1. No jobs
2. No money
Now your particular issue might be education or terrorism or energy or even too many taxes, but I assure you all of them fundamentally are a fact of “no money.” Until we get in a sustainable fiscal situation, your pet cause will never get the resources you think it needs.
An item caught my eye in Saturday’s paper that has, at its heart, the answer to all these issues. It was titled: “Study of Breast Biopsies Finds Surgery Used Too Extensively.” Huh? Bear with me.
At the core of our jobs and fiscal situation is one simple fact:
Healthcare is eating into all of our economic activities. The simple fact that healthcare costs are outpacing wage growth at this alarming rate ensures a number of things. One, any business with employees (all of them!) is getting more and more expensive to run with no increase in output. Two, any society that plans to take care of the health of its elderly or indigent has escalating costs that will eventually be unsustainable. Three, anyone who needs healthcare (everyone!) needs more and more wealth just to stay in the same financial situation. This is a recipe for disaster. If you look at our budget issues (state or federal), I assure you if you fix healthcare costs, you fix the budget. Take education. Every single school teacher’s healthcare rises 3x inflation each year. That is a huge cost that means fewer teachers, no salary increases, and more red ink. And as far as businesses go, well, each employee continues to cost more and more (without salary increases) crowding out hiring and new investments.
Entitlement reform is about WHO pays for healthcare. Even if you move the current public burdens off the government onto private individuals or businesses, the economic headwinds are catastrophic.
We have to solve this problem, and I am increasingly convinced it is not only possible, but not that hard. Which brings me back to Breast Biopsies.
If you read the article you will see data has proven that 300,000 more surgical biopsies are being conducted than should be. The result: over a billion dollars of extra cost, more complications for patients and no more information about diagnosis than could be obtained with the less expensive method. This is pure economic waste. Over a billion dollars of it. For one procedure. One of thousands in the healthcare industry.
This example is at the core of how we fix healthcare. We treat it as an industry that has accelerating returns. One that can get cheaper AND better. It can. We just need to get totally focused on fixing it. Arguing about WHO pays is not nearly as important as WHY we are paying so much. Here are a few steps (of many) in my mind to turning the tide:
1. Admit we have a problem. We spend more than 2x per capita than other advanced economies on healthcare and get no better results. This does not mean we have to copy these other systems, but our system is generating a terrible return on investment. Admit it.
2. Apply Moore’s law thinking. Returns accelerate where information is the key input. Healthcare is just such an industry. We need systemic ways to generate and apply learnings just like the biopsy example. This means accepting that doing the cheaper thing can be the best thing – in fact it means if we are not lowering costs and/or improving results we are failing. This is a huge shift in mindset.
3. Data, data, data. We need data standards, data rules, even ways for patients to share data with researchers. Information is the key to insight and right now it is way too hard to collect data, store it, mine it, and share it. There are huge opportunities here – for government, insurance companies and even entrepreneurs.
4. Reshape our view of the doctor. We tend to think of doctors as demigods. Well trained experts making tons of judgement calls uniquely within their individual power. But doctors are much more like airline pilots. They require a ton of special training to do something that 99% of the time is predictable. Their real value is applying judgement in those other 1% of cases. Unlike pilots however, the information and technology applied in healthcare is highly dynamic (akin to a new plane coming out weekly). We have to get this data to doctors and ensure they act on it. Will the information about biopsies translate into action that gets lower costs and better results? There is not an easy way for it to happen throughout the system today.
5. Tort reform. Mistakes are predictable in healthcare. They are a cost of a highly complex system. We need to create an efficient way to deal with them. Like workers comp, many such models can be easily applied. The real cost of torts in healthcare is not the actual damages, but the wasteful medicine applied to avoid them. We need a more balanced system if we want to avoid statistically ineffective treatments.
6. Hot spot focus. Healthcare has 80/20 dynamics. A few spots drive a large percentage of the waste. The surgeon Atul Gawande has written persuasively about the high costs of the chronically and terminally ill. If we start here (a targeted place to direct data needs and better decision making), surely we can start to show the power of new models.
Of course there are many many other issues to tackle – the role of insurance companies, doctor and patient incentives, and so on. It will take some big and many small changes.
Why are we not moving down this path? There is bi-partisan blame to go around. But, it has to start with voters and patients. We have to realize and accept that healthcare can get better and cheaper. We have to be open to policies that have at their core cuts in medical costs (but not drops in effectiveness). At this point, if we don’t, expect our big problems to stick around a long time.
Tablet mania has hit tech blogging circles with the world all abuzz about Apple’s announcement of their new product later this month.
I love Top 10 lists at year end. Cultural options are exploding and these lists collectively help us wade through it. I have no way to do a top 10 list for any one medium because I just can’t consume enough of it. But, here is my list (in an order that promotes variety) of 10 things that I think were great in 2009.
HP recently admitted they might not be making calculators much longer. Their geeky financial and scientific calculators are now iPhone apps.
As everyone knows, Google is going after the core of the Microsoft franchise: Windows and Office/Exchange. They face incredibly long odds. Why? In the long run, Google has only one real weapon against Microsoft: lower cost. Yes, the Windows OS is bloated and not web centric. Windows 7 will close these gaps. Office and Exchange work well despite poor web integration, but expect this shortcoming to evaporate soon (this week?). Google is not offering something substantially better. They are offering something cheaper.
This is not to say Google v. Microsoft won’t be a vicious war. It will. Google will be aggressive. They will get hardware makers to take Linux seriously. They will engage with big companies to use their products. They will get some victories. But, they will mostly invest money with little return.
By embracing the browser and web application model, Google will lower the network effect of the Windows OS, the source of their monopoly power. But, even with this strength diminished, there are still lots of benefit to using Windows: habit, ecosystem, sunk investment, etc. Everyone will dabble with leaving (partial enterprise use, threats, etc.), but in the end, they will get Windows and Office at an acceptable price and stay.
And, that’s the best thing about this war: the consumer is going to win big time.
Google will raise the bar. Free, online services, unlimited storage. MS will respond. More investment, more features and lower prices. Goodbye monopoly rents.
In the end, the two best business models we have seen in the last 50 years are colliding. The massive profits from these business models are now going after each other. What will we end up with in 10 years? Two massively successful companies, a lot more innovation and lower prices. And how about for shareholders? Well, get ready for lower returns.
Despite Robert Scoble’s constant evangelizing of FriendFeed (we pay him and we don’t get half the love!!), it remains a niche service. Since getting to know Robert, I have taken the time to understand FriendFeed. He is right about its potential: it is unlimited. But unfortunately, their current path will continue to keep it marginalized.Here is the crux of the issue: is FriendFeed a social network or a feed service that aggregates other social networks? Right now they are both. This is a losing strategy. They need to go full force on the latter.
Here is why doing both does not work. In terms of being a social network or microblogging service Twitter and Facebook have won. They are the engines that will drive most of the basic communicating. The good news is there are two (creating aggregation needs). And, they don’t own all the relevant content. Blogs, flickr and other services are still very much alive. So, the opportunity is there to help people consume all of these better. FriendFeed tries, but fails. Why? I can’t see all my twitter friend updates or all my Facebook friends, only those that have FF accounts. And, when it comes to blogs, the content creator determines if it shows up on Friendfeed, not the consumers. What? Content has to be pulled not pushed.
All this said, FF still has a huge opportunity. If they did the following, I would spend a lot of my Internet time on their site:
1. Realize your competitor is TweetDeck and Tweetie, not Twitter and Facebook. Kill your actual standalone microblogging engine.
2. Import all Twitter and Facebook friend posts – no FF account required.
3. Allow users to import their RSS feeds so they come in the steam as well. Potential side effect: become the de facto blog comments site.
4. Adjust the user interface to allow multiple streams (as customized) to flow on one screen. We all can’t have screens draped across our house a la Scoble.
5. Create standalone apps or make it easy for your partners to do it
6. Just make the service plain easier to understand and work with.
I spend a ton of time on Tweetdeck and my RSS reader. This move would replace all of those. Why? Scoble has the key insight on why FF is so powerful. Their voting, searching and commenting is awesome and hugely powerful to users. The “like” system is much better than retweeting and much more efficient. The searching is highly customizable. I can set up a search to see posts by my friends that have 5 or more “likes.” This guarantees I will see the key stories. This is Twitter and RSS with a community filter. Very powerful. And, the commenting means you can have real discussions on point and in real time right below the topic. Much better than the replies concept in twitter. All of this is why you are 10x better than tweetie or tweetdeck. This is a market you can lead. And, it will matter.
Now, there could be technical trades to be made. You might not be able to get the real time stream from twitter. But, updates every few minutes are not bad. There could be other issues. I am not an expert on the technologies and APIs. All I know is FF will remain a rarely visited site for me until it does more with its strengths and abandons its weaknesses.
It is not Pakistan. It is not the banking crisis. It is not even education.
It is healthcare. The future of our prosperity, the ability of America to wield power, our standing in the world, and our capacity to afford to educate our young all depend on us solving this one. Without solving it we cannot afford to tackle the other ones. I think most of America is clueless on how bad the healthcare mess is.
I am going to spend some of my reading time to getting smart on on it. I suggest you do too.
Here is why:
Look at the yellow and red. THEY are the issue. The purple (or interest) is just an echo of their impacts. Any budget forecast looks the same for one reason: healthcare burdens are looming and overwhelming.
Social security can be solved (raise retirement; tax benefits on the wealthy). Healthcare has no easy answers. It it strangling our public and private sector. Yet, any suggestion of reform gets all of America in a panic. I am here to tell you: change is coming. Or, we are doomed.
The situation looks the same for businesses. Their costs are either ballooning or they are passing them on to employees, lowering real income.
The debate is about to heat up. All of us need to get more educated on this issue.
Here are some of the things I want to figure out:
1. Why do we spend 2 times more than Europe per capita but live slightly less?
2. What value do insurance companies add to the equation?
3. How does the legal system contribute to the costs?
4. How do we deal with the ethical issues around treating very old members of society (e.g. heart surgery for a frail 90 year old)?
5. Where are we overspending or over treating (ie where can we save)?
6. How do we create incentives to ensure preventative care?
7. Is the system of creating supply for doctors flawed?
8. How do we trade universal healthcare needs with incentives for invention?
9. Do we know how well our treatments work? Is the default to act misinformed?
Know any good books or articles on the subject? Would love suggestions.
I don’t have any firm answers. I am open to any proposal, Republican or Democrat. But, doing nothing is not an option. We have to all open our minds to the right set of adjustments. Will let you know what I learn.
My town is having an election in early May that has become quite the scandal. The hubbub is due to a ballot initiative to freeze property taxes on citizens over 65 years of age.