Thursday, May 13, 2010

Will Medical Innovation Save Us from the Internet and Social Welfare Swamps?

When you’re up to your ass in alligators, it’s hard to remember your original objective was to drain the swamp.

Source unknown

I have a friend, Steve Merahan, MD. Steve is general manager of In this physician-oriented website, Steve is engaged in aggregating physician related content from print to online in one website. Modern Medicine now owns 17 medical print publications that have gone online to survive.

Steve is hard man to get a hold of. When I finally break through, I ask Steve where he’s been, he says, “In the swamp.” He is speaking of the electronic swamp created by Google. A swamp, for purposes of this blog, is an ecosystem in which everything is interconnected and bogs down or rises together. In traversing a swamp, one has great opportunities and great problems.

This transition from print to online is one of the greatest swamps of our time. The Google swamp threatens not only to drag down medical print publications, but other print organizations like Newsweek, now up for sale, book publishers, and the nation’s newspapers, like the New York Times.

In health care, it seems to me there are two inter-related swamps out there.

One is the Internet Swamp. The Internet, and its viral carrier, Google, has taken the world by storm, interconnecting everything instantly. When all is known, geeks theorize, the Internet will lift all health care boats. It will improve care in one fell swoop through perfect information provided by an interoperable, ubiquitous, all-knowing, all -reporting, all-accessible electronic system.

There are only two problems with this. One, For many reasons, chief among drops in productivity, disruption of practice flow, and exorbitant costs, and fear of being inappropriately judged for quality , physicians are not buying the EMR gospels of efficiency and health care improvement. Two, patients are reluctant to give up their privacy and personal information to authorities outside the physicians’ offices. We are still up to our hips in an electronic swamp, pitting geeks, government officials, and health care managers against many doctors and patients, who think care is a personal business.

• Two is the Health Entitlement swamp, also known as the Social Welfare Swamp
Different persons describe this swamp differently. Milton Berle, the late comedian, said, “When it comes to my health, money is no object.” Margaret Thatcher, the former conservative Prime Minister of Britain, said, “The trouble with Socialism is that sooner or later you run out of other people’s money.” Robert Samuelson, Washington Post columnist, describes “ the death spiral of the welfare state,” in these terms “Virtually every advanced nation, including the United States, faces the same prospect. Aging populations have been promised huge health and retirement benefits, which countries haven't fully covered with taxes.”

Thomas Friedman, the New York Times global guru, explains this debt spiral as Death of the Tooth Fairy requiring as Root Canal Politics to correct,

” Baby boomers in America and Western Europe were raised to believe there really was a Tooth Fairy, whose magic would allow conservatives to cut taxes without cutting services and liberals to expand services without raising taxes. The Tooth Fairy did it by printing money, by bogus accounting and by deluding us into thinking that by borrowing from China or Germany, or against our rising home values, or by creating exotic financial instruments to trade with each other, we were actually creating wealth.”

“After 65 years in which politics in the West was, mostly, about giving things away to voters, it’s now going to be, mostly, about taking things away. Goodbye Tooth Fairy politics, hello Root Canal politics.”

Which brings me to Obamacare. Can the United States afford to spend an estimated $3 trillion over the next 20 years to expand the health care welfare state, which already covers 100 million Americans, and with 32 million more uninsured and 78 million more baby boomers entering Medicare? Do we have the guts to do what needs to be done – extending the age of Medicare entry to 67 or maybe even 70, means testing Medicare so the wealthy pay more, and rationing care?

Will American Innovation Save the Day?

Can we claw our way out of the debt swamp through innovation? After all, we are, as Peter .F. Drucker observed in his classic book, Innovation and Entrepreneurship (1985), the world’s most innovative nation.

Can we do escape the debt-producing, health care alligators through electronic innovation? Can we do it treating people at home and remote locations through telemedicine? Can we do it by making e-visits to doctors routine? Can we do it by bringing physicians to heel by judging doctor performance and outcomes electronically and paying only for what works? Can we do through a magic interoperable information system connecting consumers, hospitals, doctors, health plans, and government?

I do not know, but I do know America is having a go at fixing health care through innovation. We have some 1200 innovation incubators around the U.S, focusing on launching successful high tech startups with access to venture capital. We have the federal government creating a Medical Innovation center at the Centers of Medicare and Medicaid (the Center for Medical Innovation, CMI). We have Kaiser creating an Innovation Learning Network, comprised of a handful of leading hospital and integrated health centers. We have multiple conferences on Disruptive Innovation, the concept that claims we can cheaper, simpler , more effective, more universal care can be provided by less sophisticated personnel.

Carry on - you forces for innovation. But watch out for alligators.

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