Health Reform Summit

The nation as a whole can win but the summit must be extended to allow for a real and public exchange of ideas. After months of discussion this has not yet happened. The media, ever eager to make a soap opera out of Washington discussing polls instead of policy, has thus far presented the public with little pertinent information about health reform.

Months into the debate even Google failed to generate search results that would allow the casual web searcher to find relevant and necessary information about health reform or even the problems it's intended to solve. All this has led to a nation ill equipped to rationally consider the issue.

Unfortunately this isn't the worse of it. The failure of the US education system over the past decades has left much of America without rational decision making skills and the ability to see when they have insufficient information. Thus we're left with politicians positioning themselves for the approval of the uneducated all while dealing with a genuinely difficult issue.

If the president can resist his own political positioning temptations and embarrass the rest of Congress into doing so as well, he could make real progress on health reform while offering a case study for rational decision making.

First there must be agreement on goals. In response to the notion of the Summit Republicans are saying the primary goal should be cost containment. While Obama first seemed to indicate that as his primary goal, in regards to the summit, he emphasized two others as well, helping the uninsured and covering preexisting conditions.

Certainly justice would have us do that for our countrymen but it could easily be framed as a new entitlement. Perhaps a compromise could be put into place whereby the funding of these two initiatives is done not through the federal budget but through nonprofit means or a voluntary "tax". Perhaps systems could be established and marketed so that churches, for example, could purchase insurance or coverage for individuals in need as they choose but at a more competitive rate. This type of compromise on goals would enable steps to be taken to meet Obama's just hopes while not burdening the federal budget thus allowing for the republican leadership to participate on the terms they have stated which aren't unreasonable but simply require charity by free will as opposed to by statute, at least for a first try.

After goals are determined then a mechanism will have to be agreed on how to evaluate proposals. This mechanism will define what is considered evidence to support or contradict a proposal or at the very least will prescribe a structured way to evaluate the credibility and reliability of the information offered for or against any proposal.

Proposals should also be diagrammed to indicate dependencies. For example, specific minimum requirements for a national insurance market presuppose a cross state insurance competition allowance.

Each proposal along with supporting or contradicting arguments should be made available in transcript form online along with a structured way to illicit focused rational commentary on the strength of each piece of evidence or other specific questions.

Promoting Savings Accounts as Community Investments

Saving could be encouraged by banks structuring and marketing savings products as a community investment. They could highlight the positive impact loans of deposits have to help businesses expand, help homes be more energy efficient, enable disabled persons to adapt their homes, or help with the purchase of energy efficient vehicles. Banks could offer savings accounts where the deposited money is tied to certain types of loans and where the depositor is given a summary of what good that money is doing.

This sort of a program would offer the public a sense of immediate benefits to saving while also further emphasizing the opportunity cost of unnecessary purchases. It could appeal to banks struggling to find a way to differentiate their brand.

Prison Entrepreneurship

Somewhere around 2 millions people are incarcerated in the US. These are people likely making little contribution to society. It's worth considering what good they might achieve in prison and how that might further efforts at rehabilitation. What productive activity may they do?

From a big picture perspective an incarcerated person of faith could do great good by developing that faith, ministering to fellow prisoners, and praying for the world at large. Numerous prison ministries exist that likely have those objectives.

In a time of economic decline we're also drawn to consider how inmates may make an economic contribution. One potentially powerful way is to enable prisoners to utilize their time and creative capacity to develop new business concepts and plans. Several prison entrepreneurship efforts exist (an article at inc.com offers a listing of some such programs around the country) but it seems most are focused on preparing inmates for entrepreneurial activities outside of prison. The potential of entrepreneurial activities in prison may be worth considering.

Such a program could be team oriented where parts of the prison compete to develop the best business plan. The best plan could be determined by expert review. The awards for winning could include bragging rights or a cut on the profits that their ideas create. Profits could be had by selling of the plan to existing businesses or other entrepreneurs outside the prison.

Some key challenges to this idea include maintaining security and cost. What is reasonably required for inmates to make a potentially viable business plan? Even the means to physically record the plan need consideration. Pencils can be turned into weapons. What percent of the inmate population would require a safe alternative to a pencil? What sort of information and communication would be required and what are the costs and security issues associated with that? What sort of training would be required?

Open Wiki Style Medical Decision Making

The pace and expanding scope of medical information growth increasingly challenges the ability of doctors to keep up to date. A shortage of health care workers also necessitates that these doctors do more with less time. These two trends combine to increase the risk of less than optimum medical decisions and practice.

Extending an open innovation approach to the medical decisions space may offer a way to mitigate the impact of this problem and achieve new gains. Medical records could be placed anonymously on a web site along with doctors decisions. Visitors to the web site could then review the patient information at their leisure and suggest better diagnosis or treatment options while citing the research that supports their position. It would be somewhat like a wiki of diagnosis and treatment with a means to present conflicting views and allow consensus building.

Patients and their doctors could then review the wiki. Patients could look at it as often as they wish while doctors may want to be alerted only once certain thresholds are reached in terms of consensus on differing diagnosis and treatment and the significance of the difference. Such thresholds could help ensure that the time that doctors spend on this new task is likely to have significant value.



This sort of approach would also allow insight into the most common errors by doctors which could be used as basis for a national effort to communicate best practices to physicians.


Key Challenges

Increased patient interaction with inexpert health commentary could lead to unnecessary further taxing of health care resources as these patients seek to present to their doctors such commentary. Thus it may be necessary to restrict patient access to the wiki in some way if it is found that patients report to their doctor with wiki information that is of no value and based on anecdotal evidence or poorly understood personal experience.

The popularity and success of wikipedia and other open innovation platforms may not transfer to a wiki of medical decision making because of some clear differences. First and foremost perhaps is that the "experts" are already over tasked so this program would likely not be able to piggy back off of their efforts, particularly MD's. It may be that Ph.D.'s involved in medical research may have sufficient expertise to quickly and efficiently review and contribute to medical records with characteristics within their scope of expertise. These experts may be more inclined to exam medical records.

Novices face larger hurdles to making good contributions than with Wikipedia. Where for Wikipedia one could find several pieces of corroborating information and include them in a relevant article with an intuitive sense of their significance, the experience with a wiki of medical diagnosis and treatment would be different. The diversity of medical conditions and their presentations make it much harder for a novice to first understand enough to evaluate the information and then know when they know enough to suggest a differing diagnosis or treatment path. It would seem feasible that, for a great many conditions, after the novice has command of human physiology not much more than is often covered in high school health classes, they may be able to work their way through a diagnosis or treatment decision tree when presented with such a tree and with access to resources like wikipedia within a handful of hours or days. This claim seems worth evaluating.

A second key difference between this sort of wiki of medical decisions and say wikipedia is that persons with a limited scope of interest or expertise may find it more difficult to find patients with the conditions they are expert in particularly if their aim is to ensure proper diagnosis and seek out misdiagnosis. It would seem easy enough to make records searchable by physician diagnosis, but making symptoms, lab work, and certainly diagnostic imagery effectively searchable seems a much more difficult task.

Bank Brand Differentiation with Interest Donation Programs

Banks could promote accounts where the interest is contributed to charity. This could be a helpful way to sneak cash out of our hands that we want to give up in light of God's Word so we can rely on Him and not so much ourselves, but cash that we won't so easily give up because of the weakness of our faith. With interest rates low so is interest on bank deposits so it's likely that many could manage this sort of contribution without financial harm even if they aren't even remotely hoping to live off the daily bread God gives instead of a masterfully orchestrated IRA.

All that said it seems to be consensus thinking among those I've heard that saving for retirement or future reasonably expected needs doesn't contradict God's call. I'm confident that's true for some. I just got a funny feeling or maybe just a funny calling...who knows:-) God has plans for each of us.

An End to Rational Public Discourse: Wasn't Politics a Dirty Word?

I seem to recall that claiming someone was "playing politics" used to be a common method of attack on elected officials so much so that the very word "politics" carried a negative connotation. Now it seems that times have changed. Major news organizations have decided they want to be known for "politics." MSNBC's proudly proclaiming itself as "the place for politics" with it's tagline often placed on the frame of it's programming. CNN joins in with "CNN = Politics" as it's frequent banner. Fox News, the ratings leader, uses no such tagline and seems to focus more on policy with a "fair and balanced" approach but compensates by incorporating the (feigned or sincere seems up for debate) fringe fanaticism of Beck and the unbridled, overly simplified partisan perspective of Hannity in it's lineup.

So what does MSNBC, for one, seem to mean by politics. With Rachel Maddow, Keith Olbermann, Ed, and Chris Matthews as evidence, MSNBC defines politics as viewing Washington as a soap opera where Democrats are the heroes and policies matter to the extent that they cause contention and personality and party conflict. They have become the reality soap opera shows.

While the lack of helpful information on policy debates from MSNBC (and all the most popular media for that matter) is troubling, particularly given the amount of time that issues like health reform have been center stage, Fox News Beck takes troubling to a whole new level. Beck seems to want to be the Art Bell of politics, with his penchant for conspiracy theories. At the same time, with his tone and perpetual and emphatic call to action, Beck seems to want to be the pastor of politics. That later would seem to be much more dangerous to a weary people searching for a purpose in life that should come far from tea parties, DC marches, and excessively charismatic pundits who know the ratings power of entertainment and intrigue. Such a purpose of course is found only in humbly seeking the will of our ever present and working Maker.

It's an interesting course of events that Fox's most absurd show host in Beck also happened to preside over one of the most helpful discussions on health care yet to make it to the mainstream media. Several days ago Beck filled a room with about 40 doctors and med students who he questioned about health reform. Surprisingly the diversity of their opinions and comments suggested they weren't preselected for conformity with Becks "health reform is Obama's way to subject the masses" perspective.

So there you have it. News organizations want to be the next Guiding Light and an American anti government version of Hugo Chavez, in terms of his concept of reason and truth, is the person to look at for a reasonable policy discussion on health care. That is, of course, in between his rants about a new fascism and how the president is a racist seeking to rule your existence.

Note: This article was written with it's own degree of simplifying slightly entertainment seeking rhetoric. In my mind, Beck and all other individuals mentioned are children of God and seem to be genuinely good people.

Fixing Health Insurance Is A Small Part of the Solution

The following was my post (with a little simplifying rhetoric) in response to an indication that the health insurance industry doesn't have the largest profit margins amongst all industries: Insurers should be paying us to hold our money. A 3.3% "profit margin" becomes a bigger deal once you realize that insurance fundamentally is little more than a shared checking account. People pay in and they pay out. Who would use a bank that takes 3.3% of all money you deposit?

But that's not even half of it. The profit margin is after expenses. So it may be closer to having a bank that takes 10% or 30% of all the money you deposit.

All that said, there's a larger problem. Even if we find a way to educate insurers on how to deposit and write checks for less expense than 30% of the check, that only represents maybe 4 years of health care inflation and may do little to slow the rapid pace of cost increases.

It may be a sad testament to our democracy, after months of headline coverage, the following fundamental issues have gotten only a glancing survey by the major media sources. First off regardless of competition among check writers (insurance), competition amongst the actual health providers is fundamental to obtaining the benefits of the "free markets" everyone talks about. Health consumers need access to cost and quality information so they can purchase health care rationally. Then innovation at the care level will be properly valued and stimulated because better providers will get higher profits.

Second, while the health industry is far from market driven, the principles of supply and demand can't be overlooked particularly with all the evidence of a health care system on the brink in terms of capacity with rushed physicians and long lines at ERs. Health care supply must be increased. Perhaps this means automating processes now carried out by doctors and finding ways to do more with less training. Care would likely improve with software making decisions based on information in a nationally updated best practices database rather than doctors, particularly in primary care, who have an impossible task of keeping up with all relevant advances in medicine.

Insurance is certainly a more conceptually accessible issue but the heart of the matter lies elsewhere after we train insurers how easy it is to write checks:) These fundamental concepts of stimulating innovation and increasing supply do happen to be addressed in the current health bills but their approach merits debate because after all these are the measures that will actually impact the rate of cost increases. A failure to recognize this is either a surrender to the notion that patients can't be rational consumers and properly choose providers no matter what help they're given (which is certainly worth debate right?) or a simple intellectual error that could literally cost trillions.