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My Wake Up Call in 2020 - Marty Hearyman, MD, CCHP

The craziness of covid got my attention. I have followed Health Rosetta from its beginning in 2013 as a result of my pursuit of Direct Primary Care. I remember coming across an article on Marilyn Bartlett, how she led dramatic changes in the healthcare environment in Montana and the birthing process of the Health Rosetta as a result of Dave Chase initiative. 

 

It fell off my radar for years but popped back up in 2020 with the pandemic being a nidus raising important questions about the dysfunction of our medical system and the government and medical institutions that failed the public's trust. The dysfunction has existed for a long time. COVID was an opportunity to pay closer attention to the existing problems highlighted by the exacerbation and prominence of the misaligned incentives.

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The following are some of my key takeaways from Dave Chase's book, "The COVID-10 Wake-Up Call, Relocalizing Health":

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page 1

The Future of Health Will B Local, Open, and Independent.

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page xxvi

70% of medical bankruptcies are filed by "fully insured" people

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page 8

The Original Sin 

In An American Sickness, Elisabeth Rosenthal explained how the way we structured health insurance was in some ways the original sin that catalyzed the evolution of today’s medical-industrial complex.

 

This doesn’t mean health insurance is a bad thing. It means health insurance as we have known it is a bad thing. We need to re-do health insurance to support the health care system we want, not the one we’ve got.

 

page 221-222

Data Ownership Rights 

• 57. Individual Rights – An individual’s access to and management of data about him/herself is a fundamental human and property right. Why is it easier to have your medical data hacked than for you to get access to it? 

• 58. Monopolies – Monopolies on medical knowledge and information are unethical. 

• 59. Single Patient Record – Now that all information can be connected all the time, there should be only one record of health data that comes from an individual, controlled by the individual. Problems with HIPAA and “information blocking” are symptoms of a broken, pre-Internet, paper-driven era. 

• 60. Property Rights in a Distributed System – Platforms will be developed to enable transactions around health data property that are decentralized, yet able to focus on the individual in an instant. Be prepared. 

• 61. Patients’ Right to Data About Them – Individuals have a right to any data that comes from measuring an internal state of their body, including from medical devices. 

• 62. Immediacy of Access to Health Data–People have literally died, waiting for their lab data. Lab and other data should be made accessible to the individuals as soon as it is available. 

• 63. Data Doesn’t Cause Medical Harm – Medical regulations exist to protect individuals from medical harm. Data, ideas, and information in the hands of individuals cause no medical harm. 

• 64. Safe Access to Data Without a Doctor’s Permission – Individuals should have access to metrics and analysis about their own body without a doctor’s permission as long as that access poses no significant medical risk. 

• 65. Right to Privacy – Individuals have a right to health data privacy and only they or their legal agent can give permission for sharing their data. 

• 66. Health Information Anti-Discrimination – Health data collected about an individual cannot be used to determine a person’s access to capital (via credit ratings), employment, education, housing, or health care services. This will be legislated and ensured by new technologies. 

 

New Roles and Relationships for Providers 

• 67. Misaligned Incentives – Misaligned reimbursement schemes have impaired providers from doing the primary job of healing and have often robbed them of their humanity. Paying for value will help them reverse course.

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