So, lets see if we agree on a couple of things that might help.
- standadize paper work. This would save at both Dr. and insurance companies. (software etc.)
Presumably by "save," you mean time and money will be saved and/or efficiency will be improved by standardization
per se. I don't agree.
There certainly have been effective efforts to standardize the way paperwork is done and the nomenclature that is used. SNOMED, which was developed by pathologists as a standardized approach to nomenclature, is one very successful example (
https://en.wikipedia.org/wiki/Snomed). Formatting of laboratory results is another example. In neither case was a regulatory hammer needed for acceptance and widespread use. SNOMED is used worldwide today.
On the other hand, DRG's and CPT coding (
https://en.wikipedia.org/wiki/Diagnosis-related_group ;
https://en.wikipedia.org/wiki/Current_Procedural_Terminology) made delivery of care far more complicated. Much of the silliness one sees in billing practices in the US results from those two government efforts at standardization. (While the AMA is tasked with maintaining CPT coding, it is tightly controlled by government.) If you look at the list provided, you might think medicine is quite simple. What isn't evident are all the things that don't fit nicely into the codes and/or that get xx999 codes, and the effect of such assignments on patient care. In pathology, and I suspect in other specialties as well, 999 codes are effectively not reimbursed. Some hospitals try to play a game of cost shifting those procedures to others. Or, in worst cases, either not allowing such procedures to be done or trying to find "best fits." There is also a tremendous amount of time wasted on deciding between several similar codes, such as the 8830x codes.
Thus, the key to whether standardization will improve delivery of medical care is in how it is implemented. To me it is completely illogical to trust such implementation to an entity that has repeatedly failed in its efforts and whose true goal is not improved care, but reduced costs.
- buy drugs in bulk (like Canada) I don't know how to accomplish this.
I am not quite sure what you mean by buying drugs in bulk. If you mean buying large quantities of currently available dosage sizes, that is already being done. If you mean having drugs sold in larger multiple dose sizes, I assume you realize that the only impediment to doing that is government regulations, namely FDA approval. There are of course serious risks to having drugs distributed in multiple dosage sizes. With current technology, it is impossible to track and to ensure that such multiple use sizes are properly used. Microbiologic contamination, adulteration (both intentional and unintentional), outdating, and improper doses are just four of the problems. Single-use packaging reduces those risks.
Another problem with large bulk distribution is getting additional supplies when usage deviates from prediction. In the previous Soviet Union, for example, antibiotics were sent to hospitals in bulk. If use of one antibiotic exceeded standards of the central planner, the hospital had to do without until its usage was back in line with those standards. So what do you do when one hospital has an outbreak of staph infections and another has an outbreak of Pseudomonas infections?
I agree with both of these, but I would like to add a third and possibly a fourth.
3 - Let's all input and retrieve Medical data into the same system for both doctors and patients. Patients can protect the data. e.g. determine sharing permissions. Under "emergency" conditions, data is open to any doctors. I won;t define "emergency". The government should create this system.
Standardization of nomenclature and record keeping practices has been demonstrated to improve care, as the SNOMED and other examples show. As for confidentiality of medical records, governmental approaches have been abominable failures. Care givers who need access can't get the information they need; insurance companies on the other hand have unlimited access. As for maintaining confidentiality, to put that in the hands of the government is insane. Anyone recall Wiki-leaks? Leaks from Medicare, Veterans administration? How about unauthorized access to IRS records being used for political purposes? Does any woman who has had a pregnancy test want that information available to politicians?
Again, compare all of those failures to the success of places like the Mayo Clinic in maintaining patient confidentiality. I do not want my medical information in a national database. Since it is my information, I don't see why an uninformed electorate should be able to dictate otherwise.
4. Create a Heuristic system that can access all of the data and test results which can suggest questions to ask, tests to perform and types of specialists to see to generate a diagnosis.
First and foremost, that is being done and is part of every medical training program in the US. Most of you have probably seen at least one episode of
House in which a list of potential diagnoses is made (differential diagnosis). And, there are handheld devices today that help in that respect. It needs to be implemented on a patient-to-patient basis by physicians, not by global checklists. As one example, taking a patient's temperature within 30 minutes of arrival in an ER is on a checklist for "quality of care" assessment. Do you really think that should apply in every case? It is a huge mistake to think than any government entity can substitute regulations and standards for judgement.
I don't think we will ever agree on how medical care should be delivered. What I don't understand is the basis for your argument that I should accept my care what you think is best for your care.
John
with myself. Me and my flipping Politics 
