Welldoc is a consumer facing tool that has been around a long, long time in the diabetes management space. It was the first company to be certified by the FDA as Software as a Medical Device, and it has moved into wide range of diseases as the consumer front-end for many organizations. Welldoc itself is hiding behind the scenes in most of these relationships but it has grown steadily and not had to raise money since 2016. A few weeks back I grabbed Anand Iyer, Chief Analytics Officer and & Marina Dorotheo, Chief Marketing Officer who also runs strategy. We had a long chat about the state of the market, the company and they showed me an extensive demo (9.40-32.00). If you haven’t caught up with this sector lately, this is well worth a detailed look.
Above the Fold
Cost Containment Through Health Improvement
By BEN WHEATLEY
The U.S. is in the midst of an ongoing—and still expanding—health care cost crisis. Even among people with health insurance, medical debt has become a persistent problem. Top executives at nearly 90% of large employers believe the cost of providing health benefits to employees will become unsustainable in the next 5-10 years. And the nonpartisan Congressional Budget Office (CBO) is warning that expanding federal debt—driven largely by health expenditures and compounding interest payments—indicates that a major fiscal crisis is looming.
On this last point, it is true that reputable people have been predicting fiscal collapse for many years. In 1988, Benjamin Friedman wrote that we’re facing a Day of Reckoning. Pointing to the rising federal debt, he said: “we are living well by running up our debt and selling off our assets. America has thrown itself a party and billed the tab to the future.”
Peter G. Peterson wrote a book in 1993 called Facing Up: How to Rescue the Economy from Crushing Debt and Restore the American Dream. In it, he said that “runaway medical costs are the single most important reason that federal spending and federal deficits have now become ‘uncontrollable.’”
Not everyone agreed that deficits and debt were problematic. In 2003, as Republicans were pursuing further income tax cuts, Vice President Dick Cheney declared: “Reagan proved that deficits don’t matter.”
David Stockman was Ronald Reagan’s first budget director and one of the chief architects of the Reagan Revolution—a plan to cut taxes and reduce the size and scope of government. He wrote in The Triumph of Politics that the Reagan Revolution failed because the administration had not been able to control spending, leading to massive increases in the federal debt.
In 2013, Stockman wrote a book called The Great Deformation: The Corruption of Capitalism in America. He said that during the Great Recession, the Federal Reserve Bank had carried out “the greatest money-printing spree in world history.” Between 2004 and 2012, 70 percent of rising U.S. debt was absorbed by central banks. He said that “the world’s central banks have morphed into a global chain of monetary roach motels. The bonds went in, but they never came out.” He concluded that it was easy money, which the Federal Reserve System had supplied for decades, that was responsible for “deficits without tears.” “American politicians…had essentially died and gone to fiscal heaven.” They were able to spend money “without the inconvenience of taxing.” Both Democrats and Republicans have taken advantage of this changed reality.
In 2020, Stephanie Kelton wrote a book called The Deficit Myth: Modern Monetary Theory and the Birth of the People’s Economy. In it, she called for a paradigm shift: since the U.S. has the ability to print its own money, we should recognize that federal spending is not financed by tax revenue or borrowed funds. Whenever the need is pressing enough (e.g., warfare), we can and do supply whatever money is needed. The real deficit, she said, is not the fiscal deficit, but societal needs that are going unmet. Regarding health care, “our failure to provide proper insurance and care for every American is not because the government cannot ‘afford’ to cover the cost.” It’s just that we are operating under the wrong budget paradigm.
Importantly, though, Kelton wasn’t saying that there is a free lunch. She wrote, “It is possible for the government to spend too much. Deficits can be too big. But evidence of overspending is inflation, and most of the time deficits are too small, not too big.” This dovetails with David Stockman’s concerns about unsound money. And it mirrors the concerns of the CBO, which has said that a fiscal crisis would involve higher rates of inflation and an erosion of confidence in the U.S. dollar.
Containing Health Care Costs
If the CBO is to be believed, deficits and debt do matter. And although there have been “Cassandras” saying the sky is about to fall for many decades now, there may come a point in time when the need for cost containment becomes immediate and vital. (Some would argue that we’re already there.) Health care is a primary driver of fiscal deficits and, in an emergency, it would become a primary target for budget savings.
In this context, cuts to Medicare and Medicaid become a central focus.
Continue reading…Who Needs Humans, Anyway?
By KIM BELLARD
Imagine my excitement when I saw the headline: “Robot doctors at world’s first AI hospital can treat 3,000 a day.” Finally, I thought – now we’re getting somewhere. I must admit that my enthusiasm was somewhat tempered to find that the patients were virtual. But, still.
The article was in Interesting Engineering, and it largely covered the source story in Global Times, which interviewed the research team leader Yang Liu, a professor at China’s Tsinghua University, where he is executive dean of Institute for AI Industry Research (AIR) and associate dean of the Department of Computer Science and Technology. The professor and his team just published a paper detailing their efforts.
The paper describes what they did: “we introduce a simulacrum of hospital called Agent Hospital that simulates the entire process of treating illness. All patients, nurses, and doctors are autonomous agents powered by large language models (LLMs).” They modestly note: “To the best of our knowledge, this is the first simulacrum of hospital, which comprehensively reflects the entire medical process with excellent scalability, making it a valuable platform for the study of medical LLMs/agents.”
In essence, “Resident Agents” randomly contract a disease, seek care at the Agent Hospital, where they are triaged and treated by Medical Professional Agents, who include 14 doctors and 4 nurses (that’s how you can tell this is only a simulacrum; in the real world, you’d be lucky to have 4 doctors and 14 nurses). The goal “is to enable a doctor agent to learn how to treat illness within the simulacrum.”
The Agent Hospital has been compared to the AI town developed at Stanford last year, which had 25 virtual residents living and socializing with each other. “We’ve demonstrated the ability to create general computational agents that can behave like humans in an open setting,” said Joon Sung Park, one of the creators. The Tsinghua researchers have created a “hospital town.”
Gosh, a healthcare system with no humans involved. It can’t be any worse than the human one. Then, again, let me know when the researchers include AI insurance company agents in the simulacrum; I want to see what bickering ensues.
Continue reading…Jody Tropeano, HLTH
Jody Tropeano is the head of content at HLTH which has become an extraordinarily large conference in digital health (12,000 attendees last year!). I met with her recently in New York to talk about this year’s conference and HLTH’s role in setting the agenda for digital health and the rest of health care. You can find out more about HLTH at www.hlth.com/2024event—Matthew Holt
Blue Shield CA, CVS Caremark & the mystery of the extra $116, with 2 UPDATES (at the end)
By MATTHEW HOLT
Today we’re going to have fun with show and tell. I’m going to show you how a little corner of American health care is making my life as a consumer worse and more expensive–hopefully someone can tell me why.
The cast members are: me, my MD, the (sort of) independent pharmacy that delivers, Alto, and my insurer Blue Shield of California and its PBM CVS Caremark, which also owns a mail order pharmacy.
The brief backstory: For some years my doctor has been whining about my high cholesterol, and a few years back I went on a statin called Rosuvastatin Calcium. Older readers may remember Jean Luc Picard himself advertising the branded version Crestor, but it’s been off patent for about a decade. About 50 million Americans now take a statin, almost all of them a generic, including many 60 year old males like me. My cholesterol has come down, but my MD told me it could come down more, so a few months ago we boosted the dose to 40mg from 20mg.
Until recently I’d been insured by BCBS Massachusetts, and you might recall a little over a year ago I wrote a piece on THCB about the fun and games to be had trying to figure out what their PBM (CVS Caremark) was doing with the pricing of my kid’s ADHD medication. But they’d never messed with my medication as my statins are cheap. At least I thought they were. In fact as recently as April last year, they were free. You can see the price from the delivery from Alto Pharmacy below.
How BCBS Mass came up with $0.00 as the price I pay I don’t know, but presumably they think it’s a good thing to have me on statins in the hope I don’t have an (expensive) heart attack instead.
Then for some reason my price for the statin later the same year went up to $23. No longer $0 but at $8 a month not really worth making a fuss about.
At the end of the year, COBRA expired and I went to buy insurance on the California exchange. And in order to keep access to my family’s doctors at One Medical, I chose the only plan they were in, the Blue Shield of California HMO.
My next 90 day supply was the first one which went from 20mg to 40mg, but it’s still a common generic. Blue Shield of California also uses CVS Caremark (although it’s been talking a good game of ditching CVS Caremark and setting up its own PBM) and the cost at Alto barely budged. Now it was $28.
What happened next: So all was going normally until late last week when my next 90 supply was delivered. Except it wasn’t. Alto delivered me a 30 day supply and charged me $19.
Continue reading…What We Can Learn From the Change Healthcare Hack
By ZACHARY AMOS
The health care sector is no stranger to cyberattacks. Still, large incidents like the February 2024 ransomware attack on Change Healthcare are enough to shake up the industry. In the wake of such a massive breach, medical organizations of all types and sizes should take the opportunity to review their security postures.
What Happened in the Change Healthcare Cyberattack
On February 21, Change Healthcare — the largest medical clearinghouse in the U.S. — suffered a ransomware attack, forcing it to take over 100 systems offline. Many of its electronic services remained down for weeks, with full restoration taking until early April.
A week after the attack, the infamous ransomware-as-a-service gang BlackCat claimed responsibility. BlackCat was also responsible for 2021’s Colonial Pipeline shutdown and several attacks on health care organizations throughout 2023. This latest act against Change Healthcare, however, stands as one of its most disruptive yet.
Because Change and its parent company — UnitedHealth Group (UHG) — are such central industry players, the hack had industry-wide ripple effects. A staggering 94% of U.S. hospitals suffered financial consequences from the incident and 74% experienced a direct impact on patient care. Change’s services affect one in every three patient records, so the massive outage created a snowball effect of disruptions, delays and losses.
Most of Change’s pharmacy and electronic payment services came back online by March 15. As of early April, nearly everything is running again, but the financial fallout continues for many enterprises reliant on UHG, thanks to substantial backlogs.
What It Means for the Broader Health Care Sector
Considering the Change Healthcare cyberattack affected almost the entire medical sector, it has significant implications. Even the few medical groups untouched by the hack should consider what it means for the future of health care security.
1. No Organization Is an Island
It’s difficult to ignore that an attack on a single entity impacted almost all hospitals in the U.S. This massive ripple effect highlights how no business in this industry is a self-contained unit. Third-party vulnerabilities affect everyone, so due diligence and thoughtful access restrictions are essential.
While the Change Healthcare hack is an extreme example, it’s not the first time the medical sector has seen large third-party breaches. In 2021, the Red Cross experienced a breach of over 515,000 patient records when attackers targeted its data storage partner.
Health care enterprises rely on multiple external services and each of these connections represents another vulnerability the company has little control over. In light of that risk, it must be more selective about who it does business with. Even with trusted partners like UHG, brands must restrict data access privileges as much as possible and demand high security standards.
2. Centralization Makes the Industry Vulnerable
Relatedly, this attack reveals how centralized the industry has become. Not only are third-party dependencies common, but many organizations depend on the same third parties. That centralization makes these vulnerabilities exponentially more dangerous, as one attack can affect the whole sector.
The health care industry must move past these single points of failure. Some external dependencies are inevitable, but medical groups should avoid them wherever possible. Splitting tasks between multiple vendors may be necessary to reduce the impact of a single breach.
Regulatory changes may support this shift. During a Congressional hearing on the incident, some lawmakers expressed concerns over consolidation in the health care industry and the cyber risks it poses. This growing sentiment could lead to a sector-wide reorganization, but in the meantime, private companies should take the initiative to move away from large centralized dependencies where they can.
Continue reading…AI Cognition – The Next Nut To Crack
By MIKE MAGEE
OpenAI says its new GPT-4o is “a step towards much more natural human-computer interaction,” and is capable of responding to your inquiry “with an average 320 millisecond (delay) which is similar to a human response time.” So it can speak human, but can it think human?
The “concept of cognition” has been a scholarly football for the past two decades, centered primarily on “Darwin’s claim that other species share the same ‘mental powers’ as humans, but to different degrees.” But how about genAI powered machines? Do they think?
The first academician to attempt to define the word “cognition” was Ulric Neisser in the first ever textbook of cognitive psychology in 1967. He wrote that “the term ‘cognition’ refers to all the processes by which the sensory input is transformed, reduced, elaborated, stored, recovered, and used. It is concerned with these processes even when they operate in the absence of relevant stimulation…”
The word cognition is derived from “Latin cognoscere ‘to get to know, recognize,’ from assimilated form of com ‘together’ + gnoscere ‘to know’ …”
Knowledge and recognition would not seem to be highly charged terms. And yet, in the years following Neisser’s publication there has been a progressively intense, and sometimes heated debate between psychologists and neuroscientists over the definition of cognition.
The focal point of the disagreement has (until recently) revolved around whether the behaviors observed in non-human species are “cognitive” in the human sense of the word. The discourse in recent years had bled over into the fringes to include the belief by some that plants “think” even though they are not in possession of a nervous system, or the belief that ants communicating with each other in a colony are an example of “distributed cognition.”
What scholars in the field do seem to agree on is that no suitable definition for cognition exists that will satisfy all. But most agree that the term encompasses “thinking, reasoning, perceiving, imagining, and remembering.” Tim Bayne PhD, a Melbourne based professor of Philosophy adds to this that these various qualities must be able to be “systematically recombined with each other,” and not be simply triggered by some provocative stimulus.
Allen Newell PhD, a professor of computer science at Carnegie Mellon, sought to bridge the gap between human and machine when it came to cognition when he published a paper in 1958 that proposed “a description of a theory of problem-solving in terms of information processes amenable for use in a digital computer.”
Machines have a leg up in the company of some evolutionary biologists who believe that true cognition involves acquiring new information from various sources and combining it in new and unique ways.
Developmental psychologists carry their own unique insights from observing and studying the evolution of cognition in young children. What exactly is evolving in their young minds, and how does it differ, but eventually lead to adult cognition? And what about the explosion of screen time?
Pediatric researchers, confronted with AI obsessed youngsters and worried parents are coming at it from the opposite direction. With 95% of 13 to 17 year olds now using social media platforms, machines are a developmental force, according to the American Academy of Child and Adolescent Psychiatry. The machine has risen in status and influence from a side line assistant coach to an on-field teammate.
Scholars admit “It is unclear at what point a child may be developmentally ready to engage with these machines.” At the same time, they are forced to admit that the technological tidal waves leave few alternatives. “Conversely, it is likely that completely shielding children from these technologies may stunt their readiness for a technological world.”
Bence P Ölveczky, an evolutionary biologist from Harvard, is pretty certain what cognition is and is not. He says it “requires learning; isn’t a reflex; depends on internally generated brain dynamics; needs access to stored models and relationships; and relies on spatial maps.”
Thomas Suddendorf PhD, a research psychologist from New Zealand, who specializes in early childhood and animal cognition, takes a more fluid and nuanced approach. He says, “Cognitive psychology distinguishes intentional and unintentional, conscious and unconscious, effortful and automatic, slow and fast processes (for example), and humans deploy these in diverse domains from foresight to communication, and from theory-of-mind to morality.”
Perhaps the last word on this should go to Descartes. He believed that humans mastery of thoughts and feelings separated them from animals which he considered to be “mere machines.”
Were he with us today, and witnessing generative AI’s insatiable appetite for data, its’ hidden recesses of learning, the speed and power of its insurgency, and human uncertainty how to turn the thing off, perhaps his judgement of these machines would be less disparaging; more akin to Mira Murati, OpenAI’s chief technology officer, who announced with some degree of understatement this month, “We are looking at the future of the interaction between ourselves and machines.”
Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside the Medical Industrial Complex (Grove/2020)
Your Water, or Your Life
By KIM BELLARD
Matthew Holt, publisher of The Health Care Blog, thinks I worry too much about too many things. He’s probably right. But here’s one worry I’d be remiss in not alerting people to: your water supply is not as safe – not nearly as safe – as you probably assume it is.
I’m not talking about the danger of lead pipes. I’m not even talking about the danger of microplastics in your water. I’ve warned about both of those before (and I’m still worried about them). No, I’m worried we’re not taking the danger of cyberattacks against our water systems seriously enough.
A week ago the EPA issued an enforcement alert about cybersecurity vulnerabilities and threats to community drinking water systems. This was a day after EPA head Michael Regan and National Security Advisor Jake Sullivan sent a letter to all U.S. governors warning them of “disabling cyberattacks” on water and wastewater systems and urging them to cooperate in safeguarding those infrastructures.
“Drinking water and wastewater systems are an attractive target for cyberattacks because they are a lifeline critical infrastructure sector but often lack the resources and technical capacity to adopt rigorous cybersecurity practices,” the letter warned. It specifically cited known state-sponsored attacks from Iran and China.
The enforcement alert elaborated:
Cyberattacks against CWSs are increasing in frequency and severity across the country. Based on actual incidents we know that a cyberattack on a vulnerable water system may allow an adversary to manipulate operational technology, which could cause significant adverse consequences for both the utility and drinking water consumers. Possible impacts include disrupting the treatment, distribution, and storage of water for the community, damaging pumps and valves, and altering the levels of chemicals to hazardous amounts.
Next Gov/FCW paints a grim picture of how vulnerable our water systems are:
Multiple nation-state adversaries have been able to breach water infrastructure around the country. China has been deploying its extensive and pervasive Volt Typhoon hacking collective, burrowing into vast critical infrastructure segments and positioning along compromised internet routing equipment to stage further attacks, national security officials have previously said.
In November, IRGC-backed cyber operatives broke into industrial water treatment controls and targeted programmable logic controllers made by Israeli firm Unitronics. Most recently, Russia-linked hackers were confirmed to have breached a slew of rural U.S. water systems, at times posing physical safety threats.
We shouldn’t be surprised by these attacks. We’ve come to learn that China, Iran, North Korea, and Russia have highly sophisticated cyber teams, but, when it comes to water systems, it turns out the attacks don’t have to be all that sophisticated. The EPA noted that over 70% of water systems it inspected did not fully comply with security standards, including such basic protections such as not allowing default passwords.
NextGov/FCW pointed out that last October the EPA was forced to rescind requirements that water agencies at least evaluate their cyber defenses, due to legal challenges from several (red) states and the American Water Works Association. Take that in. I’ll bet China, Iran, and others are evaluating them.
“In an ideal world … we would like everybody to have a baseline level of cybersecurity and be able to confirm that they have that,” Alan Roberson, executive director of the Association of State Drinking Water Administrators, told AP. “But that’s a long ways away.”
Tom Kellermann, SVP of Cyber Strategy at Contrast Security told Security Magazine: “The safety of the U.S. water supply is in jeopardy. Rogue nation states are frequently targetingthese critical infrastructures, and soon we will experience a life-threatening event.” That doesn’t sound like a long ways away.
Continue reading…What the Walmart Exit from Primary Care Means
By JEFF GOLDSMITH
There has been a lot of commentary on the largest “disrupter” candidate in healthcare, retail giant Walmart, throwing in the towel on their primary care clinic and virtual health businesses. As someone who has watched “retail health” for close to forty years, Walmart’s decision did not surprise me. This is disciplined company that has chosen its niches in healthcare carefully. And the fact that they could not make primary care work with their customer base makes all the sense in the world.
I am a Walmart shopper. I visit my local Walmart at least once a week, and buy all my commodity items there, where they are cheaper than anywhere else in town. I also buy my drugs at Walmart, and got all my immunizations (including four COVID shots) from their pharmacy. I love my local Walmart- linoleum, fluorescent lighting and all.
The shoppers in Walmart that I see every week are not “poor”. They are a cross section of the community I live in. If I am accused of a crime, they are the “jury of my peers” that I will see in court. What I see in Walmart: signs of serious family financial stress, a product of a near twenty percent increase in the cost of everything since the pandemic began. They are in Walmart for the same reason I am: they hate wasting money and their shopping dollar goes further in Walmart than anywhere else in the community. I will wager that every single uninsured person in the US, perhaps more than 32 million after the post-COVID Medicaid purge, is a Walmart shopper!
Walmart never articulated exactly the strategy behind its clinics. Primary care was never going to be profitable as a stand alone product, but rather was going to be a loss leader to something else: more prescriptions for its pharmacy, (like CVS?), more pull-through from products required by diagnoses, longer store visits. Or, as some suggested, Walmart’s clinics could have been a potential entry point into a yet-to-be-acquired Medicare Advantage plan (Humana or CIGNA were both in play), or a collaboration with MA giant, United Healthcare. Whatever the benefits expected, early losses far exceeded forecasts.
Walmart clearly underestimated the revenue cycle overhead associated with accepting Medicaid or Medicare, despite retaining OptumInsight to help with their revenue cycle issues. Walmart also likely overestimated both volumes and the cash yield on what they intended to be $40 primary care visits. Many health plans unthinkingly apply a copayment to primary care visits, an increasingly potent demand destroyer in this inflationary age. That copay or the full $40 for the abovementioned uninsured folks was going to have to compete for increasingly scarce paycheck dollars with everything in that cart. In that competition, medical care is probably going to end up being deferred, until it becomes unavoidable. And when it is unavoidable, they will go to the “unavoidable” healthcare place, their local hospital ED.
Continue reading…Getting the Future of Health Care Wrong
By KIM BELLARD
Sure, there’s lots of A.I. hype to talk about (e.g., the AI regulation proposed by Chuck Schumer, or the latest updates from Microsoft, Google, and OpenAI) but a recent column by Wall Street Journal tech writer Christopher Mims – What I Got Wrong in a Decade of Predicting the Future of Tech — reminded me how easily we get overexcited by such things.
I did my own mea culpa about my predictions for healthcare a couple of years ago, but since Mr. Mims is both smarter and a better writer than I am, I’ll use his structure and some of his words to try to apply them to healthcare.
Mr. Mims offers five key learnings:
- Disruption is overrated
- Human factors are everything
- We’re all susceptible to this one kind of tech B.S.
- Tech bubbles are useful even when they’re wasteful
- We’ve got more power than we think
Let’s take each of these in turn and see how they relate not just to tech but also to healthcare.
Disruption is overrated
“It’s not that disruption never happens,” Mr. Mims clarifies. “It just doesn’t happen nearly as often as we’ve been led to believe.” Well, no kidding. I’ve been in healthcare for longer than I care to admit, and I’ve lost count of all the “disruptions” we were promised.
The fact of the matter is that healthcare is a huge part of the economy. Trillions of dollars are at stake, not to mention millions of jobs and hundreds of billions of profits. Healthcare is too big to fail, and possibly too big to disrupt in any meaningful way.
If some super genius came along and offered us a simple solution that would radically improve our health but slash more than half of that spending and most of those jobs, I honestly am not sure we’d take the offer. Healthcare likes its disruption in manageable gulps, and disruptors often have their eye more on their share of those trillions than in reducing them.
For better or worse, change in healthcare usually comes in small increments.
Human factors are everything
“But what’s most often holding back mass adoption of a technology is our humanity,” Mr. Mims points out. “The challenge of getting people to change their ways is the reason that adoption of new tech is always much slower than it would be if we were all coldly rational utilitarians bent solely on maximizing our productivity or pleasure.”
Boy, this hits the healthcare head on the nail. If we all simply ate better, exercised more, slept better, and spent less time on our screens, our health and our healthcare system would be very different. It’s not rocket science, but it is proven science.
But we don’t. We like our short-cuts, we don’t like personal inconvenience, and why skip the Krispy Kreme when we can just take Wegovy? Figure out how to motivate people to take more charge of their health: that’d be disruption.
We’re all susceptible to this one kind of tech B.S.
Mr. Mims believes: “Tech is, to put it bluntly, full of people lying to themselves,” although he is careful to add: “It’s usually not malicious.” That’s true in healthcare as well. I’ve known many healthcare innovators, and almost without exception they are true believers in what they are proposing. The good ones get others to buy into their vision. The great ones actually make some changes, albeit rarely quite as profoundly as hoped.
But just because someone believes something strongly and articulates very well doesn’t mean it’s true. I’d like to see significant changes as much as anyone, and more than most, and I know I’m too often guilty of looking for what Mr. Mims calls “the winning lottery ticket” when it comes to healthcare innovation, even though I know the lottery is a sucker’s bet.
To paraphrase Ronald Reagan (!), hope but verify.
Tech bubbles are useful even when they’re wasteful
Healthcare has its bubbles as well, many but not all of them tech related. How many health start-ups over the last twenty years can you name that did not survive, much less make a mark on the healthcare system? How many billions of investments do they represent?
But, as Mr. Mims recounts Bill Gates once saying, “most startups were “silly” and would go bankrupt, but that the handful of ideas—he specifically said ideas, and not companies—that persist would later prove to be “really important.”’
The trick, in healthcare as in tech, is separating the proverbial wheat from the chaff, both in terms of what ideas deserve to persist and in which people/organizations can actually make them work. There are good new ideas out there, some of which could be really important.
We’ve got more power than we think
Many of us feel helpless when encountering the healthcare system. It’s too big, too complicated, too impersonal, and too full of specialized knowledge for us to have the kind of agency we might like.
Mr. Mims advice, when it comes to tech is: “Collectively, we have agency over how new tech is developed, released, and used, and we’d be foolish not to use it.” The same is true with healthcare. We can be the patient patients our healthcare system has come to expect, or we can be the assertive ones that it will have to deal with.
I think about people like Dave deBronkart or the late Casey Quinlan when it comes to demanding our own data. I think about Andrea Downing and The Light Collective when it comes to privacy rights. I think about all the biohackers who are not waiting for the healthcare system to catch up on how to apply the latest tech to their health. And I think about all those patient advocates – too numerous to name – who are insisting on respect from the healthcare system and a meaningful role in managing their health.
Yes, we’ve got way more power than we think. Use it.
————
Mr. Mims is humble in admitting that he fell for some people, ideas, gadgets, and services that perhaps he shouldn’t. The key thing he does, though, to use his words, is “paying attention to what’s just over the horizon.” We should all be trying to do that and doing our best to prepare for it.
My horizon is what a 22nd healthcare system could, will and should look like. I’m not willing to settle for what our early 21st century one does. I expect I’ll continue to get a lot wrong but I’m still going to try.
