April 19, 2007

Creative Destruction

Support the hospitalThis week on CNE I blogged about the evolutionary genetics of cancer. I have always thought there is something tremendously cool about how cancer cells are undergoing rapid evolution - destructive for the body, but a creative process for the cancer cells.

Speaking of creative destruction, one implication seems to be that if the NIH succeeds in making cancer merely a serious chronic disease by 2015 we will get a lot of chronically ill people. Add to this life extension, better metabolic control (diabetes) and that it may be hard to prevent many illnesses for purely social reasons. Chronic illness does not necessarily mean a low quality of life or even ill health. It is largely a state of having a condition that needs to be monitored and possibly controlled. But the current health care system is based on the assumptions of the sick being a minority that mostly become cured or die, with a small group of chronic patients. What if chronic illness (broadly defined, including medicalization of bad memory and addiction risk as well as genetic predispositions for various states) becomes the majority?

In such a world practically everyone wants and needs healthcare, but it can hardly be supplied from centralized orgamisations that have fixed prices. There are simply too many patients for the artificially low (due to very rigorous certification) number of health care professionals. Running it all by tax money or insurance money seems unlikely to work, especially since if there is a price ceiling people will likely overconsume. It doesn't take much overconsumption of healthcare if it is done by nearly everybody to completely bankrupt the system.

The solution I believe in is to try to get last week's CNE entry, supply side medicine to work. We need medical entrepreneurs that compete (keeping down prices) and innovate (meeting the new kinds of demand). That of course requires enabling patient choice, for example by voucher systems. I expect that McClinics will grow in number and sophistication; maybe we will also see Oncology King next to them?

Posted by Anders3 at April 19, 2007 12:16 AM