What if Healthcare Worked Like Open Source Software?
A little perspective
I’ve recently been working with both a healthcare company and an open source software company. I think this experience in both worlds provides for an incredibly unique perspective that I’m dying to share and get your thoughts on.
Believe it or not, there’s a lot in common with these two industries. Or rather - THERE SHOULD BE!
Let’s start with the impressive strength, honor, and effectiveness of Open Source projects:
Over many years and especially in this century, Open source software has come a very long way and had an amazingly strong impact on our advancement of technology, society, and global well-being.
The power and control of innovation have left the grasp of a few very large companies and decentralized into a hive of millions of sharp minds working together as if there was one team, stretched across the globe, bringing the purest innovation to light. This world of open source is not thinking of bringing new products to market, does not have a hierarchy and for the most part, is advanced by people who are driven by passion instead of a paycheck. These 'code heroes' are delivering and iterating solutions that truly make the world a better place.
The decentralized social structure of the open source community has delivered game-changing projects such as GNU, Linux, GPL, Github, and others, bringing a global standard for developers to unify and drive innovation forward with a mission to advance society through technology.
Giving power to the people - not profits
The world of open source software developers is incredibly odd on the surface for those not ‘in the know.’ There are limitless numbers of contributors who work together honoring coding standards and codes of conduct they have mutually agreed upon. Rules are not designed from the top-down, but rather collaboratively discussed, fought for and ultimately, the open source community will determine what is best for its own community. The society has no kings, no pyramid of management. Respect is given to those who contribute the most. There is no corporate ladder to climb, there is no boss to impress. There’s just the desire to give great code.
Corporations are evil
The level of honor amongst the community is impressive. But what is also important to recognize is the level of distrust in corporations, capitalism, and overall greed. Even the discussion of profits and a focus on revenue can make the open source community sick to the stomach.
This brings me to the healthcare conundrum.
Remember the ‘Greed is Good’ 80’s?
Just like software in the late ’80s and early ’90s that was largely controlled by a small handful of companies such as Microsoft, IBM, Apple and others, the healthcare industry of today is controlled by companies such as Blue Cross, United, Cigna, Aetna & Humana. In the healthcare industry we call these overlords of healthcare “The BUCAH’s” (Sounds like the perfect name of Darth Vader’s health insurance, doesn’t it?).
These 5 companies that control much of the healthcare industry have profited immensely over the last 10 years, especially since the Affordable Care Act (ACA or ‘Obamacare’) was passed.
In parallel, gone are the days of the independent doctor’s office. Virtually all practicing doctors of today are a part of a large hospital conglomerate that controls the costs of the end-to-end supply chain of healthcare treatment.
What would an open source healthcare system look like?
This leads me to the ultimate question I’m asking in this article. (Note: I’m sorry I don’t have the answer...but I have to believe that there are smart people who can figure this out.)
While I’m not exactly sure how it would work, what if healthcare became an open source model?
How to we reintroduce decentralization? How do we take profits out of the primary focus? How does an entire industry advance for the sake of advancing?
Open source healthcare system - not open source software for healthcare
I want to take a moment to explain something that might be confusing. There are many software applications that are based on an open source technology that serve the healthcare industry. I commend the people involved in this, but I’m not talking about open source software for healthcare. I’m talking about an open source model for how healthcare is decentralized, democratized and puts the control of healthcare back in the hands of individuals.
But Brett - Isn’t 'transparency' going to solve all the greed in healthcare?
Today’s hot topic in healthcare is TRANSPARENCY. The hope that revealing true costs and following the flow of money in healthcare will force a change in behavior of the big centralized corporations. There are several initiatives that are fighting hard for a transparent healthcare system. Health Rosetta has done amazing work to help the healthcare broker community understand and adopt cost transparency in order to reveal the broken financial model of today’s healthcare. Transparency is a good first step, but is it the right direction? Is it enough to change behavior?
I am concerned that transparency is not enough. I’ve already seen companies, brokers and other organizations who are doctoring the transparency model - revealing some stuff but hiding other stuff. It becomes a shell game at the end of the day. (Ooh - and sorry about that “doctoring” pun...it had to be done, so I guess I’m not really sorry about that)
What if it’s time for open source healthcare? What would open source healthcare look like? How can the pricing and cost control become decentralized in an industry where the customers (people who receive healthcare) feel like they’re knowledgeable enough about medical issues and health management to make their own decisions?
How do we use what’s worked in technology and create an egalitarian healthcare system?
Where’s the Linux project for healthcare going to come from?
Is there a Github for healthcare? What the hell would that look like anyway?
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5 年Interesting question. Here are my thoughts: 1. The consolidation of healthcare service providers would need to be reversed. That likely means some legislation around records reporting requirements and malpractice insurance that allows doctors to operate independently.? 2. Insurance needs to be totally rethought. I believe that the current model actual drives costs up through a positive feedback loop: the more costs rise, the more you need insurance and the more insurers can charge for it. This cycle needs to break. Decoupling insurance from employment would be a start. A functional public option for catastrophic and emergency care would be another good goal. The objective should be to lower costs to the point where many routine activities can be paid for without insurance, instead of continuing to subsidize outrageous prices.? 3. Less regulation and smarter regulation. Regulation is important and not always bad. But regulation should be focused on protecting patients, ensuring fair competition and eliminating rent-seeking activities. Regulation should not stifle innovation. The regulatory framework around healthcare should be rethought with the consultation of open source software leaders who can provide ideas on how to jump-start innovation. 4. Technology companies could lead the way. Instead of developing new technologies that work within the existing framework, technology companies should be using AI, data science and communications to disrupt the system. Create workarounds that give patients better, more accurate and cheaper access to diagnostics, primary care, testing, and health monitoring. Use these innovations to force the system to change. If I can go to a Watson powered site to be diagnosed, have my health monitored through a biometrics app, and use telemedicine to have a remote professional confirm data and write prescriptions that can be filled from cheaper international sources, that would disrupt the current model. But regulation stands in the way of that today.?