This is the first of a series of posts on what I believe the US (heck, make it all developed countries) should do for their population.
First up - Healthcare.
I believe that the US should:
1. Provide Universal Healthcare
Like Canada, and the UK, this healthcare should be the basic, guaranteed right of every citizen. It should be universal, and provide a solid level of care. Those who want something a little better should be able to pay for private insurance.
In the case of the US, paying for private insurance should give you a tax credit for the lesser burden you're putting on the base system.
If you smoke (hey, I do), then you pay for private insurance, or you get a government sponsored smoking cessation program.
2. Provide a Universal Health Records Database
This database will be provided by the government. Everyone's health records is put up there. There's a website you can go to to see your innoculations, your health records, the works.
No more lost records. Everyone has their data up in the cloud. To access your records, you use a number (looks like a credit card) which is assigned to you, plus a private key. VIsiting a health provider gives them access to your data. The website would allow you to revoke access at will. The card would contain all the information necessary to generate a certificate for each provider (preferably optically encoded, although magnetic's ok, with a backup of a PIN + number system on the website if necessary - say, in case you lose your card, or wipe the strip).
3. Datamine the Database
The database should be accessible by medical researchers. The data they can access will be sanitized, so it is not possible to recover a specific person's identity (although it would be possible to post data to the file, so that if they visit the doctor or check their account, information which is uncovered through the analysis can be passed on).
Ideally, travel records would be tied to this, but I can see people getting skittish already, so it's not a requirement.
This data will allow researchers to uncover patterns in disease which are not currently visible - such as, say, if your spouse has Crohn's diseases, and you have Cholangio Carcinoma, and your son got Gastroenteritis 3 months before... is there a connection here? (My personal belief is yes). Do you have brain cancer while your wife has multiple sclerosis? How many times does this pattern occur?
No one knows right now, because except in very specific cases, doctor's records don't care about familial disease unless there's a hereditary link. This is a HUGE hole in the data. Even if we don't do the database, doctors should start looking into this; two people may have very different diseases with the same underlying cause.
4. Biopsies, Swabs, etc for all
Currently, not everyone is tested for every complaint. Every new cough, new cold, new rash, new lump - when it can be easily swabbed, or when a biopsy is taken, it should be tested for every bacteria, fungus and virus known to man. And this data goes into your medical records. Which are then datamined. This will show patterns where subclinical or atypical infections (the kind currently regarded as only relevant to the immunocompromised) are actually causing other issues. No-one taking suppressive medicine for genital herpes gets arthritis? That's useful data. And it's currently being lost.
Currently, only military bases perform comprehensive testing of all personnel. It's how we track new cold viruses (eg. Adenovirus 14) when they emerge. We should be tracking all of this - it'll unlock all kinds of new cures and information.
We've had the tech to do this with viruses for about 5 years now. We can tell you which virus is in any piece of tissue - which is a much better approach than checking your blood for antibodies to the virus. This will allow us to localize the test, and tell you exactly what's where, and what might be causing a whole bunch of issues.
In fact, it'll be the most comprehensive application of scientific method to the medical practice in a very long time.
Oh yes, and who pays for this? The government. This is a public health issue, and if we start looking into this, I'm willing to bet that a whole bunch of conditions which are mysteries to us right now will suddenly become clear. Think of it as a program in the same way we managed to eradicate smallpox.
5. If you're sick, you don't come into work
The government will pick up the tab. If you're ill, you don't show up. You go to a walk-in clinic set up specifically for checking all the coughs, colds and minor malaises (you still go see your specialist or GP if it's more serious), and they perform any necessary tests. Then you go home until you're better.
If you're ill for more than 3 days, you go to your GP, and get a note. If you're ill for more than a week after that, you go back to the GP. If you're ill for more than a month, well... that's a different program.
We'd still need a way for people to deal with mental health days, and hangovers and so on. (Come on, we're all human, and people occasionally slack off and need a day to change things up).
Why do we do this?
Because when someone comes into work because they have no choice - no time off left, no money, they're a contractor or paid hourly - they get everyone else sick. And that hurts the economy massively.
This scheme would pay for itself in terms of lost productivity and the respective boost to the economy very quickly. The only thing to figure out is how much to pay into the system, and who pays for it - and that's not something I feel qualified to address. (more...)