Nov. 24, 2018 - Real Coffe - Scott Adams
13:31
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| Hey everybody! | |
| Come on in here. | |
| Today is a special, focused, Periscope on the topic of healthcare costs. | |
| I'm going to give it to you the way you've probably never had it. | |
| That sounds a lot naughtier than I meant it to sound. | |
| So once we reach a thousand people, we will share a sip of the tears of our enemies and we're going to talk about where I see the future of healthcare costs. | |
| And I think it's good news where it could be. | |
| Join me now And drink the tears of our enemies. | |
| Good tears. All right. | |
| One of the big challenges for even trying to understand healthcare and trying to figure out why everything is so expensive and where it's all going to go is how you categorize things. | |
| And I've been trying for literally years to To figure out what categories to look at to figure out where the big expenses are. | |
| And whenever you see an article on this or somebody's got some statistics about health care costs and breaking them down, they use slightly different categories. | |
| So it's just hard to make sense of where the opportunities are and where the problems are. | |
| But I'm going to give you one breakdown that I think is close to getting in the neighborhood of useful. | |
| And then I'm going to tell you all of the developments that are good news in those categories. | |
| So I made the following categories of costs. | |
| So these are the areas. | |
| And it's just one way you could break this down. | |
| There are lots of other ways you could break it down. | |
| And the problem is that all these areas overlap with the others. | |
| So there's a problem with getting them logically consistent. | |
| But generally speaking, you've got people, you've got buildings, you've got drugs, you've got lab tests, you've got insurance, transportation, etc. | |
| And in every one of these cases, there's something good happening that might lower those costs. | |
| So let's take a look at a few of those things. | |
| Let's look at the cost of a doctor. | |
| We've got these direct pay options now where you can say for $150 a month you can have all the doctoring you need by the same doctor who is a direct pay doctor. | |
| So there are a number of them already. | |
| They seem to be popular and they work well and it's the free market doing its thing. | |
| So that could be a huge improvement in the cost of just the doctor's time. | |
| There's also lots of telemedicine happening, both for the VA and in other places. | |
| I'm going to tell you more about that because my app will also be hosting doctors. | |
| I'll tell you more about that later, but the idea is that lots of doctors are going online. | |
| I use Kaiser and I can already email my doctor and send pictures and all that stuff. | |
| So that should make a big difference. | |
| Of course, you've got better online resources all the time. | |
| WebMD is actually pretty great. | |
| And that information is improving over time. | |
| And then you've got the world of wearables, the little sensors that you can wear that will help you track what's wrong with you, catch things early, that sort of thing. | |
| Now, if you look at the world of drugs, You've got regulations that can probably be fixed to improve the competitive landscape, increase the buying power. | |
| And of course, Amazon is starting to work on that area with JPMorgan Chase and the third company. | |
| So you're going to see a lot on MEDS. But I'm wondering if someday we'll be able to 3D print some of this stuff. | |
| Probably not anytime soon, but maybe someday. | |
| Then there's the supplies. Amazon might have something to do with that. | |
| You could have the supplies printed on demand. | |
| You could have them delivered to your home, and you'll probably see a lot more competition there. | |
| You could have, for some stuff that is not icky, there might be some ways to share it, etc. | |
| Transportation. I thought I saw an article where Lyft was going to be doing some, let's say, low-danger hospital runs for people who aren't so bad that they needed an ambulance, but they don't have a way to get to the hospital themselves. | |
| And you might see more value in the telemedicine because you don't have to travel anywhere if you're just doing it by phone. | |
| There's a real estate cost. | |
| Your doctor, your hospital, they need real estate and that costs a lot. | |
| But again, the telemedicine takes that cost away and a lot of your lab work, you'll be able to put a blood sample or a urine sample In the mail and the real estate is centralized someplace cheap. | |
| So there's a number of startups that are working in the lab test space. | |
| So you should expect that this will get a lot easier. | |
| You'll do it at home. It'll be simple. | |
| It'll be cheaper. Then there's a world of equipment, stuff that tests things and cascans, and there's just a ton of stuff happening here with startups. | |
| So you're going to see lower scanning devices, you're going to see very small desktop devices for testing your blood. | |
| We already have a little device that you can put into your phone that will give you an actual FDA approved EKG. So that's amazing. | |
| So there'll be more sensors that work with your phone, more miniature equipment that you could just call up your Uber driver and say, can you drop off a piece of test equipment? | |
| I just bought at the drugstore the other day a thermometer that doesn't touch your body. | |
| Have you seen those yet? You hold it about an inch from your head and push the button and it can tell your temperature from an inch away. | |
| You just have to be in the room for half an hour so that your temperature and the room temperature are normalized. | |
| So you're seeing huge advances in the shrinking of both the cost and the size of that equipment. | |
| Insurance is kind of the tough one, but here are a few things I would say about that. | |
| One is that if you have telemedicine that's available all the time, it's going to be much easier to get a second opinion on anything. | |
| So if you make it dead simple to get a second opinion, you should be able to make a type of insurance That covers that situation. | |
| In other words, if you're a doctor and you bought malpractice insurance, should you be held responsible if your patient got another opinion? | |
| Because if there were two opinions, Maybe your insurance should say that doesn't seem like your fault because you got a second opinion or the customer did. | |
| So that might help. | |
| It might also help because big data is getting smarter and smarter. | |
| So more people are sharing their health information and we'll get smarter and smarter about drug interactions. | |
| We'll know more and more about nutrition and how that impacts everything that you're doing. | |
| So the more we learn big data-wise, the lower the risk should be of doing something accidentally wrong, and the more easily you can get a second opinion just by picking up your smartphone and talking to a doctor in literally a minute. | |
| You should be able to take off some risk. | |
| You also should be able to take off some risk by robot surgery. | |
| Maybe not in the short run, but eventually we might get to the point where the robots are just so much better even if they're assisted by humans that you just don't have as many accidents. | |
| The other thing you can do is by keeping people out of your building, you don't have as many people sharing germs. | |
| One of the biggest causes of death in this country is hospital mistakes. | |
| I mean, think about it. That's one of the leading causes of death is hospital mistakes. | |
| So the fewer people who physically go to a hospital because they can do things remotely, the fewer opportunities there are to share germs and get something wrong. | |
| The more second opinions you can get at a reasonable price, the more likely you can catch a bad decision early. | |
| The more you're doing big data, the more you've got sensors on your body, the more you can check things on your own, like your own heart. | |
| The more likely you're going to avoid a big problem or at least have a second check against what your doctor is telling you. | |
| And then in nurses, I think you're going to see something like the gig economy where the nurses are coming to your house. | |
| It's more like an Uber situation. | |
| If you need a nurse, there's one there in 15 minutes and you can watch them approach on your phone. | |
| I think you're going to see a lot of medicine go to YouTube. | |
| So that when people need to do simple things such as, here's an example. | |
| Let's say you got an inhaler for your asthma and you needed to know the right way to use it and how to wash it out and all that stuff. | |
| All you have to do is have a good YouTube clip that's 30 seconds long and the person can learn what a nurse would have told them. | |
| So there's a whole lot of what a nurse does that's information. | |
| And that can be moved to video and moved to the internet. | |
| And there's a lot of stuff that nurses do that's a small device test, like testing your blood pressure, testing your temperature, and those devices are becoming, you know, commercial and accessible. | |
| You just do that yourself. And then maybe Amazon will be delivering small equipment and supplies someday. | |
| And it could be that the hardest thing you ever have to do is maybe dress a wound. | |
| And if you need somebody to do that for you, maybe there's an app for that and you find a neighbor who will do it for $25. | |
| That's sort of the broad scope. | |
| The idea is that if you can break down these categories in some kind of rational groupings, then you can start to see which startups and which trends are working against those groupings. | |
| And then you can figure out how do you accelerate that. | |
| What is the best thing the government could do? | |
| What you could do as an individual? | |
| What investors could do? What's the best thing you could do to goose any of these effects that are already positive? | |
| What could be more positive? | |
| I'll tell you one thing that I think is gonna happen. | |
| Here's my prediction. | |
| I don't know how long this will take, but I'll bet a lot of people will be doing some version of Airbnb for hospital stays. | |
| Meaning that your hospital bed will be an extra room in your neighbor's house. | |
| Or, you know, it could be anywhere, but just an extra room in somebody's house. | |
| If it has its own bathroom, and if the nature of your problem is not one that you need a clean environment... | |
| So let's say you don't need something like shots and you need just the simplest monitoring and recovery and somebody stops by twice a day and checks you out. | |
| Maybe there's a video camera on you so that you're actually being watched 100% of the time. | |
| So there's probably some way To take a hospital bed stay, which is super expensive, and compress it by 80-90%, and somebody could still make a nice profit having a clean room in their house, you know, a hospital room. Now, of course, it's only for very specific situations, right? | |
| Not for every situation, but some. | |
| So you can see how many opportunities there are for this to improve in a substantial way. | |
| Scott, afraid that you do not have a clue about sickness. | |
| Now, the people who say that, I want you to know that my very next periscope is going to be troll school. | |
| I'm going to be teaching troll college. | |
| Because I notice that a lot of people are trolling me poorly. | |
| And they need some help. | |
| So I've put together... | |
| By the way, I'm not joking about this. | |
| I'm going to be teaching troll college in my very next Periscope. | |
| So that's the background on this. | |
| That's all I wanted to say on this topic. | |
| Next time you see me... |
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