Hippocrates meets Wall Street meets Immigration

Let’s begin with a reading of the revised Hippocratic Oath I'm going to include the prayer for context as I think it's important. 

Prayer:   

I swear by Apollo Healer, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.

Oath:

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of over-treatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say, "I know not", nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

This is incredibly powerful. But… it is one sided. There is no reciprocity from the patient. Here’s a table of the differences between acute and chronic diseases. (The tables are adapted from Zimmerman, et al, “Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like?” Discussion Paper No. 8, Commission on the Future of Health Care in Canada.)

To me the operative word here is reciprocity. The healer takes an Oath, the patient expects an outcome. They’re misaligned. And then Wall Street showed up to the party - and entered stage left with a financial system that is engineered for one thing, and one thing only - Profits. Is it any wonder we’re in the state we’re in?

But hold on a moment there is one more ‘butterfly effect’ to add to this - Immigrants. 

There is documented evidence of the CIA destabilizing the countries that these immigrants are fleeing from. This begs the question - how many of these immigrants work in healthcare? The National Library of Medicine has an answer - Immigrants are a critical part of the U.S. health workforce, employed in a vast array of occupations. Healthcare has been among the fastest growing sectors of the economy for employment, with the U.S. Bureau of Labor Statistics predicting 13% growth from 2021 through 2031 [1]. Immigrants are expected to continue in the future to play a significant role in U.S. healthcare [2, 3]. In 2018, 15.6% of healthcare practitioners and technical occupations and 22.4% of healthcare support workers were immigrants [2]. Relative to their representation in the general population, immigrants make up disproportionate shares of both lower- and higher-skilled healthcare workers in some occupations. For example, they accounted for 28% of physicians and surgeons and 38% of home health aides.

• If you want to collapse healthcare, simply enforce immigration.
• If you want to collapse healthcare, engineer more profits.

Both are happening in real time. It's not sustainable.

If you want to change healthcare the answer is that the physician and patient must be reciprocally knowledgeable to improve health, and Wall Street needs a new business model to engage them both with, and maybe a modified immigration policy would help things along. Notably, a big ask.

All of this leads me to this conclusion: We don’t live in a complicated world anymore; we live in a complex world. For planning and problem-solving solutions, we need another table.

What remains is to code a solution that enables the Butterfly Effect that yields big effects. How hard can that be? As it turns out - quite hard - but it can be summed up in a single word: Choice®.

And it turns out the answer was lying in plain sight - the web. It has been assumed since it was finalized in 1996 that it was finished. As the old quote goes - software is never finished, it’s merely abandoned. 

We studied the web and did some divergent, out of the box thinking.  We discovered that there was room for improvement. We call it Augmented HTTP/HTML. It’s proven technology - already one piece is inside more than 75% of the world’s browsers. 

The other piece remained hidden in plain sight, even to us. The irony is that it took a healthcare executive asking me some very, very difficult questions to expose the answer. How could the physician and the patient be reciprocally knowledgeable to improve health? How could healthcare organizations reward Wall Street with profits that align with equitable distribution of value?

Our innovation takes what we currently have access to and expands its reach via a parallel healthcare business model. This model can offer better privacy, deeper engagement, reciprocal knowledge to improve health, more profits, and perhaps most importantly, trustworthiness, something that is in very short supply these days. I’ll leave the immigration work for the politicians. 

cc: Glenna Crooks, Ph.D.