For most of our history, the boundary between these two spheres were quite clear. But government has been moving deeply into the private sphere in this century. The rationale for this being that some things were too big for private efforts to make it happen. But now that energy seems to be moving in the other direction with the drive toward privatization worldwide, and the movement away from government, including in the United States. One of the reasons we had problems with health care reform was this new reluctance to entrust it to the government. The sentiment now is that some things are too big or important for the government to handle it. Either way, this either/or has resulted in stalled efforts on many fronts.
It starts with a number of revolutions that we are facing today in our everyday lives. The first of these is the health care one I talked about. The second one is the series of revolutionary advances in the processing and transfer of information. Many of you know far more of the details than I do, but it has boundaries that we can barely comprehend. Now, although the price tag is between 200 and 400 billion dollars, it is estimated to be a three trillion dollar market in the future. Third, joining the first two, we are on the brink of a revolution in the way we train doctors, not only in school, but in terms of life-long learning.
The primary mission of the Koop Institute is to reform education and prepare the doctor for the 21st century with the knowledge of not only the science of medicine but also the art of medicine. We've come to realize that the most important component of education is that period after formal training. The need to learn and keep up is more important than cramming for the final exams at the end of that education. This broad view is a vital part of health care reform. And in this part, high-tech communication holds the answer. But whatever form it takes, reform must depend on the opening of the telecommunication situations. With this, we will be able to open information and reduce the cost.
Immediate access, high tech surgery and procedures, and a low price is what citizens demand from health care. But it is becoming harder and harder to provide all three today. But it is also possible to now use the high technology demand to reduce prices in the other areas. Dramatic changes in communication technology have made it possible to link patients with far away specialists, something that is especially attractive in rural areas.
Our generalist physician feels isolated from the larger world of medicine. But such a feeling can afflict many kinds of physicians. Generalists, though they are often paid the least, are expected to know the most. With medical knowledge expanding every day, none can keep up without help. But now we can help this with high performance computers and communications, and put the world of high-tech medical science at the fingertips of the most isolated rural physician. We do have a way to keep our dedicated general physician at the frontier of knowledge.
But we face many obstacles, and they can only be removed with partnership. Our real problem lies in law and attitudes. There are many obsolete regulations that block the transfer of health information. We have the technology now, but the easy and efficient use of it is blocked by court regulations left over from the court mandated breaking up of AT&T. I can stand in New Hampshire and can shout a health care message to Vermont, but if I send it by telephone, it must go through NYNEX to a long-distance carrier and then back to NYNEX. If you need to do it a lot it becomes prohibitively expensive. It is time to remove these artificial and obsolete barriers today for progress tomorrow.
But there is confusion and contradictions between the relevant public agencies and a discouraging lack of private leadership. Through the Koop Institute we will work toward relieving these problems in a number of spheres.
As with every leap of technology, we need to educate people in how to use it. Physicians and other health care workers will need education and even coaxing, but once there, they will wonder how they ever practiced medicine the old way. True it will be costly, and there are glitches to work out, but as I said, the largest obstacles are legal ones and attitude. We also need to get our priorities straight, and put our money where our mouth is. Spending currently lags behind vision. As one example, this talk was originally to be transmitted live from New Hampshire, but that turned out to be too expensive, so this was taped and mailed to you. Not exactly high tech.
As you can see these changes I have been talking about are so sweeping and so important that they can only be realized by public/private partnerships. Partnerships forged at the highest level, but reaching down to the local level, down to the patients who can have access to health information transmitted right into their home.
It will be difficult, even risky, but all surgery is risky. It's like crossing the street: anything can happen, but it usually goes well if you follow the rules. I think this partnership can go fine if we follow the rules, the rules of the very best of our ethics. I think once we make the commitment to this partnership, we will be energized by the sense of pride that comes from doing the right thing. Democracies are often slow to change, but once we realize the moral value of that change, great things can be done.
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