'Reinventing the doctor' is coming up September 12 @UCSF

AI and your doctor; Medicare for All and price controls effect on doctors

At our upcoming salon on September 12, the topic will be "Reinventing the doctor." Keith Rabois, partner at Founders Fund, will be joining us.

Just as Felicis Ventures Adyin Senkut sat down with us to speak on mental health broadly, including how religion affects our mental state, we'll be talking big picture with Keith. Some questions we'll discuss: If the US has the best doctors in the world, why are our mortality rates and disease burdens higher than other countries? And would Medicare for All burden doctors more and exacerbate the doctor shortage?

Register early as these events sell out.

As always, ahead of the event, I'll be curating interesting articles and podcasts from around the Internet that are relevant to the topic.

AI and Your Doctor, Today and Tomorrow 

Dr. Eric Topol is the author of a new book: Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again. The premise of the book is that AI and machine learning software are enabling doctors to be more present with patients, thereby reducing burnout, "superficial contact with patients" that result in errors in diagnostics and unnecessary treatments and tests.  

In this podcast with @16z Bio Fund general partner Vijay Pande, he talks about how AI and machine learning can alleviate the doctor's burden of administrative tasks, such as updating electronic health records and taking notes. Much of this tedious work can take time away from the doctor's interaction with a patient. Technology, like quickly-advancing voice-recognition software, is helping doctors be more hands free of technology. Natural language processing is already liberating clinicians, said Topol. Not only is NLP transcribing communications between doctors and patients, machine learning systems are synthesizing the notes and making sense of them. Topol sees AI helping doctors practice like they did circa 1970s, when they could spend more quality time with patients. An interesting question brought up by Pande was: What's the ground truth? Today, the ground truth is getting multiple second opinions, said Pande. Topol doesn't provide a succinct answer, only to say that AI can "rev" up accuracy because it's trained on hundreds of thousands of data. 

Listen to the podcast

How "Medicare for All" would worsen the doctor shortage

At the end of June during the first Democratic debate, the idea of providing healthcare for undocumented immigrants moved into the political limelight as the 10 candidates, including Joe Biden and Kamala Harris, raised their hand when asked if their health plans would cover illegal aliens. Obviously, the devil is in the details. But covering illegal aliens when we don't even cover all Americans seems like we're getting ahead of ourselves. Let's first stick to the discussion about "Medicare for All" before we start asking the more rhetorical and litmus-test-typed question regarding immigrants. 

So what does "Medicare for All" - a single-payer system - mean for healthcare, specifically our doctors? It won't be good, according to many publications and think tanks on both sides of the political divide. Basically, it would drive doctors away from the profession, mainly because their salaries would decline. Medicare rates are fixed and are "significantly below private sector rates," and "often do not cover the true costs of providing medical services," according to one Heritage Foundation report. For every $1 American hospitals spent on Medicare patients, they were reimbursed 87 cents. The Congressional Budget Office analysis showed that across 20 services covered in the private sector, the amounts were 11 to 139 percent higher than what Medicaid paid.  

Physicians use the private sector to "close the gap." Bottom line: Medicare for All would drive doctors away.

Read more 

Consequence of price controls: scarcity, waiting lines, higher prices 

I'm not a fan of Medicare for All, especially if it eliminates private health insurance. While one could argue it's a mechanism for reining in costs, resorting to government price controls would reduce supply (doctor shortage) and hence result in waiting lines for healthcare services, and ultimately higher prices for consumers. Price controls have adverse effects and a number of reports validate this. "Since supply and demand shift constantly in response to tastes and costs, but the government price will change only after a lengthy political process, the government price will effectively never be an equilibrium price. This means that the government price will be either too high or too low," according to a Cato Report titled "The Problems of Price Controls."

One of the best examples of where price controls didn't work was when President Richard Nixon imposed them on oil prices in 1970. 

"Back then, “price controls turned a minor adjustment into a major shortage,” said Thomas Sowell, author of “Basic Economics: A Citizen’s Guide to the Economy.” Mr. Sowell says that although the best response would have been to let prices rise, giving oil companies an incentive to produce more and consumers an incentive to conserve, “this basic level of economics is seldom understood by the public, which often demands ‘political’ solutions that turn out to make matters worse.”

Read more

Image source: PBS, ABC News, Sayanthingblog