In a future version of Cheetah, scaled-up from diabetes to general health care, every individual has a health care account. The medical history of each individual is electronically encoded in a fully distributed peer-to-peer health transaction system built on open standards and open source. All data is encrypted and accessible only by those authorized, like yourself (if it's your health data), and selected doctors, specialists, hospitals, care takers and insurance companies. Your health data is available globally, but only to qualified providers of medical services selected by you. Emergency facilities are equipped to override the encryption in the event that an individual is incapacitated.
Each provider of health care has electronic equipment custom-designed for their practice, yet compatible for the overall information structure. Thus, 95 percent of the system is incrementally owned and operated by tens of thousands of health care providers and vendors in free and open competition with one another. Yet it functions as a unified whole through common and open standards and cooperatively owned elements, such as a central system to which everyone has access. An ever-increasing amount of health information and care is provided through inexpensive, interactive voice-data-video and internet equipment in the home and at an increasing number of community locations open to the public.
The system has accumulated an immense amount of online, de-identified, patient data, invaluable for analysis of health trends, preventive measures, development of new drugs and treatments, and tracking of epidemics or terrorist attacks. An abundance of information is electronically available to patients and their care-takers so that they can make ever better informed choices for maintenance of their health. The system provides insurers and funders an immense variety of data, allowing them to custom design authorization and payment procedures to balance costs, losses, and the level of service in competition with one another. The value of the data alone provides more than enough income to operate the system and finance its evolution.
The system provides a lifetime customer account into and through which money flows electronically from a variety of sources--insurance companies, government, employers, personal earnings, and charitable institutions. Funds are fully invested, yet accessible for health care at times or for purposes determined by the account holder in accordance with the reasonable constraints of the provider of funds. Funds are accessed by the same electronic encoded system that carries patient medical data. Each medical transaction is instantly authorized prior to performance of services. Payment is electronically made when service is rendered at a cost of less than two eurocents per transaction.
Government retains the authority to tax and redistribute income or otherwise set public policy in order to ensure a minimum level of care to each person, but is not involved as a direct provider, or controller of the system. Individuals have the responsibility for and control over their own health and care, as well as the money required for that purpose. They have access to reliable, low-cost medical care around the clock, seven days a week, wherever they may be or care to go. Customers initiate all transactions. It is a customer-driven system.
There is no need to continue this description because some of you are no doubt wondering if you are being misled; whether the system really exists. Every element of what just has been described exists right now, right here, on our planet. Everything required is state-of-the-art, off-the-shelf hardware, software, and communications equipment that is plummeting in price. More is being engineered at ever-reducing costs at a pace far beyond our capacity to put it to productive use. Every element of the kind of organization and management required has been pioneered, has come into being in other fields, and has produced the results described. There is nothing to be learned, invented, or tested. It is all at hand, right here, right now!
Why then, does such a system still lie dormant in the field of health? The answer is not complicated. Who would you trust to own and control such a system? The federal government? The American Medical Association? The Landelijke Huisartsen Vereniging? HMOs? State governement? Major insurance or drug companies? A stock corporation? Each question is inevitably met with a chorus of 'no' from the audience.
If you think carefully about every existing form of organization, I doubt of there is a person out there who would trust any of them with the discretion of such a system, and rightly so. Only with the evolution of a chaordic organization in which all relevant and affected parties have equitable voice in governance; in which the whole does not control the parts and the parts do not control the whole; in which competition and cooperation are harmoniously blended; only then, will a universal safe, low-cost system of health evolve.
You don't have a health care problem. You have an institutional problem, and until you deal with it, things will get progressively worse.
Can such a thing be done in the field of health? First, a few facts. Reading this article are hundreds of the most intelligent, highly educated people in our society. You are the most technologicaly sophisticated people in the world, certainly when it comes to medical intervention. Most of you are among the most caring people in the world, else why would you have entered your profession or study? Your work is the most liberally financed in our nations--publicly, privatly, charitably, and individually. For more than a century, you and your predecessors have been among the most highly respected, trusted people in the world.
Any one of you will set out virtually anywhere in the world with a small rectangle of blue, white, and gold, polyvinyl-chloride VISA card in your pocket with complete confidence that you will be transported, housed, fed, clothed, and entertained, with all the complex information the requires--currency conversions, language translations, and financial settlements--handled within seconds with complete privacy and 99.99 percent accuracy.
How can it be that you cannot provide anything remotely comparable if I walk down the hall or across the street between medical practitioners, hospitals, or laboratories, let alone have the temerity to become ill or involved in an accident in another town or country?
How can it be that you can understand and deal effectively with the most intricate, complex, systemic structure that trillions of years of evolution could create, a human body, yet remain in the dark ages when it comes to organizing yourselves into an effective, systemic structure for the benefit of those you purport to serve, even when doing so would serve your interests equally well?
How can it be that you tolerate rising rates of preventable medical error resulting in death or serious injury that would cause you to rise up in arms were it to happen in any other segment of society?
I hope you will forgive me for raising such deeply troubling questions. They are not raised in criticism of you as an individual medical practitioner, your medical association, or even health care as a whole. Lord knows, you need no more of that! I raise them because of a powerful belief that deep within your seemingly intractable problems is an incredible opportunity; because embedded in your industry are values essential to a more liveable world; because you have the ability, resources, and training to swiftly deal with your organizational problem and create something extraordinary.
Have you the will to do it? Or more correctly, for I am a patient, have we the will to do it? Now that is a very different question. A question only you can answer, for if it is to happen, the leadership must come from within those who come forward to take the lead in such a new order of things.
Slightly adapted from "One From Many", chapter 19, by Dee Hock.