The long term solution to the looming Obamacare, Medicare and Medicaid crises may be hanging around the necks of America's Soldiers and in the hands of our video game-playing youngsters. For more than five years, US troops have been wearing the so-called digital dog-tag -- a device that allows them to carry their full medical record on a chip. The Military bureaucracy refers to this gadget as the Electronic Information Carrier (EIC), but its easier to just call it the digital dog-tag. When combined with other improvements in military healthcare, this device and its supporting medical information systems have done more to improve the overall wellbeing of the deployed men and women than any other single technology, and has even contributed to the remarkable survival rate of badly wounded soldiers and marines.
Digital medical records and associated technologies are changing the balance of power in the economics of human health care. As the technology spreads from the military to the civilian world, patients will gain more and more control over their treatments. Doctors, hospitals, insurance companies, and above all the government, will see their ability to regulate what an individual can and cannot do to diagnose, manage and treat illnesses and injuries, undermined.
Today a soldier who has a cold or an upset stomach can go to his or her unit medic for treatment. The Medic plugs in the soldier's digital dog-tag into a laptop or other device and then performs a basic examination: temperature, blood pressure, maybe a basic test, and then gives the patient a few pills or, if something serious is detected, the soldier can be referred to a doctor, nurse or specialist. The encounter is recorded and the information goes onto both the dog-tag and into the digital medical record the military is obliged to keep from the moment of enlistment until death. When the soldier leaves the Military, all the records are seamlessly passed to the Veterans Administration.
The system is constantly being updated and improved, both in order to preserve the security and privacy of the records and to make it easier for the medics, doctors and patients to use. The days when patients had to ask doctors to transfer their medical records or to give them copies their X Rays are ending. A Veteran can now carry all his or her complete medical history on a card or chip.
If digital health records are parts of the solution, another part of the solution may be found in the increasingly sophisticated world of interactive video games. These have reached the stage in which the military is using the technology from this sector to develop "virtual mentor" -- trainers who exist only in cyberspace but who guide individual troops through complex training programs.
As part of this process, medical robotic systems are emerging. Already we see expensive systems, such as the various models of Da Vinci remote/ robotic surgery devices that are in operation. Simpler machines, such as Roomba cleaning robots can be adapted to clean hospitals intensively, thus helping to solve the infection problem that has become so serious in the last few decades. Like the other elements in this ongoing technological revolution, medical robots will dramatically increase the availability of health care while decreasing the cost.
The medical industry is one of the most tightly regulated ones in this country. Under Obamacare, new burdens on the medical devices industry are driving investors, innovators and entrepreneurs overseas. if the free enterprise system is given an opening, however, even a small one, it could begin a process that would, over time, dramatically increase the supply of medical care.
When these new medical systems, or a comparable ones, become widely available to the public it will become the information backbone for a whole new way of providing medical services -- one that will make the current debates over Obamacare, Medicare and Medicaid seem as relevant as the late 19th century political debates over Free Silver.
Once a way is found, either by the government, by the established health industry or by entrepreneurs, to provide the public with effective and medically certified, interactive virtual doctors and nurses, overall medical costs will start stabilize and eventually to go down. This will require technological breakthroughs in a number of areas, especially in the field of diagnostic sensors that will be able to feed data directly into a "virtual doctor" device. The improvements needed to make this a reality are all feasible within the foreseeable future
Now we either have one form or another of medical rationing, either by price, or by forcing patients to wait weeks, months or years for treatment, as in Europe and Canada; or by some kind of "Death Panel." The alternative is to find an affordable way to increase the overall supply of healthcare.
There will always be a political argument over the control and financing of medical care just as there is over any human activity. The problem with medicine as with most things, is a matter of supply and demand. The supply of healthcare in form of doctors and nurses time, medicines, hospital beds, and so on is, of necessity, limited. The demand for healthcare is, naturally enough, unlimited. Certainly this is true for old people whose bodies are failing and who want to go on living as well as possible; but its true for everyone else as well.
Making these changes will mean major reforms to our medical and legal systems. The tightly guarded privilege that doctors have of writing prescriptions is already under stress from pharmacists, nurse practitioners and other paramedical professionals, who are increasing their market share of the medical industry. Automating a large part of the practitioner-patient relationship is a logical next step, but one that will frighten almost everyone involved.
The process will certainly take more than a decade; and the fact that it has already begun is no excuse for political leaders in Washington to ignore the disaster that America's existing government healthcare financing system is inflicting on this country. Referring to Medicare and Medicaid, the historian Walter Russell Mead points out that "Thanks to these programs we have a health care system that marries the greed of the private sector to the ineptitude of government, and unless we can tame these beasts America and everything it stands for could be lost." Of course, with total government control, it could always be even worse. As one economist put it, he had never yet seen a monopoly that worked in the best interests of its clients.
Just as the silicon revolution increased the supply of data processing and data storage, and thereby changed the nature of the world economy, however, the promise of the new medical revolution could change the economics of healthcare in ways that we can only begin to imagine.
The process will take one or two decades before most Americans are fully aware of the impact of this technology in their own lives. The question for politicians and voters is how fast will things change, how much harm will be done and how much money will be wasted in the process?
