MANAGING MEDICAL COSTS
By Karl Arnold Belser
4 November 2013




One of my biggest concerns for the future is the government's promise to provide every US citizen with low-cost medical care.  The issue is that the net present value of the Obama Care promise, that is, the amount of money one must have today to cover future obligations using the current medical system, is on the order of the net worth of the United States excluding all liabilities like the national debt and the Obama Care promise. It is hard to imagine how the US can avoid a default on this promise sometime in the future.

I read an article in the New Yorker called Big Med by Auul Guwande that gives me hope for the future. The idea is a control room behind the doctors, a tele-ICU, that might prevent mistakes and insure the use of best medical practices. This would not be a government system, but rather an implementation of teamwork in order for hospitals or other medical practices to minimize costs. The doctors would get measured on outcomes, not procedures. It would also become crystal clear which doctors are competent and which are not. The article
Big Med is well worth reading.

This idea I think can be used to improve other deficiencies that are putting the US at risk. For example the educational system could have a tele-teaching supervision program.  Recording and reviewing classroom activity would allow the disruptive students to be controlled or taken from the class and put the teacher on the spot every day. Even with the Kahn Academy type of education,the teacher now really has to be an expert in the subject that he or she teaches.

A variation of this idea is currently being used the the UK to control crime. There are tens of thousands of TV cameras all over England to monitor activity in the street. This has significantly reduced the incidence of crime because the potential criminal knows that it might be likely that he or she would get caught.

I ride the bus and in the past graffiti and physical damage of the buses was a big problem, diamond rings scratching glass and painting of the seats. After the (Santa Clara County, CA) Valley Transit Authority (VITA) installed cameras in all buses, the vandalism stopped.

The collateral damage of this kind of spying on the public could be the oppression of freedom of movement and freedom of speech, in exactly the same way that the capturing of all Internet communications could be used by a malicious government to oppress its people.

I am optimistic that some balance can be achieved in which the public visibility of people's actions reduces crime and does not infringe excessively on the privacy guaranteed by the Fourth Amendment to the Constitution. The United States government is struggling with this problem today after the revelations of Edward Snowdon. I suspect that the people of the United States will have to behave in a more coordinated fashion in order to insure the greatest common good.

   
Last updated November 4, 2013
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