What if we paid doctors to keep people healthy? | Matthias Müllenbeck


It’s 4am in the morning. I’m waking up in a Boston hotel room and can only think of one thing: tooth pain. One of my ceramic inlays
fell off the evening before. Five hours later,
I’m sitting in a dentist’s chair. But instead of having a repair of my inlay
so that I can get rid of my pain, the dentist pitches me on the advantages
of a titanium implant surgery. Ever heard of that? (Laughter) It essentially means to replace
a damaged tooth by an artificial one, that is screwed into your jaw. Estimated costs for the implant surgery
may add up to 10,000 US dollars. Replacing the ceramic inlay I had before would come in at 100 US dollars. Was it my health or the money
that could be earned with me that was the biggest concern
for my dentist? As it turned out, my experience
wasn’t an isolated case. A study by a US national newspaper
estimated that in the United States, up to 30 percent of all
surgical procedures — including stent
and pacemaker implantations, hip replacements and uterus removals — were conducted although other nonsurgical treatment
options had not been fully exploited by the physician in charge. Isn’t that figure shocking? Numbers may be slightly different
in other countries, but what it means is that
if you go to a doctor in the US, you have a not-insignificant chance
to be subjected to a surgical intervention without there being
an immediate need for it. Why is this? Why are some practitioners incentivized
to run such unnecessary procedures? Well, perhaps it is because
health care systems themselves incentivize in a nonideal way towards applying or not applying
certain procedures or treatments. As most health care systems
reimburse practitioners in a fee-for-service-based fashion on the number and kind
of treatments performed, it may be this economic incentive
that tempts some practitioners to rather perform high-profit
surgical treatments instead of exploring
other treatment options. Although certain countries
started to implement performance-based reimbursement, anchored on a quality and efficacy matrix, overall, there’s very little in today’s
health care systems’ architecture to incentivize practitioners broadly to actively prevent the appearance
of a disease in the first place and to limit the procedures
applied to a patient to the most effective options. So how do we fix this? What it may take is a fundamental redesign of our health care
system’s architecture — a complete rethinking
of the incentive structure. What we may need is a health care system that reimburses practitioners
for keeping their customers healthy instead of almost only paying for services
once people are already sick. What we may need is a transformation from today’s system
that largely cares for the sick, to a system that cares for the healthy. To change our current “sick care” approach into a true “health care” approach. It is a paradigm shift from treating
people once they have become sick to preserving the health of the healthy
before they get sick. This shift may move the focus
of all those involved — from doctors, to hospitals,
to pharmaceutical and medical companies — on the product that this industry
ultimately sells: health. Imagine the following. What if we redesign our health care system into one that does not
reimburse practitioners for the actual procedures
performed on a patient but rather reimburses doctors, hospitals, pharmaceutical and medical companies for every day a single
individual is kept healthy and doesn’t develop a disease? In practical terms, we could, for example, use public money to pay a health fee
to an insurance company for every day a single individual
is kept healthy and doesn’t develop a disease or doesn’t require any other form
of acute medical intervention. If the individual becomes sick, the insurance company will not receive
any further monetary compensation for the medical interventions required
to treat the disease of that individual, but they would be obliged to pay
for every evidence-based treatment option to return the customer back to health. Once the customer’s healthy again, the health fee for that individual
will be paid again. In effect, all players in the system are now responsible for keeping
their customers healthy, and they’re incentivized to avoid
any unnecessary medical interventions by simply reducing the number of people
that eventually become sick. The more healthy people there are, the less the cost
to treat the sick will be, and the higher the economic benefit
for all parties being involved in keeping these individuals healthy is. This change of the incentive
structure shifts, now, the attention of the complete
health care system away from providing isolated
and singular treatment options, towards a holistic view of what is useful for an individual
to stay healthy and live long. Now, to effectively preserve health, people will need to be willing
to share their health data on a constant basis, so that the health care system
understands early enough if any assistance with regard
to their health is needed. Physical examination, monitoring of lifetime health data as well as genetic sequencing,
cardiometabolic profiling and imaging-based technologies will allow customers to make, together with health coaches
and general practitioners, optimal and science-guided decisions — for their diet, their medication
and their physical activity — to diminish their unique probability to fall sick of an identified,
individual high-risk disease. Artificial intelligence-based
data analysis and the miniaturization
of sensor technologies are already starting to make monitoring
of the individual health status possible. Measuring cardiometabolic parameters
by devices like this or the detection of circulating
tumor DNA in your bloodstream early on after cancer disease onset are only two examples
for such monitoring technologies. Take cancer. One of the biggest problems
in certain oncological diseases is that a large number of patients
is diagnosed too late to allow them to be cured, although the drugs and treatments
that could potentially have cured them are already existing today, if the disease had only
been detected earlier. New technologies allow now,
based on a few milliliters of blood, to detect the presence
of circulating tumor DNA and thus, the presence of cancer, early on in a really convenient manner. The impact that this early-stage
detection can have may be dramatic. The five-year survival rate
for non-small cell lung cancer when diagnosed at stage one,
which is early, is 49 percent. The same, when diagnosed
at stage four, which is late, is below one percent. Being potentially able
to prevent a large number of deaths by something as simple as a blood test
for circulating tumor DNA could make certain cancer types
a manageable disease, as disease onset can be detected earlier and positive treatment outcomes
can likely be increased. In 2012, 50 percent of all Americans
had a single chronic disease, resulting in 86 percent
of the $3 trillion US health care budget being spent for treating
such chronic diseases. Eighty-six percent. If new technologies allow now
to reduce this 86 percent, why have health care systems
not reacted and changed already? Well, a redesign of what today
is a sick care system into a true health care system
that focuses on prevention and behavioral changes requires every actor
in the system to change. It requires the political willingness
to shift budgets and policies towards prevention and health education to design a new set of financial
and non-financial incentives. It requires creating
a regulatory framework for the gathering, using and sharing
of personal health data that’s at the same time
stringent and sensible. It needs doctors, hospitals, insurers,
pharmaceutical and medical companies to reframe their approach
and, most important, it can’t happen without
the willingness and motivation of individuals to change their lifestyle
in a sustained way, to prioritize staying healthy, in addition to opening up for sharing
the health data on a constant basis. This change may not come overnight. But by refocusing the incentives
within the health care industry today to actively keep people healthy, we may not only be able to prevent
more diseases in the first place but we may also be able to detect
the onset of certain preventable diseases earlier than we do today, which will lead to longer
and healthier lives for more people. Most of the technologies
that we need to initiate that change are already existing today. But this is not a technology question. It is primarily a question of vision and will. Thanks a lot. (Applause)

100 Comments

  1. Super Englisch!

  2. There's a scene in one of the Saw movies, where Jigsaw tells his doctor about this idea, and how it is implemented in China.

  3. Love this idea!

  4. Ummmm…nope. Then everybody wanna be doctor. I think they are greedy anyways. So again, no.

  5. paying doctors only when keeping people healthy is a hundrets of years old method. It already existed . Japan or China i believe.

  6. This guy totally aligns with the solutions I have wished for some time. I hope his message catches fire.

  7. Then the public can hold healthcare ransom by smoking/eat cheese/refuse to exercise.

  8. This solution fails when dealing with the elderly or chronically ill. You cannot expect someone with systemic medical problems (heart failure, cancer, etc) to make a full recovery – it just doesn’t happen. These people will never be able to return to a “healthy” state, or at least remain there for any significant period of time, thus it would incentive insurance companies and health care providers to provide less care (under this proposed schema) since they would not be compensated for the individual services performed. If a provider invested the resources in a comprehensive workup to try and “fix” these chronic problems, they would end up losing money because 1) they wouldn’t be compensated appropriately for the work up 2) the patient would eventually return to the hospital because these are not curable conditions, so they would not be paid for keeping the person “healthy.”

    Instead, the inevitable outcome of the binary definition of “healthy” proposed in this talk would incentive providing less care to chronically ill people.

    I agree that outcome-based care should be the goal, but it cannot be as simple as “pay providers when patients are ‘healthy,’ don’t pay them when they’re not” because this overlooks the set of patients who, even when properly cared for, will still never be “healthy” (by this proposed definition).

  9. not a good speaker, but I agree with the message

  10. This plan seems to only work with the underlying assumption that people would use that information to act in a healthy manner.

  11. What if people take responsbility for their health and actions? I tell patients to floss and show them to floss every recall yet they show up in 6 months with bleeding gums and cavities and get mad. Sigh….

  12. And whats about cure and prevent desease with food? So much more natural and less expensive! Good doctor who read the data know what a plant-based diet can do for the human health

  13. implants are not 10,000 dollars…

  14. Yeeeaaaa… great idea but unfortunately good ol’ capitalism rules the western world and therefore money/profits will ALWAYS come first before everything else.
    What we need first is a change in our idea of how the economy should operate…

  15. What if we let natural selection take back over lol?

  16. sounds amazing

  17. Unfortunately this is how we control the population as well

  18. Intriguing. I am, however, concerned that this would incentivize doctors to ignore the need for extensive care that might be necessary. How would we insure that doctors are taking all the necessary steps to treat an individual that has progressed into illness when they know their pay is on the line? I can well imagine a HC provider ignoring evidence that a patient is developing a serious illness until it is absurd to continue with the charade, all because their income would be threatened should the patient no longer be healthy. How could we mitigate this in this proposed system?

  19. How about single payer?

  20. This guy should run for MP.

  21. That’s why we can’t trust doctors, only we can control our health, doctors don’t care about our holistic health.

  22. I wish TED would filter these people.

  23. He is right!

  24. 90% of doctors and people involved in healthcare business are leeches.

    One of my relative had accident and due to doctor's negligence they had to pay a lot of money, with multiple fake charges that they refused to drop despite many complaints. They stopped his medicines one day without ever contacting us because we hadn't paid our weekly payments, and the patient was on verge of dying. That same doctor performed second operation and repeated same mistake and our relative died within 2 days of discharge.

    My dentist recently took 500 rupees for 3 minutes of treatment. Let's say he has patients for roughly 30 minutes every hour, and I convert that payment to USD. He earns 18k USD or more every month. I am sure that's a lot of money for even dentist in USA. On top of that, this dentist doesn't communicate or take time to talk to you about questions you ask. He just wants to treat you and take your money. If you show him your left tooth, he won't even look at your right side and tell you what you need. It's like you are your own doctor and he is your assistant.

  25. If you make a baby (for your personal service), the probability of being ill during his lifetime is great, the probability of you suffering is great, and the probability of him dying a day is 100 %. But if you do not have a baby, the probability of him not suffering and not dying is 100%, and you will not die during delivery or catch any pathology.

  26. Likely VERY different in other countries. The US health service is the least inefficient in the developed world, and worse than in some developing countries. Yeah, you get great treatment, but at a FAR greater cost than elsewhere. That encourages greed, rather than what is best for patients.

  27. haven't watched the video yet, would prefer to answer the title first. lovely idea but it doesn't work for the same reason that teachers in more affluent communities working at public schools get paid more than teachers in poorer communities, regardless of how well either teacher performs. one teacher can't teach all the kids, and one doctor can't have all the patients. this competitive idea has been such a joke from the start, there are dead robber barons that are rolling around laughing in their graves at us.

  28. Its unfair to not have dentist view. The tooth may have been in a poor state and repair would lead to problems down the line. The dentist was most likely giving him the best option to prevent further problems with his tooth by offering implant. This ironically is what the speaker wants in his talk…. to be kept healthy in a prophylactic way. So just lie down…. relax and open wide.

  29. Volume care is designed to maximize billing… not really fix your issues. Then again, medications may or may not fix you either, but who checks and investigates for the real causes of your pain or illness? How many doctors do you see before one actually does something different trying to find the answer? Preventative care is also a joke – insurance pays for one basic blood test a year and physical which is supposed to do what unless you are already on the path to much worse illness. Sometimes I wonder if it's designed to kill off older folks through neglect and attrition to deal with our demographic problems (or rather, the failure of the strategy to transfer money from the young to the old that fails when population growth declines).

  30. this man is absolutely right!!!

  31. How abouf no?
    Privacy is already at risk in our society anyway

  32. It’s our duty to keep ourselves healthy. Doctors are there. To keep people healthy and treat who are not. Rather absurd to say otherwise. It’s all your responsibility to seek knowledge and help otherwise. Then again putting things into practice. Governments, doctors companies have spent billions over the decades to warn about smoking. Knowing that, people yet smoke. Doctors and healthcare workers do try to keep people healthy.

  33. what if the doctors dont tell you about your protential sickness to make more profit.

  34. This is brilliant, but I'm worried that if this happened, the number of doctors providing false negative diagnoses might increase. "Oh you don't have bronchitis, it's fine, I kept you healthy."

  35. This wouldn’t work in America. Insurance companies would deny sick people so they could keep the income stream coming in. Kinda like they do now.

  36. You mean doctors do things for profit instead of out of the goodness of their heart? I would rather start my own medical "system". The system is the problem. You can have your system, I'll have mine, outside of the corrupt medical colleges. Health care is a product just like any other. As a product, it has experienced little innovation. No innovation, no improvement. If we want to improve health care, we have to innovate. Guess what? People making a lot of money doing what they're doing don't like to innovate. Monopolies don't like to innovate. We have a global medical monopoly supported by the violent Left wing. What about a second, third, or twelfth medical system? Then, these systems can battle it out for the medicine consumer. We are being controlled by the WHO, medical associations, governments, and the media. They are blocking us from improving the state of health care by preventing competition. It's sad. Chronic disease is common, and people have no way of fighting it. Doctors have done more harm to this world than any religion. We are talking 100's of millions of lives and trillions of dollars. We begged and pleaded with car manufacturers to build us safer, more efficient vehicles. And, they refused. They refused for the profits. It took Tesla to get things going. The same is happening with medicine. We are pleading for better care, and we are not getting it. They are not giving us better care because the money is in keeping us sick. If we want better care, we need our own system, Openmedicine, medicine 2.0, etc.

  37. This is the based principle that we use here in Sweden when it comes to STD's and primarily hiv-patients. This is because a healthy hiv-positive patients is far less likely to engage in risky behaviors and therefor decreases the risk of spreading hiv by themselves alone. And yet the individuall gets complete freedom. It is the most effective way, according to me to at least, to implement upon infectious chronically diseases. And I wish that all chronicle diseases would be treated this way, at least. But we are not there yet. It is imperative and of most importance that politicians start too look at diseases as something that needs to be discovered and treathed before the person gets to sick to work. A person that can not work will always cost money and it doesn't matter where that money comes from. But a healthy person can always increase the money put into the system. It is disturbing that even in 2018 we still do not implement this way of thinking but are still only looking at where the money comes from instead of seeing it as where does the money stop.

  38. Wow! Awesome!

  39. The best subject yet!

  40. Nice speech, but we'd need to change Capitalism first if we expect the current sick-care system to become healthcare.

  41. I can't even get people to stop drinking Mountain Dew and smoking. I can't keep anyone healthy. That's 95% up to an individual.

  42. So as a doctor I would be incentivized to drop sick patients?

  43. Then the sick patients can never have doctors.

  44. Oh, wow! He talks about communism element, where government really cares about ppl living out there

  45. The doctors will kill the sick people. Dead people are not unhealthy. We will have euthanasia for the elderly and the sick.

  46. This is really important to be able to shift to disease prevention policies than disease curing mindset

  47. If your fat loose weight

  48. Pay your healthy-tax

  49. What if we paid bankers to keep us debt free?

  50. this is too utopian idealogy, there is no 100% way to prevent diseases from happening. Health care providers cannot prohibit someone from becoming alcoholic and smoker. No Healthcare provider today is encouraging people to go smoke, to expose themselves to unnecessary radiation. But there are still people who don't care about their own health.

  51. I like that he addresses the problem but his solution is extremely dangerous! The motivational feedback he describes favors a high healthy/sick ratio but this would mean it's logical to kill the sick or at least use super risky treatments with high risk high reward. It's most important to minimize the time of being sick so even if there is no chance of surviving a late-stage cancer they would prescribe chemotherapy so that you die faster. And BTW: he says health institutions should get money for every healthy person and once someone becomes sick they stop getting money for that individual and have to pay all treatment expenses. I don't see why they would spend a penny on the sick (by that logic alone) as it is more practical to let them die and focus on birth rates instead. Compare poor countries with no healthcare at all and an age-average of 17 years with rich countries with best hospitals and an age-average of 40+. You really think that in the latter example you have a better healthy/sick ratio?
    But I agree with the overall idea that the motivation-system in health care should be optimized!

  52. 👍👍👍

  53. No, cause i don't want all of my health data to be constantly tracked.

  54. You'er talking about universal health care. The countries that have it are called civilized. Can we please get civilized.

  55. Don't wake me I'm dreaming, never in this society, where dozens of wholistics doctors have mysteriously died in the last couple of years……………….

  56. The intent is to make money, not make you good

  57. Same story when you take your car to a service..

  58. there should be a national mandatory health history system.

  59. Make sure that healthy operation to keep people healthy such as vaccination do not count toward the sick day.

  60. if this would happen, basically everything remotely dangerous to your health, like running or eating ice cream would be forbidden by insurance companies. Complete dystopia.

  61. We do, hospitals get slapped for readmissions, and it gets stuck on us nurses for Education, upon more education, followed by even more education.

    Most patients I see are the "frequent flyers." Most people do not desire to do what it takes to be truly healthy. Some draw the short straw in the gene pool; requiring them to work 4 x harder to stay healthy. Most say f*** it

  62. Oh my, that German accent.

  63. Hush. You shouldn't ask such reasonable questions. People don't like ideas they've never thought of before.

    Also in that category:
    Why is the US Mail system not optional and still a governmental service?
    Why do individual citizens need to complete tax information when the government takes out a set amount anyway?
    I would like a lawyer to explain to me exactly how Non-Compete's and financial interest is actually legal without using a historical context.

  64. oml by his accent i could instantly tell he was german

  65. Unless appropriate measures were put in place, this would also incentivise euthanasia, unless those people that became chronically or terminally ill were moved onto a different standard, otherwise palliative care would disappear over night.

    I think that if it became a case of quality of life, considering the parameters of a chronic disease (or even a genetic defect), then it would work, but to attach the idea to the elusive definition of "healthy" would be a mistake.

  66. Interesting idea, but seems a bit manipulative. America is a country driven on the individual who's responsible for himself or herself. If you force others to take responsibility for you, it is no longer your body, thus taking away freedom. The focus should be more on parents and making sure they're teaching their children how to lead a healthy lifestyle.

  67. The whole health care system has been designed to only benefit the system already designed involving all the parties concerned as we all know and don't want to change, because they will lose all the benefits .No matter how long and to whom one may talk only, but can't do anything. SAD. It is all about MONEY/ GREED.

  68. This sound great at first, but then it gets scary!
    1. Insurance companies will be paid a health fee for healthy individuals, and be required to pay costs when those people become ill.
    Problem: what if the insurance company decides the individual just didn't do enough to keep themselves healthy and decides not to pay?

    2. Insurance companies could be paid with public funds.
    Problem: This is how a socialist conversation often starts. They seem to envision a pile of unused cash labeled "Public Funds" as the perfect pocket from which to draw. But there is no such unused pile. "Public Funds" is code for your tax dollars and mine. The federal budget is already strapped and most of it with programs like this. In order to make this additional program a reality, it's a much higher percentage of your paycheck taken from you. The private sector is much smarter and more effective with a dollar than any government program has ever shown itself to be.

    3. Individuals would need to share all their health data with insurance companies to prevent illness.
    Problem: the whole purpose of this talk is to shift the incentive for doctors and hospitals away from unnecessary procedures and toward maintaining health for their customers. Rather, what it does is shift the incentive for unnecessary procedures wary from doctors and hospitals and onto insurance companies. When insurance companies have an individual's health data, and they have the threat of monthly funding being reversed if something I that health data goes wacky, they will be highly motivated to put strong pressure on the individual to make whatever they decide are the right choices. But what if he elects to enjoy more sugar than they want him to? Or she wants to try treating a mild condition with Essential Oils before taking a medication that will knock it out, but is riddled with filter chemicals and laden with side effects? This system represents an extraordinary invasion of privacy. Additionally, the rule is that the one who pays gets to decide who does the work, so this system is the end of choosing your own doctor. But this also means they aren't vying for your dollar, so bedside manner and individualized care matter far less than seeing the most people possible every day. Very little changes.

    4. Health care will be individualized based on your health data.
    Problem: In a group of a few hundred it would. But when was the last time your insurance company treated you like an individual? With this kind of incentive not to lose money, are they not more likely to force those who enjoy alternative medicine into the mold of conventional medicine? Isn't that fascism? This is also the point at which you inevitably have men telling women what to do with their bodies. First, we would be subject to many more prenatal tests- and they would not be optional. If problems appear with the unborn baby, we would likely be pressured to abort. Why would a health care system that only wants healthy people allow one who might be sick a lot to enter the program? And what happens when someone gets old and is sick more often? Offing the elderly is cheaper than spending years of focused attention helping them stay healthy longer before honoring them with a dignified natural death.

    A final note. This speaker drew lines of connection such as Government paying insurance companies for people who are healthy, insurance companies paying doctors and hospitals for people who are sick, and all people sharing their health data (perhaps with each of these entities?). Nothing was said about individuals receiving bills from the insurance companies for decisions they make. But when your everyday decisions might cost them a lot of money, and they know which decisions you make because they receive your health data, they will be sure you compensate some of that potential loss. It costs more in taxes, and more in insurance fees. The real trouble with health care may just be the insurance companies themselves! A Bill-Share group or Healthcare Savings Account (HSA) are much more efficient and cost effective for many people. These put the individual in the position of responsibility and freedom to make the best choices for themselves.

  69. You steal it from ancient China and Osho

  70. Several Problems:
    1) Definition of sickness
    Who is defined as sick? Someone who has a cold? is obese? has type 2 diabetes? arthritis? gastroesophageal reflux? any form of inherited disease? COPD? CAD?
    Many of those are inevitable or are overwhelmingly but not exclusively linked to the behavior on the side of the patient. Is the doctor responsible for it? Should we keep them out of the equation although they do require treatement?
    2) Developement and / new discoveries
    Be it completly new diseases or simply improved methods of diagnosis or treatment or even simply a change in categorisation or standards… all of this changes rapidly. In some instances even on a monthly basis. Who can keep track of all of this in regards of the potential costs, especially because those need to be equally divided through all of the potential patients?
    3) More bureaucracy
    All of this leads into the need for more governing bodies. Requiring even more people who want to get their pay at the end of the month who do not take part in the treatment of the patient. So more ways to loose money on the way.
    4) Who decides where the money goes?
    Who and how can you make sure that some hospital in less densely populated area gets the funding it needs while some hospital in the middle of the huge town doesn't get way to much money? Some of the best potential treatments are also the most cost-intensive although the benefits compared to more established methods are sometimes quite low. Is it ethical to deny someone the best possible treatment just because it is too expensive? Especially if the whole system is build around providing the best possible treatment?
    If you socialise the healthcare completely who will regulate the pharma- and other medical-companies to keep their prices low? If you keep the system private who will make sure that doctors / clinics / insurances don't take on only healthy and/or young patients?

    All of this sounds great. But it is has more flaws than the current system. Of course there should be more incentive to keep patients healthy and the public funding of general health-care needs to be reworked in many countries overall. But this is definitely not the way to go.

  71. This sound like typical anti-utopia story…

  72. even easier, cull the sick

  73. As long as millions of people continue eating at Mac Donalds, KFC and buying the cheapest meat at the supermarket, without thinking one second about the consequences, nothing will change. We have the power. Not Nestlé, Bayer, Monsanto, or any pharma industry. What I experience every day is, that people do not want to take self-responsibility for their own health. They just listen what the doctor says, take the pills and look where they can get the next ready-made meal, because this is so convenient. I really wish that we could change this world sometime, but we only can do it together.

  74. What would the "Healthcare" lobbyists do? They'd lobby the US Congress member to defeat this idea just to keep their jobs. Or would Healthcare insurance companies see a benefit in this method?

  75. I think this doctor its all right.better prevent than take care of deases. Thank you

  76. This sounds like a good idea.It also sounds like science fiction.Its too intrusive unless there could be some sort of privacy with a physician.When you put all data in a computer you allow access from any where.

  77. The food system would have to be part of this plan. Marketing and selling toxic foods to children, the sick and the misinformed are responsible for? 30% to 80% of chronic disease?

  78. Interesting concept, but what about the people who don't want to be healthy? Or choose to be what they are. My dad has smoked cigarettes for the past 40+ years. I'm sure he will until he dies. Because he chooses to do that, would doctor's then choose to NOT see him for the rest of his health because he would not be considered healthy? It's just a different version excluding pre-existing conditions.

  79. This would go well with blockchain technology.

  80. How exactly it can be implemented in such a large population? And how can the govt. Or any committee look into every doctors' practice? It is one of the best ideas I heard about. If it gets implemented this can lead to a fairer healthcare division in any country.

  81. What about those with auto-immune diseases?

  82. Everybody else is talking about how this would mean that doctors, and particularly insurance companies, would only be incentivized to look after healthy people, which is a real problem with this that I'd be worried about too, but it's worth noting that this idea also disproportionately affects poor people. "Healthy living" is great if you can afford it, but fresh, healthy food is expensive and most of it is perishable and can't be stored for long. Exercising regularly can be great for your physical AND mental health, but it also takes time that a lot of people who earn less simply cannot afford to spend because they're always working. (Not to mention that if you're already sick, exercising is often either impossible or counterproductive.) We barely have the time and resources to get the help we need in our CURRENT system, much less one that would try every single option, up to and including just flat out not seeing you, before actually treating you. Maybe it works in other countries that do it right (and that actually pay their people…living wages…), but here in the US, with the way our current climate is, and how focused all these companies are on maximizing profit, if you try to implement a system that puts individual healthcare into the patients' hands like this, that opens the door WIDE for blaming sick people for being sick. This is already a huge problem — just think of how often you hear people talk about eating healthy, taking supplements, doing yoga, "easy solutions" like a chronically ill person can just eat a banana every day and be cured — and this would make it so much worse. If you took profit out of the equation, or adjusted the system with those problems in mind, it might work, but as he presented it, it's not just potentially but LIKELY to be very dangerous.

  83. Interesting idea, only one big problems, many times, sickness is generated by certain human behavior, for example, why blame a dentist for a teeth that is rotten because the person didn't care about its mouth cleaning.

  84. Life needs to be very long potentially infinite etc the world needs more people like you more kindness u r a remarkable inspirational man keep it up

  85. Yes, but this also goes into social economics as well as our health care systems – which would also need to be addressed. “People need to eat healthier. That’s why they get sick!” Yes, but eating healthy costs more money that eating poorly. A case of water costs more than a case of Pepsi. For people who can’t afford to put proper food on their table because they need to pay other standard bills might agree but say that’s the way things are. Another point – would this then also put a negative connotation on getting sick at all? Getting sick unfortunately is part of being alive… some people don’t have a choice on if they get sick or not (cancer, autoimmune conditions, genetic defects, and more) Would they then have to “pay” even more as a shift in that incentive. A good discussion indeed and a point well noted… but I believe this runs deeper than just the health care system.

  86. This idea is not new. Something similar was used in practice by H. Ford. He paid his mechanics only when machines worked properly and stopped paying in periods when something was broken. So by doing so , the mechanics were very concerned to keep machines working properly.

  87. He is forgetting two factors; which is impossible to remove from human being's psyche;

    1- Greed

    2- Sense of privacy
    —————-

    With all due respect this speech is so stupid on so many levels. If God forbid this plan ever put into action. It would be the end of humanity. Cause, the next step would be death for the sick. it is the only logical choice.

  88. Oh, easy, man. You really think noone wants or think about such approach? The main question – where will you find enough money for such strategy? Tell better about this, not about "it's good when all will be healthy" – everyone understands it.

  89. You could give control of your life to insurance companies. They would be monitoring your health and personal information at all times. So you would be micro managed at all times and told how to live your life.

  90. If we do what he is proposing, then doctors/insurance agencies will be inclined to ignore the people who really DO need intervention by calling them "well" or not accepting them as patients in order to avoid charges/penalties.

  91. I understand the argument, but on the other hand, doesn't the competition currently also help make sure that doctors don't take advantage of every patient? Because doctors have to try to get their patients coming back, they have an incentive to provide the best services (including not trying to trick people into paying more) to encourage people to come back through their integrity. A personal example, a dentist also tried to trick my family and me as well, and we immediately switched to another, more truthful and helpful dentist. Perhaps this video's thoughts are more towards more monopolistic systems in healthcare.

  92. Thank you for thus talk 👍🏽👍🏽👍🏽👍🏽

  93. He stated that everyone involved would be incentivized to keep you healthy but he didn't mention consequences for the individuals themselves. How can the insurance companies control the individual's lifestyle or genetic factors?

  94. This would just create a system in which people who did not need health care would have access to it and those who need it would be denied either by health care providers or insurance companies, because doctors would not treat people who are at risk of developing disease or be paid to treat people with chronic ailments that will not be cured. Our doctors would be paid for doing close to nothing, including turning away the patients who need the most help. Imagine having to search and search to find a doctor who will take you on, only to pay extremely high uninsured rates for treatment just because your parent died of heart disease, because you were obese, or because you were born with a genetic illness. This is not something to strive for. These people are in the most need of treatment, or at the very least access to information and a professional opinion. Not to mention how crazy it would be that a child would be turned away for a flu shot because they had been diagnosed with type 1 diabetes and would never bring in revenue because they would never be "healthy", especially not without treatment.

    The current system is far from perfect, but paying doctors for not being needed is an incredibly badly thought out idea that keeps them from having any incentive to do their jobs.

  95. Love the idea so much. <3

  96. Seems like this would incentivize providers to claim sick people are healthy, to categorize some disabilities and diseases as normal, to jump to aggressive treatments instead of waiting patiently for low impact treatments to work, etc. We have to do our best to consider the potential unintended consequences.

  97. The Idea is great.. what is proposed is nonsensical… in that we already pay a great deal for healthcare insurance.. here in the US as much as 1000$ / month for a family of 4, and an annual deductible of 5-7K per yr…. what is needed is legislation to control our healthcare providers and health insurance companies to actually perform as a patient care system and not as profit center…. when healthcare changed from not for profit to profit based in the early 1990's all consideration for the patient went out of the window.. and greed stepped in!

  98. First, I would like to agree with Mr. Mullenbeck that there needs to be a change in health care, and a change that focuses to keep patients healthy in order to decrease unnecessary health costs and procedures. As a student osteopathic physician, we are taught to focus on keeping patients healthy, and trained to give the best treatment with the best outcomes for the benefit of the patient, doing the least or no harm. This points to two ethical ideas of beneficence and maleficence. Acting for the good of the patient may point physicians to use more expensive and invasive procedures, but every patient has a right to gain informed consent about every procedure option. Gaining informed consent includes learning the risks of undergoing the procedure and the risks of not undergoing it. With this in mind, I would have to disagree with Mr. Mullenbeck’s idea to change health care so that physicians get reimbursed for keeping patients healthy instead of doing procedures, because the purpose of many procedures is to keep the patient healthy. Mr. Mullenbeck himself also refers to patients as “customers” numerous times throughout the talk; the use of the word customer instead of patient fundamentally goes against his whole notion that patients are not customers and healthcare is not a business. Though going from “sick-care” to “health-care” is a great idea, I believe it is unrealistic in practice as well. For example, there are some patients with chronic or inherited illnesses that cannot be prevented and many physicians such as oncologists focus their care on these types of patients. I could see how we need to shift the focus for doctors to get reimbursed for keeping patients healthy, but the greater issue here goes beyond the doctor to the insurance companies and the patients themselves. Under the scheme that Mr. Mullenbeck proposed, insurance companies will need to restructure completely, and will need to be even more involved in physician’s practice and patient’s lives than they already are if they are to keep track of how many days a patient is kept alive and healthy. Also, this will create a huge debate for what defines a patient as healthy. Mr. Mullenbeck also proposed the idea that a doctor will not be reimbursed until a patient is healthy again after an illness, but this may also be unrealistic. There are some conditions that cannot be prevented, nor cured, that can use many resources and a doctor’s time such as Multiple Sclerosis which has an unknown cause and no cure. Definitions of healthy and long life vary from individual to individual, and to have a standard set by law or insurance companies could potentially create even more harm. Also, the idea that many cancer patients could be helped if their cancer was detected early is not as simple in nature as briefly described in this talk. First, the talk began with the anecdote that a dentist tried to sell Mr. Mullenbeck a platinum tooth implant that he thought was unnecessary, but many individuals could think that blood draws or genetic testings for cancer are also unnecessary and another way for physicians to profit. Additionally, it takes more than a health care provider doing proper physical exams and blood draws to determine whether or not a patient has cancer. Detecting and communicating symptoms, and seeing a physician in a timely manner is a responsibility of the patient, as Mr. Mullenbeck briefly stated at the end of the talk. I agree with the speaker in this respect, but many patients have difficulty affording and accessing care due to the health care system today, and even when they can many will not notice symptoms in time or deny them out of fear. Though Mr. Mullenbeck has a great, positive idea, I believe there are more key players in the process of keeping an individual healthy than changing the way that physicians are reimbursed.

  99. One problem: if you're chronically, incurably ill, then companies incentivized only for total patient health have no incentive to help you when you also get pneumonia, and you're screwed.

  100. The way I see it…..
    Dr's should be paid according to their specialty.
    Wearing they see 10 patients or 1000 patients annualy. They are paid the same amount each year.
    It would then be in the drs best interest to keep the patients healthy. A healthy patient means less work but not necessarily less money.
    There should also be a rule if a patient requests a consult the dr MUST see the patient at least once and full health check be made. This will also help prevent drs becoming lazy.

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