Tuesday, May 18, 2010

An Apple (and a Facebook) for our good health.

Writing in The Washington Post this morning, Jennifer Brokaw, an emergency room physician in San Francisco, opined that one solution to the ER crisis was for doctors and policymakers to make better use of more information:

Every municipality or county should have a detailed understanding of where needs are and a plan to address them. For example, by knowing the exact numbers of diabetics, smokers, and people with kidney disease and high blood pressure in our communities, we can predict how many CT scanners or, say, vascular surgeons are needed. Gaining this knowledge will require cooperation and information-sharing among all health-care entities: insurers, hospital systems (both public and private) and managed-care systems.

OK, that’s a familiar prescription: more information.  And yet such a prescription is hard to fill, because of HIPAA-ish privacy concerns, not to mention the general my-data-is-my-castle orneriness of the American population.  As we have seen this year, it’s a challenge for the government to conduct a census, to say nothing of enumerating all the diseases and conditions that people have, and then sharing that information among healthcare providers.

So another approach is needed, as Dr. Brokaw is quick to point out.   Social networks, most notably Facebook, seem to have become quite skilled at eliciting information from people.    (Perhaps too skilled, in the waggish opinion of humorist Andy Borowitz,  who jokes today that the Chinese government should forget about secret police and just “friend” the entire population of China, as a better way to keep tabs on people.)

But Facebook, for all the recent concerns about its privacy policy, has proven popular with 400 million or so people, who have proven willing to share much personal information in return for a free service that helps them connect and stay in touch.  And if Facebook comes to viewed as irredeemable, then it would be easy enough to come up with another sort of social network--a medical network.  Because, after all, the goal of this effort is not to make money for the network, but to distribute better health.  

In the meantime, the need, and the opportunity, looms large.  Here’s more from Dr. Brokaw:

We need to employ the new ideas and technologies that have emerged from the Internet and social networking revolution to link patients with informed advice about their conditions. In a fully realized online system, simple medical questions can be answered by health advisers in real time. Patients can be directed to walk-in clinics, urgent-care centers or even emergency rooms when necessary.

It seems to me, here at SMS, that the key is to make such information-sharing successful is to make it voluntary.   Like Facebook, unlike the government, as we understand government today.    And how to do that?  How to get people to cough up information about their coughs, and other health issues?   The answer is to make the process of information-disclosure cool, or otherwise gratifying, or remunerative, to the individual.  And that requires a rethinking of the basic “business model” of healthcare, including the business model of govnernment.  

I wrote this piece in January for Foxnews, noting some differences between the iPad and Obamacare: I noted that people were standing in line to buy the new tablet computer, while most people were fleeing from the thought of Obamacare.   As I put it:

What the American people want is a health care system that works as well as Mac--it’s nice that it looks nice, but the real value is that it works. It gets the job done. And it’s easy to use--from the start, when you take it out of the box.

Is that too much ask?  That things work?  That Uncle Sam do as good a job as Steve Jobs?  If it is too much to ask--if Uncle Sam can’t be bothered to make his systems work--then don’t expect people to trust the government.

The point is not that a corporation is better than the government, as BP demonstrates. The point is that Steve Jobs is better than the government.    As I also wrote in that same piece, four months ago:

We can only imagine what the world would be like today if Obama had sat down with Jobs a year ago--and, in the spirit of fair & balancee, with other top CEOs and tech visionaries, too--and said, “How can we make our health care system cool? How can we make it work better? How can we make it cheaper? How can we make it do all the things that you do in your business--drive costs down, drive performance up?” The answers that would have come back from those techsters would have been hard for a liberal Democrat to swallow--and that’s why the meeting never happened. But Silicon Valley types would have pointed the way toward a popular plan that would have been popular--as popular as an iPhone app -- 3 billion of which have been downloaded so far. Now that’s popular enthusiasm, the kind that the Democrats sorely need right now.

Instead, of course, Obama chose to sit down with Harry Reid and Nancy Pelosi.   And more recently, Democrats have been taking advice from wordsmiths, such as Emory University’s Drew Westen.    Their plan, it seems, is to talk their way out of their political problems.

Some people, of course, are creeped out by Jobs, or Apple. But the company has built one of the most trusted brands in America; most people--and this is a democracy--would agree that Jobs and Apple have been more successful at solving problems than the government.  So why not find a way to arbitrage that talent and effectiveness for other problems?  Isn’t at least worth a try?

Others see the value of seeking out the best and the brightest--the true best and brightest--to solve urgent national problems.  One such is comedian-commentator Bill Maher, who had this to say recently about Steve Jobs, as reported by The Huffington Post:

"America needs to focus on getting Jobs -- Steve Jobs. Because something tells me that Apple would have come up with a better idea for stopping an oil spill in the Gulf of Mexico than putting a giant box on top of it," he said.

He explained why he thought Jobs and his Apple team could do a better job running America, joking that we might have to change the country's name (Hello, "iMerica."):

“In 2001, Apple reinvented the record player. In 2007, the phone. This year, the computer. I say, for 2011, we let them take a crack at America. Our infrastructure, our business model, our institutions. Get rid of the stuff that's not working, replace it with something that does. For example, goodbye US Senate -- Hello Genius Bar! So good luck, Steve -- you'll need it!

Maher is right.   And Dr. Brokaw is right.  Knowledge is power in healthcare, just as knowledge is power in every other field.   The challenge is using that knowledge-power in the best way possible.     Our health depends on it.


  1. The problem, as you know, is that Apple and other great businesses are consumer- and innovation-driven. Government at all levels is power-driven and trapped in "legacy systems" from the great government expansions of the 1930s, 60s and 70s. Liberals' (and most conservatives') idea of innovation is to strap new contrivances onto the old legacy systems instead of rethinking them.

  2. Ok, on an Apple & a Facebook for our health.

    Re your paragraph 2
    “Every municipality or county should have a detailed understanding......”
    “It seems to me, here at SMS, that the key is to make such information-sharing successful is to make it voluntary.”

    Ask GE for the data!! I know they have it. Hey, maybe Obama can ask their CEO for it. After all they do share their Quid Pro Quos.

  3. Being a 14-year veteran of Apple during two different tours of duty (one including the company's ten year anniversary), Mr. Pinkerton's post is particularly intriguing. The power of Apple, of course, is its focus on individuals, and Bob hints at this in his comment on Apple's consumer and innovation focus. This deserves to be fleshed out even more.

    For example, consider the 200,000 iPad/iPhone/iPod apps that have been developed in the iTunes ecosystem. Then, consider how many of these have been written by Apple? By development houses? By individuals? Apple didn't go through institutions to make this happen. They created a compelling environment and let people's imaginations run wild. The good apps get downloaded or purchased; the bad ones don't. No committees, no hearing, no bureaucracy... just people making choices.

    And, that is where government shouldn't sit down with Steve Jobs but just get out of his way... and for that matter, get out of the way of lots of entrepreneurs. Set some good ground rules, so the game is played fairly, but then stop trying to steer. Institution versus individual. Steve Ballmer, for example, comes from the institution/hierarchy approach, and interestingly, he is the one that has spent a lot of time at the White House already.

    We don't need government to the public sector version of Walmart, offering everything to everybody. In creating our constitutional democracy, our founders looked to government as protector of individual rights (rights that pre-existed our Constitution) and not as a vehicle for building bigger agencies and more bureaucracy. More on this in a recent law review article here:


    I'll make a separate post on new ways to look at information in harnessing the Internet (and people) in our healthcare solutions.

  4. I would like the medical system to work as well as a Mac, but the minute someone starts talking about removing my ability to say no to something you can be 100% certain that it's not going to be something pleasant and certainly not something as pleasant as a Mac. Of course as the Obama administration folks keep mentioning, this isn't about our being happy with what we get, it's about their being in control over us and being efficient as they do their terribly important work and "saving money". Their money. The money that used to be mine before they confiscated it.

    Personally, I find that HIPAA's restrictions on information undesirable in general. I would rather have all of my medical records published on the front page of the local newspaper than take a 1% risk of a one minute delay in my treatment in an emergency but I am not given any choice in the matter by the law. It's as always with the government, the government knows best and one size fits all.

    On the other hand, I am just fine with the Socialists not having my medical records so maybe it's not so bad that HIPAA keeps them hidden after all. Alas, it won't be long before the socialists wrangle some legal way to see all of the private stuff. I am sure that was their plan all along.

    Whether the government would do a better job or how it could do a better job at making my decisions for me is beside the point though. I don't care what kind of geniuses or fools they hire or whether they use computers or doctors or court jesters to make medical choices. The choices are not theirs to make in the first place so all this talk about what methods of taking our choice away merely serves to divert attention from the core issue at hand.