Friday, November 11, 2011

Returning Veterans as Entrepreneurs

So far, the entrepreneurial economy is purely an America phenomenon.

Peter F. Drucker (1909-2005), Innovation and Entrepreneurship: Practice and Principles,1986

Innovative entrepreneurs and dedicated clinicians have found ways to break down barriers and redesign care to better help their patients and communities. But bringing the best in our system to every community in the country is the health care challenge of our time.

Donald M. Berwick, MD, “Making Good on ACOs’ Promise – The Final Rule for the Medicare Shared Savings Program,” New England Journal of Medicine, November 10, 2011

November 11, 2011, Veteran’s Day - This morning I read an article “On Veteran’s Day, An Opportunity for Entrepreneurial Excellence, “ in Real Clear Politics. Since 2002, Its author, Carl Schramm , has been president and CEO of the Kauffman Foundation. Kauffman is the world’s leading organization dedicated to creating new firms and understanding their role in economic growth.

Schramm observes,

“On November 11, Veterans Day, we as Americans have an opportunity to recognize our great debt to our armed forces. At the same time, we can and should acknowledge how veterans’ service to the country can continue even after they have taken off the uniform.

The men and women who have served share a number of common traits: persistence, decisiveness, tenacity, adaptability, comfort with risk and preference for bold action, and personal sacrifice for something larger than themselves.

Not surprisingly, these are traits that are also often attributed to successful entrepreneurs.

In fact, many of America’s most innovative – and most successful– companies were founded by veterans.

Consider FedEx, founded in 1971 by Fred Smith, who just a few years earlier had been serving as a Marine in Vietnam.

Veterans who are also entrepreneurs say military service imbued them with a number of attributes that equipped them for success as business founders. They know how to work in teams, to lead, and to build camaraderie. They are decisive in the face of the unknown – it’s something they had to confront regularly. They know how to not only survive, but thrive in chaotic situations – invaluable raining for the inevitable surprises that confront every entrepreneur sooner or later.

They also understand the need for a strong work ethic. “When I saw an opportunity for this business, I hustled every day, working 80 hours a week,” one veteran told the Wall Street Journal recently.n “Because of my experience in the Marines, the hard work didn’t scare me.”

America’s veterans have served at the frontiers of our nation’s foreign policy. It is from a desire to serve that they first donned a uniform, and even though they may no longer wear it, the desire remains.

Our country would do well to make it easier for them to serve at the frontier of our nation’s economy–at a time when we need to fully tap the entrepreneurial potential of all of our citizens. Perhaps our veterans today can become American’s “greatest generation” of entrepreneurs tomorrow.”

When I finished reading Schamm I read Dr. Donald Berwick’s piece in the NEJM on what America needs to cut Medicare costs. Bewick described how CMS had reached out to the hospital and physician communities for comments on the initial March 31, 2011 guidelines, How CMS had received 1200 formal comments for change, and how CMS how modified the rules to satisfy reluctant providers, who so far have said, still no sell, too many risks, too rules, too little to gain, and too much to lose.

Then I turned to the Morning Joe TV program, where I watched Ezekiel J Emanuel, MD, former White House Advisor, talk of the promise of Obamacare.

Dr. Emanuel said the key to cutting health care spending was finding new ways to pay doctors besides fee-for service. This could best be done, he explained , through government-directed programs such as ACOs, bundled billing, and medical homes.

The government should spend federal monies only to those doctors who follow government guidelines and protocols based on the precepts on data from best practices and evidence-based medicine.

Emanuel said fee-for-service medicine, with doctors paid to do more, was the central cost and quality problem of our system.

He dismissed the notion that “defensive medicine” contributed to high costs and that malpractice reform would cut costs.

As I read Berwick’s comments and as I listened to Emanuel, who writes regular opinion columns for the New York Times, I realized a wide , perhaps unbridgeable, chasm exists between the philosophy of the entrepreneurial community, who believe innovative bottom-up activities, as the best means of promoting growth, cutting cost, and improving care, and Obama followers, who maintain that government actions promoting a “shared commitment” to “coordinated care” are the only path toward financial sustainability, i.;e. adaptation of the U.S. to a European-style social welfare model.

In his 1986 book, Drucker pointed out that from 1970 to 1984, the United States economy created 20 million jobs, while Western Europe lost 3 to 4 million jobs. Drucker attributed this gap to American entrepreneurial management and to small businesses entrepreneurs. He commented, “Fastest growing are the ‘freestanding” health facilities, such as hospices for the terminally ill, medical and diagnostic laboratories, freestanding surgery centers, freestanding maternity homes, psychiatric ‘walk in’ clinics, or centers for geriatric diagnosis and treatment.

Today I would add to this list of entrepreneurial-created facilities - hospital satellite clinics, orthopedic and other speciality “walk-in” clinics, free-standing EMR centers, focused facilities for diseases like diabetes or for conditions like wound healing, cosmetic-related centers, urgicenters, fitness centers for the elderly, concierge practices.

But since 1986, two fundamental thing have changed in the global economy.

entrepreneurs around the world have taken note of America’s success with its entrepreneurial economy. These foreign entrepreneurs – in Israel, and emerging economies such as India, China, and Brazil – are coming to America to set up entrepreneurial companies

Two, America-trained entrepreneurs are returning home to apply their U.S.-acquired skills. Native sons have gone from working in the West to fixing problems at home.

We need to encourage them to keep on coming by loosening restrictions on visa requirements and we need encourage them to stay. And we need to encourage our returning veterans, who have technological and leadership skills, to become entrepreneurs.

Tweet: Veterans have entrepreneurial skills the U.S. needs: decisiveness, adaptability, comfort with risk, action, and personal sacrifice

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