Feedback systems watch -- Health Care

 Aretae's 1st law is: The feedback system dominates. 

Being as I'm among the loudest folks on the internet pushing this line...and because I've gotten some feedback (!!!) recently that suggests that this is one of the more valuable services that this blog provides...I'll be attempting to spend more energy looking at data from a feedback systems perspective.

Where are the feedback loops in Health Care, and which ones are working right?
 The available feedback systems that I can see from here:

1. Individual choices, outcomes:  Eat bread --> get fat.  Exercise --> get healthy, but not thin.  Take Vit.D in the morning and Sleep better that night.
2. Patient : Doctor system.  Doctor says:  Do X, Patient tries it, Doctor receives info about results
3. Doctor: Prescription system.  Doctor suggests X...cumulative results cause success 30% of the time, therefore doctor changes pattern.
4. Patient: $ system.  Patient spends money...solution doesn't work...patient doesn't spend money same way next time...and neither does his brother.
5. Doctor: $ system.  Doctor who cures illness frequently gets paid better than doctor who doesn't...so the doctor is incented to do things right. 
6. New treatments feedback system.  

 How many of these feedback loops are operational, powerful, effective.

1. Choice/Outcome:  The problems with choice/outcome is twofold.  
1. Choices only lead statistically to outcomes...many results are very hard to figure out...and the pattern-seeking brain generalizes to patterns even when there are none.
2. It takes work.  Seth Roberts argues that the core feedback loop in Health Care is the individual and what he/she is doing.  Seth-Roberts style 10-minutes of self-testing and record-keeping a day would do more to cure health issues in the world than any other set of health practices imagineable.  10 minutes a day is a lot.
2. Patient/Doctor:  No feedback at all.  Doctors don't make money from phone consults (because of medicare rules)...therefore there are none.  Someone on my blogroll wrote about this in the last week.  Because visiting the doctor is an ordeal...you don't have a normal-cases feedback system.  Just an extraordinary cases system.
3. Doctor: Prescription -- Very low feedback.  Doctor prescribes...no results unless it doesn't work badly.  
4. Patient: $ -- Almost no feedback.  Patient pays insurance company...insurance company pays doctor.  Insurance company increases premiums next year.  Interrupted feedback loops are atrocious.
5. Doctor: $ --Almost no feedback.  Long term success and payment are unrelated. 
6. New treatments -- Actively inhibited.  Doctor Licensing and FDA approval form an almost inpenetrable barrier of innovation-resistance.

I'm counting 0/6.

Currently, there is some motion on 1B...which is great.

6 is the super-move...but no way no how is that going to get fixed.  In the absence of 6, the best health-system known to man (Singapore) gets #4 correct, while our 2nd best option is to get #5 correct.  A bad 3rd choice, still better than what we currently have is to replace #4 with state/$ single payer choice.

Any working feedback system, with a rapid rate of: bad results lead to abandoned practices, and new things get tried would be great.  BUT...we have 6 available feedback systems and ALL of them are broken.