The Corner

Permissionless Innovation: The Solution to Our Broken Health-Care System

I occasionally write about health care because, while I’m not an expert on it, I think it’s one of the issues that can tip the balance toward ever larger government with no chance of going back.

But the issue is hardly exciting or uplifting — with one exception. That’s the research of both my colleague Adam Thierer and Robert Graboyes. Together, they’re trying to create a world where everyone, not just the mega-rich, has access to modern, affordable, high-quality care, where doctors don’t need to beg bureaucrats and insurance administrators for permission to save lives, and where entrepreneurs actively compete to lower prices and innovate novel solutions. I explained how in my Washington Examiner piece this morning:

Robert Graboyes, our resident health care expert, believes that the health care debate produced the wrong diagnosis. While most health commentators focus on the demand side and service provision, Graboyes says the real sickness lies in the outcomes of those services. He asks, “Why is there no Steve Jobs of health care?”

That’s a good question. Where are the visionaries of vaccination innovations, the capitalists of cost-cutting care provision, the impresarios of imaging technology?

Grayboyes notes that recent advances in “[g]enomics, 3-D printing, nanobots, wearable sensors, social media, telecommunications, imaging, artificial intelligence, state-of-the-art data mining and other new technologies” have not been substantially integrated into health care provision despite their obvious benefits. These kinds of cutting-edge applications are not only possible, they are necessary to break (not just cut!) the health cost curve.

Graboyes has collected amazing stories of unexpected health-care entrepreneurs who have come up with remarkable and inexpensive solutions to problems. The innovation  he tells us about are remarkable, but ultimately fragile: They can crumble overnight at the stroke of a regulator’s pen, or a change in an insurance company’s policy, or a lawsuit filed by a jealous entrenched interest. Graboyes has a metaphor for the problem: The frontier of innovation is being quashed by the fortress of entrenched interests. But there is a solution:

Here’s where my second colleague, Adam Thierer comes in. His excellent new book, Permissionless Innovation, makes a passionate case for knocking down these barriers to innovation erected by governments and special interest groups. Thierer argues that the creators of new technology shouldn’t have to seek the blessings of skeptical, out-of-touch regulators before being allowed to develop and deploy innovations.

Compare this permissionless innovation to the stifling “precautionary principle” norm favored by public officials. This principle allows regulators’ imaginations to run away with them: Any perceived threat of a low-probability, worst-case scenario is a good enough excuse for these officials to stifle technological developments. The Frontier is strangled so the Fortress can keep its power for another day. …

This is just one battle in the war for the soul of technology. By extension, the future of health care rests in which of these two visions prevails: the permissionless innovation of the frontier or the precautionary principle of the fortress?

Here is the key point, I think: “As Thierer concludes, “the case of permissionless innovation is synonymous with the case for humane freedom more generally.” Better yet, the case for human freedom is ultimately the case for progress. If we can apply that freedom to our ailing health system, my two colleagues and friends promise it will rock our world.”

The whole thing is here. Make sure to read Graboyes’s stories. They are uplifting and worth fighting for.

Veronique de Rugy — Veronique de Rugy is a senior research fellow at the Mercatus Center at George Mason University.

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