Category Archives: General

Capitalism in Health Care – Do you still believe?

Capitalism (kăp’ĭ-tl-ĭz’əm)

1. An economic system based on a free market, open competition, profit motive and private ownership of the means of production.
2. Descriptive of a system that encourages private investment and business, compared to a government-controlled economy where investment money is obtained from private sources (shareholders).

I, along with everyone else, has been walking around hollow-eyed given the speed of the recent financial meltdown. 100 year old firms disappearing in a weekend, markets roiling with every bit of news, experts clamoring about the greatest calamity ever in the recorded history of finance, and politicians actually working weekends to attempt to rescue the largest and most important financial system in the world.

This is serious business.

I have also been amazed at the Governments response to nationalize “key” companies – AIG, Fanny/Freddie, and probably a few others before it is all through. Several people have made the connection between the nationalization of financial companies with the potential nationalization of the health care systems. Actually the wealth-health connection is probably stronger than you think. Just as the current financial mess is related to the “toxic” subprime debt on the books of the eviscerated companies, hospitals are also being laden with “toxic” debt from consumers who are also leaving them holding the bag on their bad debt.

Will the bad debt get big enough that health systems begin to fail? Can you imagine Kaiser Permanent, Sutter Health, Geisinger, or the Cleveland Clinic going down financially because of consumers bad debt? Can you imagine what would happen if these organizations cash flow problems began to shut down hospitals, affect care, and the ensuing outrage that would follow. Given recent events, would the government come in and “take over” these hospitals by infusing capital into them, folding them into the medicare system, or some other hybrid financing mechanism. Clearly, I understand the issue with sub-prime was the subsequent “securitization” of the risk which was how the “toxicity” was bought and sold. However, it does give one pause to consider the possibilities in light of previously unthinkable actions we have witnessed the last month.

Further still, it gives me pause to reconsider the capitalistic system running aground in a world wherein we are trying to outsource our brand of “economic progress”. Its a tough sell, particularly with a very angry international environment not only for the perception of imperialism, but also how our system of capitalisms is dragging the entire world economy into a vortex we created. Ouch. Might need to adjust those international travel plans.

In considering these issues and the sustainability of our capitalistic system, I read through a recent Newsweek article by George F. Will which helped to restore my confidence in the invisible hand despite the very visible recent carnage:

Capitalism, Ruth reminds him, is a profit and loss system. Corfam—Du Pont’s fake leather that made awful shoes in the 1960s—and the Edsel quickly vanished. But, Ruth notes, “the post office and ethanol subsidies and agricultural price supports and mediocre public schools live forever.” They are insulated from market forces; they are created, in defiance of those forces, by government, which can disregard prices, which means disregarding the rational allocation of resources. To disrupt markets is to tamper with the unseen source of the harmony that is all around us.

The spontaneous emergence of social cooperation—the emergence of a system vastly more complex, responsive and efficient than any government could organize—is not universally acknowledged or appreciated. It discomforts a certain political sensibility, the one that exaggerates the importance of government and the competence of the political class.

Government is important in establishing the legal framework for markets to function. The most competent political class allows markets to work wonders that government cannot replicate. Hayek, a 1974 Nobel laureate in economics, said, “The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design.” People, and especially political people, are rarely grateful to be taught their limits. That is why economics is called the dismal science.

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Filed under General, Healthcare, Industry, Irony

Tick, Tock: Time for the Annual HISsie awards

HISsified (hĭ-sə-fī’d) adj.

1. To be openly put to scorn by a withering Mr. HIStalk rant.
2. To be recognized with an annual industry award by Mr. HIStalk.

Last night I was privileged to be invited to the hottest Health Care IT party at HIMSS: the first annual HISTalk Shin Dig. Mr HISTalk, while ruminating with pipe in mouth, determined that since invites to the hot parties were occasionally difficult to come by for an anonymous blogger in his underwear, that he would throw his own party. Turns out a few people were interested – like more than 400 (Healthia scored by sponsoring this!).

It was cool, crowded, loud, and relaxed, unpretentious atmosphere. Was able to catch up with some good friends within the community like Jane Sarahson-Kahn (she rocks!), Matthew Holt, Jay Parkinson, Neil Versel, Nancy Brown of Athena, and Jon Teichrow of Webreach. It was fun to make some introductions and to be introduced to several new people of interest within the community. The food was good, the soda drinks expensive ($4 bucks for a sprite – I couldn’t convince the bartender that the $8 beers should subsidize my sprite).

The focal event of course was the annual HISsies. The most concentrated form of satire that you will find at HIMSS or within Health Care IT for that matter. This is where Mr. HISTalk is truly in his element. This year he went to the next level by having the folks at HitchTV produce the awards show in video form. It was really funny. So, with rented booth babes wearing, “Kiss Me, I’m Inga” to cover their barely there attire, the awards I could remember shook out like this:

  • Best Vendor: AthenaHealth
  • Best Vendor Move: Athena Health IPO
  • CEO to have beers with: Jonathon Bush, AthenaHealth
  • HISTalk Person of the Year: Jonathon Bush, AthenaHealth
  • Annual Throw a Pie Award: Neil Patterson (9 year winner)

Clearly, the Athenista’s had voted en block for their man man. Jen and her marketing girls rallied for the event along with PR Maestro John Hallock expertly working the room, blocking and tackling for the main event as Jonathon took the stage. I was sitting by Jonathon before his speech and corroborated a few things that he wanted to say in his “acceptance” speech. It was scribbled on the back of an envelop, but was delivered in his unique style. Once you peeled back his unique delivery style, he had some solid things to say:

1. Success – Congratulations to Mr/Mrs HISTalk for his work in documenting the current state of Healthcare IT. The blog is read by millions of people.

2. Insight – Congratulations on being THE source of information and for influencing a generation of health care IT people. This insight should be translated into foresight to allow us to collective put our guns down and hammer them into collaborative plowshears to advance the cause of patient care. I continually think about all the siloed waste and really appreciate the slow, difficult, but enabling work of all the standards body whose work will unleash the collective creative force required to create next generation health care.

3. “Digital Cajones” – Jonathon hailed Mr. HISTAlk for his courage to call out the crazy things we do in the industry. HISTalk success is based on this candor and challenging dialogue. Jonathon even challenged the premise of HIMSS as a big boat show – perhaps the reason why Cerner might not be here next year (I thought Cerner won’t show because of how bad Neil got worked at the event).

But, the greatest part of the night was to actually be able to speak with Tim and Inga. They were both quite humbled by the event, the turnout, and the just the MoJo that has developed around the blog and as demonstrated by the event. I am one of three people who actually has seen Tim and he is a really standup guy. Also, I was able to pay homage to Inga in person as well. Let me tell you – those rented babes just don’t compare to the lovely, graceful, and eloquent sidekick. She’s got vim, verve, and quite a vernacular (to die for accent!).

As the theme of the HIMSS show indicates (“Its our time”), Cerner or later, its always about timing. And a great time it was at the HISsies.

Tick, Tock.

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Filed under Conferences, General

Blogging – One Year In/Out

I just noticed that this December 31, 2007 note had not been published.

Blogging (blŏg) n.

1. A website that displays in chronological order the postings by one or more individuals and usually has links to comments on specific postings.
2. The act of writing entries, creating materials, or maintaing a weblog.

I published my first blog post last November 20, 2006. After making my blog publicly available at the beginning of the new year, I have since been amazed to see the network effect in my own personal life. Having had alot of pent up ideas, I found that blogging became an immediate and highly effective medium from which I could communicate, share, and respond to readers I would never otherwise had the opportunity to meet. While this experience is certainly not unique, it really brought home to me the powerful professional influence the dissemination of ideas can have.

A couple of interesting statistics from the first year (made challenging by my October 31, 2007 switch to WordPress):

  • 88 posts
  • 18,545 visitors
  • 10,103 unique visitors
  • 106 different countries
  • ~25,000 page views

Top articles from last year included:

  1. Health 2.0 Definition
  2. Adware within Health Care
  3. The Canonical Representation of Health 2.0
  4. The Change Agents of Health 2.0
  5. Knowledge Prostitution
  6. Value Driven Healthcare
  7. Adam Bosworth “On Vacation”
  8. New Dimension -Introducting the XHR
  9. Health 2.0 Business Models
  10. Healthcare FICO Score

Honorable mentions, but not enough votes due to posting later in the year:

  1. HealthPlanMine: Scoring the Future
  2. Genomics vs. Proteonomics: Accessorizing
  3. Back in the Saddle and Ready to Ride
  4. Openly Confused: Misys Seeks the Source
  5. Diabetic VistA – The First Amputation

The blog has been ranked as high as 154 on the Health Care 100 blogging ranking system, as well as the blogroll of most of the prominent folks within the Health IT and health care delivery space.  I have had about 90 comments to the blog (roughly 1:1 post:comment ratio) and it has led to numerous personal and professional introductions.

So what have I learned?

Blogging is a powerful tool – it has been more effective than I ever imagined in communicating ideas, trends, and observations with a ready audience. While most folks take 2 minutes or less to read blog posts that took an hour to write, that fleeting connection can open up significant opportunities. I have also appreciated the permanence, or collective memory, it provides to me as someone trying to push the boundaries on new subject matter areas. It also saves me time from re-explaining things, both in terms of forcing my thinking (through the process of writing), but also of being able to direct someone some place for further reading.

My approach to the blog will remain the same with a target of two posts per week. Since my blog is not a summary of news, but rather a commentary on events, I spend a little more time on the thought provoking and verbally pithy blurbs.  I will continue to comment on the ideas around Health 2.0, open source, Health Plan 2.0, risk models, healthcare delivery and finance models, and general Health Reform initiatives.

Looking forward to a great 2008! Bing-batta Boom-batta Blog!

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The Comeback

Comeback (kŭm’băk) n.

1. A return to formerly enjoyed status or prosperity
2. A return to popularity
3. A Reply, especially a quick witty one; a retort.

As a kid, I used to love to listen to LL Cool J. I can still rattle off the rhymes from those summer jam sessions of long ago. One of the lines I always remember was from the 1990 smash hit, “Mamma Said Knock You Out

Don’t call it a comeback, I been here for years
Rockin my peers and puttin suckas in fear
Makin the tears rain down like a monsoon
Listen to the bass go BOOM!

I have had several people ping me on my month long hiatus. Nothing special – just lots of busy summertime activities, travels for work and for fun, and trying to mix in some family time. I actually have alot of blogs queued up for review and will be jumping back on the Health 2.0 train, consumerism, and the interesting world of the healthcare revolution shortly.

So like my boy Todd Smith (aka LL Cool J) sez, “Don’t call it a comeback . . .

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Part 1: Values – Something Worth Fighting For

Values (val yoos) n.

  1. A principle, standard, or quality considered worthwhile or desirable.
  2. Beliefs of a person or social group in which they have an emotional investment (either for or against something)

Prime Minister Tony Blair delivered a powerful speech to the Los Angeles World Affairs Council back in August 2006 that had profound implications. The main point of his speech was to remind people of the fundamental, underlying reasons why we are compelled to fight wars. He pointed out that while the names, images, and destruction of the current world crisis are at the forefront of our minds (particularly given the election results), we need to remember that this is not just a war about a specific ideology, but the fundamental values that underly the ideology. The speech was less about the future of the war, and more about the war for our future.

By highlighting the concept of values, and their foundational role in our society, Blair made was able to make a persuasive argument of why these values should be defended. Despite our every peaceful intention, our natural desire to negotiate an alternative, or our fears regarding potential conflict, some things are truly worth fighting for. The very founding of our country resulted from a monumental struggle over values – whereby people of all classes were willing to lay down their lives for the values of freedom, democracy, and representation.

Freedom is certainly a value worth fighting for. Freedom is certainly a value prized by the Open Source community. Given all the ongoing and recent events (Red Hat-Oracle, Novell-Microsoft, etc) in the Open Source community, I believe we are entering a new age of Open Source in which the fundamental values of the movement will have to be (once again) actively and aggressively defended to preserve the ongoing success of the movement. I personally believe (and will blog more later) that the Open Source movement has a clear set of core values that are fundamental in understanding the movement itself, namely: Meritocracy, Transparency, and Legitimacy. These Open Source values are worth standing up for, aggressively defending, and yes, even worth fighting for.

In the words of Tony Blair,

“That is why I say this struggle is one about values. Our values are worth struggling for. They represent humanity’s progress throughout the ages and at each point we have had to fight for them and defend them. As a new age beckons, it is time to fight for them again.”

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