted: Sun - July 30, 2006 at 08:34 AM  Tag


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