Care in the home

http://www.ted.com/talks/eric_dishman_take_health_care_off_the_mainframe.html

The summary of this talk is that we currently have a centralised system of healthcare. People go to their GP or the hospital, have a 15-minute exam and get a treatment and then are sent out into the world again. Eric Dishman wants to take care out of the institutions and into daily life and the home.
This might work for some illnesses; acute infections that can be cured by a simple drug prescription, or broken bones because of a bad rugby tackle, but it's a grossly dysfunctional way to approach chronic conditions and ageing, which are by far the biggest burden on healthcare, and will be even bigger in the future, with an older population.

Chronic conditions wax and wane, and ageing is a gradual process. These things only get people to a doctor once the damage is done; when a pensioner has fractured his hip or after the asthma attack.
We have the technology for constant surveillance: to monitor how long it takes to recognise a friend on the telephone, and to analyse gait in the house. These things can detect subtle changes long before the patient will, and provide solid evidence of change. With such systems we won't have intelligent people getting sent away from Alzheimer's clinics because they still function well, even though they and their families know that they were once much better.
We have the basic systems (in this country: the US is worse) for care in the home. We have district nurses who visit patients who need minor care, and they do a fantastic job of freeing hospital beds, saving money and allowing people to enjoy the familiarity and comfort of their own homes.
We have GPs, who have some degree of personal knowledge of patients. But they don't get personal information, they don't necessarily know their patients well, and they typically don't make home visits.

We need to expand our system of caring for people outside of hospital (which is expensive). More nurses, more health visitors, and more automated early detection can all help prevent injury and disease.
As I know well, patients much prefer to live at home. Every nurse will remember patients moaning endlessly about wanting to go home, patients fighting to be let out, patients who are unco-operative because they're just not happy and patients who are rude. Patients refer to hospital as 'the gulag' and similar words, expressing their appreciation for incarceration.
We need patients to feel grateful for their medical care, and that will be more likely to happen when it comes as an addition to their lives, not as a replacement of their lives.

So, as Eric Dishman says, we need more research and effort to be put into home care. It is already well known to save money, despite not being as effective as it could be. With inventive home monitoring and better support the system could make patients happier and healthier (and we know that happiness has health benefits), hospitals less crowded and budgets less tight.

And if patients are seen in their own homes they won't be affected by hospital-acquired infections and epidemics. There will be much less risk of picking up a cold, C-Difficile or any of the other problems that plague the long-term bedridden.

A free market in political systems

There was a wonderful talk at the TED conference here in Oxford about charter cities:
http://www.ted.com/talks/paul_romer.html
I enjoyed it because I've been disillusioned with the possibility of actually changing (significantly) any existing country for the better, despite the constant stream of problems I diagnose. Great masses of people with a certain mindset and companies and individuals with interests in the status quo cannot change their way of life quickly or easily.

On the other hand, founding a few charter cities (or charter countries, as I've fondly imagined) gives us the opportunity not only to allow citizens of poorly developed countries economic opportunities, but could also give people everywhere political and philosophical choice.
Paul Romer was interested in economic improvement without upsetting the leaders or interests that already exist, but he's not mentioned the final idea that allows us to set up a virtuous circle. The idea of charter cities can be used to test ideas for changing rules. We can try different constitutions, different ways of setting up charter cities so that we improve not only economic and political choice, but also all future charter cities!

One of the major problems of the world is the assumption that labour can move freely, as capital does. However, capital moves as easily as the click of a button (or few), coming from one side of the world to invest in another. For free market assumptions to hold true (which they don't in a myriad of other ways too) labour must be free to switch countries. However, labour is trapped by language, capital barriers (people need investment in order to move) and 'externalities' such as political, philosophical and health concerns (ranging from potential natural disasters to local diseases).
My problems with free market fundamentalists can wait for a moment, because here I'm in support of a roughly free market idea: the idea that people should be able to choose the political entity which suits them best.
If we had a free market in countries, with different political systems representing the competing products, then even people with odd and extreme ideas (as mine seem, sadly, to be) might be able to find an enclave somewhere where things would be run as we would like best.
Charter cities offer an excellent method for achieving such political variation. Do we like or dislike the death penalty? Do we want to outlaw gayness? Do we want Sharia law?
If moving cities were as simple as free market fundamentalists think it ought to be for economic purposes, this freedom could be hijacked for political, as well as economic, improvement of people's lives.