The Disease Management Care Blog has been delighting in the geopolitical lessons of George Friedman’s book The Next Decade: Where We’ve Been . . . and Where We’re Going. While most of Dr. Friedman’s work deals with foreign policy (for example, a better relationship with Argentina can serve as an important counterweight to the emerging power of Brazil and its threats to sea lanes in the south Atlantic), there were two unexpected healthcare insights toward the end of the book.
They are 1) U.S. technology innovation is in decline and will stay that way for years, and 2) the next area of innovation will be “robotics.”
First, the technology.
The United States’ twin health care challenges are demography and technology. Most DMCB readers understand the demography: there is an aging baby-boomer population that is well on its way to living long enough to develop degenerative diseases that will sap the available labor pool and cause consumption of expensive services to soar. Yet, the problem with the parallel issue of technology, according to Dr. Friedman isn’t cost. It’s that technology occurs in waves of innovation that have crested and is now in decline just when we need it.
Technological “waves,” you ask? Looking back, Dr. Friedman argues that the first great wave in the 80’s and 90’s was characterized by the advent of increasingly powerful computers, microprocessors and robust data storage. Think Microsoft. The second was this decade’s massive data transmission and communication. Think the Internet. Unfortunately, both technology waves ended with an emphasis on expanding capacity and finding new applications for the existing technology. In the 90’s, personal computers plateaued and Microsoft’s business model focused on protecting its business models. While today’s Internet is still being rocked by Facebook and Twitter, the fundamentals of “many to many” communication haven’t really changed for years. Productivity gains from technology have peaked and the rest is, in the author’s words, a matter of rearranging the deck chairs.
Despite our investment in medical research, that pales compared to the benefits from military research spending. Ironically, that, not the Institutes of Health, has been the most powerful impetus to new waves of health care innovation, from penicillin to MASH units to remote robotic surgery. All that is now in decline, thanks to the U.S. focus on applying current technologies (the exception being remotely piloted drones) to a limited style of infantry-based land warfare. Another impediment is America’s budget woes combined with the unwillingness of the private financial markets to commit capital to anything other than safe bets. Add it all up and Dr. Friedman argues that it is unlikely that another technological innovation wave is going to occur before 2020.
Dr. Friedman points out that there aren’t enough people to care for all the aging boomers. He says that the answer will be devices that he says “change reality,” but could be better termed as capable of manipulating the environment. When the DMCB thinks about this, aren’t all those blue toothed glucose meters, remote blood pressure monitors, telephonic heart devices and other “input” devices merely “half” of what is ultimately needed? The other half will be “output” devices that administer medicine, generate a treatment, give advice or trigger other responses from the health care system. They may not “look” like “robots” with a pair of flashing eyes or waving arms, but they will definitely “speak” to their masters and will probably be mobile.
They will need even higher levels of computing power as well as more powerful batteries. We don’t have that yet.
It’s no accident that the military seems to be leading the way on the robotics. Ironically, the DMCB has a new appreciation for that technology and is now cheering it on. That’s because until they come on line, the only answers we have are 1) drugs that may delay the onset of the diseases plaguing the boomers along with 2) providing palliative services. Neither options seem to be very attractive.
2020 is about when the DMCB and the spouse are going to be in their 60s.
Jaan Sidorov, MD, is a primary care internist and former Medical Director at Geisinger Health Plan with over 20 years experience in primary care, disease management and population-based care coordination. He shares his knowledge and insights at Disease Management Care Blog, where this post first appeared.