Tuesday, January 19, 2010

Scale Economy in Medicine

There has been some discussion today about an article about Baumol's "cost disease" and it being an explanation for why the cost of health care will never decrease. Simply stated the intent was to show that health care was akin to musicians in an orchestra. That there is no way that there ever will be economies of scale in the delivery of health care.

As with a great deal of what Baumol has stated for a while I beg to disagree. The change in computing and in turn our economy was the deployment of the computer and especially the PC. The same will occur in health care with the deployment of genetic techniques to ascertain predispositions for diseases, for the staging of these diseases, for their treatment and in turn for their prevention.

As we have argued many times before, we sit on the precipice of this change occurring. We see that there are many ways in which we can now determine if a person has a predisposition for disease as extreme and rare as Marfan's syndrome, and the BRCA genes for breast cancer, the PTEN gene expressed or not expressed in many cancers. The staging and assessing of many diseases and especially many cancers will allow for improved and more efficient treatment.

We are there now, we are at the edge of change. In many ways genetic therapy and prevention is akin to computing in 1947. If it continues to develop it will solve the health care dilemma and it will show that Baumol's cost disease will remain with musicians and will no longer apply to health care.

However if we institutionalize the current way of doing health care as is being done with the current plan then more than likely we will see this occur well beyond our collective lifetimes.