Guest Post: David Rothman on the iPad Stimulus Plan

But how to cost-justify a well-stocked national digital library system? Multibillion-dollar savings and other benefits could result from iPad-style technology in a number of ways, beyond the library world, if the United States had a better information strategy. Simpler e-commerce and tax forms--at local, state and national levels--are just a start. Healthcare is the real paper dragon to slay, and the Americans might even live longer if we acted. The National Institutes of Health and other leading institutions could more effectively distribute medical information to doctors and patients alike, and the sick could use the same machines to monitor treatments and juggle around pills, not just track the financial details. 

Let's look, close up, at the paper dragon. When a Northern Virginia man suffered a heart attack in September 2008, this AARP member felt as if the healthcare industry had bullied him into becoming an accountant--caught as he was between the hospital, the doctors and the insurance company. Costs reached an outrageous $85,000. His wife's plan from her job, far better than the typical one, covered all but a fraction of that amount. But the paperwork ate up hours and hours that he could better have devoted to his work and cardio exercises.

The right hardware and software would make the health system more transparent to our friend the cardiac patient so hospitals and service providers were less likely to try to squeeze him unfairly--no small consideration if we remember that healthcare costs are among the leading causes of personal bankruptcy and steal away so much of our national wealth and income. Even as far back as 1999, the year studied by Harvard and the Canadian researchers, U.S. healthcare paperwork amounted to an estimated $1,059 per American or $294.3 billion. A single-payer system would be wonderful, but meanwhile the nightmare won't stop, wasting both money and time.

I know first-hand of the horrors here. You see, I'm the cardiac patient from Northern Virginia, and remember mine is a best-case scenario or at least somewhat close to it. The hospital itself was theoretically within the insurance company's network for almost full coverage. But oh, the loopholes! I still had to bargain with the surgeon's office and pay his people thousands. Dozens and dozens of mailings beset me from the insurance company and the other medical providers. I could have made a career of the paperwork. Alas, the current default for some doctor's offices and hospitals seems to be, "Let's see what we can get past the insurance company, and if that won't work, then we'll lean on the patient for the money--whether or not we're definitely right." I'd have paid out hundreds and perhaps even thousands more if my wife and I had not hung tough. While the Obama health-care legislation was a milestone, it hardly ended the possibility of a similar auditing nightmares should I suffer Heart Attack II. 

So why not use iPad-type machines and easy-to-use software closely tied in with the devices? Then, for example, I could instantly show why an insurance company rejected problematic items that the doctors' offices or hospitals were now trying to get me to pay for. 

Forget about just paper-based information or facts from separate corporate Web sites with password hassles and other joys. Give me instead a simple iPad-style application or a centralized Web-based "dashboard" or maybe a choice, so I can more easily try to reconcile information from different sources--and quote the source material in my boilerplate e-mails to hospitals and insurers. Here's to the magic of Web links and of facts consolidated via XML-based technology! Case by case, let patients themselves play more of a role in policing our health system, thereby lowering costs while actually taking up less of their time, thanks to the right automation. On top of that, with more automation at the patients' end, Americans would be more likely to benefit from shingles vaccines and other medical offerings that millions are foregoing now because of the paperwork often required (insurance companies may force you to buy the drugs and jump through the hoops for reimbursement for the $165+ often charged).

The same dashboard could also help me retrieve drug information--I gulp down five pills a day, a small number compared to some patients'--and alert me to relevant medical news. Likewise it could display my health records with plain English explanations from my physicians or others in text and audio (perhaps recorded during doctors' visits). No longer would patients have to depend so much on memory, their own notes, or doctors' scrawls.

Federal Chief Information Officer Vivek Kundra admirably wants to open up more government data to the citizenry, but we need to go further and use the federal government as an enabler for individual Americans to get a better grip on information about them in healthcare and other key areas so we can all save money and perhaps on occasion our lives.

Do you really think that the healthcare and tech companies on their own will give me everything I want and need, no matter which hospital or doctor I visit for for treatment? No, corporate executives prefer to balkanize markets or at least waste time duking it out to be the standard even if this may deny the sick an easy, comprehensive solution. I love Google on the whole and even own a tiny speck of stock in it as a long-range retirement investment, but does Google or Oracle care about my health and my pile of envelopes from doctors, hospitals and  insurance companies? Hardly. Beyond that, under the current system, digital records can be grossly inaccurate, as a cancer-stricken user of Google Health discovered when Google startled him with a list of medical conditions he did not have.

The good news is that the Obama Administration wants to turn NHIN-Direct (NHIN stands for National Health Information Network) into full-fledged reality. The government is to oversee this platform for doctors, hospitals and other health-services providers and deal with such issues as interconnectivity and technical compatibilities and even patient access to records. But hopes are a long way from a working system and your ability to download to your iPad your cardiologist's precise diagnosis and advice. 

Can such miracles actually happen? Actually at least one health cooperative is already emailing some actionable health tips to patients based on their doctors' findings--no small help when the patients may not immediately grasp all the nuances of orally delivered advise, and when 70 percent of Medicare spending involves 10 percent of patients in the program. This a shocking percentage even if you consider the expenses related to patients near the ends of their lives. If nothing else, imagine how much more effective drugs will be if taken correctly. Easier to master than conventional desktops, touch-screen tablets with the right software could make a major difference for the elderly and perhaps shave a percentage or two off that 70 percent.

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James Fallows is a national correspondent for The Atlantic and has written for the magazine since the late 1970s. He has reported extensively from outside the United States and once worked as President Carter's chief speechwriter. His latest book is China Airborne. More

James Fallows is based in Washington as a national correspondent for The Atlantic. He has worked for the magazine for nearly 30 years and in that time has also lived in Seattle, Berkeley, Austin, Tokyo, Kuala Lumpur, Shanghai, and Beijing. He was raised in Redlands, California, received his undergraduate degree in American history and literature from Harvard, and received a graduate degree in economics from Oxford as a Rhodes scholar. In addition to working for The Atlantic, he has spent two years as chief White House speechwriter for Jimmy Carter, two years as the editor of US News & World Report, and six months as a program designer at Microsoft. He is an instrument-rated private pilot. He is also now the chair in U.S. media at the U.S. Studies Centre at the University of Sydney, in Australia.

Fallows has been a finalist for the National Magazine Award five times and has won once; he has also won the American Book Award for nonfiction and a N.Y. Emmy award for the documentary series Doing Business in China. He was the founding chairman of the New America Foundation. His recent books Blind Into Baghdad (2006) and Postcards From Tomorrow Square (2009) are based on his writings for The Atlantic. His latest book is China Airborne. He is married to Deborah Fallows, author of the recent book Dreaming in Chinese. They have two married sons.

Fallows welcomes and frequently quotes from reader mail sent via the "Email" button below. Unless you specify otherwise, we consider any incoming mail available for possible quotation -- but not with the sender's real name unless you explicitly state that it may be used. If you are wondering why Fallows does not use a "Comments" field below his posts, please see previous explanations here and here.


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