The US healthcare system will fail "very soon" -- and ours could be close behind. In the second part of our interview with Walter De Brouwer, the man behind Star Trek-style medical scanner Scanadu predicts the failure of the current medical system will usher in a new era of robot hospitals, Disney-branded healthcare and the rise of patient power.
We recently chatted to De Brouwer about how personal tragedy inspired the Scanadu, "an emergency room in the palm of your hand", that talks to your smart phone. In 2005, De Brouwer's son fell into a coma, and the year in hospital brought De Brouwer an understanding not just of the importance of data in healthcare, but of the medical system itself -- leading him to an extreme conclusion.
The system doesn't work
De Brouwer has a bleak outlook for the financially driven model of healthcare, as seen in the United States. "Medicine is a very big medical-industrial complex, and is entrenched. I think it's the first system that will systemically fail -- and this will be very soon."
But the US isn't the only country in trouble. "I think the governments of this world, certainly in Europe, will find it very hard to continue to afford a healthcare system like we have. Europe has a big red heart. We still suffer from the idea that the state should take care of us.
"When we moved to the States with our son, who has weekly problems, we didn't know how lucky we were. My son had more than 10 operations (in Europe), but I think we paid altogether -- I hardly dare to say it -- not more than €10,000. Do that in the States and you're completely bankrupt.
"There are people who don't dare to go to the doctors because they don't have the money. In Europe we don't see it that much, but in America you have older people saying, 'I won't go to the doctor because I don't want my kids to have any debts.'"
And it's not just the patients: the doctors have to balance the books too. De Brouwer believes this need to change: "Nobody in this system is satisfied. The doctors are not happy. The hospitals are not happy. The government are not happy. Who is happy?"
Fortunately, De Brouwer believes the old systems will make way for something new. "Obamacare has set up an alternative system already. When today's system fails you won't even notice. And I think that the rest of the world will follow, like they do everything. And the new system will say, like Google, that you have to measure everything. I could be a health insurance company that only insures healthy people and I make you a good deal if you are very healthy. Or I can insure very sick people, and I make you a good deal if you are very sick."
De Brouwer believes you as a patient taking ownership of your own data could reach even beyond healthcare. "I think the power we saw in the 20th century in trade unions will shift towards disease communities. This is what you see in Silicon Valley: they start to organise themselves. What if tomorrow all the people who are cardiac patients organise themselves and say to British Telecom 'We'll all change to your service -- what deal can you offer us?' Utilities, hospital, insurance. Scary.
"Every brand in all their boardrooms are thinking about it. They know that medicine will be the next big thing. It will touch everything, like beverages did, like tobacco once did."
And data will be at the heart of it. "I think this will be the big business model of the future. Medicine will almost disappear into the environment, becoming ambient, being taken up by the brands who will offer passive collection as a service. Imagine you buy a car and the car collects all this information, and for two years you get all the information for free into your user aggregated records."
"It's just going to happen in people's minds. That's the great thing about consumers: it takes a long time, but then they change their minds overnight. They modify their complete belief system.
"It happened, for instance, with email. There was a time when there were people without an email address, and they said, 'You put your email address on your business card? Who do you think you are?' It quickly changed. Do you know anyone without an email address? I don't. Even my grandparents have one. They have a Facebook page. I don't know if they do it themselves, but they have it."
Attitudes to health can change surprisingly fast, like on issues such as obesity. "One day we will live in a world where being unhealthy is politically incorrect. It will be like smoking. Suppose you see a sick person, you start thinking, 'People shouldn't do that because we are paying for it.' It's like that in San Francisco. 'We are paying for your lungs, pal!' When we first moved there, my wife and I, we walked on the street in Palo Alto, and there was this girl and she lit a cigarette in the street -- and people started to shout at her! 'Who do you think you are?' 'Go back to wherever you come from!' 'Are you a tourist? We don't do that here!'"
If that sounds like a rather joyless vision of the future, then perhaps we still need to work out a new line between personal health and personal freedom. "We don't know where that line is, because we don't know how this new behaviour will manifest itself."
The future of medicine: robot hospitals and doctors in call centres?
So what will healthcare look like in ten years time? "It will be a completely different model. This is speculation of course, but the big hospitals will be closed. What every government agrees on is that the place of care will shift back to the home, where it belongs.
"If you're dying you might as well die at home."
A disruption in medicine could mean an opportunity for business. "I think perhaps the brands will take over. Walt Disney started their first hospitals in Florida -- enormous success. They're paediatric hospitals with hundred of doctors. Kids pretend to be sick just to get in there!"
"There must be a brand that people trust that one day will take on drug abuse or dementia. Boutique places, maybe.
"I'm sure there will be roboticised hospitals which only do surgery."
Robot hospitals? Now you're talking. "There are some parts of medicine which require more art than science, because doctors see so many patients they start to see the same things recurring. But there are other things which are precision medicine that a machine can do. Somebody asked me 6 months ago, 'Medicine without doctors? Would you get on a plane without a pilot?' But pilots don't fly planes any more. It's ceremonial. They don't touch anything. They are the last voice on the black box, that's all. People don't realise it but they don't fly any more."
But there's still a place for the humble family doctor. "We also need comfort, we need to talk about things. The therapy of telling your symptoms is very important. It's a bit like religion, the confession. If you come from a religious upbringing, it's a relief, you can start all over again."
That said, technology will allow you to access your doctor in new ways. "I think the doctor's office of the future is going to a be a call centre, where you first are triaged and then talk to your doctor on your screen. The physical transport of your body to anther body to talk [to]. My generation still wants to have face-to-face contact, but my 21-year-old son doesn't believe in that."
The doctor will see you now
De Brouwer believes a new world of data and technology will benefit the next generation of doctors as much as it will us as patients. "Doctors are very interested in data -- and so are insurance companies, of course. What I learned in Silicon Valley is that it's all because of Google, because they quantified us. They quantified everything, and people accept it."
The collection of data allows for a change in the relationship between doctor and patient. "Treating your doctor as a data analyst seems a far better situation than as an accountant for your records. Who can keep the records better than yourself? Your doctor didn't study seven-to-twelve years to keep records."
"But data analysis? That's something of interest to him, because he can sell his point of view. He can sell his -- I don't want to use the word 'diagnosis' because it's so 20th century -- the 21st century word would be 'recommendation'."
And if you don't get on with your doctor? Shop around. "We have changed every relationship into a transaction. I see no reason why we shouldn't do that with doctors. If you don't like him, take another one. Get some second opinions."
Do you think medicine needs to change? Would you use a hospital run by a brand or by robots, or should healthcare be provided by the state and by humans? Tell me your diagnosis in the comments, or scrub in to our Facebook page -- stat!