Sunday, March 1, 2009

National Healthcare

After seeing Sicko I was kind of shocked I must admit. I am sure it draws a highly exaggerated picture, but it started to make me think. Here in Orange County health-care seems to be excellent. Perhaps too good to be true. My wife has been offered an MRI scan for her knee after having been told the diagnosis with a confidence bordering certainty. After inquiring why an MRI was necessary in this case the answer was, well, "it's not necessary". So she refused and with no consequences to the remainder of the (successful) treatment.

Myself, I was also recently offered a (insert complicated name here) scan. After asking why I needed it, the response from this frank MD was: "because it is required if symptom X is present". Seems reasonable one could think. However, in my case the symptom was explained away by a very innocent issue. After confronting my (really very good) doctor with this fact, he said: "if we don't recommend it we can get sued". He offered in addition that "in our society we have chosen to over-treat one sub-population (read: the rich) at the expense of not treating another sub-population (read: the poor). I refused this treatment as well (not necessarily out of noble considerations: the scan is definitely uncomfortable and time consuming).

There is also another issue at stake. Hospitals are required to treat anyone who comes into the ER and many of those are not insured. This costs money, lots of money (ever seen an ER bill?) To make up for it, doctors send patients with insurance who don't need scans to have expensive scans anyway. This is their way of making money.

All of this on top of the message of Sicko, namely that it is a really bad idea to place health-care in the hands of companies who think about making profit rather than about making healthy.

So I say to president Obama this. There is a huge opportunity to save an enormous amount of money on health-care by making sure doctors don't over-treat patients (those with insurances that is). I am happy paying the enormous amounts of money I am paying to healthcare right now, but please use this money not to send me from one unnecessary scan to another. Use it to give every citizen in the US the RIGHT of health-care. Let's not be afraid to be socialistic about this (btw socialist is NOT communist). We are after all already quite socialistic about the right of protection through sponsoring the federal government to maintain an army.

In the long run, the increasing costs of new medical technology and drugs will force us to make very difficult decisions on who to treat and who not. A good start would be to assess whether the scan or treatment can detect and prevent a disease that has a probability of killing or disabling that is significantly higher than other risk factors for an average patient. We can be conservative about this and still save big time. In my case, the scan was meant to detect a form of cancer that I was so unlikely to have that my chances of dying in a car accident are many times higher.


  1. Hi Max! Interesting post. With regard to your last paragraph: perhaps machine learning can play a role here. It seems that this is a problem for Bayesian Experimental Design, in which potential medical tests are chosen (or not chosen) according to the utility averaged across the possible outcomes of the tests. Of course, the normal difficulties with Bayesian methods exist. You've got to construct a proper model, learn good parameters, and then develop tractable inference algorithms. It gets even trickier when trying to assign quantitative values to ethical issues. But, there is certainly great incentive for making progress on this problem.

  2. the care they need to have with our health with a very important issue, I think is quite interesting to see how people often neglect this opportunity to