This week I had to go to a medical specialist for an eye examination. My ophthalmologist, who operated on my cataracts last year, wanted me to get a specialized diagnosis.
I am having trouble reading small print with my right eye. I had the same problem before I had cataract surgery. My left eye works fine when I wear my glasses. I can read the smallest print. This is for reading distance: about 22 inches. But my right eye cannot read the bottom two lines of small text.
I think my ophthalmologist just can't fix it with a new lens. He doesn't know why he can't fix it. So, he sent me to a super specialist. If the super specialist said that something serious is wrong, my regular ophthalmologist will solve the problem: "Let him fix it." I understand what he's doing. I would do it the same way. We want the other guy to be responsible for fixing somebody's problem, when we are unable to fix it.
I was told in advance that the eye examination would take about two hours. I went into the office. It took about half an hour to get me into the examination room. Then it took about 20 minutes for a lower-middle-income lady to run all the exams. The office has sophisticated machines. She is certainly capable of running these sophisticated machines and looking at the results. She doesn't have a degree from a medical school. I don't imagine she is paid a lot of money for her services. But, between her skill and the machines, at least 80% of the examination process was done independent of the high-paid ophthalmologist who was in charge of the office.
Then I sat for maybe 20 minutes until he came in to look at my eyes.
I was sitting in a secondary waiting room. Modern medicine is based on waiting rooms. I noticed that there were probably half a dozen women going hither and yon, taking care of patients. I never saw the physician as I waited for him to come and examine my eyes.
Finally, for about 10 minutes, he came in and did a cursory examination. He already knew what the situation was, because he had looked at whatever the machines had recorded. I am sure he had 90% of the information he needed at that point. He did a cursory examination of my eyes by shining a bright light into each of them. Then he told me I had no major problem. I didn't think that I did.
He had no recommendation. He simply typed a brief note to my original ophthalmologist, thereby handing me back over to him to fix whatever was wrong. In all of this, I am the equivalent of the old maid. Each of the players wants to hand me off to the other one.
I probably will have to go to an optometrist, who may be able to find a lens that will solve my problem. Or maybe I just can't get this fixed. It's not a life-and-death situation, but it is an annoyance. I have trouble reading six-point type, meaning footnotes, in printed books. But since most of my time is spent in front of a computer screen, this is not a major problem.
MACHINES DO THE GRUNT WORK
What I noticed in all of this was the following. The treatment I got was adequate. Most of the treatment was provided by a technician. She had never been a medical school. I suppose she never went to college. It doesn't matter whether she did or didn't. She is being paid to do assembly-line examinations. She uses machines to do most of the grunt work. The machines have been designed by specialists.
What did the ophthalmologist bring to the table to earn his keep? Basically, it is this. He has been certified by a medical school. He has passed some kind of medical exam to get his license. He buys medical malpractice insurance. The insurance companies insure only certified specialists, so that defense-team lawyers can persuade juries that the problem was not the fault of the insured.
On the other side, if something goes wrong, there is a large target for lawyers to sue. They cannot sue the technician. She doesn't have any money. They can sue the company that produced the equipment, but this is a long shot. Nobody else is suing this company, so the company can probably escape the lawyer. But the ophthalmologist who officially is in charge is a large target. He has money. He is insured. He is part of a professional practice. He has been certified. If something goes wrong, the lawyers can extract a lot of wealth out of him or his insurance company.
In other words, the system that we have today of extremely well-paid specialists at the top of the medical food chain are really not at the top of the overall food chain. Lawyers are at the top of the food chain. They eat physicians for a living.
Two decades from now, the diagnostic machines are going to do 95% of the evaluation. The technicians will simply put people in front of a machine, and the machine will do the evaluation. This is basically what happens today. What we're going to see is that there will be ever-more precise machines that deal with a wider variety of diagnoses. The machines are going to do most of the grunt work at the bottom, and they are also going to do most of the evaluation work in the middle of the process.
FREE TRADE IN DIGITAL MARKETS
With the international division of labor, we are going to see machines hooked up to diagnostic centers outside of the geographical boundaries of every nation. The in-house machines and the off-shore evaluations will be provided at the lowest possible cost. The only thing stopping this now is the regulatory system. Basically, the lawyers want easy targets. They want somebody with money to sue. If the evaluation process is sent offshore, and machines do 80% to 90% of this, then the technicians who run the machines will not have to be paid very much, and therefore there will not be obvious targets for the lawyers to sue. The lawyers will fight this tooth and nail.
I don't see how this process of off-shoring can be stopped. The person who brings in the lowest bid is going to win the marketplace. If somebody can use the Internet to evaluate the results of an examination conducted by a machine, and he can do this cheaply on a mass-produced basis, medical services are going to get cheaper. This is good for customers, but bad for lawyers.
Mass-produced medicine is already here. I saw it in action this week. We have all seen it in action. This is not true of surgery, but it is true of most medical services.
This is why Walmart medical clinics or something equivalent are the wave of the future. Robotics and algorithms are going to do the grunt work, and low-paid technicians are going to show people how to sit in front of the machines. This is happening now. A physician will then come in, glance over the results produced by a machine, make a final evaluation, and send the patient on his way.
The patient will walk next door to a Walmart pharmacy, where in-store machines will produce the pills. There will be a few low-paid ladies to hand patients these pills, and there will be one pharmacist on duty who oversees the procedure. He is there mainly to be sued. He is not necessary to the process in 80% of the cases. In 20 years, this will be down to about 5% of the cases. Maybe I'm wrong. Maybe it will only be 10 years.
This is going to be great for patients. It is not going to be good for most physicians and pharmacists. It will surely not be good for lawyers. But the free market system is not there to benefit the producers; it is there to benefit the consumers. This is the way of the world under liberty.
TERMINAL MEDICINE
Today's health care delivery system is in its terminal stage. Computer terminals will replace today's medical establishment by 2030.
The free market provides high-quality service at competitive low prices.
As consumers, we benefit. Consumers have economic authority in a free market. They own money, and money is the most marketable commodity. Everyone wants a chance to serve consumers with money.
Medicine is regulated by the state. This is why it has not been open-entry price competition since about 1913. But we are moving back to pre-1913 medicine. Machines are doing the grunt work. Low-paid technicians supervise the machines. Physicians supervise technicians, and lawyers sue physicians.
The free market is making up for lost time: 1913 to today. It is restoring price competition. Machines are not licensed by the state's medical-licensing boards. Open entry and price competition set the rules governing machines.
We like this. We can take our blood pressure at home. Diabetics take blood tests at home. In 2030, we will buy cheap computer programs that will diagnose our blood at home. The machines will eliminate the middle men in 80% to 90% of the cases.
The medical establishment will fight this. But government-run compulsory health insurance will force this development as a cost-cutting measure.
A new era of home remedy medicine is coming. The machines will be our physicians. They already are. It is just that they are in offices. In 2030, they will be in our homes.
Here is the lure of the sellers of machines: "We make house calls . . . 24x7."
The machines will offer concierge medicine. They will connect to online diagnostic centers with massive data bases.
We will go to physicians' offices to get legally valid prescriptions written up for us. The government will require this. But these offices will be at Walmart. So will pharmacies.
Surgeons will prosper until robots replace them for routine surgery. My prediction: 2050. It may be sooner.
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