Skip to comments.One Step Forward for DIY Health Care (Walter Russell Mead)
Posted on 08/22/2013 7:08:06 AM PDT by neverdem
The California Supreme Court has ruled that public schools can give insulin injections to students without bringing in nurses. Prior to the ruling, some schools in the state required that shots only be given by licensed professionals, but the skewed nurse-to-student ratio was hampering children’s ability to get routine care. Parents with diabetic children sued for relaxed standards, and in the higher court, they won. LA Times:
Laura Mecoy, mother of two teenagers with diabetes and a Los Angeles board member of a diabetes foundation, said the ruling “delivered a wonderful back-to-school present to our children.”
“As a working parent, I either left my job to help my child or employed a nanny who could provide that service when my child was too young to administer his own doses,” Mecoy said. “Once my son was able to administer his own injections, he was permitted to do so. So the school allowed an 8-year-old to do what it wouldn’t allow an adult health aide to do.”
This is small victory worth celebrating in its own right, but it’s interesting primarily for the disintermediation of healthcare that it points to. As the ACA exacerbates the doctor shortage and tech empowers people with lower (or no) training to administer more care, we’ll see more and more stories like this.
Some powers previously belonging to doctors will get devolved to nurse practitioners or nurses, while other powers will be given to unlicensed staff or ordinary laypeople. Indeed, while this story had more to do with shortages than tech, in the case of insulin shots, there are several recent promising innovations that could reduce the hassle and pain of self-administered insulin (and other) injections.
One challenge to this trend will come from the medical professional lobbies, which will try to retain control over care. The nurses lobby fought hard in California against letting laypeople administer insulin, and doctors in other states have resisted laws giving more authority to nurse practitioners. Part of this resistance comes from a worry that laypeople can’t provide care effectively, while part of it is out of (understandable) fear for jobs.
Although we feel for those medical professionals concerned for their future in a tech-heavy world, the best response is to work on creative and empowering ways to adapt to this new world, rather than fighting it. Doctor shortages mean that we’ll have to find new ways of delivering care, and med tech’s ability to kick basic care down the line will ultimately help lower costs without sacrificing quality.
Obviously, the state of California has considered every possible less than desirable outcome. I’m sure the legal profession is scheduling seminars today.
Insulin pumps and glucose sensors probably obviate the need for school nurses and health aides for in insulin injections for the vast majority of school age type 1 diabetics, IMHO.
The sad thing is that the devolution of care to less-trained practitioners is actually a great thing, and could have significantly lowered the cost of providing health care.
But because of Obamacare, it will be forced upon people while their actual costs skyrocket.
And the reason this hasn’t happened previously is because of our insistance on medical insurance for everything, which tends to push all medical care into the hands of trained professionals, since the people who have insurance want the best care for the least money, the insurance companies needed professional organizations to deal with, the laws forced providers to be trained, mostly because they were written by politicians who got elected because of large donations by the health care industry that wanted to force everybody to use their expensive providers.
It’s like haircuts. You can really cut your own hair, or someone in your family could easily do it. It isn’t a hard thing, just snipping hair. But in most places you need a license, which means a trained “professional” who graduated from some “school”, and the whole thing is driven by political contributions and backroom deals.
A smart person with the internet could probably treat half of what walks through the doctor’s office. We certainly didn’t need 8 years of schooling for the typical “hey you have strep throat or something” diagnosis.
Of course, we hardly really need master’s degrees for teaching, but that is the price for getting into a “protected” field.