A Fisking: Intel’s Andy Grove Pitches a Plan for Fixing Health Care

From Wired comes this introduction:

Intel’s Andy Grove Pitches a Plan for Fixing Health Care

Kristen Philipkoski 05.02.07 | 2:00 AM

Andy Grove, the Intel co-founder and one of the most important technologists of the modern age, wants to fix the broken U.S. health care system with — surprise, surprise — technology. But there’s a twist.

As technology executives get older, they seem to inevitably become interested in health care. The Bill and Melinda Gates Foundation has had a major impact on global health. Steve Case, former CEO of AOL, has just launched Revolution Health, a health management site. They’re joined by Grove, former chairman and CEO of Intel, who is touring the lecture circuit proselytizing his solutions for the troubled health care system.

Well, okay, some fellow who has forgotten more than most know about his field decides his expertise in one field means he’s an expert in others, and medicine is the target.  From that standpoint, he’ll have to get in line.

I’m going to skip ahead, but please do follow the link and read the entire article; it’s very well-written, and I’m not trying to deny the good people at Wired any bandwidth / exposure (trying to play nice with the ‘fair use’).

Grove breaks the problem of health care into three manageable chunks. Two have technological solutions — but not complex tech. Grove wants to keep the technology as simple as possible, a surprising idea for a man who put millions of transistors on a chip.

First: Keep elderly people at home as long as possible (an idea he calls “shift left”). Use high-tech gadgets to help them remember to take their medicine and monitor their health. In one year, if a quarter of the people now living in nursing homes went home, it would save more than $12 billion, Grove says.

This is idiotic, and I’ll bet Mr. Groves never once cared for someone from or in a current nursing home.  If he had, he’d realize they aren’t there because they need ‘health monitoring’ or scheduled medications, they’re there because they’d die if actual people didn’t come and take care of them, every day.  The few I’ve seen from nursing homes who were there just for medications were so exceptionally unable to care for themselves it’d be criminal to send them anywhere other than a strictly supervised environment.  Jail is out, so nursing home it is.

Oh, and who’s going to monitor the monitors, and respond when the readings don’t jive?  Are they factored into this equation of 12 Billion saved?  How much of that 12 BN will be spent making all those homes safe for the disabled, etc.  I could go on, but you see the basic error here, no need to belabor it.  There are more errors to be dealt with.

Second, Grove advocates addressing the uninsured by building more “retail clinics” — basic health care centers in drugstores and other outlets that can take care of problems that are presently, and expensively, addressed in emergency rooms.

ED’s are definitely expensive, and are not great places to get primary care.  Ask WalMart how the clinic idea is going (they’re trying); more later.

Lastly, unify medical records using the internet. In his vision, every patient carries a USB drive containing his or her medical records, which any doctor can download.

An utterly horrible idea that will shut down hospital networks coast to coast when the USB dangles are infected with the trojan of the day.  I dread the day someone hands me their USB and says “All my information is there”; it could be one typed page, but it’s likely to be dozens to hundred of pages, some typed, some scanned, and CT’s, etc.  Which I am now expected to digest and absorb prior to their care?  No thanks.  Tell me the bullets, give me the photocopy of your meds and your latest EKG, and we’ll all be better off. 

After a recent lecture in Berkeley, California, Grove sat down to explain in more detail his ideas about “shift left,” treating the uninsured and how to best unify health records.

….

WN: You believe insurance companies are less important in the big picture of health care than they used to be. Can you explain why?

Grove: There are 50 million uninsured, as compared to 10 million 40 years ago. We’ve got a problem of a quarter to a third of the U.S. population (not insured) to deal with. Insurance companies are not being helpful or harmful because they are outside of the system.

The counter argument has been made by others, for years.  Style points if not logic points, for not taking the easy road.

WN: What’s the most important problem in health care to solve in the next five years?

Grove: The uninsured and emergency care being used as a primary care provider. As the population ages, people are being thrown out of the insurance boat at a faster and faster rate and it’s the forgotten part of medicine.

We have the Human Genome Project, personalized medicine, war on cancer, CyberKnife, stem cell research on one hand — no doctor to be found or to take care of your sore throat on the other. That’s a pretty ugly picture. It’s pretty ugly today but it’s going to be uglier five years from now.

Actually there are a lot of doctors who would like to treat a sore throat, and I’m one of them.  It takes me about 4 minutes, start to finish.  Sore throats aren’t clogging up ED’s.  And, all those other interesting things have nothing to do with primary care.  It’s a big non-sequitur.

WN: Universal health care is such a buzzword these days but you clearly don’t think it’s the answer. Why not?

Grove: I’m not excited about the implementation or our willingness or capability of implementing that concept until we figure out … what to do with a third-party industry that all of a sudden gets blown up, transported to the moon or whatever. (Insurance companies) would probably be less than enthusiastic about the move. (Insurance is) a large industry and employment for a lot of people — like it or not it’s a real problem.

The second part is — nobody talks about it — but deciding what you provide under this universal health care system and how do you keep the treatment inflation from making it more and more expensive? How do you make certain treatments available and not others … as compared to everyone being entitled to every scientific possibility out there, which is the current mind-set. Unless we deal with these two problems, all we do is flagellate ourselves…

Well, we can agree on no to Socialized Medicine.  Did you notice those insurance companies that were outside and not causing the problem are now a problem?  How’d that happen?

I fully agree with him that determining what SM covers, and more importantly what it doesn’t are one of the biggest stumbling blocks to its implementation.  And I hope it stays that way.

WN: You described retail clinics as a disruptive technology that could be the answer to the emergency room problem. Can you explain?

Grove: There is an incredible need of medical help for the 70 (percent) or 80 percent of medical care that is routine … where the diagnosis is straightforward and treatment is basically codified. They are conveniently located to where people live or shop or show up for emergency care. And by concentrating on effective delivery of standard care, they can do it conveniently but also much less expensively than doing the standard production. That’s the complex manufacturing logic — this inflames doctors when I describe it that way, but it’s exactly what I’m talking about. You wouldn’t think about building a toy on the same production line as putting up airplanes. The factories will be different and the cost structure will be different.

I would invite Mr. Groves to come and spend a shift with me in the ED.  Treatments are indeed becoming more ‘codified’, but need individual variation for individual circumstances.  Here’s the trick: The treatments are based on diagnoses, and that’s where the skill, training and many times testing comes in.

Your proposal doesn’t inflame me, by the way, it makes me roll my eyes and dismiss you as someone who has never picked up a chart and tried to differentiate COPD from CHF from CAP, and then apply the ‘codified’ treatment for the one you figure out.  Want to borrow my stethoscope?

WN: Will reliance on retail clinics increase the chance of incorrect diagnosis and generally result in lower-quality care?

Grove: You have to ask: as compared to what? The current system has 50 million people who have no insurance and therefore no primary care provider or clinician at their disposal. Relative to what those people experience, the risk is greatly reduced. Relative to going to the Mayo Clinic or the Cleveland Clinic or (University of California at San Francisco), it’s obviously riskier.

To date, nobody is willing to sacrifice quality for convenience, and the lawyers would drool over this idea. 

There’s more, but you get the basic idea.  He’s no doubt brilliant, but out of his depth on this issue.

I’m serious, by the way, I’d take him on a shift in my ED.  It’d be good for him.