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What’s wrong with this string of syllables?

‘Why isn’t there an Uber of health care?” That’s the question that Manhattan Institute health care expert Avik Roy asks in the opening of a must-read paper, “Health Care 2.0: Ushering In Medicine’s Digital Revolution.”

Correct. When someone cites Roy as an expert on anything but shrieking “Bleah bleah Obamacare!!” you’ve got a problem. However, this is an IBD article. IBD exists to make the Wall Street Journal look like it is run by Marxists, so it isn’t terribly unexpected.

OK, asking why isn’t there an Uber of health care is also a problem because call me persnickety, but I believe there are a few differences between driving a car and providing health care.

“Why can’t we deploy, in health care, the same forces that are improving quality and lowering costs in virtually every other sector of the economy?”

Because you free market chuckleheads haven’t figured out a way to outsource face-to-face patient services to children in a developing nation.

Would be my guess.

These are questions that so-called health care experts rarely ask. Instead, they complain about how MRIs are expensive and how breakthrough drugs cost too much and how more government intervention is needed to keep it all in check.

You know the “Evil/Stupid/Both” question that often arises when neo-cons are the topic of discussion? I think the question should be “Who cares why this stupid ass is such a stupid ass?” Articles about health care that ignore the on-going effort to move the health care delivery and payment model from quantity- to quality-based, using technology even, are one of the many reasons why.

But it isn’t just the Koch shillbots pushing this stuff. Doctors are getting Uber Fever too:

The Uber for health care would allow anyone to access the expertise of the best doctor for diabetes, bladder infections, or cancer care. Like GPS once this health care software or app is developed, make it widely available to the public. They will be expertly guided and learn if they need treatment, what type of treatment, or perhaps they might choose no treatment. After all, the problem patients wanted solved is that they have symptoms, want to know the cause of their symptoms, and, if necessary, get the treatment needed to resolve the issue.

While increasingly there is more software and apps that connects doctors to patients, what we need is software that takes medical expertise and makes it available to the public.

Once this class of software is widely available to public, then the Uber for health care will have arrived. People will discover health care can super convenient, quick and easy, and inexpensive.

Just like Uber.

1. Create app.
2. ????
3. Health care!!

I originally saw the article on Kevinmd.com and was actually relieved to learn that version had been edited. The full version is essentially an advert for Dr. Liu’s own app-driven health care service, Lemonaid Health.

He probably doesn’t think that his service can be scaled up to treat skin cancer or congestive heart failure.


You know what? Forget it, I’m not sure about anything any more.

But Dr. Liu’s model does not involve direct patient/provider contact. Patients fill out questionnaires and for some conditions (hair loss, acne) send in pictures. The doctor on the other end writes a prescription et voila! Health care. Or a dramatic and exciting paradigm shift AKA a pending medical malpractice lawsuit. Who can say? The trick is knowing when to dump your stock in it.

A month before Dr. Liu’s article ran, Dr. Jay Parkinson wrote about his experiences as a web-based health care pioneer. His diagnosis? Fuggedaboudit:

Here’s how I spent the day. I’d wake up and hope that I got a few early appointments during the night. I’d read their stories and then email them to arrange the housecall. If I needed to draw blood, I’d ensure the right supplies were in my doctor bag. If I needed vaccines, I’d have to swing by the pharmacy to pick up the vaccine. If I had to draw blood, I’d have to drop that off to be picked up. If I knew a housecall wouldn’t solve the problem, I’d email the patient with a referral recommendation and a reason why. I could do all of this while traveling, which was increasingly being done by cab so I could communicate and travel.


House calls are not only unscalable for an absurd litany of reasons, especially outside of hyperdense NYC, they’re irresponsible for the system. But it boils down to two issues: It’s ridiculously inefficient and very, very few doctors will actually want this kind of life. I do think they should exist as a ridiculously expensive option for people who don’t care about money, because America.

I don’t agree that house calls don’t work, period. However, Parkinson’s experience is informative because it was a lot more like Uber and traditional health care than Lemonaid.

Not that I expect anything to stop invisible handers from going on about UberCare for the foreseeable future. Especially if they suspect it would increase human suffering and Piss off the Liberals.

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  • Malaclypse

    There are many dumb ideas floating around, most due to JenBob’s return. But “lower entry barriers so that any schlub with a smartphone can practice medicine” is some weapons-grade stupid.

    On the other hand, Jennie McCarthy is a mom, and I understand that’s just like a medical degree, so maybe it will all work out.

  • Housecalls are inefficient from the point of view of the doctor, but very efficient from the point of view of some patients–the chronically ill, for example. I’m pretty sure that visiting nurse programs are extremely good value at maintaining high cost patients (patients with chronic health problems plus problems with compliance) from needing to go to the emergency room. There are countries–first world countries–where new mothers all routinely get well baby visits in their own homes instead of being required to travel to the doctor’s office. These are also supposed to have very good outcomes.

    • I actually know a doctor who runs a solo house call service. His patients are generally too frail to go to an office and have unstable chronic conditions.

      He likes it a lot more than working in an office, but he’s unusual. (Also, unlike Dr. Parkinson, he has a car.)

      • I’d guess house calls might be good in pediatrics. Contagious brats infecting the other little bastards running around the waiting room is not always the best idea.

        ‘Though I s’pose it could result in greater income for the croaker.

    • ThrottleJockey

      This suggests that it might not just be “high cost patients” who benefit from home visits:

      Most care-management systems rely on nurses sitting in call centers, checking up on patients over the phone. That model has mostly been a failure. And while many health systems send a nurse regularly in the weeks or months after a serious hospitalization, few send one regularly to even seemingly healthy patients. This a radical redefinition of the health-care system’s role in the lives of the elderly. It redefines being old and chronically ill as a condition requiring professional medical management.

      Health Quality Partners’ results have been extraordinary. According to an independent analysis by the consulting firm Mathematica, HQP has reduced hospitalizations by 33 percent and cut Medicare costs by 22 percent. https://www.washingtonpost.com/news/wonk/wp/2013/04/28/if-this-was-a-pill-youd-do-anything-to-get-it/

  • Warren Terra

    Speaking of Uber: Uber’s Cutting Its NYC Prices by 15 Percent Today. Because they technically sell their services to independent drivers who therefore can’t bargain collectively, their drivers – excuse me, the drivers who use their service – have to accept this 15% decrease in pay.

    No word on whether those drivers will also be seeing a 15% decrease in car payments, gas prices, and grocery and rent bills.

    • Just_Dropping_By

      The price cut is on a per trip basis. If the price cut stimulates more ridership (which is what the price cut has to be intended to do — Uber’s main source of income is ride sales, so price cuts on a per ride basis don’t benefit it unless they produce increased ridership), the cut in drivers’ total revenues will not be 1-to-1 with the price cut.

      • Philip

        From what Uber drivers have reported, most are already busy essentially at all times while they’re working. Any flex will come from more drivers, not more rides/driver.

        (Also, it’s been pretty well demonstrated that Uber’s surge pricing drives down demand, rather than driving up supply, because supply is not that elastic. So.)

      • Bill Murray

        if the drivers can make more rides during their time working, sure, but is it clear that more than a few can do this?

      • Warren Terra

        Each driver would have to get at least 17% more rides just to break even. Many are getting about as many rides as they can handle already. And even if they got those 17% more rides (and a touch more because of increased gas use), that means they now must work harder to break even.

      • Tyro

        It would work great if an Uber driver could subcontract out his rides to multiple drivers simultaneously. But he can’t, because you can’t “scale” driving: there is a limited resource (a car) and a limited number of hours in the day.

        It just shows that the Uber model is essentially fraudulent: in a true marketplace for rides, Uber would just be providing facilitation so that drivers could specify their price, and riders would choose which driver would pick them up.

        • LWA

          Too bad these drivers aren’t independent contractors, who could set their own prices and..wait, what?

        • Scott P.

          Uber is not a true marketplace for rides, but it’s not clear a true marketplace would benefit current Uber drivers. If it’s true that there is a large number of people who would take Uber if it were cheaper, then drivers would have to lower their prices to attract them.

          Current drivers could try to maintain their higher prices, but Uber users would quickly become aware that there were drivers who charged less. There would be a price war until the margins dropped as low as they could go.

          You could perhaps try to compete on quality, but unless you own a limo, I think that would be hard to do.

          • Tyro

            Drivers could compete against on quality– age of car, type of car, leather vs. cloth, etc. AirBnB is a great counter example to Uber, because AirBnB really IS an open marketplace where real estate holders set prices and the application just acts as a broker.

            But Uber is just a car service with a lot of drivers contracted out using its capital to dominate markets until drivers are no longer necessary.

    • ThrottleJockey

      IANAL but as independent drivers, wouldn’t anti-trust laws prevent Uber from setting prices for drivers much as those same laws prevent McDonald’s from setting prices for independent franchisees?

      • Warren Terra

        If you read the article at the second link, the fact that they set all the conditions, including prices, is a factor in the lawsuits alleging that their drivers are in fact employees.

        I’m also not a lawyer, but I’m not sure anti-trust rules are an issue.

  • Hogan

    what we need is software that takes medical expertise and makes it available to the public.

    “Hey, nerd, write me some code that will replicate four years of medical school and five years of residency training.”

    “On it, boss.”

    • For what it’s worth, healthcare really is considered to be a pretty fruitful domain for applied research in AI, knowledge engines, etc. See IBM’s Watson. We can expect to eventually see the expertise of MDs supplemented with technology, because a lot of medical decisions basically come down to checking a set of symptoms, identifying a probable cause of those symptoms, and selecting the most generally successful treatment. I mean, doctors already use reference materials for this stuff. And if you’ve looked at any of the reporting around pharmaceutical marketing, the evidence is pretty clear that a medical degree doesn’t automatically confer the competence necessary to select the right course of treatment for a patient.

      None of that makes an “Uber for healthcare” anything other than gibberish. Nothing about Uber’s business model, user base, market, etc. has any similarity to healthcare.

      • Philip

        I think this is one of the core problems with the contemporary tech industry. There are a lot of hard, complicated problems where computers can make a significant positive difference. But, for the most part, they’re hard, complicated problems. Joe Brogrammer isn’t going to be able to solve them with a couple thousand lines of javascript in a weekend. But the simple “solutions” to problems (Uber, Airbnb, etc) are what gets attention and funding.

        Take transportation: even setting aside the question of what happens to cab/bus drivers, a hybrid transit grid with mostly self-operating vehicles could actually do a lot of good by making mass transit use without car ownership easier. But creating a safe self-operating vehicle is a massive research endeavor. It will take a lot of work to design a proper hybrid system, and even more to navigate the social issues of convincing people to give up their own cars and use mass transit.

        In medicine, like you said, there’s real space for computer-aided diagnosis, computer checks on human decisions (“are you sure it was the left kidney, Doctor?), and honestly even just halfway decent IT systems in hospitals for keeping track of patients. But these aren’t thinks you solve with a stupid app. They take a lot of thought, significant resources, and years of testing. Most of my industry isn’t interested in doing that.

      • a lot of medical decisions basically come down to checking a set of symptoms, identifying a probable cause of those symptoms, and selecting the most generally successful treatment

        Absolutely. I’ve thought this since the first time I read about doctors who considered their patients to be “lists of symptoms”, & apparently symptoms in which they weren’t always interested.

        Might also improve outcomes for the not-wealthy & the non-Euro whose care may currently be influenced by unadmitted or unconscious bias on the part of medical pros.

        • Philip

          Might also improve outcomes for the not-wealthy & the non-Euro whose care may currently be influenced by unadmitted or unconscious bias on the part of medical pros.

          Depends; there’s a real risk that when systems are trained, they’re trained on data drawn from unrepresentative groups (e.g. probably whites, and quite likely men), in which case they end up just perpetuating the same worse care.

        • so-in-so

          A long-ago employer gave me a book of flow-charts for home-health assessment. Follow the symptom chart and decide if you need an aspirin or an ambulance. It is actually fairly decent, I’ve kept it and used it on occasion.

          Still not Uber for medical care. Why not Air-bnb for hospitals? Or at least Orbitz?

          • LWA

            Yeah, I saw the veterinary version of that in a Far Side cartoon.
            The list of ailments of horses on one column, matched by the list of treatments in another. And every treatment was the same- “SHOOT”.

            • Warren Terra

              That’s this cartoon here.

              see also this one.

            • B. Peasant

              That reminds me of an SNL skit with Bill Murray as a naval surgeon. Every symptom was treated with amputation of a leg.

          • Lee Rudolph

            A long-ago employer gave me a book of flow-charts for home-health assessment.

            Especially valuable for surgical problems; Max-Flow, Min-Cut, that’s my motto!

          • Moondog

            You should keep using that chart for decades on end; those standards will never change.

          • Dr. Ronnie James, DO

            Algorithms like those are a crucial part of late medical school training (i.e. how ton diagnose what’s causing acidosis, how to manage a GI bleed, etc.). The “value add” (forgive me) in becoming a real doctor entails knowing when the algorithm is full of shit. I’m not sure how an app can replace that anytime soon.

        • Dr. Ronnie James, DO

          A lot of doctors I know (OK, most) (OK, all) rely on Epocrates, UptoDate and even Medscape as a backup/ confirmation source. They are particularly useful for checking a patient’s 5-10 prescriptions for harmful interactions. It’s to the point where Epocrates is rolling out an EMR and secure messaging platform for docs that links your management, diagnosis, prescriptions etc to

          With that said, nobody wants an algorithm as their doctor/ pharmacist, robots can’t do exams, etc.

      • esc

        My spouse used to work for a medical school department that dealt with that kind of thing. They call it bioinformatics. I gathered the researchers were working on things like doctors being able to analyze in real time how well a new chemo regimen is working across a broad swath of patients. Maintaining patient privacy is the tough part.

      • For what it’s worth, healthcare really is considered to be a pretty fruitful domain for applied research in AI, knowledge engines, etc. See IBM’s Watson.

        Well, for decades. It’s never played out as hoped, but it generally doesn’t until it does.

        We can expect to eventually see the expertise of MDs supplemented with technology, because a lot of medical decisions basically come down to checking a set of symptoms, identifying a probable cause of those symptoms, and selecting the most generally successful treatment.

        If it really were that easy we’d be done ;) there plenty of clinical decision support out there. Sensing is a big part of the problem. Also our rules aren’t well grounded usually.

        I mean, doctors already use reference materials for this stuff. And if you’ve looked at any of the reporting around pharmaceutical marketing, the evidence is pretty clear that a medical degree doesn’t automatically confer the competence necessary to select the right course of treatment for a patient.

        Partly because nothing conveys such. It’s very unclear what to do in all sorts of situations.

        • ‘Auto-doc’ technology seems to have some of the same obstacles as self-driving cars: life-or-death stakes, an unclear path forward for liability, and a deeply skeptical potential user base. Human doctors fuck up all the time at a rate that would never be accepted from a computer, but we’ve accounted for that risk already.

      • guthrie

        The issue is that where we see ‘supplemented’ as a useful aide to diagnosis, the capitalist-medical-industrial complex or whatever you want to call it sees “replaced by at lower cost”.
        Net result being that something which is worse than before gets loaded onto the proles without proper testing or anything, in order to make more money for some people.

    • Ken
      • cpinva

        my wife was just recently in the hospital, and I’d swear I saw that chart at the nurse’s station. explains a lot.

  • DrDick

    Talk about people unclear on the concept. Of course we are talking about libertarians here and they are unclear on all concepts.

  • Roger Ailes

    Why isn’t there surgeonless open heart surgery?” Roy also wondered.

    • Big government’s refusal to allow surgery by pre-programmed da Vinci units is just one more way the Obama administration has failed the American people.

  • There is, Avik. They are called Urgent Care facilities, and work nicely for people who can’t afford a doctor and those who can’t wait for a hospital.

    They also charge an arm and a leg and can refuse to serve you if you don’t have insurance or sufficient credit.

    You know, like Uber. And like Uber, the rest of us pay for the fact that assholes like you refuse to acknowledge the real problem here: greed.

    • Dr. Ronnie James, DO

      Yeah, Uber for doctors is a great idea…in a world without gigantic out of network charges. You could do Uber for doctors within network, which you could call…urgent care/ telemedicine. Oh wait most of them already do that.

      You know, I’m starting to get the idea Avik Roy really has no idea what he’s talking about.

  • I think what these guys mean by “an Uber for healthcare” is a service which will enable them to skip the line with the proles. They like the idea of a way to summon medical care that is fast, discreet, private, cheap, but mimics a limo. They don’t like the idea of a mass transit approach to health care in which, to beat the metaphor to death, there are frequent, highly subsidized, buses that pick up and drop off everyone, regardless of class status, all around the city at all times of the day and night. Because waiting for even a minute for a service that is going to be used by a lot of people, or in which you might have to give up your seat for someone in greater need than yourself, is anathema to these babies.

    • Hogan

      So you’re saying Avik Roy has been binge-watching Royal Pains?

      • cpinva

        love that show! the actress who plays the PA is effing gorgeous!

    • Malaclypse

      I disagree. Uber is “disruptive,” disruptive is good, be like Uber. That’s the extent of it. This is what happens when you have a culture where “Who Moved My Cheese?” is seen as deep, insightful thinking.

      • The Temporary Name

        Why isn’t there an Uber app for my cheese?

        • dr. fancypants
          • cpinva

            “Uber Eats”

            I’ve heard that, only “Eats” wasn’t the word they used.

    • FlipYrWhig

      I bet there’s something to that: cheap and yet not icky public.

    • Tyro

      I think what these guys mean by “an Uber for healthcare” is a service which will enable them to skip the line with the proles

      We have that! Concierge Medicine. On a less-expensive scale, it’s done by One Medical, where you pay $150/yr for a “membership” which gives you access to doctors who can schedule you in more easily, won’t be late, and have nice officers.

      It’s the ultimate Uber-like solution in that it helps a well-paid professional make his life more convenient.

      • Brett

        Only $150/yr? That’s not bad. I thought it would be a lot more expensive.

        • That’s really cheap for concierge. And they take private insurance, so there’s some on-going monitoring of their work.

      • cpinva

        “and have nice officers.”

        I don’t care if their officers are nice, I do care if their Dr.’s are competent, and I don’t have to spend half my life waiting for them to finally get to me.

        • Tyro

          Weirdly, though, people do care if the offices are nice. So it works for them.

          $150/yr is like the original Uber service of giving you a black car for a $15/ride minimum: ie, more expensive that you traditionally expected to pay but would be none the less willing to pay for the promise of premium service.

      • Hogan

        and have nice officers.

        In the civilian world we call them “nurses.”

  • Murc

    The Uber for health care would allow anyone to access the expertise of the best doctor for diabetes, bladder infections, or cancer care.

    Why on earth would the leaders in these fields feel like treating patients sight unseen over a smartphone app? Why wouldn’t they be working at Johns Hopkins or the Mayo Clinic where they can, you know, reasonably demand that anyone who wants their expertise pay them a visit in person?

    Doctors could stand to utilize technology better, but… I mean, medicine is actually hard and doctors actually do require a lot of training. It’s not like driving a car, which any idiot can do with a reasonable degree of proficiency.

    Mr. Roy has been living in economic areas where a labor surplus is taken for granted for far, far too long. There is not a labor surplus of doctors, which means you can’t commodify them, at least, not easily.

    • Philip

      It obviously doesn’t apply to Roy himself, but I think a lot of programmers like “Uber for X” ideas because they don’t understand how X can be that difficult. Everyone says programming is hard, but they’ve never found it difficult! The fact is that most of them are godawful programmers, and just don’t recognize it. They can get away without recognizing it because, unlike in medicine, in tech you don’t have either mandatory tests or dead patients to demonstrate your total incompetence.

  • SP

    I read IBD as Irritable Bowel Disease which is probably less annoying than Investor’s Business Daily.

    • rm

      Same output.

  • Joshua

    The reason Uber works is because it’s a simple service. Everyone understands driving from point A to point B.

    Other attempts at Uber-ing services haven’t worked so well. I remember reading a Uber for house cleaners but I don’t think it’s went anywhere. Going inside someone’s home and cleaning it is a lot more personal, invasive, and varying in quality than getting a ride. I wouldn’t use a Uber for walking my dog, even though gazillions of people are capable of taking my dog out for a walk. Not gonna do it.

    Needless to say it’s tough to draw a line from using an app to get a ride and using an app to go to the doctor.

    • I remember reading a Uber for house cleaners but I don’t think it’s went anywhere.

      Homejoy. It went out of business for a reason that is common to a lot of these “Uber for X” startups: its service providers were actually independent contractors. As a result, customers would use the service until they found a cleaner they liked, and then they would establish an ongoing relationship and stop using Homejoy.

      Uber works because a lot of its usage is spontaneous and timely — you weren’t planning on needing a ride, but you need one, and you would like it as soon as possible. Its riders also don’t really have a strong motivation to enter into direct relationships with drivers. Cabbies have been taking on “personals” for ages, but that’s still a tiny percentage of total ridership, for riders who take cabs regularly. This also gives Uber a lot of leverage over its drivers.

      The situation is reversed for home cleaning services. Certainly, there are people who mostly clean their own houses, but might occasionally find themselves with an emergency cleaning need — unexpected out-of-town visitors, party got a bit out of hand, someone got sick, etc. In a case like that, sure, you might want to find the closest reputable cleaner who can be there in an hour. But that’s such a tiny market. Most people who can afford to and want to hire a cleaner want an ongoing relationship for a host of reasons. Most of the people who don’t are already acceptably served by the various existing cleaning services.

      What’s amazing is that Homejoy received an ungodly amount of investment, and from pretty reputable investors, even though their business model was obviously unsustainable. They never had a credible way to keep people using their service after the initial relationship was developed, which essentially meant they were a massively overfunded and narrowly-focused Angie’s List.

      The moral of the story is that investors are rich people, and a lot of poor investments can be traced back to the fact that investors live lives where they can bypass a lot of life’s details and difficulties by throwing money at them. A lot of Silicon Valley startups are just selling streamlined ways to throw money at problems.

      • Brett

        Diversification may have been at work as well. These folks invest in a lot of startups, and expect a high frequency of them to fail anyways. They might have tossed a ton of money into HomeJoy just in the unlikely event that it worked out.

  • Jay B

    You know, in LA there’s already an Uber-like mobile health care disruptor, it even has its own dedicated dispatch number: 911. It totally breaks through the paradigm.

    • I still (technically, I’m sure any records are long gone) owe the City of L.A. about $30.00 for an ambulance ride (c. 1975) to an urgent care facility after some schmuck opened his car door in front of my bicycle, sending me over his door & onto the asphalt. (Needed one suture near an eye.)

    • heckblazer

      Eh, it’s overrated. Years ago when I lived in LA I fell off my bike and broke my arm, and when I called 911 I was put on hold.

      (True story. In LA 911 calls from cellphones go to the CHP on the assumption it’s an accident report, and I broke my arm during rush hour).

      • Linnaeus

        Obligatory link.

  • Gwen

    The problem with this article is that it is entirely oblivious to the lack of any real competition in the way health care is delivered in this country.

    * In many areas, one hospital or hospital chain dominates care.

    * Even if you can get providers to compete against each other, they’ll often only want to offer one type of care (usually the most expensive) rather than a substitute that is less effective (and equally or only slightly less efficacious).

    * It goes without saying that people who need emergency care are usually not in a strong position to bargain for it.

    * It also goes without saying that many people who are in a position to “shop around” will not do so, because choice is expensive.

    * With regard to drugs, the government is actively discouraging competition by prohibiting import of drugs and propping up ridiculous intellectual property regimes.

    The result is that you have a system where the cost and quality of health care are only casually – if at all – related to one another.

    But anyway, health care already got “uberized” 20 years ago when HMOs tried to reign in costs. It didn’t work, and patients hated them.

    • heckblazer

      That broken arm I mentioned above? I broke it during a gap in coverage. It was severe enough to need a steel plate for stabilization, and let me tell you shopping around for the best deal on surgery was not fun.

      • dr. fancypants

        This is exactly the sort of health care I point to when anti-ACA idiots turn to the “you can always be seen at the ER!” nonsense.

        The ER will make sure your broken bone won’t kill you, but when it’s time to get that surgery you need so you can actually heal properly, you better be ready to come up with $10k pronto.

        I had an ex who broke her ankle during a gap in coverage, and the surgery was a rough financial hit for her.

      • Karen24

        My husband is a severe diabetic. In 2007 he developed pancreatitis from a gallstone. We went to the ER, he was admitted, and immediately his condition went from “emergency” to “scheduled.” His surgery wasn’t considered an emergency for insurance purposes, even though his admission was. We had insurance, so we paid $12,000 of the $85,000 bill, and that’s not counting the years of follow-up visits and thousands of dollars of drugs since then.

    • Dr. Ronnie James, DO

      It’s also oblivious to the fact that the big hospitals/ networks already offer care-on-demand via urgent care/ telehealth.

      As always, Avik Roy is an ex-Wall Street analyst playing dress-up in health wonk clothes.

  • Breadbaker

    1. Create app.
    2. ????
    3. Health care!!

    Sidney J. Harris called. He wants his joke back.

  • Mike G

    Instead, they complain about how MRIs are expensive and how breakthrough drugs cost too much and how more government intervention is needed to keep it all in check.

    Maybe because those items actually DO cost magnitudes less in other countries that have more government intervention?
    But pay no attention to how it is done in other countries that are doing it better. Because commies and MURKA and FREEDOM.

  • MartinAlexander

    I’m really not sure why people take Avik Roy seriously…I mean the guy is,a great example of wing nut welfare. Roy couldn’t even finish college yet people for some reason consider him a health care expert.

  • N__B

    ‘Why isn’t there an Uber of health care?

    Health care where the price of a flu shot increases during a flu epidemic. Fucking genius.

    • heckblazer

      Evil genius, yes.

    • Bill Murray

      isn’t that the Shkreli Plan?

      • N__B

        No, his plan was to increase the price on days ending in “y.”

        • Bill Murray

          with such subtlety does evil distinguish itself, and extinguish the rest of us

  • BigHank53

    But there is an Uber for health care. You can ask Michael Jackson how much he enjoyed his experience with an on-call doctor.

  • Tyro

    The thing is that there are not a lot of savings to be squeezed out of primary care. We’ve basically gotten as much as we can get out of it. Yes, there’s probably some savings to be made from remote-diagnosis dermatology, but that doesn’t resolve the overall issue.

    The cost drivers are drug costs, highly specialized procedures, and end-of-life care. An app isn’t going to help those.

    • Lack of care co-ordination is another cost driver. The days of specialists only caring about the specific conditions they treat are coming to an end because it costs to much. For the same reason efforts are being made to put primary care providers back in the … er … primary position of patient care.

      • Dr. Ronnie James, DO

        This – although too many PCPs take the attitude of “this is too complex for me, let the specialist handle it.” Also How to Coordinate Care Awesomely still isn’t taught in most med schools. The big pay-for-outcomes organizations are probably going to have to teach it (eg Kaiser Permenante just created its own med school in CA).

    • cpinva

      “and end-of-life care.”

      surprisingly (well, to me, anyway.), dying a normal, old age related death is just incredibly expensive in the US. even if hospice is utilized, it still ain’t cheap. your family would be better off if you got behind the wheel of a car, and “accidentally” ran it into a brick wall at 80mph. this is one big reason why the idea of deciding for yourself when you’re going to leave this mortal coil has become a thing.

    • Scott P.

      Well, also doctor’s and nurses salaries.

  • Epsilon

    1. Create app.
    2. ????
    3. Health care!!

    I laughed uncontrollably at my work desk reading this, and I can count on two fingers the number of times I’ve done that. Thank you, Shake, I really needed that.

  • Linnaeus

    I appreciate the link to the Electric Six, by the way. I laughed out loud at “John R. Dequindre”.

    • I appreciated that too. Metro Detroit represent!

      I’m still not sure why they aren’t the biggest band in the history of the world.

  • swaninabox

    Clearly the answer is to outsource care to Underpants Gnomes. Although they might be unionized, which is probably a deal breaker.

  • rm

    It really sounds like he is describing WebMD.

    Put in your symptoms, get a insta-diagnosis, what could go wrong? It’s not like people misdiagnose themselves — that would be impossible given their rational incentives to get good health care.

  • At age 64 I’m an old fogey physician and variants of this notion have rattled around for years. It also might have some limited uses. And some physicians have been experimenting for quite a while with remote, online encounters with patients that could be cheaper, more efficient, and maybe even represent a better experience for all. But this Roy guy is an idiot gasbag.

    I practice on a crossroads of total opposites — high tech and extremely low tech. I do pediatric critical/intensive care. We have machines galore that go beep and bing and imaging and testing modalities that are astonishing. But I am constantly amazed at how often the important things I do are the lowest of low tech, using my hands, my ears, my eyes, and sometimes my nose. There’s no app for that stuff.

    The way I think of medical practice is that it is a mixture of science, near-science, intuition, guesswork, and blind luck. Plus maybe some witchcraft. Individual patients tend more to some of those things than to the others, but I think the generalization still holds. There’s no app for that sort of thing, either.

    • N__B

      First, thanks.


      The way I think of medical practice is that it is a mixture of science, near-science, intuition, guesswork, and blind luck.

      Mrs__B is an infectious-disease researcher, I’m an engineer. The more we talk about the topic, and especially since Mini__B was born, the more we come to the conclusion that medicine more closely resembles my work than hers.

      • Warren Terra

        Oh, yeah. Even when docs do basic (ie non-clinical) research there’s (as a stereotype, obviously not always) a difference in outlook and approach from when biologists look at similar questions.

        • N__B

          a difference in outlook and approach

          I’d define it as an interest in what works rather than what matches (or refutes) theory.

          Empiricism rulez, dood!

          • A very large component of what I do, including the high-tech stuff, does not have high quality evidence to support it. We do it because it works. But . . still . . . the science does matter. Folks without a strong understanding of physiology, pharmacology, etc. will do something because it worked worked with the last patient with condition-fill-in-the-blank, but this new patient may well be different in subtle ways.

            That observation folds into the chronically raging debate of what it is appropriate for nurse practitioners and other mid-level providers (our new, kind of ugly term) to do and what it is beyond their skill set to do. I see examples of that all the time. And now this idiot wants an app for that.

            • N__B

              Of course. It’s an analogy, not an equality.

              • Yeah, I know. I just wanted to mount my hobby horse for a brief ride. I’m down off it now.

                The topmost guy in my med school class originally trained as an engineer.

                • N__B

                  I’ve always wanted to create a hobby-horse cavalry, but I could never think of the paper music for the bugler to play for CHARGE.

    • Hogan

      The last time someone asked me whether medicine is a science (Usenet–whaddaya gonna do), I said something to the effect that it’s a set of technologies based more or less on science. That still works for me.

      • N__B

        It is the science of balancing the body’s humours.

      • Dr. Ronnie James, DO

        As a doctor-to-be and former research scientist (married to a doctor), I’m quite comfortable saying that medicine at root is a synthesis of the Reader’s Digest/ Cliff’s Notes version of a wide range of hard sciences. Most doctors won’t ever know 1/5th as much physiology, molecular biology, etc as the average PhD in those fields.

  • Ktotwf

    Doctors are actually powerful and socially respected in a way that taxi drivers…you know, aren’t.

    • Hogan

      Unless you’re Thomas Friedman.

  • Calming Influence

    Right after I figure out how to fix global warming in my garage (I’m going to assume Jeb! is talking about that portion of global warming located in my garage) I’m going to build an UBER MRI (I have the tools – my Dad’s a plumber). Cha-CHING!

    • Yeah, but that 30 ton magnet will be an interesting challenge.

      • jim, some guy in iowa

        I think there might be one in the ACME catalog

    • Casey

      I’m whipping up a nice homemade batch of insulin as we speak. It’s an old family recipe. One part ins, one part ulin. Just like gran’ma used to make.

  • Zipp Zanderhoff

    Pretty much any time someone starts talking about “the Uber of X”, you know you’re about to hear a load of bullshit.

  • Casey

    I could see a food truck/bookmobile style service being effective. One of the biggest problems for working poor people is just getting time off of work and getting to the doctor’s office. If someone could just go to the mobile clinic that’s parked in their neighborhood once a week, I think that could really help delivering care to underserved communities. I also wonder if a mobile addiction clinic could work. Or women’s health.

    There are lots of logistical inefficiencies in how healthcare is delivered. But they’re just not profitable. People who are making 8 bucks an hour are not taking a lot of Ubers. People don’t take Ubers because they’re cheaper than the bus. They take Ubers because the extra money is worth the convenience and time, and they can afford it. Thinking that an Uber for Healthcare is going to fix anything is predicated on the belief that the big problem with healthcare is that it’s too hard for richer people to pay a premium to get better service. That is not, and will never be, the issue.

  • Casey

    I’ve also been thinking about a model where instead of drugs, they have you read 20th Century Jewish philosophers. I call it Buber for Healthcare.

    • N__B

      Better than treatments consisting entirely of potatoes, AKA Tuber for Healthcare.

    • Hogan

      With the ophthalmological version, Eye and Thou.

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