Digital Health in the Age of Trump
To the barricades!
Yet another shot has been fired across the bow of the Affordable Care Act, and this time it is a flaming arrow. Angered by the failure of Congress to repeal Obamacare, President Trump is reaching into his quiver to try to kill this steely beast. Whether going rogue will succeed is unclear, but one thing is for sure: it has never been more important to stay healthy.
Whatever you may think of President Obama's effort to provide universal health coverage, it is fair to say that killing or eviscerating it without a clue what to do with the people insured by it does not inspire confidence. Which is why a Republican majority could not do what it promised for seven years. It is a colossal failure of planning on the part of people elected by many precisely to do just that. Talk about malpractice.
The body blow to the healthcare system by an Administration that has no inspiring idea or feasible policy to offer the tens of millions of people directly affected by it is the polar opposite of the creative destruction that transforms industries. It is disruption for politics' sake, a malicious attack to score points without any of the innovation work required to design a solution. Our advice: get some Xanax while it is still covered.
Anxiety is, according to Darwin (who suffered from an extreme case), a survival mechanism, leading people to avoid danger and seek a measure of control over their fears. But how can we gain control over the complex dynamics that are threatening the health of our families, our communities and ourselves? After all, if the government won't protect the air we breathe and water we drink, and health insurers won't pay for the lifesaving medicines we need, and doctors won't accept our plans, and hospitals won't admit us until our conditions are dire, what control can we possibly assert?
Truthfully, not much. That said, there is something we can do - all of us - to activate a grand strategy from the bottom up to transform health in our country. It requires a profound change in mindset about how we manage our personal health - an embrace of individual responsibility, advocacy and accountability. Borne from crisis, it inspires a pivot from ignorance and dependence to enlightenment and empowerment, nothing short of a cultural, attitudinal and behavioral shift to a collective self-awakening.
It won't be easy. After all, we are a society conditioned for centuries to react to illness rather than prevent it, partly because it's easier – there’s a drug for that - and partly because we spend a lifetime outsourcing our health to other people. Good or bad, right or wrong, one thing for sure is they know more than we do. Which is not hard, because for the most part we know nothing. We describe our symptoms, submit to tests, then follow or ignore doctor’s orders. Our role is no more than the doomed soldiers in Lord Tennyson’s The Charge of the Light Brigade: Theirs not to make reply, theirs not to question why, theirs but to do and die.
Think about it. For two decades, we study all kinds of difficult subjects, yet the closest we come to learning basic medical science is in high school biology. Even then, we are taught more about photosynthesis than human anatomy. Health Class, a misnomer if ever there were one, is just an awkward attempt at sex education – too little, way too late – slipped into the curriculum somewhere between dodge ball and driver ed.
Medical science, the science of dealing with the maintenance of health and prevention and treatment of disease, is simply not part of our curriculum. The most essential information required for health literacy is a gaping hole in our education, seen as too rarefied, complicated and unnecessary for our study. As a result, understanding how our bodies function, develop, break down and die requires a complicated industry of experts so vast it makes up 20% of the GDP. Doctors, nurses and other healthcare providers are anointed guardians, as we outsource our most valuable asset to them.
Of course, 2,500 years ago when Hippocrates, the Father of Medicine, transformed the field from voodoo to science, this made sense. A class of highly-trained physicians began to treat patients based on observable evidence rather than the will of the Gods. Naturally, they soon became God-like, healers with mystical powers to save the lives of common people. There was no reason for patients to be part of the process. What could they add, and how dare a mere mortal engage with a deity? It was an efficient system with both parties motivated to stick to their roles. So efficient it continues today. And as medical science becomes increasingly complex, the knowledge gap widens further.
Enter digital health, the convergence of healthcare and technology, to bridge that chasm. And not a moment too soon. Digital experiences - mobile, social, wearables, virtual reality, artificial intelligence, voice-activation - are to the disruption and transformation of healthcare what railroads, factories and electricity were to the Industrial Revolution. They will be an engine of change that will enable people to take ownership of their health and participate in shared decision-making with physicians, a sea change that over time will result in superior outcomes and longer, higher quality lives. It is the silver lining in today's dark clouds, the promise of progress and advancement for all people that will fuel a genuine populist movement.
To the barricades!