Sunday, January 29, 2012

Life in an Information Society

When I try to engage in the health care debate, I am deluged with questions like:

"Do you know how much a bone marrow transplant costs?"

"Do you even know how much open heart surgery costs?"

"Do you even know how much chronic disease x costs?"

The answer, of course, is: "No!"

The amounts actually being paid for these procedures are closely guarded secrets of the health care industry.

We get anecdotal information from people's experience, but there is so much fudging going on in the billing system, that I find all the data I come across in the public domain suspect.

First of all, medicine is not a commodity. In a free market, the prices should vary according to conditions. Since health care is not a commodity, there will not be a commodity price for the care.

If you look at the real cost of heart surgeries, you should see some sort of bell curve depending on the conditions of the surgery.

To make matters even more confusing, major medical procedures often lead to chronic conditions (or occur as part of a chronic condition). A heart surgery followed by a chronic condition is more expense than one followed by full recovery.

Contrary to our fantasies, there is not a fixed commodity price for any medical condition. For every medical condition from acne to broken arms, there should be a wide selection of ever evolving treatment options with differing price tags.

In every case, the actions of the patients affect the cost of a condition. A person who exercises will respond better to most ailments than couch potatoes.

The amount of money people spend on health care also affected by the amount of money people have to spend on health care.

If you have a good record system in place, you can start asking intelligent questions about health care. If you had a big database on health expenses, you can do things like enter demographic information about a person and see how others in the same demographic group fared.

This is the direction that I want to take the Medical Savings and Loan. This program challenges people to self-fund their care with a system of savings accounts and loans.

The beating heart of the program is a distributed record keeping network run by a group of people called Health Care Advocates.

Your experience in the Medical Savings and Loan is that that you will periodically sit down with an advocate who maintains records regarding your health experience. The advocate will query the network for information about people in similar conditions to help you set up a structured savings plan to pay for your care.

When you need care, the advocate will query the network to see what others paying for a given service and help you negotiate pricing and service with local care providers.

The advocate will record info on the care you receive. NOTE: The system will periodically publish an abstraction of your expenses (with personal information removed).

In this network, you will control over both your health care resources and health records.

You will have an advocate who is directly in your employ who maintains your records. The advocate will have access to a rich database which shows how your experience compares to others.

The advocate will have both access to what people actually paid for expensive medical procedures and the likelihood that you will need such a procedure in your lifetime.

The current insurance paradigm actually gathers the same information. The difference is that it holds most of the information as a closely guarded proprietary secret.

The Medical Savings and Loan is more than just a financial gimmick. My hope is to transform health care from a system where pricing information is held internally as a closely guarded secret to one where pricing information is published externally in coordinated effort to help individuals self-fund their care.


  1. Great piece, medical procedures are published by the government and what they pay for via medicare. But most people don't know this. And I agree 110%, healthcare prices should be transparent. Doctors should be able to advertise price even. This would be a fundamental part of true healthcare reform, so it was not included in the faux Obamacare reform.

  2. The government data makes a good starting point.

    In my book, the prices published by Medicare are suspect. When you self fund care, you don't get the government published price.

    Even worse, the doctor's bill for medicare patients is usually driven by the Medicare requirements and not the condition of the patient.

    Creating a system to self fund care will require the creation of information resources designed specifically for that purpose.

    You are correct to point out that there is not as much re-inventing the wheel as my posts imply.