If our great minds were put to the task of overhauling the healthcare system and creating a non profit model for all the world to look to what would it look like?
This would include research and development of drugs, procedures etc. What motivations could be used? Assume good wages, benefits and perks.
It is hard to ignore how dedicated people become to hobbies they enjoy. They will often work tirelessly for years on end pursuing perfection in something with no thoughts of financial gain. Pursuits of passion are often abandoned not because of lack of interest but because of the strain of finances and demands that family member can no longer tolerate. Incorporating similar philosophies into careers that actually paid good salaries would seem like a solid plan.
Never mind profit, we need to get rid of inefficiencies.
Paper records need to be abolished.
They are far too easy to misplace or damage, and might be used after they go out of date. They are also harder to share with multiple providers. They also take a lot more time to deal with, which means paying more wages.
Any record mix-up could lead to poor patient care, and any mistakes made in treatment can be extremely expensive.
Another major inefficiency is poor inventory management. When I worked for a nursing home company, I spent more time digging through the homes looking for missing equipment than I did on my actual job.
Any functioning equipment that can still be used after decommisioning should be sold, not given to employees. That same company often gave away computer monitors to employees after upgrades.
Police services and fire services seem to provide quality services without profit motive.
People are lined up to be cops and firemen, because it pays well, offers stability, and comes with great benefits. All while not requiring a profit motive to evolve and innovate.
I think it’s important to remember that the government funds a lot of research. In fact, it might be the majority of research. The “profit motive” generally creates incentives to avoid basic research entirely, except for cheap marketing research.
I propose that we declare war on the healthcare crisis.
Take the army medical corps, the navy medical corps, the air force medical service, and the U.S. Public Health Commissioned Corps. Combine them into a single organization with its own uniform and its own rank structure.
At age 18, every citizen gets conscripted to spend 2 years working in hospitals and clinics serving low-income areas.
If you have absolutely no talent for any form of medicine, you will spend 2 years mopping floors and washing bedpans, then muster out and go to college on the G.I. Bill.
If you have an aptitude for healthcare, the government will pay for as much training as you can master, in exchange for a longer tour of duty. The training takes place at private schools, financed by government loans. The loans are interest-free, but until they are completely paid off, you have to stay in uniform, and subject to the discipline of the service. Once the loans are paid off, you can muster out, and go into private practice.
Instead of malpractice lawsuits, incompetent doctors would be subject to UCMJ penalties. A monumentally incompetent doctor would be busted back to E-1, and spend the rest of his tour cleaning bedpans in Point Barrow.
Q: Why the military shtick? Why conscription?
A: Because it is too easy to sit on your backside, in the comfort of your home, and say, “Those rich people over there can afford to pay for it.” If you are going to force other people to contribute their money to the project, then you should be willing to contribute your time and labor to the project.
Taiwan already did this, when they set up their UHC system a few years back. They did a fairly detailed examination of all the models out there, as far as I remember.
They are still a bit giddy that your President actually called them back and called them a real country. You can probably have a copy of the work for asking.
Switzerland, I think is for-profit insurance. Ok results but on the average it ends up in the top 3 systems for cost.
Interesting (to me, anyway) the history of national healthcare policies is linked to a response to warfare. In short, countries said, “we need to take care of all the sick and injured soldiers? - might as well roll it out to everyone.”
Your proposals take it a few steps further into actual militarization of healthcare.
Basic and applied research is where we live - it’s our wheelhouse. To be an innovative Pharma, you have to be willing to throw a LOT of money - billions* every year - at pipelines of research taht may NEVER pay off, often don’t pay off, and even if successful, may not return their investment. Oh, and you have to be willing to wait maybe 8 to 12 years before you can even begin to see some payback. Also: We get from government jack shit for funding. We DO collaborate, but generally it’s with other companies, occasionally non-profit groups.
Drug development companies take on *huge *risk - the VAST majority of tested molecules will fail. Each failure has an R&D cost to it. The further along in development, the more costly the failure. I’ve seen molecules fail that had already absorbed more than US$300M in R&D - and ten years time. This isn’t incompetence - it’s science. And yes, we DO make a profit - We’re a favorite of retirement fund and big investment packages. We’re in your 401K and your pension plan, and your local municipality’s security fund. Our investors know they’re taking a huge risk - and they demand a commensurate income.
You can remove profit from the R&D portion of healthcare. But you’ll also gut innovation, too. I mean really - do you espect a goverment bureacrat to stick their neck out and authorize spending money exploring an obscure and possibly pointless gene mutation in a niche cancer population? **
*US$5.5B in 2011; $5.89B in 2016, for examples.
This was exactly where I was hoping the topic would lead. As a backyard researcher who gets very involved I can at least relate to what motivates a good many people doing research. I have a feeling a certain amount of guaranteed time to pursue your own projects using lab facilities could be a good incentive. Even if it meant having additional equipment and space to accommodate this and even if they were developing something they would later want to sell.
Some institutions work like this. Most are actually pretty directed - But the researchers are often researching something that they already find fascinating. Me? I get up and work because of a sense of mission - I saw financial thread post by the father of a child saved from death by one of our meds:
“Because of this medicine, I won’t have to bury my daughter.”
I mean, really, what can you say to that? What I said was: “This. This is what I want to do, every day.” When I start work each day, I know I’m going to touch something that is going to make someone’s life better - usually tens of thousands of lives better. THAT is stealing fire from the Gods.
Exactly my point, researchers are driven on passion, I would like to see encouraging that passion with more access to facilities. In most cases the assigned projects themselves would accomplish this as in your case but in many cases I suspect there are some dream projects some of these researchers would like to carry out.
I am pleasantly surprised that it wasn’t immediately flamed. I think it might also help with two other problems:
First, it would help reduce youth unemployment.
Second, if we could get a significant percentage of the population trained in at least the rudiments of real medicine, I have a forlorn hope (probably vain, but I can hope) that the popular culture might become less tolerant of pseudo-scientific nonsense like homeopathy and the New Age woo.
The EGFR genetic mutation test I linked about above was one such dream project. Some of our scientists (Roche wasn’t the first - they’ve improved on what we did) saw some strange data that didn’t make intuitive sense: Why did this particular product work better for some ethnicities? :dubious: Weird. So, they followed the rabbit down the hole - and in the process created a brand new pargdim of ‘while-you-wait’ genetic testing AND resurrected a moribund product in a much more narrowly-targetted patient population - which we can now preciesely identify, thanks to curiosity indulged.
“Follow the Science” is one of our big mantras, and they did. The results were so important that we open-sourced the test; too many other (potential) genetic mutation-specific drugs exist for us to just sit on that test - Because one of our other mantras is “Patient First.”
Having mantras sounds cheesy - it FEELS cheesy, but it’s useful when it comes time to make a decision where there’s some doubt - Consider them to be the default ‘coin flip’ answer: Patients first, follow the science, play to win - If a judgement call can answer one of those in the positive, we go for it.
What would be the motivation for getting rid of these inefficiencies?
In a for profit world the companies that do the best to get rid of inefficiencies get the most profit. They are then rewarded with more investments and get bigger. Profit is the reason why the industrial revolution happened and we aren’t all subsistence farmers.
This does nothing to reduce the costs of healthcare. It merely transfers the cost from the older and richer consumers of healthcare to the much poorer young people being forced to work as orderlies.
