Elon, Do We Have a Disaster for You!

One of the most interesting twists resulting from Hurricane Maria striking Puerto Rico was Elon Musk's offer that Tesla could help Puerto Rico solve its energy crisis, with a long-term, 21st century fix.  After all, its electrical grid was devastated, with almost all the power wiped out.  It didn't help that even prior to this disaster its system was antiquated and badly in need of repairs.

It is telling that we don't have similar offers to rebuild the Puerto Rico's health care system, which is similarly devastated.  Or, for that matter, our system, which is its own kind of disaster.

Mr. Musk was asked on Twitter if Tesla could help Puerto Rico using solar and battery power, and he responded in the affirmative, saying it had done so on smaller islands but faced no scalablity issues.  Next thing we knew the Governor of Puerto Rico and he were talking.  Now Tesla is starting to deliver their battery systems to the island, so we'll see.

The appeal is obvious.  The island has a perfect climate for solar power.  Rebuilding the power plants and power lines is a daunting task, especially for an island that is essentially bankrupt.  Solar is renewable, oil and coal are not.  And, being a tropical island, Maria is not the last strong storm that will strike Puerto Rico, so future outages are inevitable.  Solar/battery at least decentralizes the grid, lessening how wildspread such outages might be.

Maybe it is a marketing stunt on Mr. Musk's part -- if so, you have to give him credit for it -- but the idea has merit.  A disaster like Maria is a once-in-a-lifetime opportunity to try bold new ideas instead of blithely rebuilding what was there before (let's hope Houston does the same with its zoning and floodplain issues).

Meanwhile, Kaiser Health News reports on the toll Maria has taken on the island's health system and residents' health, both now and for some time to come.  Relief workers are doing the best they can, but there's no easy fix for the underlying problems the system was already facing, like high prevalence of chronic conditions, funding shortfalls, and an ongoing brain drain of health professionals, all exacerbated now by lack of clean water, adequate supplies, and shelter.

Still, even Elon Musk isn't bold enough to offer to rebuild their health care system, much less ours.

Sometimes disasters do make us rethink our health care system.  Katrina, for example, has often been credited with creating the impetus for electronic health records (EHRs), since it destroyed countless paper records, wrecking havoc on care for thousands of patients.

But we didn't pay enough attention to even that very visible crisis.  We do have a lot more EHRs now, but less than 30% of hospitals self-report being interoperable, and half of physicians' time is supposedly spent on their documentation efforts.

The records themselves remain largely physician-centered and exclusively medical, although Epic, the nation's largest EHR vendor, is finally saying they will move to a "comprehensive health record" (CHR).  "Because healthcare is now focusing on keeping people well rather than reacting to illness, we are focusing on factors outside the traditional walls, Epic's CEO told HealthIT News.  Rivals say they are doing the same.

I'm glad that in 2017 EHRs vendors are finally realizing there is health outside a medical facility.

It shouldn't take a hurricane -- or an earthquake, or a bickering Congress -- to realize that we have an in-progress disaster with our health care system.  Sure, health care hiring is booming and hospital/medical construction is everywhere, but those are signs of the disaster, not of the robustness of the system.

We spend way too much on medical care, we get too much unnecessary care, we are subject to too many medical errors (including deaths), and we suffer from too many lifestyle diseases, such obesity and diabetes.  Our longevity is embarrassing -- and declining.

We give tax breaks to "non-profit" hospitals regardless of how they use those breaks, and to employer health plans, which end up disproportionately benefiting the middle and upper class.

We finally managed to give health coverage to millions of previously uninsured Americans, but now those gains are under attack, while half of the poor and near-poor remain uninsured.

We bounce from one new dietary finding and/or fad to another, while eating too many processed foods and not nearly enough healthy foods.  Meanwhile, few of us get enough exercise, and we spend too much time on our various screens.  Our social networks are increasingly online rather than in-person.

There is not nearly enough "health" in our health care system, just ever-more "medical."

If all that isn't a disaster, I don't know what is.

Let's say we were starting from scratch.  Let's reset what our health care system could be.  Let's say we didn't have all these hospitals, hadn't trained any physicians, hadn't deployed any medical devices or used any prescription drugs, although we could start with the knowledge of what each of those could accomplish.

Would we remake the system as it is, or would we design something new?

In a previous post I enumerated several things about our health care system I was dying to redesign, and in another I gave some specifics about how a re-engineered system might work.  Even those, though, didn't start from entirely scratch, still focusing more on the medical than on the broader health perspective.

We should be spending more on our health needs -- broadly defined -- than on our medical care.  We should be more worried about if people are going to the park than if they are going to the doctor's office.  And when we do get medical care, we should make sure it is care that has solid evidence of working, rather than too often accepting care that might work.

Elon Musk has his hands full saving humanity, not to mention helping Puerto Rico, so we probably can't count on him to offer to reinvent our health care system too.  So who will it be?