Holidays are nice. Labor Day marks the end of summer and its (hopefully) enjoyable 24 hours are perfect for reflecting upon the “coolness” of life. Here’s some help for getting your reflections started via the good folks at Snarkmarket:

Superpowers, Revealed because “sometimes the best abilities are the ones the world can’t see.”  The Morning News

And then this: Moments from Radio Lab, via Jonah Lehrer. Just something special about it.

It’s a fable!

I’m left wondering: who would I least like to be, the congressional intern flipping the charts or a fellow Senator in the audience musing about what my House counterparts are doing on their time away from Washington?

The Daily Show With Jon Stewart Mon – Thurs 11p / 10c
Chuck Grassley’s Debt and Deficit Dragon
Daily Show
Full Episodes
Political Humor Spinal Tap Performance

A new approach to insurance

This thought from the Atlantic‘s Idea of the Day sounds Seth Godinesque:

Now that college is over, you may have noticed that many of you and your pals are suddenly uninsured. According to a report by the Commonwealth Fund, young adults are disproportionately represented among people who lack health insurance, accounting for nearly 30 percent of the 45 million uninsured people younger than 65, even though they comprise just 15 percent of the population.

Once you organize and take a head count, go price group health-care coverage. And after you calculate the rate at which the larger the group the cheaper the insurance, go out and gather up everyone else you can–through your massive social networks–who might be interested in the cheapest health insurance. It will only be a matter of time before your organization is so large that you can become your own underwriters. Then you can really throw some weight around.

And if you can remember that you started this venture not to make a buck but to obtain affordable health insurance–if you can stay on the nonprofit side of things and avoid antitrust laws–you might just have the motivation and support that corporations and the government are lacking to provide universal health-care coverage.

SimHealthCare (plus some reform links)

Health care reform heated up over the weekend, here’s a rundown of both the Senate and House proposals; Democrats generally seem to be in agreement; Republicans not so much; President Obama’s call for action was met with angry tweets (one, two) from Senator Chuck Grassley’s mercurial Twitter stream.

All of that serious stuff aside, the question is will the new plan work?  And if not, what would?  Using a point from Noah as inspiration, Robin comes up with a really cool idea (especially for those of us who enjoyed the Sim series growing up, or still do…):

Or how about some kind of bifurcated simulation: SimHealthCareSystemAndIndividual. One side’s macro, the other’s micro. You play both, and see how decisions on one side affect the other. I like the sound of that, actually. The trick with any social simulation is that, inevitably, the way you design it says a lot about how you view the world. So the micro/macro sim would play up that tension; the models might even be designed to sort of “fight” each other. SimBourgeoisAndProletariat.

That would be fun.  Also educational: we could find out what iteration of our “health care system” works best *and* improve stakeholders’ orientation of micro decisions on the macro environment.

When everyone has insurance what will happen to hospitals’ not-for-profit status?

Undeniably, the most important advantage of a hospital’s not-for-profit standing is the tax-free status that it grants.  Save for very few exceptions: no taxes on income.  None on property.  Most significantly no tax on bond-issued debt.

The reason hospitals are granted not-for-profit status by the IRS is because they are considered charitable organizations.  A charitable organization needs to provide charity; in hospitals charity usually consists of free care provided to patients who can’t pay.  Community benefit also exists, but few agree on how exactly to measure the financial commitment of such considerations and that makes its charitable contributions murky.

As we move closer to health care reform and decide upon what that reform will look like, one reality is rising to the top: we need to insure everyone (even the insurers are game on this point).  Charity care will no longer be necessary when all Americans have insurance.  So what then will happen to hospitals’ not-for-profit status?  More realistically, what will become taxable?

It’s unclear what exactly a new taxable status would hold except that hospitals would not be required to provide charity care.  What would become taxable?  What happens to charitable donations?  Would it prompt hospitals to privatize?  Access to capital is a big consideration and would it require organizations to become publicly traded in order to raise funds (research concludes capital is cheaper in the not-for-profit setting)?  Widespread hospital IPOs don’t seem like such a palatable reality to those currently leading health reform legislation.

The most probable answer is the creation of a hybrid status where taxes will be levied on profits and property but access to tax-free debt will remain.  Charitable hospitals have become an American institution; some (many?) may have real concerns with all hospitals becoming privatized.

If hospitals want to run their operations like business, complete business, taxable status may be the consequence.  And since 501(c)(3) status prevents these organizations from doing any kind of lobbying activities…they won’t have much say (that may be naive).

Aside: The Congressional Budget Office released its extensive thinking on health reform possibilities recently.  Discussion of taxable status may be amongst the 400 pages but I haven’t had a chance to comb through.  Here’s a quicker rundown from Health Care Policy and Marketplace Review.

(ht: Scott Snyder and our daily back-and-forths)


Well, it got here a whole lot quicker than expected (hmm…).  I’m going to dedicate my usual blogging time (as if I’ve had much of it recently anyway) to standing in line in the early A.M. at the polling location in Battle Ground, USA.  No links to health care plans today, we all have many important issues to consider.  No endorsements either, for in the words of one astute political observer (Hi, Dad), “We’ll have to work with the winners either way.”

Get off your RSS reader, get off this website: Go VOTE!

The Potential of Health 2.0

Carol Diamond and Clay Shirky from Health Information Technology: A Few Years Of Magical Thinking? (via ReadWriteWeb):

The challenge of thinking of IT as a tool to improve quality requires serious attention to transforming the U.S. health care system as a whole, rather than simply computerizing the current setup. Proponents of health IT must resist “magical thinking,” such as the notion that technology will transform our broken system, absent integrated work on policy or incentives.

Optimism abounded throughout the two days in San Francisco—as well it should when a group of pioneers embarks upon new territory.  But whispers of what it could be–bubbly–were heard throughout.  My feeling on what will prevent a bubble pop is the inherent potential in Health 2.0: helping patients muddle through health care and managing their wellness.

There were very cool technologies on display—some completely new, others focused on helping health care catch up to the rest of the internet-dependent world.  There are a few success stories.  Some companies are on the brink of success.  But it’s quite practical to think that there will be some failure, probably even a lot.  That’s the nature of new.

A way to reduce that chance of failure?  Focus on h-e-a-l-t-h (the broad definition).  But the focus of Health 2.0 is health, you may be saying, it’s right there in the title.  Yes, it is/was for many of the companies touting their utilities.  But for a few (maybe more) their focus on profit was completely transparent.  I don’t think that model will work.

So in my (no skin in the game) humble opinion, here are two areas where the people of Health 2.0 need to focus in the coming months:

Integration – I like Scott Shreeve’s definition best: “New concept of health care wherein all the constituents (patients, physicians, providers, and payers) focus on health care value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care.”

Most Health 2.0 companies are working with patients (obviously), physicians (obviously), and a few with payers (by the way, they have the cash, so unless your plan is game changing, it would be best to include them).  But throughout my two days at Health 2.0, I was disappointed to see an almost blatant neglect of working with providers (who I’m going to call hospitals/clinics/points of health care delivery).  The providers have the data (tons of it).  They are the facilities where an astounding amount of care is delivered (even a Hello Health patient may need to visit a hospital).  If Health 2.0 is to realize its true potential, hospitals etc. must be included in the game (Google Health and Microsoft Health Vault have began a few partnerships, but this area remains flush with opportunity).  Which leads to the next point…

Collaboration – The tools available today are astounding.  A patient (sorry, I’m old school on calling health care users patients, the term consumer connotes dirty images in my mind) can price compare services.  A patient can enter labs data into a PHR.  A patient can price shop for insurance coverage.  A patient can participate in communities.  A patient can manage their health care expenses simply.  A patient can find information on physicians.  A patient can compare quality (it’s getting better).  And this is all precisely the problem.  As a patient myself, I have no desire to visit eight different websites to manage my health.  I have trouble enough managing my money with five different institutions.  I want to visit one place.  One site where I can do it all.  The company that is able to bring together the tools that have been created to a single location where patients can easily use/share/create health information will lead the Health 2.0 transformation of health care.

That’s why Health Vault and Keas excite me the most.  Keas has been quiet (understatement) on what they are trying to do.  But their “sneek preview” at Health 2.0 gave me the inkling that they may be creating a platform that brings together a cadre of services in one location.  We wait to find out.  Health Vault could be the killer app in this equation (that’s what we’re all waiting for, isn’t it?).  A talk that took place after Health 2.0 actually provided more insight.  Health Vault is building a platform on which others can build applications to help patients manage their health (think iPhone App Store).  Acquisitions need not happen to make this work, the tools just need to work together.  For this reason, I think acquisitions will be fewer than what has occured in the Web 2.0 world.

Anyway, these are the opinions of a humble observer.  There is reason to be optimistic for what Health 2.0 will do for patients, but first it must become much easier for patients to utilize multiple tools (and include the providers!).

I think the sign of true success for Health 2.0 will be this: when we drop the 2.0 and simply use these tools to manage our Health.

A short open letter to our dearest Health Care

Dear Health Care,

I thought it would be good for you to know that it really is possible to change—even if you’ve been set in your ways for most of your history.  Yes, it seems difficult.  But you’ve have shown a few instances of wanting to do better (indeed you may have been coerced; however, the good faith efforts have been duly noted).  I have confidence in you, even as you continue to make unsustainable business decisions.  If you need further inspiration, read this story about a 100-year-old newspaper that decided to stop actually printing a daily edition and publish in online format only.  Just remember: anything is possible if you put your mind to it.