Matthew Holt

Kamen: Healthcare Debate “Backward Looking”

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Segway inventor Dean Kamen thinks the wonkish debate over healthcare reform in Washington is largely missing the point. In an interview with Popular Mechanics editor-in-chief James Meigs and deputy editor Jerry Beilinson, Kamen tells the magazine:

“We now live in a world where technology has triumphed, in many ways, over death. The problem with that is that it’s enormously expensive. And big pharmaceutical giants and big medical products companies have stopped working on stuff that could be extraordinary because they know they won’t be reimbursed, according to the common standards. We’re not only rationing today; we’re rationing our future. ““If you project forward these horrific costs of treating everybody and you want to assume we are not going to respond to that by making the therapies better, simpler and cheaper and in some cases completely wiping out the [diseases], well you know what? We might actually get to that situation—if we stop investing in technology, if we stop believing that the future ought to be better than the past. ““If somebody in this country wants to explain to me that we ought to be spending about twice as much supporting sports as on all of our pharmaceuticals, then stop spending.”  “I think this debate shows a fundamental lack of vision, a lack of confidence, a lack of understanding of what’s possible.”

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  3. The healthcare debate was a dog and pony show with Obama the self appointed ring master. When Mitch McConnell pointed out halfway through the morning session of the ‘healthcare debate’ that the Democrats had spoken for 52 minutes and the Republicans 34 minutes, President Obama replied that opening remarks had consumed a disproportionate amount of time and “I am the President”. Let’s drop this ‘Mr. President’ stuff and just call him ‘Your Excellency’.

  4. We need competition at the user level. To have competition, people need to see prices. Therefore —
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    The proposal requires only an addition to the Medicare/Medicaid reimbursement regulations. Technically easy, politically challenging.
    With current health care costs at about $ 2.5 trillion dollars a year, even a modest competitively driven reduction in costs would have significant benefits for our economy. For details, see http://teapartydelawaremot.org/

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  6. I can only see the goverment next health care program as a take off of the movies as logans run and siolent green.

  7. http://opinionator.blogs.nytimes.com/2009/08/07/weekend-opinionator-a-sick-debate/
    August 7, 2009, 8:13 pm
    Weekend Opinionator: A Sick Debate
    By Tobin Harshaw
    Comments:
    12. August 8, 2009 1:57 am
    I have lived in Europe, the USA (NYC and FLA) and currently live in Canada. I am a reasonably well-informed financial executive. I make my living as a capitalist.
    I wouldn’t know where to begin re: the health care debate but I will make a couple of observations:
    1. The USA has the finest health care in the world — bar none — provided that you have a no-limit gilt-edged money is no object health plan. Or you are rich. In my experience the 2 go hand in hand.
    Failing such insurance or such boundless wealth how any rational human being with an IQ over 75 and an income below, say, $250k (forget the social compassion argument) could defend the existing system is beyond comprehension.
    2. The outright lies — yes lies — that critics of health care reform spew is disturbing. The intentional misrepresentation of the Canadian and European models is outrageous. The Canadian model is flawed. There needs to be greater access to ‘private-delivery’ alternatives (which currently exist in some fields.) Having said that, since I returned to the province of Ontario in the late 1990’s until now the improvement in standards and care is staggering and in most cases matches anything I witnessed or experienced in NYC. Yes, health care is rationed here (hence a need for ancillary private care) but it is rationed everywhere — including the US. The exception being as per point #1 above. Per capita Ontario spends approximately 65% of what the consumers/taxpayers of the US/NY spend. However Ontario delivers 90% — or more — of the US standard. That is one very big financial/efficiency/productivity gap. That money gap goes to the US insurance companies, doctors, malpractice lawyers and lobbyists. The common canard about Canada etc is that “faceless bureaucrats make life or death decisions” (as opposed to, say, faceless HMO clerks). The truth is that in Canada the ‘gatekeepers’ who allocate critical care are the physicians themselves — the specialists.
    3. Aside from private-payment plastic surgeons it is true you will not see many doctors in Canada driving a Rolls Royce. But you will see an awful lot driving a Benz or a Jag. Doctors here work hard and are well compensated. What we lack here is the concept that a medical degree should be attributed Venture Capitalist returns.
    4. Lastly, a general observation/question (again, I really am a capitalist). Why is it that in the USA (a country I genuinely love) millions of people who barely make a living or are working class and/or just holding on to the ‘middle class’ are the most vocal — hysterical wouldn’t be an exaggeration — in defending the privileges of the rich and the corporate? Against their own self-interest I might add. Anywhere else in the western world the existing US health care tyranny would have people in the streets demanding reform — not ‘debating’ it.
    — jon c

  8. Analogously, in medical care, therapies become better, more complex and far more expensive. The normal economics, as many have observed on THCB, simply do not apply.
    bev this only applies to services paid by third parties. Medical care paid by the consumers has seen termindous advancement in technology and reduction in price. Lasik surgeries, cosmetic surgery and dental work. This would seem to imply the payment of care might have a major role in the cost.

  9. “and many other devices used in the treatment of diabetes, heart disease, cancer and other conditions.”
    Mostly ALL preventable with diet, exercise, stress reduction and avoiding contact to carcinogens. Just simple stuff without the need for complicated and expensive technology.

  10. “If you project forward these horrific costs of treating everybody and you want to assume we are not going to respond to that by making the therapies better, simpler and cheaper….” (Kamen)
    My husband uses a Segway as a disability device and, although he loves its functionality for his particular problem, observes that they have NOT become cheaper nor simpler. He believes that part of the reason they have not caught on is their inaffordability for most people. Perhaps Mr. Kamen should take note.
    Analogously, in medical care, therapies become better, more complex and far more expensive. The normal economics, as many have observed on THCB, simply do not apply.

  11. Matthew,
    You’ve started a nice little blog here, but if you don’t understand what Kamen is saying, you might want to look in the mirror. Judging from your typical slant, it’s much more likely you’re intentionally attempting to distort what he’s trying to say, starting with your characterization of him as simply a Segway inventor. If you had actually read the article linked above, it would have been hard for you to miss this nugget of germane information:
    Popular Mechanics editor-in-chief James Meigs and deputy editor Jerry Beilinson recently interviewed inventor Dean Kamen for a future issue of PM. Kamen, head of the Manchester, New Hampshire, firm Deka Research, is one of today’s most celebrated inventors, holding over 440 patents, primarily in the medical field. His innovations include the first wearable infusion pump, a portable kidney dialysis machine, a more flexible stent, one of the world’s most advanced prosthetic arms, and many other devices used in the treatment of diabetes, heart disease, cancer and other conditions.
    The bottom line is I suspect Kamen has contributed a little bit more to modern health care than you have.

  12. Matthew, I re-read his piece and also don’t understand what his point is – except to say technolgy will save us IF we spend tons of money on payback of “innovators”.
    The Segway actually made our health worse by giving us even more reason not to walk. Technology is not the answer, just plain old proper eating, exercise and stress reduction.

  13. Rick,
    When you don’t tell the other team where the game is they can’t be expected to show up. Maybe your not familiar with the legislative process in this country but Congress is suppose to propose a bill, debate it, then vote on it, there is an adorable cartoon if you need more detail. The Bill is being rushed through and cramed down the public’s throat.
    Until there is a bill, and not even fully then, you can’t debate it. What we discussed in committee 18 months ago has zero meaning when something different is written into the bill, or some vague idea is inserted to be written later like congress loves to do.

  14. I have no idea what Kamen is talking about. Worse, I sat through a talk he gave at Aspen Health Forum where it was clear that he didn’t know what he was talking about either. That’s OK, I wouldn’t know how (or why) to invent a Segway, but just because he did, somehow it gives him license to spout crap about the health care system.
    In any event I did gather that he’s in the select minority who believe that we don’t spend enough on health care, and further that we should spend more because we spend too much on sports and movies. (Yup he said this pretty directly in Aspen). Personally I think that if health care is going to be in the same categories as sports and movies the customer experience had better improve and the physical quality of the employees had better improve!

  15. I love how the wingnuts are trying to say the healthcare reform legislation is being “rushed” through Congress (a la “Family Health Insurance” above). Hearings on the present legislation started 18 months ago.
    If your pet issue hasn’t been aired to the relevant people, you blew your chance. And healthcare reform has been a top issue in the U.S. since Truman. Missing a five-decade opportunity to have things your way is not the fault of those who choose to show up, roll up their sleeves and get to work. It’s an abdication of your responsibilities.
    Put another way, when my kid’s softball team shows up to play and the other team doesn’t, it’s a forfeit. Nobody tells the team that showed up that they rushed things.

  16. “Ever dealt with a BCBS claim? Why is billing multiple insurers with multiple claims rules and multiple contracts more efficient that billing one payer with one set of rules?”
    Becuase that one payer with one set of rules is worse then the combined inefficienies of all the other payers combined. Why can any of 1000s of builders build a building cheaper then the gov? Why can UPS and FedEx deliver cheaper then UPS? Why can I administer Health Plans cheaper then Medicare? Why can Armark and other food service companies serve meals cheaper then the Gov?
    When multiple companies have to compete to stay alive they are more efficient then a government entity that has no reason to be efficient.
    “Because the system is so expensive that, “those that need help” are now ALL OF US! Being able to see a PCP without fear of what it will cost IS an improvement to quality of life, being able to get required hospital care without fear of going bankrupt IS an improvement to quality of life, getting timely care you can afford that will save your life IS an improvement to quality of life.”
    I don’t have a single one of the concerns you mention. Most of those covered by Medicaid, a single payer, do have those concerns. If your going to ignore the obvious and deny the truth there really is no hope for you.
    “Keeping insurance companies in profits and their executives in fat bonuses IS NOT an improvement to quality of life. Making specialists rich ( at the expense of PCPs) with the ability to buy multiple vacation homes IS NOT an improvement to quality of life.”
    But allowing special interest to buy excessive profits and their executives to steal fat bonuses is an improvement in quality of life. Making Peter’s politicians rich with the ability to buy multiple homes, with the help of known criminals, and $540 shoes is an improvement.
    “Giving Pharma companies the ability to market expensive drugs that at best work 30% of the time and cause numerous side effects IS NOT an improvement to quality of life.”
    Unless your one of those 30% and it saves your life but that’s not being a good comrade. Peter expects you to die and die cheaply, how dare you spend the fruit of your own labor on drugs that will keep you alive or improve your quality of life, Peter had plans for your money you earned and he’ll be damned if you are allowed to blow it on yourself.

  17. The government and policy wonks are uninformed of the root causes of the problems in health care. Little debate would be happening if the care was cheaper and everyone had access. So instead of building a ghoulish structure on a cracked foundation, the government needs to hear from those adversely affected by decades of flawed policies.
    Root causes include insurance company abuse and over utilization to protect from malpractice and in reaction to price controls and abusive regulation causing excess wasting of professionals’ time.
    The key to resolution is within the doctor’s grip as they control how every health care penny is spent. The behavior of this spending is directly related to the flawed policies. Evaluating and managing a sick patient indeed is different than assembling an automobile.
    The government can not legislate cost effective medical care without destroying medical care.
    Instead of complex government manipulation, we need insurance reform, tort reform, and a program of paying health care professionals to practice cost effective medicine that is individualized for each patient.
    This is the simple approach to assuring access to cost effective medical care.

  18. Family Health Insurance:
    You keep saying “The federal Health Care Financing Administration, which oversees Medicare & Medicaid (the parts of the healthcare system which are run by the government), estimates that the government loses 30 cents to every dollar from fraudulent practices in the medical community.”
    Please provide a reference.
    Thanks

  19. There is a bigger missing point in this article. The premise is wrong. No one is saying that do not do a futuristic research…what is being said is that control the waste. If the ideas is to destroy the present to build a future….well there may be no future!
    The comparison with sports does tell us that we have this silliness going on everywhere. But there at least you spend because of your choice and no one goes bankrupt.
    rgds
    ravi
    blogs.biproinc.com/healthcare
    http://www.biproinc.com

  20. The problem here is that community efforts, preventive care, the Chronic Care Model and increased reimbursement to PCPs are not sexy.
    These are plain Jane efforts that will take a long time to bear fruit. They involve a multitude of dedicated, but nameless people, working every day and making small contributions to the larger goal. There are no exorbitant payoffs, no publicity, no interviews, no medals and no honors to the individual “inventor”.
    Fixing what ails the nation today is no less imperative than finding a vaccine for polio was a hundred years ago. Unfortunately, the one swipe heroic deed that worked for polio, will not work for today’s health problems. There will be no Jonas Salk.
    That is not to say that we need to stop research and advanced technology development. People like Dean Kamen should continue their work. We should fund it, and companies that cash in on this work should moderate their greed.
    And, please leave professional sports out of this. Football season is about to start and some of us need that as much as health care 🙂

  21. You can’t succeed when you turn commercial Health Insurance products into social tools. It just gridlocks trading of certain goods and services and ruins that economic sector which then trickles to the rest of the economy.
    If Obama wants to insure more people then put them on some kind of medicaid paid by other cuts or at worst case by increasing taxes. But forcing Insurance companies to accept preexisting conditions is nuts. It’s like forcing GM to give away every 10th car for free to someone who can’t afford it. Accepting preexisting conditions is not “Insurance”. Insurance is supposed to spread risk where many people pay for the few who happen to “get” sick. Forcing a healthy person to pay a sick persons health bills by forcing Ins. companies to accept them which in turn forces the Ins. company to raise premiums is sick economics.
    And by Obama trying to sell it as a health care overhaul is a lie. By Obama saying it will help the economy is a damn lie. By “showing” statistics are on his side that’s a scam.
    In the short term some people will be getting something for nothing and be happy. In the long term these same people will be losing the most. The same way the Soviet Union helped their needy. It was all about self serving lies.
    ========================================================
    Everybody please post this and other good posts all over the internet to stop this health mess from hitting our shores.

  22. I, for one, am not going to deny someone in need of major heart surgery the hugely expensive technological fix that will save his life (for as long as thirty years or more). Nor am I going to quibble at the coming advances in brain surgery made possible by new technology and scientific advance. At the same time I seek a health care system that rewards prevention and early intervention. One that treats communities through public health messages as well as individuals through primary care. So we need to reset the incentives in our system – not to exclude technology but to let it find its true value; not to force government-ownership of health care but to allow government to shape the incentives in our current system towards better health care; not to force or deny treatments based on government seals of approval, but to allow cost effectiveness information to be disseminated to allow patients and their doctors informed choices.

  23. Kamen’s comments are in sync with James Watson’s op-ed in The New York Times on renewing the war on cancer. This is important, but I think the focus on techno miracles, created by funding giant corporations (that seem to pay lobbyists and executives rather than sharing savings with the “little people”) is one place “health care” has taken a wrong turn. I would love to see money put into localized models that support large numbers of people in avoiding common chronic illnesses and their consequences.
    I was listening today to the WIHI broadcast on Medical Home, with Doug Eby, who coordinates medical services for a care network serving thousands of Alaska Natives. I was struck by the huge potential of funding models like his, which are “customer-driven” (not a thin veneer of “patient-focused”) and use the whole clinical team to support patients in promoting their own health. There is such huge potential savings in human suffering and economic loss in improving chronic care, and Eby’s group has produced some impressive clinical and cost results. An extension of the Chronic Care Model.
    Eby also discussed the lack of results in several “care management” pilots, which he attributes to diluted approaches–scripted/checklist cold calls from nurses in a remote care management company, vs. meaningful 1:1 interactions with a primary care team that the patient knows. If I got to choose (I have little illusion that I do), I’d direct my tax dollars to localized efforts based on effective models that promote health.

  24. “Why are they not addressing the inefficiencies in the system”
    Like over utilization, over billing, over prescribing, over specialization, over treatment, over pricing.
    So how would “government” solve this, cause sure as hell the private sector is not?
    “and lifestyles of American’s that drive up costs?”
    Like over eating, too much sugar, too much meat, too many carbs. So how would the “government” solve this, cause sure as hell the private sector is not?
    “The federal Health Care Financing Administration, which oversees Medicare & Medicaid (the parts of the healthcare system which are run by the government), estimates that the government loses 30 cents to every dollar from fraudulent practices in the medical community.”
    You mean the same medical community that doesn’t want any government control of healthcare? Would you be willing to hire (tax dollars) 100s of “government” investigators?
    “All of these issues if corrected, would save billions of dollars every year.”
    Sure, but how would “government” do that?
    “40% of the American population is now obese. And this 40% of the population uses 40% more medical care than the rest of the population! These figures are staggering, and not one of them will be fixed with a government run health care system.”
    And just how would you advocate the “government” solve obesity?
    “if we do indeed have a government takeover of the medical insurance system, these problems will just become more deeply buried in bureaucracy and red tape.”
    Ever dealt with a BCBS claim? Why is billing multiple insurers with multiple claims rules and multiple contracts more efficient that billing one payer with one set of rules?
    “Why is the government not focused on such items that can improve quality of life, save lives, save money and help subsidize healthcare for those that need help.”
    Because the system is so expensive that, “those that need help” are now ALL OF US! Being able to see a PCP without fear of what it will cost IS an improvement to quality of life, being able to get required hospital care without fear of going bankrupt IS an improvement to quality of life, getting timely care you can afford that will save your life IS an improvement to quality of life.
    Keeping insurance companies in profits and their executives in fat bonuses IS NOT an improvement to quality of life. Making specialists rich ( at the expense of PCPs) with the ability to buy multiple vacation homes IS NOT an improvement to quality of life. Giving Pharma companies the ability to market expensive drugs that at best work 30% of the time and cause numerous side effects IS NOT an improvement to quality of life.

  25. Boy do I agree with you! Up front costs of technology and all in can do for us is expensive but in the long run will cost less for all..The point about spending on sports and entertainment is so well taken. We are talking about a vision of healthy and maybe disease free humanity.
    1.)Let’s get our American Public Health System and Mental Health Structure back. Pre ’80’s we had already eradicated small pox in the USA without technology …just imagine what this partnership would do…
    2.) Let’s use vision and stop the debating over nonsense and turfing…

  26. I completely agree!
    It seems that we are headed in a direction of stagnation. Many do not understand how this direction of government taking over healthcare one step at a time is a very bad for the US.
    The administration talks about lowering healthcare cost, but none of its actions or focus indicate that is the goal. Instead their actions and focus are on taking over the healthcare system. The president has been rushing congress to come up with a bill, and reading the one recently submitted it is clear why it has been rushed. There are so many areas of grave concern within the bill, and that infringe upon the rights and freedom of people: The government wants access to everyone’s individual bank account, care is rationed using a system similar to that of England’s, looking very much like euthanasia!
    Why are they not addressing the inefficiencies in the system and lifestyles of American’s that drive up costs?
    The federal Health Care Financing Administration, which oversees Medicare & Medicaid (the parts of the healthcare system which are run by the government), estimates that the government loses 30 cents to every dollar from fraudulent practices in the medical community. This is a huge problem that must not be ignored; especially when you consider that the combined total spending that is projected in 2010 for Medicare & Medicaid is $675 billion! That is over $200 billion of taxpayer’s money that is being wasted in the current government run healthcare system!
    Hospitals, doctors and other medical professionals think part of the blame lies with the complexity of the system itself. Ironically, the proposed bill has over 1000 pages and is being rushed through congress, not affording those concerned sufficient time to evaluate the provisions within the bill.
    It has recently been shown in the death of Michael Jackson how medical practitioners can use their license to support the drug habits of their patients. More people died every year in the USA from prescribed drugs than from illegal street drugs! All of these issues if corrected, would save billions of dollars every year. And this does not begin to deal with how much could be saved if people lived healthier lifestyles. 40% of the American population is now obese. And this 40% of the population uses 40% more medical care than the rest of the population! These figures are staggering, and not one of them will be fixed with a government run health care system. In fact, the likelihood is that a government run system will act as an enabler, perpetuating the problems. One of the biggest concerns is that if we do indeed have a government takeover of the medical insurance system, these problems will just become more deeply buried in bureaucracy and red tape.
    It was also recently reported that obesity costs America approximately $150 Billion per year in health related costs.
    Why is the government not focused on such items that can improve quality of life, save lives, save money and help subsidize healthcare for those that need help.

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