Conceptual Art and the Future of Health Care?

The third function listed on my new business card is conceptual artist.  (The card includes a "zoom" from one of the embryonic paintings in my new series, Ham & Swiss on Rye; full image below.)  So, what is conceptual art, and how does it relate to health futurism and medical economics?

Sol Lewitt, one of conceptualism's pioneers, provided a classic definition: "In conceptual art, the idea or concept is the most important aspect of the work.  When an artist uses a conceptual form of art...all of the planning and decisions are made beforehand and...the idea becomes a machine that makes the art."  It is self-executing art, which in painting means that the fundamental creative activity occurs before the artist starts putting pigment on canvas.

Early conceptual artists rejected traditions of painting and galleries.  For example, many created wall-mounted works from words, rather than visual images, and others used unconventional materials to actualize new ideas and explore different ways of seeing the world around them  (e.g., happenings, installations, earth sculpture).  Conceptual art took root in the late 1960s, when I was a student at Colorado College, a great little liberal arts school that brought many of the movement's leaders to campus.  I was so busy with studies in basic and social sciences that I never had time to try the creative techniques that the visiting artists discussed in lectures and shows I attended.

My artistic interests lay dormant for many years until my Kellogg Fellowship mentor, Ben Barker, inspired me to do something innovative with the opportunity provided by the program.  With his support, I abandoned my original fellowship project -- a study of urban medical centers' impact on rural health -- and began learning to paint.  The other fellows presented papers on their academic research projects at the end of our three-year program, but I displayed a dozen paintings and explained how immersion in art had opened my mind to creative thinking.  The experience profoundly changed my approach to the future of health care...and life.  Thank you, Dr. Barker!

In the process of becoming a conceptual artist over the past three decades, I have learned that a pre-determined process can lead to unexpected discovery and improvement.  I have also learned how artists see the world as a realm of possibilities that can be organized in many different, aesthetically defensible ways.  Now, in the process of returning to self-employment, I am trying to apply this same artistic inspiration to my work as a health futurist and medical economist -- while preparing 30 paintings for a gallery show this spring.  Our existing health care system is not a pretty picture, so why not approach health reform with the creative vision of a conceptual artist?  What would good health look care look like, and how can we create it?
                  

                                                                          copyright 2011, Jeffrey C. Bauer

Empty Storefronts and the Price of Health Care

My work as a conceptual artist (next week's post) gives me quality time to think about the future of health care and medical economics (last two posts) while painting.  Juxtaposing images and colors on a canvas opens my mind to synthesized thinking about health care, too.  Here's how it happened this Tuesday...

I went out for coffee with a friend and neighbor who works in commercial real estate.  It being municipal election day, we discussed the daunting challenges confronting our new mayor.  Chicago has serious economic problems that are visible in many ways, including a growing number of empty storefronts in the neighborhood where we live.  My friend has specialized in leases for small businesses in the area for the past 20 years, so I asked him about prospects for filling the empty retail spaces in Lincoln Park.

His answer was disturbing.  Historically, the most common client for smaller stores along the major streets has been an entrepreneur who takes out a second mortgage to create a "mom and pop" business -- a jewelry store, small restaurant, art gallery, clothing outlet, specialty book shop, wine or cheese store, neighborhood gym, etc.  The crisis in housing has effectively shut down financing via second mortgages, which means no start-up capital for small business entrepreneurs, which means the store fronts will stay empty for the foreseeable future, etc.  

I know a few small retail property owners, and yesterday's coffee talk led me to thinking about something they have had in common with health care proprietors.  For landlords, commercial tenants have always come and gone, but empty space was not a long-term problem because money was available to support replacement businesses...until now.  For the first time, retail property owners cannot count on new entrepreneurs to fill empty space.  Small business owners don't have their traditional access to start-up financing, and their customers cannot pay higher prices due to stagnant incomes.  Landlords have only one obvious way to fill empty properties now -- lowering the rent for retail space, perhaps a lot.

For decades, health care enterprises could turn to insurance companies to keep their businesses going. Third-party payers passed expenses along to employers, who absorbed most of the added costs and passed some of the increase along to workers....until now.  Global economic problems in general and domestic unemployment in particular are health care's equivalent of disappearing second mortgages.  Disposable consumer income is very hard to find.  How will health care businesses keep their doors open when consumers don't have any more money to pay rising costs of health care?  I see one obvious way -- lowering the price for medical services, perhaps a lot.  I can't see a pretty picture emerging for providers that fail to reduce costs and pass the savings along to payers, purchasers, and patients as lower prices.  I think the Affordable Care Act is a misnomer; it doesn't help solve the problem of keeping providers in business.  What do you think?

  

What Is a Medical Economist?

Economists are a diverse lot, focusing on everything from international trade and currency exchange rates to single industries and production processes.  Macro-economists focus on "big picture" phenomena like national income and employment, the money supply, and government economic policies.  Globalization is literally turning their world upside down.  The economic theories and models they learned in graduate school don't apply any more, so macro-economists are struggling to find new policies that will produce desired outcomes in international marketplaces.

Micro-economists, on the other hand, study resource allocation and productions processes at the level of specific industries -- including health care.  A medical economist with graduate training should have the skills to study the flow of goods and services through a medical enterprise (hospital, medical group, drug company, health plan, etc.) and to identify changes that would reduce costs of production, improve quality of output, or otherwise enhance productivity of workers, equipment, and capital.  A good medical economist can easily find wasted resources in the health care delivery system and then develop ways to put them to more productive use.

Medical economists should be busily at work in today's health care organizations because resources for medical services are becoming very scarce.  Patients and their traditional third-party payers simply don't have any more money to pay for care.  The health sector is finally hitting a budget constraint.  It is no longer "different" from other sectors of the economy, so conventional economic analysis is now applicable to solving the serious problems on one of our economy's most inefficient and ineffective sectors.

When called upon to apply their analytical and problem-solving skills, medical economists can be very valuable members of clinician-led, multi-disciplinary teams with responsibility and authority to make sure that medical services are provided correctly all the time, as inexpensively as possible.  I would never expect a medical economist to solve health care's problems single-handedly, but neither would I expect the problems to be solved without appropriate input from one.        

Unfortunately, medical economists have tended to concentrate their efforts on a macro-economic issue, health care's rising consumption of the gross domestic product (GDP).  This narrow focus makes me think of many medical economists as Chicken Littles who loudly proclaim that the sky is falling without taking time to understand what's really happening.  My health sector friends in Europe have come to the same conclusion.  They note that the U.S. has far more medical economists than any other country (by at least a factor of ten, I'll bet), yet it has one of the developed world's most unproductive health care delivery systems.  I think that the health of our economy and our residents would be a whole lot better off if medical economists would quit talking about health care's rising costs and start doing something about it instead.  What do you think?

      

What is a health futurist?

My ongoing transition from corporate VP to self-employment is posing several challenges, including the need to design a new business card.  I decided to list three functional roles after my name rather than an executive title -- generating the next three blog posts because each function deserves an explanation.  My primary professional self-identity is being a health futurist, so just what does that mean?          

Ever since serving as the Colorado Governor's health policy adviser back in the 1980s, I've purposefully analyzed the five trends that I believe are most likely to shape health care delivery over two to five years.  I decided to follow only the top five trends because they account for at least 80% of the changes that ultimately occur, and organizations and their leaders rarely have the capacity to deal with more than a handful of challenges at a time.  I selected the 2-5 year horizon because it's the time frame within which strategic decisions can be made and implemented.  It gives a sense of immediacy for actions that need to be taken while outcomes can still be influenced.  (Whether organizations actually take timely steps to shape their futures is a separate challenge that I generally leave to colleagues with expertise in organizational change.)  

I also believe a health futurist should forecast the future, not predict it.  Predictions are statements of what will happen and when, such as health care spending will hit 20% of GDP in 2015.  Predictions assume continuation of trends that shaped the future in the past -- an absurdity in today's uncertain world because health care is being transformed by a revolution in clinical knowledge, unprecedented progress in communications and information technologies, and dramatic redistribution of financial responsibility in the medical marketplace.

Forecasts are estimates of the probabilities of possibilities, such as the likelihood that health care spending as a % of GDP in 2015 will be more, the same, or less than it is now.  (My current forecast for these possibilities is 20%, 60%, and 20%.)  The health futurist as forecaster is responsible for identifying the circumstances that could lead to each possibility and recommending interventions that could reasonably be expected to increase the probability of desired outcomes.

To me, being a health futurist is fun when motivated by a strong belief that progress can come from creative, purposeful responses to anticipated changes.  Forecast-based futurism sure beats the alternative of trying to cope with rigid, prediction-driven "reforms" like HITECH and PPACA.  I think we in the business can do better than the politicians, which is why my role as a health futurist is pondering the realm of the possible and suggesting options to create a variety of really good medical systems.  How do you approach the future of health care?  Are you having fun yet?

Did the Fat Lady Just Sing in "ObamaCare," the Opera?

Being a big fan of Wagnerian opera, I readily relate to the common saying that it isn't over until the fat lady sings.  Yesterday's action by U.S. District Judge Vinson has already generated more than one comment that the drama of ObamaCare is in its final scene, but I disagree.  We've still got lengthy acts to endure.  The legal denouement must still be determined by the Supreme Court, which apparently will not act any sooner than next year.  I am not qualified to second-guess the high court, but my reading of expert commentaries suggests that consensus within the legal community has shifted from strong belief in constitutionality a year ago toward considerable uncertainty -- even reasonable doubt -- today.  This opera has never been produced before, and its ending is yet to be written.

To borrow a thought from director Peter Sellars, ObamaCare really is a "mess worthy of an opera." (Sellars collaborated with composer John Adams in "Doctor Atomic" and "Nixon in China," two excellent operas based on political history.)  Health reform has a rich plot with several levels of conflicting action.  A president pushes a major project that is inconsistent with his historical personality and arguably a diversion from more pressing issues of the time.  The fated turn of events leads to unexpected outcomes that are both good and bad, etc.  I won't be surprised if "ObamaCare" is produced someday at the Met (whose excellent HD production of "Nixon in China" is coming to a theater near you on February 12).

Will this new opera be a tragedy?  A farce?  Sadly, I expect it will be a bit of both, and the Supreme Court decision will be only one of several forces represented on the stage when the final curtain falls.  Health reform's lack of coherence will figure prominently in the finale; the plot didn't make sense from the beginning.  Above all, a dysfunctional economy -- the ominous threat that should have been dispatched in the first act -- will turn out to be the villain that prevents a happy ending.  The chorus representing patients, providers, and payers will be expressing their dismay that things did not work out as hoped or planned.

Like Wagner's Ring cycle, the saga of reform will continue.  Even if the Supreme Court puts an end to ObamaCare, the U.S. still won't have an efficient and effective medical economy.  We must continue waiting for the fat lady's stirring pronouncement of health care Valhalla.  What other operas might help us understand the mess we are in and how to get out of it?