What's really happening in healthcare

A few minutes after the Supreme Court released its ruling, CNN's home page declared "Mandate struck down" while the MSNBC home page declared "SUPREME COURT UPHOLDS OBAMA'S HEALTH CARE LAW." A CNN breaking news alter a few moments later read: "Correction: The Supreme Court backs all parts of President Obama's signature health care law, including the individual mandate that requires all to have health insurance." An hour later, the story accompanying the lead on the New York Times website noted "Insurance Rule is Deemed a Tax; Victory for Obama," while the Wall Street Journal's page did its best to emphasize: "Justices Find Fault with Medicaid Expansion." Throughout the next few hours, attorneys, and lobbyists weighed in, and the noise level was somewhere between a 747 taking off and Black Sabbath's "I am Ironman."

Here's the point. While the news reporting has focused on events, a long-term process has been at work, one that is good for the country, the economy, and for business. And as is often the case when business demonstrates leadership, the news cycle has missed it.

The big story is in two parts. First, businesses have been demanding cost containment within healthcare. Invoking the "who has the gold makes the rules," companies -- which pay most of the burden of private insurance -- have been negotiating with players throughout the industry to reduce overall expenses.

The second part of the story is that the business of medicine -- yes, medicine is a business -- has responded with innovation, collaboration, and leadership. There is emerging evidence that old adversaries -- physicians, insurance companies, and hospitals -- are becoming partners.

One small part of the story is a company like HealthCare Partners (in full disclosure, a client of my consulting firm), a physician group operating in California, Nevada and Florida. While many people were wringing their hands about what would become of healthcare, this company was quietly collaborating, cobbling together practices into integrated models of care, and increasingly assuming the total risk for patients. As evidence of just how much such efforts are worth, DaVita (a Fortune 500 kidney care company) agreed to pay $4.42 billion for HealthCare Partners.

The broader story is the emerging evidence that parts of the healthcare system working together can lower cost while raising quality. Elliot Fisher from Dartmouth and his colleagues are demonstrating that integration of care is easy relative to the benefits, in both cost and quality.

For those of us who study leadership and collaboration, none of this is news. My co-authors and I opened up Tribal Leadership's story of ten years of research on corporate culture and performance with the tale of Griffin Hospital.

A lot of my time at USC was spent encouraging physicians to reclaim their role as leaders of the business of medicine, which I wrote about this week in my personal blog.

This trend has been developing regardless of what the Supreme Court ruling was. Because the real leader in the American economy is, has been, and always will be, business.

Going into the presidential election, my hope is that people will focus on how business can be given the tools to do what it does well -- plan, find opportunities, mobilize, and implement. Those tools include educated workers, a favorable economic environment and national policies that promote growth. But let's notice that even in confusing and antagonistic environments, business has been finding a way to lead. That, more than anything else, is the story of this country.

Have you seen business showing leadership in healthcare or other industries? I hope that you will share your observations below.

Photo courtesy of Dalboz17, CC 2.0.

[sjc_1]

I wish this was the case, I wish this was the case 20 years ago, but business has NOT pushed back on prices and that was and is a MAJOR problem.

I don't know if it was professional courtesy, like the old lawyers and sharks joke, or just laziness, but business just went along with premium increases and wrote it off on their taxes.

There is SO much waste, inefficiency and sloth on the part of the WHOLE health care industry, any competent business consulting firm could tighten it up in short order. But that has not happened because there is NO feedback from a market system.

People get their health insurance from employers and see it as a "free" benefit. When something is seen as free, it is taken for granted and abused. It is time that the patients and employees got in the loop, then you will see people watching every penny.

[MrClobber]

Absolutely correct. The biggest problem with healthcare is lack of cost competition among providers. Because patients see care as a "free" benefit, they do not shop around. Most don't even know that the cost is of the care they wish to receive.

The solution is simple. Companies need to move to plans with high deductibles (at least $2000), and then put the amount of the deducible into a savings account on behalf of the employee. At the end of the year, the employee can withdraw whatever money is left as part of their pay. This would make so every penny of employees' care is covered, but still cause employees to shop around for low-cost care. Competition would increase dramatically, and costs would plummet. Add some tort reform for good measure.

[kenzwilhelm]

By visiting "************" you can start lowering your medical insurance premium and help you get better coverage.

[WhoBamaCaresFor]

It is hard to believe what the WeDon'tCare conservatives stand for. Dr. Logan, to understand the role AND efficiency of the private sector in health care under a government run universal health insurance system, look no further than Taiwan. I lived there for 20 years and worked extensively with thousands of doctors as an international adviser. One very famous American professor and friend who once lead one of America's top think tank got married to a Taiwanese diplomat. He moved to Taiwan with her for a couple of years and then moved with her to NY when she was re-posted. Once upon a time, he had some heart ailment. Now this guy is kind of famous, so he thought he would have proper treatment easy. But No. The doc said yes, according to the EKG, the tests, & al, you probably need an intervention (angioplasty). I can book that for you in 18 months... Good old prof upon hearing that flew back to Taipei the next morning, went to the National Taiwan University Hospital to see his doc, and the job was done the next day. He called me one day and said, well, just for health reasons, I think I will retire in Taiwan! The morale of the story: I can't get into details, but Fareed Zakaria did when he commissioned a study of advanced health system worldwide for his GPS show. He put Taiwan as No 1 in the world, and that is a few years after The Economist Intelligence Unit put it at No. 2 after Denmark. He asked a few of my friends who were in charge of establishing universal health insurance in 1995 what kind of models they had studied to come up with such an efficient system. He specifically asked if they had studied the US system. Now, most specialists in Taiwan trained in the US. But the good fellows answered NO WAY! The US system is the worst we could possibly look at, and knowing it very well, we specifically avoided it. 90% of Taiwanese hospitals are private, and vigorously compete with each other to provide the best care on the spot.Care in Taiwan is designed to be delivered as you need it, and you can see any specialist when you want, not when there is a spot 18 months later, which gives you the time to die many times over. And everybody, from autonomous workers like taxi drivers to any body in any business is covered by the health insurance, which everybody pays for. I was laughing when the CNN journalist of Fareed's show, a Navy veteran, asked Dr. Chang Hong-jen, an old friend who was once the deputy head of the National Health Insurance Bureau, the following question: I had this injury to my shoulder due to shrapnel back in my war days. I need to consult an orthopedic surgeon every once in a while for that. If I want to see one here, what is the waiting period? Imagine, they are sitting in the middle of a square for the interview that is just in front of the National Taiwan University Hospital, a minute away from where I worked. Dr. Chang answers: wait? What for? Our system is designed to serve you exactly when you need. So let's walk over and you will see a specialist within a few hours. The journalist was kind of dizzy at the answer. Dr. Chang said, don't worry, we designed this system to actually respond in a timely manner.

Seeing is believing. Go and study the way the private and public sector works there. The American system is really a disaster in terms of service. Taiwan's system has its hiccups, but in 20 years there I never ever waited to see a doctor. Now back in Quebec, which once had the best system in North America, I have to find a GP in order to get to a specialist. BUT, in Montreal where I now live, I am told that not a single GP takes a new patient on the island. I say what, wait a minute, what is this BS?

There are so many flaws in our North American health care systems, and we are so behind in understanding how to let the private sector cooperate. Like the old prof, I think I will also go back and retire in Taiwan....

Mr MitCan'tCare and his hordes of conservatives are seriously suffering from health system delusion. And WhoBamaCaresFor is heading in the right direction, hopefully dragging Mit back to his Massachusetts senses! Good luck America. Hope you will not end in MitNowhere.