The tsunami in healthcare

As the thousand people in Washington, whose healthcare is covered for life, figure out how many millions they would like to deny the same benefits, the industry is going through a massive transformation. The system, suffering from misaligned incentives and sophisticated gameplay, is likely the most complex. It is a lot easier to figure out autonomous cars and even “artificial intelligence.” The fundamental question in healthcare is how to maintain the health of every individual in a cost-effective fashion. There is only one class of humans who come close to this objective – providers who take care of patients and clinicians in manufacturing companies who want to solve big problems.

However, providers are suffering from technophobia. In less than five years, steering wheels will disappear from automobiles and humans will be a rare sight in manufacturing and power plants. Machines, without biases, are proving to be superior to humans in many decision processes. Every aspect of medicine, even the most cherished clinical components, will be influenced by machines in a few years. Machines, like it or not, will get better at diagnosis and treatment. The role of the provider will change to explain rather than to determine, for humans constrained by slow evolutionary processes will remain prisoners of the present.

The tsunami in healthcare is on the way. In its foggy supply chain including manufacturers, providers, payers, and patients, sunlight will descend and there will be no hiding anymore. Prevention shall matter more than treatment, non-invasive intervention more than invasive procedures, primary care more than specialty care, inventions more than incremental therapies, the patient more than a singular disease state and care plans more than procedures.

Providers who embrace technology will accelerate this trend and others could get ossified.

Knowledge dark ages

It appears that complexity is increasing in every field. Past experience tells us that knowledge only arrived by simplification, the exact opposite of what seems to be happening currently. In Physics (1), theories have been emerging from every corner but most of them are pure fantasy and remain to be unprovable. Having a mathematical foundation to a theory does not mean that it is useful - one could always dream up such constructs but they have no implication for knowledge for lack of testability. In Medicine, doctors seem to believe that humans are extremely complex to figure out and they seem to adhere to empirical tests of small samples that emerge routinely. In economics, simple theories are now considered commonplace and academics are constantly on the hunt for more complex formulations.

Are we reaching the limits of knowledge? The slope of aggregate knowledge has been declining since the 1930s, and it is problematic for a society that believes it is progressing forward. Yes - technology and engineering have made strides but those are applications of knowledge not the creation of it. There, the current crop of technologists appear to be highly efficient - Artificial Intelligence and all - but none of these ideas are going to make a step-function change in knowledge. To make matters worse, money has been a luring influence on emerging thinkers, who have shunned academics and headed to the nightmare on Wall Street or the valley, replete with coding testosterone. The few who have stayed behind seem to be more attracted to complexity rather than creating insights. The committees who award prestigious prices, including the Nobel Prize, also gravitate toward complexity and that provides misguided incentives to young academics.

We are slowly slipping toward the next dark ages of knowledge creation. With no progress in aggregate utility metrics for society, one could argue that we are living through one of the worst time periods in human history. The arrival of the next genius, who can simplify and create knowledge is the only hope.

(1) https://www.quantamagazine.org/edward-witten-ponders-the-nature-of-reality-20171128