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The Conference Board Review® Article
The Healthcare Crisis — Solved?
In an interview in our July/August issue, Harvard management guru Michael Porter discussed his new book, Redefining Health Care: Creating Value-Based Competition on Results — co-written with Elizabeth Teisberg of the University of Virginia's Darden School of Business — and the book's competition-based proposals for tackling America's healthcare calamity. We asked several healthcare authorities to evaluate and comment on those proposals. The original interview is available on our website.
By A.J. Vogl
Andy Kessler:
I applaud Michael Porter for his insight into improving the efficiency of the current medical system. But somehow, it seems that he might also have worked to monitor feed bags, track layout, and whip length to improve the efficiency of the horse-drawn trolley system, just as planes, trains, and automobiles were about to tip through it, or micromanage scheduling, posture, cable length, and phraseology of telephone operators just as electronic switching and 800 numbers rendered them more or less obsolete.
No amount of tinkering with deck-chair placement is going to save the fee-for-service healthcare industry. Perhaps the only way to save this $1.8 trillion mess is for all of us to stop getting sick. And how do we do that? Get doctors out of medicine.
Technology has already weaseled its way into medicine, mostly to reduce hospital stays. Laparoscopic surgery and stents got widespread adoption, because administrators and insurance companies found it could reduce hospital stays from a week to overnight. But that's just a start. Silicon is about to invade medicine and do to doctors what ATMs did to tellers: get them out of the way.
It's not hard to miss the direct impact of silicon not only on computers, digital cameras, and telephony but also on music, broadcasting, and even librarians (Google does not employ 1.2 million librarians to look up your search inquiries, nor did it hire Professor Porter to calculate successful outcomes per dollar).
Silicon lets you change the rules. Today, the medical profession lets nature do their screening for them. You have a heart attack, you get patched up for $30,000. How about alerting me before I drop on the floor? A tumor found on your ovary? A virtual death sentence, but not before hundreds of thousands of dollars are spent keeping you alive for six hard-fought months. How about finding that tumor early enough to get rid of it safely and effectively?
Computed tomography is one of the first silicon-based medical technologies that is advancing at the same pace as Silicon Valley. One-slice-per-rotation scanners gave way to four-slice, to sixteen-, to sixty-four-, and now 256-slice scanners. Anyone buying a flash-memory card for their digital camera knows these numbers. What most have only the vaguest notion of is the economic model — Silicon Valley drives cost down by 30 percent per year. Thousand-dollar scans will soon be $500, then $250, then $100. At some point, the giant spreadsheet in the sky will flash green, and insurance companies will reimburse for these life-saving scans, and no longer will we consumers have to wait for nature to do its brutal screening.
Same for cancer. Biomarkers and molecular imaging are improving at a similar pace. Once able to detect cancer early — five years early — then the solution to runaway chronic-care expenses can be mainstream screening using chips with antibodies bound to silicon nanotubes to screen your blood for unique cancer proteins. Expensive? At first, but all chips eventually sell for under $1.
For my research dollar, the way to save health care is to change the game. Because of this silicon invasion, we are at the start of a twenty-year transition from chronic care to early detection. This will be fun to watch.
Andy Kessler is author of, most recently, The End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor.
Comments? Write a letter to the editor.
Return to the September/October 2006 The Conference Board Review® issue.
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