A False Dichotomy: Dr. Robert Pearl on Technology versus Health Care
By Ana Santos
Dr. Robert Pearl closed the first day of Medicine X 2015 by sharing his views on health care’s biggest transformation: patients’ growing involvement in their care through technology
FRIDAY, Sept. 25 – Patients have become so engaged and informed that the health care industry is largely starting to refer to them as consumers. But the two aren’t synonyms, and the labels aren’t interchangeable, said Dr. Robert Pearl in his closing keynote speech at Medicine X 2015. He speaks from experience: as CEO of The Permanente Medical Group, which is the largest in the nation, Dr. Pearl is responsible for the health care of 3.4 million Kaiser Permanente members.
The Medicine X audience faced a grim reality during Pearl’s keynote. Today, 18 percent of the United States’ Gross Domestic Product (GDP) is devoted to health care, and this share is projected to rise sharply. As he explained, if health care costs continue to grow at such historical rates, the share of GDP expenditures will grow with it, reaching 34 percent by 2040. “American health care faces major challenges with its unaffordability,” Pearl said.
Many Americans believe that the United States has the most expensive health care system in the world because it gets better health outcomes. The evidence, however, does not support that view. “For all of the dollars that we spend, the quality of the care that we receive is simply in the lower half of the industrialized nations,” Dr. Pearl pointed out.
Luckily, the American health system is at a turning point, and many have proposed suitable solutions to the conundrum; some of them are technological solutions, other go deeper in the system itself. But according to Dr. Pearl, one question remains: “As the technology and the systems change, what are we going to call these people who get care: consumers or patients?” For technology companies, he argued, it may make sense to adopt the consumer approach, as patients have specific needs, ones that can’t necessarily be serviced by medical-centric platforms—much like any other service or product now catered by tech. The critics, continued Pearl, “believe instead that health care is an art, a patient-doctor relation. There is a reason why doctors spend years in medical school, training… And the debate goes on.”
Dr. Pearl believes that the solutions lie beyond the dichotomy of technology and human care. He said that health care seekers, and providers, have to figure out how to foster technology, while enacting the much needed system changes going forward. As an example, he pointed to Dr. Aaron Carroll, who shared in the New York Times his own struggles to get proper medication for his chronic disease. Pearl explained that Carroll ends up going back and forth between his physician’s requirements, the insurance approval, and the pharmacy systems. Meanwhile, Pearl argued, “technology could solve every one of his problems. And yet it’s not happening… because the system behind it don’t allow it.” He explained that this is a classic business problem: people are not going to have access to the technology unless the system changes, but unless the system changes technology won’t be available. “The real debate comes when we ask why,” he added.
Dr. Pearl concluded by stating that changing the American health care system will be difficult, and that there isn’t one single answer. Yet, he urged the audience to think further about the problem—and ultimately stand up against it. “I want you to understand that choice is more powerful than circumstances. That we can say it is wrong, it is happening, and we can change the situation.” Let us all embrace that choice.
Ana is an MA student at Stanford’s data-driven journalism program. She has extensive experience with reporting and corporate communications in her home country of Brazil and in Europe. Find her on Twitter at @anacrochas.