For generations, the American health care debate has focused entirely on one question: "How many people have insurance cards in their wallets?" The drivers of the debate have proudly sported bumper stickers reading:
The opponents of this worldview (including typical Reason readers) probably don’t have a bumper sticker, but if they did, it would look like this:
Like it or not, the UNIVERSAL COVERAGE side's stickers provide a compelling vision for many Americans. Their opposition’s sticker is compelling for no one. It is reactive, lacking both in message and substance. One side long ago ceded the debate, so all discussion has veered toward the demand side of health care, neglecting the supply side. Fortunately, a Cambrian Explosion of new technologies is poised to radically reshape health care. These innovations offer a chance to shift the conversation from the Fortress of centralized control to the Frontier of innovation. Here’s a four-step plan to do so:
Task 1: Answer the Pre-ex Question
The essential first step is to deal with the omnipresent question, "How can we handle people with pre-existing conditions?" The UNIVERSAL COVERAGE answer is clear, simple, and wrong: "Mail them insurance cards." The Affordable Care Act makes it worse: "Force insurers to mail them insurance cards." This is a recipe for adverse selection, insurance market death spiral, and health care rationing, but makes a heartwarming story until that happens.
John Cochrane of the University of Chicago identifies the greatest source of the pre-ex problem: we can't purchase long-term health insurance at a guaranteed future rate, as we do with life insurance and long-term care policies. Cochrane's remedy centers on "Health Status Insurance"—supplemental coverage that kicks in to cover higher premiums when a person becomes ill.
Cochrane's idea is one of a number of logical, credible answers, but all are technical and tedious to explain out loud. The task is to produce a concise, logical, persuasive written response. When someone asks about pre-ex, respond with, "Excellent question. The answer comes in two parts. Part One involves tedious insurance technicalities that are painful to say but easy to read about in five minutes.” … (Hand the questioner a printed copy.) … “Part Two is far more important and exciting, and that's what I'll talk about today."
Any time you attempt to explain Part One, you will lose your audience, and that is a permanent problem. The segue to Part Two is where you excite the audience with adrenaline-stoking stories of innovation. It is where you demonstrate that the best thing for people with pre-existing conditions is to make their treatments better and less expensive so getting coverage and paying for treatment don't entail financial ruin. The message of innovation is clear, simple, and correct—and transcends ideological divisions.
Task 2: Learn the New Technologies
In 1964, only the most visionary technologists were beginning to sense the world that would lead to laptops, iPads, smartphones, Amazon, Street View, Facebook, Blendr, Grindr, OnStar, Kindle, Twitter, Siri, Wolfram|Alpha, and the Internet of Things. Everyone else was stuck on, “How can we improve access to room-size million-dollar mainframes.
We are at a similar juncture in health care. The possibilities can thrill audiences of varying ideologies: Drugs designed for a single individual's DNA; 3-D printed transplantable organs made from a recipient's own cells (no need for donors or rejection); nanobots to repair a patient's damaged genes; wearable telemetry to continuously monitor a patient's biometrics; vastly expanded capabilities for telemedicine; better detection, treatment, and prevention of illness via social media and state-of-the-art data mining; and—less sexy but no less important—lean production methods to squeeze more care and more health out of a given quantity of resources.
The promise of these technologies becomes far less abstract when one meets some of the innovators who are already changing the delivery of health. I've had the thrill of meeting quite a few lately, and here are just four of them:
Jon Schull, of the Rochester Institute of Technology, founded E-Nable—a web-based global consortium that enables amateurs with access to low-cost 3-D printers to produce functional prosthetic hands for somewhere below $50 apiece and to give them to recipients at no charge. In contrast, an FDA-approved prosthetic costs $25,000 to $80,000, with health insurance paying relatively little. (Mechanical printed hands given away for free are not currently subject to FDA approval.)