Saturday, February 14, 2009

A thousand points of pain

E-patients, listen up. We have work to do, work we can do.

First, the challenge. Imagine you're trying to untangle a massive, knotted ball of strings, and every time you tug on one, you hear a scream of pain.

Now imagine that it's an economic knot, and every scream is a billion dollars of pain.

And now imagine there are a thousand strings in the knot ... a thousand points of pain.

That's the reality we face in American healthcare. It's a $2.4 trillion knot, severely dysfunctional in that it costs more and has poorer outcomes than any other developed country. Yet as Tom Daschle's book Critical details excruciatingly, every time we try to improve it by tugging on one part of the problem, powerful parties scream in pain, because they have a lot of money at stake.

(Strictly speaking, it's 2400 points of pain, each a billion dollars. I'll stick with the "thousand points of" meme.)

$2.4 trillion is 40 times bigger than Microsoft and Google put together. Imagine if you had to try to fix something that big. How long would it take?

Another view: it's been said for years that healthcare costs 50% more here per person than in most developed nations. If we could fix that with the wave of a hand, our total spending would drop by one third. And that means we'd instantly cut out $800 billion of business (1/3 of $2.4 trillion). Somebody would be spending $800B less, and somebody would be getting $800B less.

Citizens, that's going to hurt. And a lot of people are going to fight against it - not because they don't want better healthcare, but because they have a lot at stake, and it's tangled.

This is a big issue, but we do need to fix it: lives are at stake. Patients and their families are facing lethal diagnoses every day, and we/they need the system to work better than it does today. And that brings up another way to look at "a thousand points of pain": there are 1,000 cancer diagnoses in the US every six hours.* We need the system to serve us well. (And that's not to mention other life-changing diagnoses: Cushing's Syndrome, diabetes, and so many others. Did you know rare diseases are more common than the most common disease? Rare Disease Day is Feb. 28. Might be a thousand points of pain every hour – in the US alone.)

Personally, I'm starting to think that as patients, our fastest access to better solutions is to take matters into our own hands: use the Internet to gain access to information (and to each other) and create new tools of our own.

The thousand points of pain will work on their aspect of it, and we need them to: I may be an e-patient, but I wouldn't have dreamed up the high dosage Interleukin-2 treatment that stopped my disease.

So let's get moving – let's show 'em how e-patients can git 'er done! Let's gather our facts, band together, create new tools, and spread the word to each other.

Shall we band together? I'd love to build a killer-fine list of noise-making, world-changing empowered patient blogs! As new Web tools come online, we can help each other build the new world of participatory medicine.

List yours here for the world to see, if you want. We'll keep in touch.

*1,444,920 new cases in 2007


  1. And just for the record, Robin has at least four blogs. Good start.

  2. On the same subject from another angle, have you read Dr. Rob's latest post?

    "I read something disturbing in Dr. Val’s blog (if you are not r.. "

    It directs the reader to Dr. Val's blog, too, and both are worth reading. Their view impacts us, too. I'd be interested in your take on them.

  3. I'm not sure what to say, Robin. I've never been to a Congressional hearing, but I wouldn't doubt that they're largely theater. I'd expect that to be the case, at least for the televised ones.

    I do know that a lot of doctors I've spoken with personally have expressed frustration at being unable to achieve what they set out for when they put in all those years of school. Other docs don't have those concerns.


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