World Medical Needs a Foundry/Cloud Model, 18Trillion Market

[Arthur Hanson]

Medical, in all forms will be by far the largest market for semi/nanotechnology of all types and range from the areas from before inception to death. It will go beyond just basic health care to enhancements and replacements we haven't even dreamed about. It will be involved in the growth of new organs and the manufacturing of new body parts. It isn't hard to see more devices that interact directly with our brains. This will be the largest of all markets and the competition will be fierce. Even many pharmaceuticals could be replaced by electronic devices in many circumstances, an area that is just starting to open up. This is a race the US can't afford to loose.

Medical is run on an obsolete model that in the US consumes 3.3 trillion at 17.9% of our entire GDP, while delivering 37th in quality in country rankings, with the highest costs by far. World wide medical consumes 18.2 trillion out of a 78.2 trillion GDP. With markets and numbers like this, the medical field desperately needs to learn from and use the technology and business models of the semi/nanotech sector for its ability to increase functionality, quality, performance, distribution all while dramatically lowering cost. There should be no individual doctors offices or small medical facilities except in sparsely populated areas. Sharing of the latest information of providers of medical services is spotty at best and literally endangers hundreds of thousands of lives where solutions are known but not distributed. Medical research should be done on a combined EDA/Foundry model and made available on a cloud platform to the actual providers real time. It's a wonder how many solutions to medical problems are known, but totally unknown to the providers that deliver the services. The semi/nanotech sector has developed many business/research models that are totally superior to anything in medical including lowering costs and increasing functionality at an ever increasing rate.

This is an opportunity of literally staggering proportions from the figure of an 18.2 trillion dollar market with staggering inefficiencies at every stage of the process, from research to products to final delivery. Medical needs to come into modern times with low cost wearable monitors and automation of everything possible to the cost savings from an EDA/foundry model to lower research and production costs while speeding research and development times. Have no doubt, most of us will be using many medical monitors/controllers and our doctors will be working with AI/ML/automation platforms that have the ability to reduce costs and improve service. Many current medical practices are totally obsolete and protected by strong, entrenched special interests such as the individual doctors office in a densely populated area. This doctor is obsolete in that he can't have the spread of knowledge, equipment, platforms and tools of AI/ML/automation to deliver top care at good value. More efficient models already exist and are tested in the semi/nanotech sector that are proven and can be adapted to the medical not only in the US, but around the world. This is the largest single opportunity for the semi/nanotech sector and the tech sector in its totality since medical still in its very, very early stages of coming into the connected, modern world. This is a chance to prosper and deliver desperately needed services at a reasonable price, but will require dragging the medical sector/special interests kicking and screaming "It's Impossible" into the future as the tech sector has done in everything from factories to retail to advanced research. None of these shifts were easy, but made the world a better place. I have personally talked about advanced models for surgery and told it couldn't be used in the US, when it has been successfully used in other large countries. MIT Technology has already called for not training radiologists for technology will make them obsolete and has already passed them in some areas.

What other industry could get away with delivering 37th in quality on a world ranking at the highest prices by far.
Only massive corruption could allow such a situation. Also almost all don't know our rankings and cost including those in medical who are always shocked when I bring it up and they go to their phone or computer to prove me wrong and are always snocked by the result. All this and they have shamelessly promoted themselves as heroes and saints. No other industry could get away with this and this creates many openings for the hyper competitive tech sector in all areas on a foundation of semi/nanotech. On top of this US medical has denied competition from other countries by not allowing remote diagnosis not allowing Medicare to pay a small fraction of the price for better care at a fraction of the cost in other countries.

Comments, thoughts and additions solicited and welcomed

 

[Daniel Payne]

Arthur,

As a first step, how about our medical and health care professionals stop using paper and clipboards to register and track clients?

Here in the Portland area we have a growing franchise of urgent care facilities called ZoomCare, and they designed their practice to be 100% paperless. Patients can sign up online for an appointment, show up and pay with credit card, all reports are emailed, there is no paper in the entire process.

 

[IanD]

As a first step, why doesn't the US adopt a medical system closer to that in all those (old-fashioned, socialist...) European countries that deliver much better outcomes for a lot less money?

Would that be because they also make much less money for drugs companies, medical insurance companies, private hospitals/doctors and so on, and the US government is unwilling/unable to challenge this sorry state of affairs?

I'm not saying that technology couldn't deliver great advances in medical care worldwide, but my prediction is it won't reduce costs or improve overall outcomes in the US compared to other countries given a system whose fundamental purpose is to make money for the providers not provide the best healthcare for patients.

And before anyone says that profits and healthcare aren't incompatible, the evidence says otherwise -- the healthcare systems which deliver the best bang for the buck are all socialised, the ones which deliver the worst (like the US) are privatised.

 

[Arthur Hanson]

As a first step, why doesn't the US adopt a medical system closer to that in all those (old-fashioned, socialist...) European countries that deliver much better outcomes for a lot less money?

Would that be because they also make much less money for drugs companies, medical insurance companies, private hospitals/doctors and so on, and the US government is unwilling/unable to challenge this sorry state of affairs?

I'm not saying that technology couldn't deliver great advances in medical care worldwide, but my prediction is it won't reduce costs or improve overall outcomes in the US compared to other countries given a system whose fundamental purpose is to make money for the providers not provide the best healthcare for patients.

And before anyone says that profits and healthcare aren't incompatible, the evidence says otherwise -- the healthcare systems which deliver the best bang for the buck are all socialised, the ones which deliver the worst (like the US) are privatised.

In reality socialism fails since you eventually run out of other peoples money. We now have the capability of the massive application of big data and automation and augmented automation to massively reduce costs. Our regulatory system is controlled by special interest and needs to be controlled by advancing science carefully applied to reducing cost and individual responsibility. Currently our system denies personal responsibility and is like insuring drunk reckless drivers for the same rate as good, safe drivers. Any system that denies personal responsibility will fail, not matter how efficient. You can't outrun a bad habit, whether your own or someone else's. Still best practices and new technologies could lower costs dramatically. It's actually a government problem for the government is the largest purchaser of medical care and is controlled and guided not by technology, but by deeply entrenched special interests. Beware anyone who declares themselves a saint or a hero.

 

[Arthur Hanson]

Arthur,

As a first step, how about our medical and health care professionals stop using paper and clipboards to register and track clients?

Here in the Portland area we have a growing franchise of urgent care facilities called ZoomCare, and they designed their practice to be 100% paperless. Patients can sign up online for an appointment, show up and pay with credit card, all reports are emailed, there is no paper in the entire process.

Dan, the bottom line is that the medical industry, and that's what it is, could learn much from the semi/nanotech sector in everything from business structure, execution, utilization of knowledge across platforms, R and D, mass production, applications and especially driving down costs while increasing performance. Having worked in medical facilities and tech facilities, there is absolutely no comparison of the efficient application and efficiency between the two industries and this is not only my opinion, but that of an award winning industrial engineer who specialize in efficient application of resources.

 

[IanD]

In reality socialism fails since you eventually run out of other peoples money. We now have the capability of the massive application of big data and automation and augmented automation to massively reduce costs. Our regulatory system is controlled by special interest and needs to be controlled by advancing science carefully applied to reducing cost and individual responsibility. Currently our system denies personal responsibility and is like insuring drunk reckless drivers for the same rate as good, safe drivers. Any system that denies personal responsibility will fail, not matter how efficient. You can't outrun a bad habit, whether your own or someone else's. Still best practices and new technologies could lower costs dramatically. It's actually a government problem for the government is the largest purchaser of medical care and is controlled and guided not by technology, but by deeply entrenched special interests. Beware anyone who declares themselves a saint or a hero.

In reality socialised medicine -- not necessarily government as a whole -- works far better than the US system, and makes much more effective use of money to provide effective treatment for more people. Every time there's a league table countries using such systems come top and show no signs of going bankrupt because of it, the US comes near the bottom and does.

You can object to socialism all you want as a system of government -- though many people might disagree with you -- but the evidence year after year says it's the best way to deal with people's health.

If advanced technology helps improve healthcare, it's unlikely to change this fact -- the US system will still be one of the worst.

 

[Arthur Hanson]

In reality socialised medicine -- not necessarily government as a whole -- works far better than the US system, and makes much more effective use of money to provide effective treatment for more people. Every time there's a league table countries using such systems come top and show no signs of going bankrupt because of it, the US comes near the bottom and does.

You can object to socialism all you want as a system of government -- though many people might disagree with you -- but the evidence year after year says it's the best way to deal with people's health.

If advanced technology helps improve healthcare, it's unlikely to change this fact -- the US system will still be one of the worst.

I agree fully, but I feel an even better system could be built. Why build something good, if you can build something great. I feel that just like the tech sector in the US changed the world, I feel it can also change medical. Only the tech sector has the influence and money to take on the US medical system which is based on greed as the current situation shows it delivering poor care at super premium prices. If a tech company followed this business model, they would go bankrupt so fast your head would spin.

 

[IanD]

I agree fully, but I feel an even better system could be built. Why build something good, if you can build something great. I feel that just like the tech sector in the US changed the world, I feel it can also change medical. Only the tech sector has the influence and money to take on the US medical system which is based on greed as the current situation shows it delivering poor care at super premium prices. If a tech company followed this business model, they would go bankrupt so fast your head would spin.

The problem is that the tech sector is -- unsurprisingly! -- also driven by making money, so its interest in medical is just the same as the medical companies/insurers/drug companies i.e. how to make money out of it. If in the meantime it improves patient care and/or reduces costs then that's a bonus, but that's not what drives it and isn't guaranteed to happen -- given the ever-present choices between providing better care and making more money (because the two are almost always exclusive) it's obvious which will win. Not blaming the companies, their job is to make money for their shareholders, not to be nice to be people if this costs them more.

No amount of sexy tech or tinkering with the system will change the fact that the best health care comes from (socialised) health-care systems whose primary purpose is to provide the best care for patients while trying to keep costs down, not making money out of them -- if they manage to reduce costs, this is used to provide better care for more people not pocket the profits. All the available evidence backs this up.

Saying that "a tech company which did this would go bankrupt" (poor care at premium prices) isn't true, because in this case there's no alternative in the US except other companies doing exactly the same thing.

An example is that the NHS here in the UK drives far harder bargains with the drug companies than in the US by having a central negotiating body (NICE) for drug prices, and refusing to pay ludicrous amounts -- either the drug companies drop their prices to something sensible, or they don't get any business in the UK. In the US the drug companies (who make money) present the bills to the local billing authorities who have to pay up because they've no negotiating power, and anyway the bill is mostly passed on to insurers (who make money) so who cares. The net result is that many drugs cost hospitals (and patients) 10x as much (or more...) in the US as in the UK, because nobody with any power to change this has any interest in reducing costs, and there's a massively well-funded lobbying activity to keep it that way.

 

[Arthur Hanson]

IanD, The US medical system has bought off the government and conned the people to keep any real competition at bay. Only the tech sector has the resources to take on the medical cartel. The tech sector is brutally competitive and disruptive. Look at the companies like IBM and Xerox that were once leaders and are now followers declining in importance by the day. Medical needs disruption and the only hope of this is from the tech sector with enough influence and money, it is the only sector that stands a chance of reforming the medical cartel which has convinced most people they are saints and heroes while delivering low quality at staggering prices. When I tell doctor's and nurses they are delivering very low quality care, they go to their computers to prove me wrong and are literally in a state of shock when the see the US ranks 37th. US medical has become the greatest con job in history. What other industry could deliver bottom of the barrel quality at the highest price?

 

[IanD]

IanD, The US medical system has bought off the government and conned the people to keep any real competition at bay. Only the tech sector has the resources to take on the medical cartel. The tech sector is brutally competitive and disruptive. Look at the companies like IBM and Xerox that were once leaders and are now followers declining in importance by the day. Medical needs disruption and the only hope of this is from the tech sector with enough influence and money, it is the only sector that stands a chance of reforming the medical cartel which has convinced most people they are saints and heroes while delivering low quality at staggering prices. When I tell doctor's and nurses they are delivering very low quality care, they go to their computers to prove me wrong and are literally in a state of shock when the see the US ranks 37th. US medical has become the greatest con job in history. What other industry could deliver bottom of the barrel quality at the highest price?

Lawyers? Estate agents (realtors)? Auditors?

Maybe you're right and the tech sector could force change on the US medical system, but I suspect that this will replace one group of firms ripping people off and getting rich on the result with another group of firms doing the same but rather more cheaply and efficiently -- but still costing more and providing a poorer service than socialised systems where caring for patients is the #1 priority, not making money out of them (and which can just as easily take advantage of new technology).

 

[Arthur Hanson]

Lawyers? Estate agents (realtors)? Auditors?

Maybe you're right and the tech sector could force change on the US medical system, but I suspect that this will replace one group of firms ripping people off and getting rich on the result with another group of firms doing the same but rather more cheaply and efficiently -- but still costing more and providing a poorer service than socialised systems where caring for patients is the #1 priority, not making money out of them (and which can just as easily take advantage of new technology).

IanD, the difference is that if the tech sector builds it, it has to compete with tech sectors the world over that can build the same products and solutions, unlike our health sector that has no competition. Even diagnostics and remote surgery could be done from overseas if the US medical sector had not bought off the government to avoid any real competition, like Medicare has to done in the US to pay. If we could have the option of being done outside our borders and split the savings there would be true competition, which the US medical sector has the government through the control of money and regulations maintains a very abusive monopoly. I deeply appreciate your view points, point counter point is the best way to reach solutions in almost everything, sort of like GAN AI. Thanks

 

[Tanj]

Socialism is not the point here. There are 1st world countries with way better medical systems and lower costs - not a socialist in sight. Take a look at Switzerland. That system (which incidentally was a model for the ACA, although the ACA was hopelessly compromised by the time it was shipped) is designed around private choices mixed with intelligent actuarial principles. So, policies do not cover you for ordinary expenses (your insurer is not in the middle of the retail chain, like here) and deductibles are relatively high, does cover you for catastrophes, and everyone is required to have insurance. A bit like drivers require insurance, so does anyone expecting to use the health system. But since individuals choose the insurers, and individuals pay a lot of the expenses, the market is at work even while the principles of insurance (shared exceptional risk over a broad population) are in effect and the products offered must meet a definitional minimum.

Of course it helps that Switzerland has a population willing to think about the issues involved. In the ACA the general approach was mimicked but (especially with the current administration) all the important bits are upside down. The companies vie to become middlemen for all your everyday transactions, they take away your choice of practitioner, they exclude coverage for ruinous scenarios, and they are free to exclude anyone who actually shows risks. In short, they are leeches not a healthcare system.

If you benchmark the waste in our healthcare (the difference between what we pay and what a basket of the next 12 richest large countries pay - all for better outcomes than us) then we waste about 6% of our GDP relative to the WORST of them. Never mind the stars like Switzerland, which has an essentially universal private care system. That is over twice the size of corporate taxes, or about 75% of income taxes. And of course that money is paid by the broad gainfully employed workforce and their employers (the poor are not paying, either struggling along in misery, or covered by medicare, again paid by .. guess who) so this is a burden of waste which is a massive handicap on our economy. Fixing this would give us back almost as much as cancelling personal income taxes.

The "socialism" argument is just a distraction by those who want us not to solve this. After all, it is the biggest feeding trough out there.

 

[Arthur Hanson]

Socialism is not the point here. There are 1st world countries with way better medical systems and lower costs - not a socialist in sight. Take a look at Switzerland. That system (which incidentally was a model for the ACA, although the ACA was hopelessly compromised by the time it was shipped) is designed around private choices mixed with intelligent actuarial principles. So, policies do not cover you for ordinary expenses (your insurer is not in the middle of the retail chain, like here) and deductibles are relatively high, does cover you for catastrophes, and everyone is required to have insurance. A bit like drivers require insurance, so does anyone expecting to use the health system. But since individuals choose the insurers, and individuals pay a lot of the expenses, the market is at work even while the principles of insurance (shared exceptional risk over a broad population) are in effect and the products offered must meet a definitional minimum.

Of course it helps that Switzerland has a population willing to think about the issues involved. In the ACA the general approach was mimicked but (especially with the current administration) all the important bits are upside down. The companies vie to become middlemen for all your everyday transactions, they take away your choice of practitioner, they exclude coverage for ruinous scenarios, and they are free to exclude anyone who actually shows risks. In short, they are leeches not a healthcare system.

If you benchmark the waste in our healthcare (the difference between what we pay and what a basket of the next 12 richest large countries pay - all for better outcomes than us) then we waste about 6% of our GDP relative to the WORST of them. Never mind the stars like Switzerland, which has an essentially universal private care system. That is over twice the size of corporate taxes, or about 75% of income taxes. And of course that money is paid by the broad gainfully employed workforce and their employers (the poor are not paying, either struggling along in misery, or covered by medicare, again paid by .. guess who) so this is a burden of waste which is a massive handicap on our economy. Fixing this would give us back almost as much as cancelling personal income taxes.

The "socialism" argument is just a distraction by those who want us not to solve this. After all, it is the biggest feeding trough out there.

Tanj, I definitely agree with you on the Swiss system that I have studied extensively. Swiss hospitals are set up for highly efficient care, unlike our own. Also the Swiss don't have nearly the obesity problem we have. They have true competition among insurers and have the right to switch during an open enrollment period of the year. Singapore is another country that has a highly efficient system. One thing that has to be required in the US is individual responsibility. Gangs consume huge amount of medical resources with shootings that are largely the result of failing prohibitions where medical problems are converted at staggering cost into criminal problems when alcohol c2h5oh alcohol is one of the most very dangerous drugs being a non specific solvent that attacks every part of the body. The US has many unique problems along with a highly dysfunctional medical, criminal, bad diet with no individual responsibility requirement combined with mandatory free emergency medical that have made the US a unique total mess where everyone from medical to law enforcement to individuals and gangs all contribute to a terrible economic mess.

The bottom line and point of this forum is that it is a staggering market that is growing from population increase and aging for semis/mems/nanotech that the tech industry which drives technology, costs and functionality like no other industry while US medical is the worst ranking 37th in quality and 1st in costs.