InsideSources

One of us is an economist, the other a doctor, and both of us look forward to uberizing healthcare. Healthcare will be the better for absorbing some of the technologies that made Uber a great success story. In the popular imagination, “uberization” has many meanings, so we’ll be more specific.

Uber created a fast, convenient means of requesting that an automobile pick you up at some spot. A Google search on “uberization of medicine” and “uberization of healthcare” suggests that many people using these terms focus mostly on the ease and speed of making appointments and reaching doctors. The popular KevinMD.com site, for example, says that Uberization will, “bring consultations by physicians to patients via their smartphones, on-demand, wherever and whenever they request them.” But that’s only part of Uber’s success. In multiple ways, Uber offered markedly improved quality over traditional taxis.

As we’ve written elsewhere, Uber makes it easy for anyone with a smartphone to summon a ride with just a few taps. But Uber also accumulates vast data on roadways and destinations to improve the quality of the ride. During peak-demand periods, it raises prices to minimize wait times and smooth patterns of demand and supply. It provides riders with second-by-second progress on the car’s whereabouts before and during the ride. It offers drivers real-time advice on optimal routes—with a constant awareness of traffic jams, accidents, and closures—giving novice drivers virtual geographic expertise that would otherwise take years to accumulate. (See “Gigs, Jobs, and Smart Machines,” by Graboyes, on Uber versus London cabbies.)

Uber enables rapid evaluation of driver and passenger quality, expedites payments, and provides passengers and drivers with precise records of the times and route. Riders and drivers receive information on one another before they meet—imparting a degree of safety that taxis cannot replicate. And Uber makes all of these processes highly intuitive to both driver and rider.

Uberization of healthcare means the development of digital technologies that similarly ease the process of connecting patients and providers, expedite their care, offer clinical advice along the way, simplify record-keeping and payments, enable patients and providers to monitor progress and results, and accumulate indicators of quality and safety—all in intuitive, convenient ways.

We’re confident that in the not-so-distant future, a 52-year-old man who feels thumping in his chest will open a medical smartphone app and be connected in seconds to a qualified healthcare professional. Not only will this clinician have immediate access to a fully digitized record of the patient’s past medical history, but also the results of vital signs and an EKG transmitted by sensors from the patient’s smartwatch. Algorithms will incorporate the patient’s past and current conditions into the provider’s data. The system will generate a diagnosis-and-treatment plan.

If the patient needs prompt medical care, an ambulance will be dispatched to bring him to an emergency room. If the situation is less dire, an Uber driven by a medic will be on its way. If further consultation with a specialist is advisable, that can be accomplished within minutes by telemedicine.

Pregnant women with cramps, diabetics with vomiting, and children with a cough and fever will get similarly rapid attention, regardless of the time of day or night. The medical organization to which the patient subscribes will have participating healthcare providers around the globe in different time zones. There will always be awake, alert, well-trained, certified clinicians available when the patient opens the app. Importantly, patient satisfaction will be continuously monitored. Competition between different healthcare plans will help keeps costs down and quality high.

Will patients and providers want uberization? We can only respond with a question: In 2008, how many Americans wanted a button on their cellphones that would summon a total stranger, driving his own car as a side gig, to pick them up late at night in a dicey neighborhood and drive them to their home? Very likely, few would have said “yes.” But Uber correctly gambled otherwise.

To quote another high-tech entrepreneur, Apple CEO Tim Cook, “Our whole role in life is to give you something you didn’t know you wanted. And then once you get it, you can’t imagine your life without it.”

Modesty is an essential ingredient of good medicine and good policy.

I’ve taught the economics of health to hundreds of physicians, nurses, therapists, administrators and other professionals. There’s no telling how many tens of thousands of lives they’ve saved. Though lecturing to such students is profoundly humbling, one of my principal goals is harnessing economics to teach humility to those who have much reason for pride.

In the 20th century, physicians attained godlike stature, a process described in Paul Starr’s book “The Social Transformation of American Medicine.” But the border between pride and hubris is porous, and hubris is a dangerous tonic.

My job is mostly to ask questions and poke holes in conventional wisdom — not to provide answers. Four documents described below help me in this effort.

“Determinants of Health” is a complex, but comprehensible, graphic produced by Edwin Choi and Juhan Sonin of GoInvo (a digital studio focusing on health care). It asks, “What explains differences in health across individuals?”

For providers, it’s sobering to see that medical care explains only 11 percent of the variation. Individual behavior (alcohol, drugs, diet, etc.) explains 36 percent; social circumstances (literacy, occupation, family circumstances, etc.), 24 percent; genetics and biology, 22 percent; and environmental factors, 7 percent.

This doesn’t mean medical care is unimportant. It might suggest that in pursuing health, one might spend the next million dollars on something other than medical care. It might suggest that health care isn’t to blame for America’s somewhat foreshortened average lifespan. The key is “might.”

“The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century” is a 1977 research paper by John and Sonja McKinlay. For my physician-students, a showstopper is the McKinlays’ graphs showing massive declines in deaths from measles, scarlet fever, tuberculosis and typhoid after 1900. Perplexingly, all four show effective medications (vaccine, penicillin, isoniazid, chloramphenicol) were introduced after the mortality declines, not before. What does this mean for health care? You decide.

Nobel economist Robert Fogel sought to explain why human mortality declined precipitously over the past few centuries. His 1996 paper “New Findings about Trends in Life Expectation and Chronic Diseases” mined centuries of data on agriculture, calories consumed in labor, military recruits’ height, incidence of bad teeth, and more. He found that medical care, public health and other conventional answers couldn’t explain the decline. The likeliest explanation, he found, was the decline in malnutrition during the first few years of life (including the months in the womb). No matter how well one eats later in life, poor nourishment in those early years, it seems, make organ failure and early death likely decades later.

A powerful implication is that in our well-nourished era, Americans may live longer than managers of pension funds (or Social Security) assume. Financial trouble ahead?

Finally, James A. Maccaro’s 1997 article “From Small Beginnings: The Road to Genocide” contrasted humility and hubris in mid-century European medicine. Leo Alexander, an American psychiatrist (and expert at the Nuremberg Trials) investigated why German doctors didn’t do more to stop the Nazis’ program of genocide and barbaric medical experimentation. He discovered they didn’t do more to stop the horrors because they were instrumental in creating them.

German doctors enthusiastically volunteered for servitude to, and leadership within, the Third Reich. Deputy Fuhrer Rudolf Hess declared Nazism “nothing but applied biology,” and many German doctors apparently agreed. They collectively decided that medicine’s primary purpose was building an economically productive populace — an emphasis that opened the floodgates for atrocities.

Dutch physicians, Alexander found, unanimously rejected this assumption after the Nazis conquered the Netherlands. They viewed their role as healing and comforting the sick and dying. Though threatened with punishment and death, humility assured that no Dutch doctors participated in the Holocaust.

Finally, let’s ponder the notion of humility with two fitting quotes: “Some of the biggest cases of mistaken identity,” economist Thomas Sowell wrote, “are among intellectuals who have trouble remembering that they are not God.” Novelist N.K. Jemisin once cautioned, “We can never be gods, after all — but we can become something less than human with frightening ease.”