Being a health care futurist is not easy these days. (Paradoxically, it is fun.) The executives and caregivers who read my writings or listen to my speeches want to know exactly what to expect so that they can prepare accordingly. Most would prefer a clear picture of where our industry is headed—even if they didn’t like it—to an ambiguous and confusing view.
I often sense their disappointment when I make the case that health care is moving in many contradictory directions at once. I try to convince them that they understand what’s happening if they are confused. Washington’s efforts to solve the medical economy’s problems don’t follow a logical path toward a discernable and desirable outcome. Neither party has taken the time to define a good health care system and a viable plan to create it.
Insurance overhaul is driven by a compelling need to stop the relentless rise in spending on medical care. The “Obama Care” laws include major cuts in government spending, but they do not create an efficient and effective health system for patients who are being mandated to make up the difference. The laws also allow outcomes to differ substantially on a state-by-state basis, and they will create a wide variety of unintended consequences across the nation. The result will be chaotic—the opposite of ordered.
Health care is not the only American industry headed toward disorder in the absence of a viable, coherent goal. The recent proliferation of best-selling books on complexity and uncertainty focuses on other sectors of the economy, particularly finance and natural resources. Health care is not the only industry suffering from serious problems created when independent economic entities compete for fixed resources in a zero-sum game that has no shared rules or respected referees.
The good news is that chaos is not necessarily a bad thing. Science teaches us that order can emerge from disorder, either randomly or purposefully. One of the 20th century’s great economists, Joseph Schumpeter, used this principle to show how a process he called creative destruction replaces dysfunctional enterprises with progressive competitors. In other words, today’s progressive health care leaders will see disorder as an opportunity to replace old ways of doing business with new ones.
Health reform from Washington will get in their way, but it won’t prevent them from harnessing medical science, information and communications technology, and collaborative partnerships to create health systems attuned to the resources of their marketplaces. The work won’t be easy, but it will be rewarding. I’m excited by the opportunities to embrace change and reinvent health care. How about you?
2 comments:
Dr. Bauer:
For an economist you certainly are optimistic. Government regulatory uncertainty does not promote or even tolerate Innovation. When the potential penalty for not doing it the government's ways jail and felony convictions, innovation is supressed.
When success of an innovative treatment is subject to a slow moving bureaucracy and politics, innovation is retarded. This does not lead to improvements in healthcare or in health.
Longer- term, the best and the brightest go elsewhere, leaving the plodding and subjugated. Innovation then becomes the economic deadweight of trying to do the economically rational by finding ways around the dead hand of government regulation.
Just look at the utter waste in dealing with the overly complex tax code, the FCC regulation of what type of traffic should be allowed on the Internet - it will come down to who can get the ear of a politician or government agency factotum, not who has a good idea they are willing to test in the market.
This is true in healthcare and the rest of the economy.
I agree with the gist of Skeptic's comments regarding regulation and innovation in the medical industry. Government regulations are directly responsible for considerable waste in health care. I believe many of my writings over the past 25 years are critical of government rules and regulations that have hindered progress in medical science and technology. (See, for example, my books NOT WHAT THE DOCTOR ORDERED and TELEMEDICINE AND THE REINVENTION OF HEALTH CARE, both available for free dowload at www.jeffbauerphd.com/writing.htm.)
I have also written a lot lately about major regulatory roadblocks created by ARRA/HITECH, so-called health reform, accreditation processes, and P4P. Hence, the positive perspectives in this blog post must not be read as implicit endorsement of government regulation as it has evolved in health care over the past 40 years.
On balance, I am still more optimistic than pessimistic about the future of health care because I see impressive examples of progress being made all across the country in spite of regulations and reform. We have many creative health system executives, caregivers, consultants, payers, and entrepreneurs who work to improve health care. I have the pleasure of interacting frequently with these leaders and seeing first-hand the progress they are making. They share our dismay with the regulatory process in our industry, but they don't let it get in the way of their vision and passion.
To be clear on a general point, I am not anti-regulation per se. The absence of regulations can be as devastating as overregulation, as demonstrated by the unconscionable economic disaster created by unregulated financial instruments over the past 10-15 years. The country would be better off if regulators had prevented a few investment "innovations" from being tested in the marketplace.
Perhaps it's a good time to develop a general theory of regulations for the 21st century. We have new tools to enforce accountability and transparency in ways that were unimagineable when current concepts of regulation were developed in the 19th and 20th centuries. I can't think of any regulations that would prevent a skeptic from reinventing a process that is indisputably dysfunctional...
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