Here are three more "smart medicine" ways to make healthcare cheaper by making it better.
This first one that might be kind of surprising, because it is not high-tech at all: For any procedure that has standard steps that are important, use a simple, standard checklist. When you hear this, you're going to be amazed that they are not already doing this. There was a pretty well-known trial called the Keystone Initiative, which was published in December 2006 in the New England Journal of Medicine. Doctors and nurses in the Intensive Care Units of all Michigan hospitals used a simple 5-point checklist for a very common procedure called inserting a central line into a patient. These were simple, obvious things like: Drape the whole patient. Wash your hands. Glove up. Wash the site with chlorhexidine. Bandage the site properly. Using the checklist saved 1500 lives and, by the way, $175 million in 18 months. Imagine if we used that one checklist across all 50 states, and you are talking about 30,000 lives saved and over $3.5 billion dollars per year for one checklist on one procedure. Imagine that multiplied by all the similar problematic procedures across healthcare, in all 50 states: easily a hundred thousand lives or more saved, and scores of billions of dollars. The healthcare industry has not done this, even on central lines, let alone on all problematic procedures. I think that's pretty amazing. Why not? That's a puzzle for psychologists, not a medical question.
Second: We can bring down malpractice costs. How? Once again, by supporting standardized, evidence-based medicine, computerizing everything, automating things as much as possible. Such "smart medicine" not only means fewer mistakes, it also means that everything is clearly documented – and when there is a bad outcome, you can see whether the standards were followed. Besides, today, doctors often order tests and procedures that they know are not necessary, just because they are afraid that someone will accuse them of not doing everything possible, and sue them. If you agree on common standards and stick to them, quality goes up, mistakes go down, malpractice costs drop, and a lot of the fear goes out of medicine.
Finally: You may be amazed to know how often doctors do things like, for instance, hip transplants on frail elderly people who are permanently bedridden in long-term care, heart valve replacements on people dying from kidney failure, or eye operations on people who are deep in the final stages of dementia. There's really nothing to stop them. I know of many such cases, and you may too. We should use standards-based medicine to eliminate paying for such clearly inappropriate medical care. These things do more than cost money, they constitute cruelty to the old and helpless.
So three things: Use checklists, bring down malpractice costs with "smart medicine," and use new medical standards to eliminate unnecessary and unhelpful medical care.