Reece, personal musings - What I Have Learned About Health System

• I have learned hospital and doctor rating systems are overrated.

• I have learned most health care critics focus on top-down national uniformity rather than bottom-up regional cultural diversity.

• I have learned those who complain about comparative U.S, health care longevity statistics rarely take domestic, street, and highway violence into account; if they did, they would learn our life spans are just as good as those of Japan or Europe.

• I have learned bad news about health system outsells good news.

• I have learned most doctors still gain patients through word of mouth rather than through the Internet.

• I have learned new technologies rarely cut cost of care.

• I have learned EMRs are irresistible but inadequate.

• I have learned a vast interoperable online real time system with everybody talking to each other and having secure privacy and security protection is an irresistible dream that doctors and hospitals resist.

• I have learned entry of Google and Microsoft into personal health market may change landscape by empowering patients, with the operative word being “may.”

• I have learned many doctors do not think the AMA acts in their best interests.

• I have learned the Medical Home concept appeals to all but may not have legs because of hassles of implementation and inadequate compensation.

• I have learned online innovations to inform patients do not work well unless doctors use them.

• I have learned doctors welcome practical innovations they can deploy in their offices but resist innovations requiring new business models or changes of location of their practices.

• I have learned the media regularly reports on the 45 million uninsured but rarely mentions the 250 million uninsured.

• I have learned physicians don’t like the third parties.

• I have learned physicians are ambiguous about universal EMRs, universal coverage, and universal Medicare.

• I have learned predicting futur trends is difficult because it involves the future.

• I have learned the Internet hastens the pace of medical change.

• I have learned CMS demonstration projects rarely demonstrate what they are supposed to.

• I have learned primary care is in a bad way, and its practitioners are not crying wolf.

• I have learned many physicians think EMRs are for someone else’s benefit.

• I have learned the greatest innovation of them all would be doing away with wasteful paperwork.

• I have learned practicing physicians yearn for a national organization that would provide them with practical benefits.

• I have learned America’s 800, 000 doctors lack a strategy of sustainable innovation that would put in the center of health reform.

• I have learned fragmentation is another word for individualism and ca , in some cases, be overcome through collaboration and partnerships..

• I have learned critics and rule makers of doctors have rarely spent any sustained time in doctors’ offices watching them work.

• I have learned ideology dominates heath reform thinking more than reality.

• I have learned the left thinks a paternalistic government made up informed bureaucrats will solve most health care problems.

• I have learned the right thinks a materialistic marketplace made up of informed consumers will solve same problems.

• I have learned both are right but mostly wrong.

• I have learned the Federal Employee Benefit Program which covers 10 million federal employees and Congress would be a good model for the rest of us.

• I have learned hospitals may have a superior organizational model to doctor organizations because of scope, community presence, access to capital, and hierarchical structure.

• I have learned many successful innovative health care models go to where the patient is rather waiting for the patient come to them.

• I have learned new physician business models evolve because of a desire to get around the 60 hour, 25-patient, 50-phone call, low reimbursement day.

• I have learned business models that lean too heavily on informed consumers making intelligent decisions without doctor help rarely work in real world..

• I have learned health care outcomes depend more on what happens outside the office rather than what patients were told inside.

• I have learned patient told they need surgery forget 80% of what they were told about the procedure within 10 minutes after leaving the doctor’s office.