From Fortress to Frontier: How Innovation Can Save Health Care

for 70 years we've languished in a bitter partisan unproductive battle over how to fix America's health care system directly or indirectly both left and right have steered the conversation toward coverage a number of people with insurance cards while mostly ignoring quality of care and how much it actually improves health to get this debate out of its rut we need this new goal to produce better health for more people at lower cost year after year to start we have to recognize that the real dispute isn't between left and right it's between philosophies I call the fortress and the frontier let's define them the fortress has two goals first is to imagine all the terrible things that might go wrong in health care and prevent any of them from happening second is to shield those in the medical industry doctors hospitals insurers drug and device manufacturers from potential competitors who might threaten their turf frontier is different it understands that big quality improvements in cost reductions don't come without accepting some risk and it understands that real innovation won't occur unless doctors and hospitals face new competitors like IBM faced Apple and Western Electric based blackberry while left and right think of themselves as radically different both are deep in the fortress to illustrate fortress and frontier let's do a little thought experiment get in a time machine go back to 1989 tell your family how healthcare has improved in 25 years statins new vaccines face transplants they'll appreciate the new technologies but won't be all that surprised that's the fortress now and you're still in 1989 tell them what's ahead in IT tell them how inexpensive these things are now they'll think you're delusional that's the frontier why'd you say the two industries aren't comparable health care is life and death pain and suffering Computers they're harmless they just sit on your desk really on the internet you'll find financial fraud identity theft predators and violations of privacy cyber bullies cell phones have served as tools of crime and terrorism does this make you wish the Internet and cell phones would go away I doubt it for an interconnected world and all of the benefits that come with it we take risks and accept costs and we allow upstarts in garages to challenge multinationals in skyscrapers in 25 years we've gained near universal access to information technology that didn't require a long vicious congressional debate no cumbersome mandates no one had to ask innovators to innovate and innovators didn't have to beg bureaucrats for permission to create our challenge now is to move healthcare out of the fortress and onto the frontier to make healthcare as dynamic as IT has been in our lifetime that means accepting some risks and allowing genius to arise from unknown people in unexpected places make no mistake enormous changes are coming soon to healthcare transplantable organs made of your own cells drugs tailored to your individual DNA microscopic robots inside your body repairing the genes that threaten your life are we willing to move American healthcare to the frontier so if you lead the way toward these new technologies or are we gonna remain in the fortress and let other countries seize the high ground we have time to choose but not much we can spend the next 25 years squabbling over insurance cards but that won't get us to the real goal better health for more people at lower cost year after year I'm Bob gray boys and all this is in my new study fortress and frontier in American healthcare it's at Burke ADA's dot org you


  1. Get government out of the health insurance business as much as possible. Limit them to limited regulations and financial support for health insurance to those who need it.

    Government is about half the health insurance market with Medicare, Medicaid and the VA. This is why the health insurance market is not functioning like a normal market in any other industry.

    Obamacare, Medicaid, Medicare and VA hospitals should be phased out. People under these programs and those who are financially below the poverty level should be given a yearly amount that they could use to purchase health insurance.

    Keep the federal regulation stating that insurance companies have to cover pre-existing conditions as long as the person had previous insurance.
    Allow people to purchase insurance from any state. Deregulate state health insurance markets. Unhinge medical insurance from employers in the tax code.

    Getting government out and increasing competition in this way will lower health insurance costs. It cuts the bureaucracy costs, cuts the fraud costs and improves competition and quality of care.

    Why not do financial assistance for health insurance the same way we do financial assistance for food?

  2. Great point of view. Reminds me of the Time article on healthcare costs.

  3. I think there is an important point here that is being overlooked. Medical care cannot be delivered by innovators who dream up new procedures in their garages, like hi-tech geniuses did. The medical schools and establishment will still control delivery, therefore making Mercatus's hypothesis not viable.

  4. If your state accepted the state exchange for ACA, it probably is cheaper and more competitive for you now than before. This whole mess is definitely a quagmire created by both the left and the right though, that much is true.

  5. Statins…

  6. surprizing good view of opening the medical market … in the USA

  7. great argument…. but better health care isn't what the democrat party wants. They want to CONTROL the system.

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