Medical Care by the Minute

After spending months examining the failure of the institutional systems which are the working foundation of America, we are seeking answers to the problems these failures have caused including the very weakening of America itself.

We began with education because we believe that America is now in lockstep with all the great powers of history which lost that status forever when they stopped educating their children. We see evidence of that loss today as we learn of dropping enrollment in public schools, growing truancy rates, districts across the country closing schools, teachers walking away from their careers and Schools of Education losing the teachers who teach teachers, as well.

Our approach was to suggest that in a very short time Artificial Intelligence would not only provide better, individual approaches to the teaching of all subject matter, but would be able to actually reach and teach each student as no public education system has ever done.

Individual AI chatbots are now teaching children one by one…able to assess interest, ability and what is necessary to inspire involvement and motivation one student at a time…essentials to learning no education system has ever been able to achieve.

Here we look at how to improve the quality of healthcare in an America now almost at the bottom of the list of industrial nations in its delivery of healthcare and even below some of those we call third world countries.

Our medical institutions – medical centers and schools – remain among the World’s best and available to the best medical students from abroad – East and West – who come to learn medicine in America.

But despite those facts our delivery of healthcare remains dismal… in many cases literally unhealthy. Now, another blow: medical care itself- the doctor-patient relationship – is undergoing major changes which by their very nature reduce the quality of care we expect from our doctors.

The power of the insurance industry is such that doctors are giving up their private practices to become members/employees of Medical Corporations in an effort to receive compensation for their work which they can no longer expect from the insurance companies which essentially fund all healthcare in this country.

As corporate employees, doctors are being instructed to treat patients as commodities: each patient is worth so much money in income and the time doctors spend with them has been limited to guarantee that a certain number of patients are seen daily. When a doctor is with a patient, a clock is ticking.

All of this is about money.

In recent years a profound and troubling reality has emerged in the lives of physicians: they are no longer making the living that caused bright, highly motivated students to take on the long, difficult educational and physical demands of becoming a doctor. Once achieved, there was the expectation that such special and satisfying work would also produce an income that would allow them to live comfortably above America’s upper middle class.

Once that was true. Now, it is not.

INSURANCE COMPANIES IN CONTROL

The existence of such brilliantly devised mechanisms of medical care – think MRIs, Cat scans, radiation machinery and robotic arms – became ‘must haves’ in every hospital.

Biomedical research produced increasingly successful medicines and treatments – think radiation and chemotherapies – that have turned once fatal diseases into chronic health conditions, which often demand constant care. The cost of all of these advances rose beyond the financial capacity of the average American.

Some were lucky enough to have their employers support these costs with medical insurance. Most did not. And then after years of insisting that our Constitution demanded that this country meet the obligations of a healthy citizenship, Lyndon Johnson and a Democratic Congress finally passed a bill called Medicare for those reaching the average retirement age of 65. Despite all kinds of pressure for and against, America never excluded private insurance companies from taking their place in the mix. To guarantee that reality, the healthcare insurance and pharmaceutical industries provided politicians with the influential financial support that made certain that Medicare never paid more than 80% of any medical bill.

If you signed on to Medicare, you then signed with a private insurance company to help pay that additional 20%.

The tortured development of what became known as Obamacare, was open to all America through television coverage. We watched the then President’s effort to help all those “younger” Americans get cheaper health insurance coverage from a newly proposed public health insurance company. We saw him helplessly give in to the truth of what he was told: no Congress would ever support the idea of Americans buying insurance from a public health insurance company in competition with the private companies.

Big Pharma and insurance lobbyists did their job again and the big idea was crushed. Getting insurance to help pay for the major increases in the cost of medical care became a serious challenge for all but the wealthiest Americans and those over 65.

But that was only the beginning.

And now, we see the final step…the control of what physicians are paid by Medicare and Medicaid. It is no secret. Just take a moment to study the regular reports from Medicare and supplemental insurance companies and you can see physicians’ requests for payment and what they actually receive.

The difference is often stunning.

And so, physicians, no longer receiving the compensation they have expected, have taken steps to strike back. They have formed Medical Corporations. Doctors throughout the country are giving up their entrepreneurial status and becoming employees of growing corporations – all funded by Wall Street. The largest of these is MDVIP, now financed by Goldman Sachs.

These new corporations actively recruit physicians from communities throughout the country. They invite selected physicians to fully paid weekends in areas like Phoenix or Palm Beach, Florida. They are wined and dined. Saturdays are spent in conference listening to exactly what joining that corporation will mean to their practice and to their incomes.

They learn that they no longer need pay for liability insurance protecting them from charges of malpractice. For most that was their first payment when going into private practice. No other professional is sued as often as a physician. Liability lawyers, the ones who advertise on television, exist to sue physicians.

The medical corporation takes over the management of a new member’s staff…providing the most cost-effective staff operation.

All the doctor must do is agree to see a certain number of patients every day. To handle that mandate, the doctor must limit his time with patients to from 15 to 20 minutes. Select time allowances are made for new patients or patients with special treatment needs…otherwise the time with each will be 15-20 minutes.

Make no mistake – to earn the largest salary most doctors have seen or seen in a long while – they have become employees with patient quotas.

ANOTHER WAY

First, do no harm. The oath doctors take on entering the field is real and critical.

The key to the work itself is first and foremost diagnosis. Whether in an office setting, an emergency room or an urgent care facility, that diagnosis triggers the entire medical process. If it is correct, the right treatment is recommended. If not, trouble.

Right now the professionals involved in artificial intelligence are working with doctors, patients and a range of diseases to develop the mechanisms that will make a diagnosis far more accurate than any individual doctor can ever make it…no matter how experienced, how intuitive, how expert. AI’s treatment recommendations follow and again the all-encompassing knowledge behind them will far surpass an individual physician.

Results to date indicate a new world of medical care is already here if not yet the way.

Mammogram tests indicate that AI can not only detect positive or negative results better but can accurately predict the possibilities of breast cancer far into the future just from the data gathered at that visit. These are abilities far beyond what exists today.

The brilliance of being able to accumulate all the knowledge of a disease and all the possibilities of treatment for it in such a way that it can detect and predict the future is beyond any experience ever known in medicine.

What will this approach mean to the practice of medicine and to the cost of it?

Will doctors no longer be necessary? Today Nurse-practitioners already exist in busy physician offices to do what doctors used to do.

Will they be adequately prepared to feed the correct data to the AI “tool” which will then provide the ultimate diagnosis and treatment? Or will that forever be the doctor’s new role?

Answers to these questions exist and will soon be tested. The practice of medicine has changed over time in many ways and for many reasons. Mistaken beliefs have been corrected. New treatments make old approaches instantly history. More changes are certainly necessary now.

THE REALITY OF AI

Those major firms involved in the rapid development of AI exist to make money, yes…but fears presented by businesses out of the AI loop that AI will transmit significant mistakes either by accident or design act as if America’s disappearance into their IPhones has never happened.

What IPhone dependence has done and is doing to the minds and health of Americans of all ages through often blatant misinformation or the need to sell products is unprecedented in American history. And it does not and will not stop until a Congress no longer on a “corporate payroll” passes laws to stop it.

The existence of AI and what important changes it will soon make in the institutions of medical care and education, will not necessarily be the same in other foundations of America’s structure.

But time will tell.

Only knowledge makes common sense and a common will possible. We can see what a lack of knowledge today is doing to both.

AI provides us with an amazing opportunity we have never known before. So overwhelming is that fact, that the decision to accept or reject AI will not be ours.

And that is the most amazing reality of all.