January 06, 2020
Rose
By KIM BELLARD
The end of one decade and the beginning of another seems to be a time when various pundits like to look back and/or forward. In particular, I’ve seen a lot of such articles about tech, both noting important technologies of the 2010’s and speculating on the tech coming in the 2020’s.
Oddly enough, the article about new tech that struck me the most was one that seemingly has nothing to do with healthcare, but which I think has important lessons for it. It is the introduction of hypersonic missiles.
If you don’t follow weapons development closely (and I don’t usually), hypersonic missiles are ones that can fly at several multiples of the speed of sound, such as Mach 5 and above. They fly so fast that there is virtually no defense against them. Existing anti-missile defenses are problematic enough against conventional missiles, but a hypersonic missile is at its target before a defense system can react, due to its speed, low altitude, and maneuverability.
Russia just claimed that its hypersonic missile, the Avangard, has been deployed. Some reports claim Avangard can fly as fast as Mach 27. Russia has been working on the technology for as many as thirty years, tested it in 2016, and in 2018 Vladimir Putin made it public, describing it as: “It heads to target like a meteorite, like a fireball.”
The U.S. is also working on hypersonic missiles, but has not made it as high a priority. Our version is not expected to be available “for a couple of years,” according to Defense Secretary Mark Esper. China, India, and France are also supposedly working on their versions.
Many experts downplay Avangard’s importance. While it cannot be stopped, it also would not knock out the U.S.’s offensive missile systems, so an attack would still lead to massive retaliation. Some are also skeptical that the Russian technology will work as promised.
What Putin may like best is that it allows him to boast: “Not a single country possesses hypersonic weapons, let alone continental-range hypersonic weapons…The West and other nations were ‘playing catch-up with us.'”
We’re spending billions of dollars on aircraft carriers that don’t work and fighter plane that don’t fly, which seems a little like the old adage that generals are always fighting the last war. The new wars may be fought in cyberspace, and/or with inexpensive drones and IEDs, not to mention with hypersonic missiles.
We knew that the technology for hypersonic missiles was possible. We knew our adversaries were putting an emphasis on developing it. We knew we’d need some of our own at some point. And we had a pretty good idea when one of those adversaries would deploy its first instance of the technology. But we had other, more expensive, more traditional priorities.
This is what makes me think of healthcare.
Healthcare is still pouring lots of money into its versions of aircraft carriers (think hospitals), fighter planes (think physicians), and bombers (think prescription drugs). We’re still spend most of our public policy discussions on the need for increasing coverage because our healthcare system is so expensive, rather than admitting that coverage is so important mainly because our healthcare system is so expensive. Need for coverage is not the problem, it is the result of the problem.
We seem to assume, or at least expect, that our future healthcare system will look very much like our current healthcare system, just more expensive. What we are not preparing for are healthcare’s versions of hypersonic missiles — technologies that can strike so quickly that our healthcare system can’t respond.
As Steven Simon wrote about hypersonic missiles: “If past is prologue, deployment of the systems is going to take place well before their ramifications are fully understood.” We want to try to debate, discuss, and think through all the ramifications before making changes in healthcare, but we may not have that luxury.
For example, many think that CRISPR is going to be a game changer. We’re investigating, using all due caution. Meanwhile, of course, China is plowing ahead, perhaps with fewer ethical qualms. They may have sentenced the scientist behind the world’s first CRISPR babies to jail, but, meanwhile three such babies have been born.
The U.S. may have shaky data privacy standards, but what China is doing with aggregating huge data sets is way beyond even our privacy laws, and is helping to fuel their A.I. development. Healthcare is a key sector.
There are technologies out there that we know are coming, which people in the U.S. are working on, but for which the regulatory, political, and payment systems we have in place are not at all ready: AI, CRISPR, 3D printing, cybercurrency, among others. When we all have 24/7 monitoring, and we will, who will have access to that information, who will be obligated to act on it, and will be object?
The example I keep wondering about is: when — not if — AI doctors arrive, who will license them, how, for where?
Healthcare is not prepared for the future, and that future will be sooner than it thinks.
The future is going to be a lot like hypersonic missiles. It will come fast. It won’t look like what we’re used to. It will arrive before we’re really ready for it or can react to it. And it won’t come as a complete surprise.
The U.S. should be scouring the world for technologies and approaches that deliver the best care in the most cost-effective manner. There are already many examples, but we think that they are just “developing nations” solutions — ignoring the fact that some portions of our population suffer developing nations’ health outcomes. We should be trying to crash our existing cost structures, not enable them.
So, let’s be thinking of not how 2030 will be like 2020, but of how it will be different. Let’s spend less time on further developing 2010’s technologies and more time delivering 2020’s technologies. Let’s make that future what we want, not what we’re resigned to.
If Kara Swisher can imagine our lives without our mobile devices by 2030, what we can imagine for healthcare?
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