Hey, I’ve been thinking about the whole health insurance reform issue, and I don’t really understand the politics of it very well, so I tried to think of what policies I would put in place if I was a health insurance company who wanted to do more than just make money, but in addition help people (and possibly implemented using social networks).
I came across a model of medical device usage and payment that was analogous to the computer timesharing model. Let’s focus exclusively on cancer diagnostic equipment, and MRIs specifically, because they are much safer than CAT scans o X-ray machines.
I have a strong belief, although this may be unfounded, that if the frequency of cancer scans increased beyond a certain threshold over the entire population of adults over a certain age, that a large enough proportion of cancers would be found at an early enough stage for treatment to be effective. For instance, if every person over forty years of age were able to be tested for the twelve or so most common cancers every six months, and these tests were extremely sensitive yet excluded false positives, then these twelve cancers, if they had developed, would be detected by their sixth month of progression, at most, and on average by three months, if it was detectable at such a state. Presently, such a comprehensive diagnostic regimen wouldn’t be carried by any insurance company that was looking to stay in business, and without insurance, would be so expensive that only very wealthy people could afford it.
But computers were once used only by large corporations and the government. What are computers? They are machines. I believe that MRI diagnostic devices are similar to computers in that they are both machines, which by definition can be mass produced. Of course, just because something can be mass produced doesn’t mean that it will be. So far, MRI machines have a small market; namely, hospitals, medical school facilities, radiologist private practices, etc, just as computers once had a similarly limited market.
What if this present state of affairs regarding MRI machines can be changed, so that mass production can be initiated? I think it can, and that the key to doing so is asking the question of who owns the machine?
MRI machines are too expensive for the average person to purchase, and so are purchased by institutions and physicians, who either lease them from a manufacturer or intermediary, or purchase them directly, obtaining full ownership. Regardless of which option is taken, the institution or physician who offers access to the MRI’s use value has full effective control of the machine. In a world where few control the capital good that is so effective at diagnosing cancer, their usage per scan is going to be very expensive.
I figured it would be better for individual workers in a company, say, or even a group of people who live in the same neighborhood, to agree to come together to buy a single machine, or two or three (and perhaps at a group discount if more than one machine is purchased), and agree to split evenly the costs of the machines purchased, each individual also taking that even share of ownership in the machines so purchased. What they get from this deal is lifetime usage of the machine for themselves and anyone they so choose to allow to use it for free, within their fraction of the machine’s time/use value,and an opportunity to earn income from the machine by selling units of their own time allotment to others, either for a market price, or at a mandated discount price that would make cancer scans substantially more affordable for the average person. Since the number of people in the pool who group-bought the machine(s) is large, each person has to put in only a small fraction of the total cost, which would be exorbitantly high otherwise, allowing them to have a reasonable chance at not only having access to cancer scans for free in perpetuity (as long as the machine “lasts,” which can be 20 years, although they may become outdated and no longer cutting-edge), but also in recouping their initial purchase by selling a portion of their time to third parties (at a mandated discount price).
This takes advantage of the fact that the MRI machine, over a period of a year, can be used by an extremely large number of people; its use-value is directly proportional to the number of diagnostic scans run per unit time. So one person, or even a relatively small group of people, cannot make full use of an MRI machine’s use value, if they are using it only to scan themselves for cancers. For much of the time, the machines will be sitting around, not being used. But the present state of affairs is that people in general use the machines, but don’t have (even a) fractional ownership of them. I’m not a Marxist by any means, but wouldn’t Marx’s idea of collective ownership of the means of (cancer diagnosis, not really “production,”), implemented using free markets and voluntary participation, through either pre-existing institutions and large groups, such as workplaces, schools, that are already recognized by insurance companies as qualifying for group discounts, and self-selected organizations that were made through say, social network websites (SocialMedicine.com anyone?), or simply people who live next to each other on the same street and couple blocks down, result in the first steps toward mass-production, and eventually a long-run possibility of expensive medical devices being reduced in price by an order of magnitude or so, bypassing the insurance companies and physicians, so that a group of people have health clinics with machines that you walk in at an appointed time, with algorithms optimizing the time, with the machines owned collectively by the people…not unlike a computer timesharing place or even a Kinko’s, where you go in and get what you need “scanned,” and a computer algorithm analyzes the image, detects or doesn’t detect the cancer with a 99.99% success rate/no false positive rate, with the result being that the number of people who die of cancer in America drops down to the number who die of smallpox nowadays, since everyone pretty much finds their cancer, if it develops, early enough so that it’s almost a done deal that it will be treated without remission?
If a cure for cancer is discovered, that would be phenomenal. But I think that a quick and dirty solution for reducing the number of cancer deaths, although perhaps not the number of incidence of cancers, per year, to a tiny fraction of what it is today involves giving power to the people by having them obtain fractional ownership of the machines. When we get over the cult of the expert, namely that only doctors can be trusted to run these machines, and that the people cannot do this themselves safely, we will take our health into our own hands, and live happily (for a longer time than we are doing now).
Do you think social networks can be used to organize groups of people to purchase medical devices, who then own these devices and are both users and sellers of time on the machine, and that this will eventually lead to cancer scans being so accessible that the actual number of cancer deaths can be reduced significantly, even if the cancer incidence rate does not? Is this idea legal, or is purchasing medical devices and operating them limited to specific groups of people and institutions?