Comment by chubbard | Hacker News Reader

Comment by chubbard | Hacker News Reader

Parent Full thread

That's a horrible story I'm so sorry to hear that about your friend. I think you're right on track that prevention and screening is our weapon against these things. Screening and prevention costs way less than "the cure".

If you read Christensen's latest book "Innovator's Prescription" he analyzes the medical industry through the lens of disruptive technology, and concludes that the forces of disruptive technology have been dismantled which keep prices high. The is such a unique perspective in this health care debate because it's basically been framed as "You pay the high price", or the "Government pays the high price". However, Christensen is giving us a third option saying fix the economic engine and disruptive technology will drive prices down over time and things will get better too. Neither side of the debate can guarantee this either.

His idea is that Doctor's cost a lot of money, but when you have to have the very best analyze what's wrong with you have to pay it. Doctor's jobs are very hard and time consuming. However, certain types of care can be provided without a doctor for things that are well defined. Prevention is just such a thing. Screenings are just such a thing.

The problem right now is that technologies that enable us to screen better are often wrapped up so that you can only go to a doctor to get them. Things like MRI's and CAT scans require prescriptions from doctors. The price of a CAT scan has remained the same since it was invented. 1970 technology the same price!? Where else in our free markets does this happen?

Prevention is more easy to provide without having to tackle the prescription system, but screenings are very important part of medicine in the 21st century.

A CT from today is very different from the first CT scans in the 1970's.

http://www.imaginis.com/ct-scan/history.asp http://en.wikipedia.org/wiki/File:Ct-workstation-neck.jpg

The only difference being image clarity, 3D? Yes it's improved since then, but so does everything we create. The underlying technology hasn't changed that much. By this logic we should continue to pay 1950s prices for a TV because a cathoray tube today is different from a cathoray tube from 1950. What's interesting about our TVs, VCRs, computers, etc is that not only do they get better, but they get cheaper too. Ever noticed how LED and plasma TVs existed before 2006, but it wasn't until their price dropped below a certain level that everyone started getting them? Point being that these technologies have to come down in price before we can scale them to a large audience. Right now they cost way too much, and are not available to a large enough audience to really start making health care better overall. Lowering disease prevalence, raising life expectancy, etc.

Here's one problem with screening: A colonoscopy is a $2000+ procedure, and insurance won't always pay for it unless it's medically necessary.

So, if you have a family history of colon cancer and you've entered the age range where screening typically starts, you may be out of luck. Yes, treating cancer is vastly more expensive than screening for it. So why not pay for regular screenings? I think health insurance companies (and employers) probably do a cost analysis and determine that the cost of detecting and catching stage 1 colon cancer in a screening is more expensive than the cost of waiting for it to develop into something that requires treatment, because by that time there's a very good chance that the worker will no longer be at the same company.

I'm hopeful the costs and effectiveness of non-invasive imaging technologies and auto-analysis will come down in the next 10 years to the point where "screenings" can be done for a fraction of a colonoscopy. But, of course, the manufacturers of the current generation of imaging technologies -- the Siemens and Intels of the world -- are perfectly happy with the jaw-dropping price tags that hospitals and clinics have to pay and pass onto the consumer. If some smart startup comes along with a cheaper solution, just buy 'em out or use monopoly muscle to take them out of the picture.

OK, end of rant. Back to our normal programming.

Colonoscopies cost loads of money because they are performed in a Dr's. office. Insurance won't pay for them because they don't want you to actually go to a Dr's. office. Screenings can come down in price if they can be performed outside of Dr's. offices which they completely can. We need to separate these things out so we can move insurance out of the day to day choices about your health. That way you are in control of our health and improve your health on your own dollar with your own choices. It won't happen overnight, but getting people to think about the problem differently is the first step.

Reply on news.ycombinator.com