The Fortress and the Frontier: The Divide Over American Health Care

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Graboyes frames the real divide in health care policy as pitting Fortress (risk-averse and fearful of outsiders) versus Frontier (risk-tolerant and welcoming to outsiders). He argues that both ends of the American political spectrum have veered sharply toward the Fortress in recent decades-thereby stifling innovations that reduce costs and improve health.

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The Fortress and the Frontier: The Divide Over American Health Care

  1. 1. The Fortress and the Frontier: The Divide Over American Health Care Dr. Robert F. Graboyes Mercatus Center at George Mason University Roadmap: There’s been no real debate. … The real divide is Fortress (fearful of risk, insiders protected from newcomers) vs. Frontier (tolerant of risk, insiders compete with newcomers) … The Frontier in computing. … The Frontier in health care. (Meet some innovators.) … Where is innovation taking us? … What’s stopping innovation? … What role can you play?
  2. 2. IOBAMACARE IOBAMACARE lite!
  3. 3. Problems pre-dated the ACA
  4. 4. John Cochrane (University of Chicago) “[W]hat’s the biggest thing we could do to ‘bend the cost curve,’ as well as finally tackle the ridiculous inefficiency and consequent low quality of health‐care delivery?” “Look for every limit on supply of health care services, especially entry by new companies, and get rid of it.”
  5. 5. Richard van As Ivan Owen Jon Schull, e-Nable
  6. 6. Ian Shakil, Augmedix Pat Basu Doctor on Demand Jenna Tregarthen Recovery Record
  7. 7. • 3-D printed organs (from the patient’s own cells). • Drugs designed for a specific individual’s DNA. • Wearable telemetry for continuous patient monitoring. • Nanobots to repair damaged genes. • Social media crowdsourcing, processing, and disseminating medical information. • Cutting-edge data-mining techniques. • Lean production techniques. • Bio-sniffers – self-manage your health.
  8. 8. Federal • Tame the FDA. • Reform Medicare Reimbursement – island-by-island. • Reform Medicaid. State • Allow specialty hospitals; eliminate certificate of need. • Relax scope-of-practice restrictions. • Protect innovators from arbitrary tort judgments. • Revise medical school curriculum. • Eliminate obstacles to telemedicine. • Right to Try (Dallas Buyers Club). • Right to Know (23andMe). Island hopping and leapfrogging.
  9. 9. Shea innovate HEALTH

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