Friday, August 3, 2018

The coming model for health care.

Doctors have a monopoly on health care.  It sounds so obvious and so right headed that nobody would see this as a problem.  The only problem is that it stops many people from getting needed health care!  The reason is simple: doctors have high investment in self and they do it in order to get paid.  Highly paid.  The whole medical profession is built around keeping out the "riff raff" in order to create a shortage of medical specialists so that the field retains artificially high pricing power.  Not everyone can afford these inflated prices.

If this sounds crazy, go look at the history of other countries, including the likes of Germany where in years past the doctors made normal wages.  And even in the US in the 1950s, doctors made better wages but not 5x-100x of other workers.  So the medical industrial complex has figured out how to keep supply low in an a rising demand environment to thus ensure high prices.

Well, as the old saying goes, the solution to high prices is high prices.  Someone will do something innovative to change things for the better of those using the services.  In the past I have mentioned in these pages that government should offer free basic training to a large number of people. Those who show aptitude should be allowed to practice basic health care.  Those who don't meet the minimum standard should look elsewhere for employment.

In exchange for this free training, the med techs, if you want to call them that, must work for regular wages, $50-60k per year perhaps after they meet a certain minimum internship program requirement for on the job training.  A full doctor of medicine oversees their work and is responsible for not assigning them tasks that are beyond their demonstrated capabilities. 

Thus, if a person comes in needing open heart surgery there is doctor level staff that can handle it but if someone needs a broken limb set, non life threatening wounds to be sutured up, etc. then a med tech with basic skills is allowed to handle the job.  The results are then quickly reviewed by the lead doctor and the patient pays a reasonable cost for right sized medical care.

Of course, there are many possible variants of this.  In extreme cases like India, some people have simply decided to self teach whatever they can learn about healthcare and then to provide low cost service to others based on this self learning.  Of course, the authorities are mortified by all of this because the people using these services seem to love these so called "quack doctors" as it represents a huge step up to what they had before.   If allowed to get too popular then many might begin to ask why a doctor's visit for something basic should cost $175 + cost of meds should they be needed.

I for one know that without much training and only access to google that I could, using similar skills that I employ for debugging a variety of technical issues in my current job, easily diagnose 70% of what people might complain about.  I proved it in my own case recently in correctly diagnosing myself with a case of shingles.  All I did was look for similar pictures online and then researched what caused it.  When I found it could be serious I went right in for medical care.  The doctor starts asking me questions about measles (which is a precondition of shingles apparently) and right away I told him "so I guess I have shingles, right".  He says, "yeah, classic case".  Would I want to rely on this self diagnosis?  Of course not!  But I can say that because I am not dirt poor.  Unfortunately, lots of people are dirt poor.  If you have ever been poor then you will know that something is always better than nothing.

For those that are dirt poor, like many in India, innovative solutions are happening to provide right sized healthcare to the masses.  The status quo over there saw this happening and knew that the medical monopoly was beginning to tumble and so they stepped in provide just enough help to be viewed as being helpful while at the same time trying to retain control of their own elevated status.  Instead of focusing the 100 hrs on medical training it seems a lot of time is spent persuading the participants (and indeed making them promise) to stop calling themselves doctors.  That's how paranoid the medical industrial complex is, and rightfully so, because behind those 20% cases where 12+ years of intensive training is really required in order to do the right thing medically, the other 80% of cases can probably be reasonably addressed with 100 hours of training and a good Internet connection.

Again, people living in western countries will say, "yeah man, you go right ahead.  I will take a real doctor for all my medical needs.".  But these people do not stop to think that they are not smarter than working class people in India even though we westerners  make far more money.  The US and other western nations live so lavishly up and down our economic chains for one reason and one reason only:  People are stupidly loaning us money at cheap interest rates.   We will never repay it because we do not have the means to but while it lasts it pumps up all of our lifestyles far past what we have earned relative to other nations which do not have access to these massive loans.  That is why it is cheaper for westerners to retire in other nations than the one they made their money in.  And that is why it cannot last forever.  It used to be said back in the 1930s that "that guy is rich like an Argentine".  No, really, it's true.  Go to Google search and type in "rich like an" and this is what you get:

Of course, they fucked it all up with wild spending habits that depleted their cash and then similarly stupid debt based consumption and socialism (stealing from the productive to give to the unproductive) and now it is a failed nation state only 80-100 years later.   That's only one person's lifetime folks.  As a result, parts of Argentina today remind us of a scene from Mad Max.  It's a truly fucked up place.

The things we think we deserve today and the lack of abject 3rd world style poverty in the US are both driven by our ability to trick people of other nations into loaning us the money to consume beyond our collective lifestyles.  Those days are now numbered.  Many of my readers will live long enough to experience a change of heart about who their healthcare provider is.   Not because they want to, but rather because they are left with no other choice.

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