On the road to sustainability

The ramifications of the credit crisis are/will be many.  Here’s one that’s good: sustainability.


A morsel of sanity comes from David A. Rosenberg, the North American Economist for Merrill Lynch. Instead of some horrible economic apocalypse, he forecasts a near future of frugality, where people concentrate on paying off their debts, and live a simpler life.

The meat, via Paul Kedrosky (and a few others):

As far as I know, there are only two ways to eliminate debt. You either walk away from it, which people obviously are doing, which is why we got these write-downs and these foreclosures, or you pay it down. I think people with a FICO score that they are concerned about are going to pay that down. That means that the savings rate is going to be forced higher. This, again, is going to be very, very disinflationary. It means that fashions are going to change. It means frugality is going to set in. We’re going to be living in smaller houses, driving smaller cars and living more frugally. It’s not going to be the end of the world; it’s going to be a necessary process to truly embark on getting the balance sheets down to more comfortable levels so that we can actually embark on the next cycle.

A question and a thought.  From the hospital’s perspective, what does a frugal America mean for health care spending?  Answering that question may be a good task for the planning departments in hospitals where capital projects have been pulled because of the credit freeze.

This, though, could also be a backdoor to sustainable health care.  A more reasoned America may very well begin to reduce health care spending at the “America’s health care system” level.  Slow and gradual would be the desirable approach to such thoughts of reduced growth.  Because if the financial crisis is any indication of how a requsite pullback in health care spending will occur, we know this: it will be long and painful.

Why there is dislike for administrators

Because at a moment of obviousness, it just isn’t.  Read about the issues at this hospital system (link via Kevin MD).  Dr. Robert E. Khoo offers some steps to success:

What should Memorial do? It could start by listening and responding to physician and nursing concerns, better organize its system of care delivery and health information, focus on the patient not on budget cuts and not bow to pressure from its headquarters in Orange County. The delivery of health care is unique to this community. We are underserved, and the problem is growing.

Sounds simple.  Message: Make delivering health care easier, not more difficult.  Often it’s not this easy, but sometimes it is.

“If something looks too good, people won’t touch it”

Clay Shirky (as always) makes some interesting points in the interview below.  This has some application to health care, too.  For (many?) patients, the perception (brand?) of physicians and hospitals (albeit decreasing) is one of perfect order.  As Mr. Shirky says, “If something looks too good, people won’t touch it.”  That’s problematic in health care.  Interaction is important.  Conversation counts.  Participation is powerful.  Let’s continue to break down the barriers.  Transform the brand.


[via PSFK]

Presentation Season

The MHA world is entering the presentation season again.  Here’s last year’s reaction.  Here’s this year’s proaction courtesy of Seth.

Best Point: Don’t use PowerPoint at all.

Best Articulation:

Here’s the deal: You should have to put $5 into the coffee fund for every single word on the wordiest slide in your deck. 400 words costs $2000. If that were true, would you use fewer words? A lot fewer? I’ve said this before, but I need to try again: words belong in memos. Powerpoint is for ideas. If you have bullets, please, please, please only use one word in each bullet. Two if you have to. Three never.

Something different…

A coal miner in Wyoming has taken a nontraditional approach to reducing health care expenses: incenting workers to receive care at the nation’s best health care organizations.

From Bloomberg:

The coal producer says it has found an unconventional way to cut health costs: Seek out the nation’s best care and give workers incentives to use it. About two-thirds of operations have proven to be cheaper at better-rated hospitals out of state. Even when the price was higher, the Linthicum Heights, Maryland-based company saved money by reducing misdiagnoses, complications and repeat procedures.

The cost savings:

Health-care costs for an average employee at Foundation’s two Wyoming mines have dropped about 5 percent a year since the program took full effect in 2005, while U.S. spending rose about 7 percent annually. As Foundation’s Wyoming workforce grew, its total medical bills remained steady at about $5.5 million a year.

The article says the Wyoming experiment could be a model for regulators centered on curbing the growth of health care costs in this country.  “The approach in Wyoming is a twist on efforts by insurers and Medicare, the U.S. health program for the elderly and disabled, to encourage better care by rewarding hospitals that meet national quality standards.”

The thought is good, the reality is trouble.

This part is easy: capacity limitations would prevent the majority of Americans from seeking care at places like the Mayo Clinic.  Our health care consumption habits require large amounts of capacity and receiving care from a national health care leader is just not realistic for every patient.

Replicating quality efforts is a much more realistic thought—and one that could pave the way for better care for everyone.

We can’t blame any company for focusing on a fix for their health care problems; but a collaborative effort to reduce costs for all is much more likely to become a health care solution.

Nationalized Health

Mexico is getting fat.

The government is doing something about it.

“Vamos Por Un Million de Kilos” (Let’s Lose a Million Kilos) is the name of a successful campaign to get Mexicans to lose weight.  The Mexican government expects its country’s obesity levels to catch those in the United States.  Fifty percent of Mexico’s population is overweight and childhood obesity is increasing.

There are other nationalized efforts underway.  According to this AP article in the USA Today:

Mexico is working to mandate more physical education in public schools and encourage employers and unions to give workers time for exercise. The administration of President Felipe Calderon says it has built or renovated more than 800 public sports facilities around the country. And the National Institute of Public Health is promoting food education and healthier choices in schools, such as fruits and vegetables instead of chips and soda.

The weight-loss campaign reached its goal in just four months and has now entered a second phase “Vamos Por Mas Kilos” or “Let’s Lose More Kilos.”

Except for the examples of success, the article mentions very little on the Mexican citizens perspective on the effort.  Such a national effort in the U.S. would probably be laughed at and unsuccessful.  An effort, though, is needed.

Protectionist Health Care?

Wondering if American economic protectionism will be a back door into more government intervention/universal health care/single payer/significant payment reform of our health care system.

From The Wall Street Journal:

In an effort to control rising costs, a small but growing number of insurers and employers are giving people the choice to seek treatment in other countries, a practice known as medical tourism. Until recently, most Americans who traveled abroad for medical care were uninsured, or were seeking procedures not covered by insurance, such as cosmetic dentistry or aesthetic surgery. Now, a handful of plans are beginning to cover treatment overseas for heart surgery, hip and knee replacements and other major surgical procedures.

While medical tourism isn’t expected to be a solution to the country’s soaring health-care costs, the practice is intended to produce savings for insurers, employers and workers. Open-heart surgery, which can cost roughly $100,000 in the U.S., can be done at an internationally accredited hospital in India for just $8,500, for instance.

Significant health care dollars flowing overseas is not going to sit well some people, especially those who are opposed to any kind of government role in health care and leery of free trade.