Wednesday, April 13, 2016

What Happens If Doctors Could Bill By The Heartbeat?

The New York Times had an article about an innovative new way computer companies are able to monetize their vast networks of cloud servers. Amazon, Google, and Microsoft are charging their corporate users just fractions of a penny every time the servers are accessed. For instance, Amazon Web Services gives free access to their servers for the first one million times a company uses A.W.S.'s computer code. After that it charges for every one million lines of code processed at two-millionths of a penny per code. With the lightning fast processor chips that web servers possess, a million lines of code may only mean a fraction of a second that the server is being used.

However, when added all up, these cloud companies are raking in billions of dollars every year. A.W.S. has become quite the Wall Street darling and is the main reason stock analysts recommend owning Amazon stock. A.W.S. was started only in 2006 and reached $10 billion in revenue in ten years. Next year it is forecast to make $17 billion.

Contrast these meteoric and innovate businesses with our dowdy healthcare industry. In medicine, we are beholden to third party payers who dictate how we are to run our businesses and how much they are willing to pay us for doing it. Silicon Valley is run by an almost purely capitalistic ideology of making money with the most creative ways possible while medicine is more akin to Soviet era decrees issued from faceless and brutal bureaucrats.

What could happen if true capitalist animal spirits were unleashed in the healthcare industry? What if hospitals billed patients for every heartbeat they experienced? Or every breath they were given or taken? Would doctors try to keep their patients alive longer if there was a profit motive? Sounds ludicrous? Yes it does. But does charging two-millionths of a cent for every computer code that was accessed more bizarre until some really smart people realized you can make billions of dollars doing it?

But of course medicine can never be run as a real free market enterprise. Why? Because healthcare alone, not food, not housing, not clothing or transportation, is considered so essential that is is almost a human right like the air we breathe. Therefore it is considered gauche, even amoral to even think about making money off of its users.

Look at all the handwringing about doctors who want to improve their patient relations by switching to concierge medicine. "Oh no! Only rich people will get access to decent healthcare!" No we can't have that. Medicine has to be 100% egalitarian unlike the cars we drive or the food we eat. In medicine, every single patient deserves their Rolls Royce and filet mignon. Nobody is allowed to have medicine that is any "better" than anybody else's. They all have to be treated special. When that happens, then nobody is treated special anymore.

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