The ACA's Effect On Entrepreneurs Will Be...?

An article in yesterday's Wall Street Journal asked "Will Health-Care Law Beget Entrepreneurs?"

Will the availability of reasonably-priced insurance through public marketplaces or "exchanges" cause entrepreneurs to strike out on their own, leaving behind the comfort of big company benefits?

It's a good question, albeit one with no clear-cut answer at the moment. It all depends, I guess, on one's definition of "high-functioning exchanges" and "reasonable prices."

Still, it's a question to which large companies ought to be paying close attention. How many people work at jobs simply for the health insurance, jobs they'd leave in a heartbeat to follow their passion if insurance wasn't an obstacle? I don't know for sure, but I'd bet the answer is somewhere between "more than a few" and "a whole heckavu lot."

And those leaving are likely to be those the company wishes would stay - the innovators, the passionistas, those with entrepreneurial drive and burning competitive fires.

They leave and who stays?  The timid, the risk-adverse and the "Yes, but..." crowd.  I guess you can always hope that your competitors are as bad at retaining talent as you are.

2:18 PM

An Industry Bankrupting Its Own Customers Cannot Thrive

Wonder why you haven't gotten a raise recently?  Does it seem your income goes less far than in years past?  Blame healthcare inflation.  Or, as one economist said recently, "...healthcare stole your raise."

 Brian Klepper, PhD, blogging at KevinMD.com predicts that healthcare is in for a new organizational structure.

At our first meeting years ago, Tom Emerick, Walmart’s then VP of Global Benefits, told me, “No industry can grow continuously at a multiple of general inflation. It will eventually become so expensive that purchasers will simply abandon it.”

He said it casually, as though it was obvious and indisputable.

Health care is playing out this way. From 1999 to 2011, health care premium inflation grew steadily at 4 times the general inflation rate. During that same period, the percentage of non-elderly Americans with employer-sponsored health coverage fell from 69.2 to 58.6 percent, a 15.3 percent erosion rate.

Health care’s boosters like to argue that it has buttressed the economy, and that it means more jobs and economic prosperity within a community. A February 2011 Altarum Institute report estimated that private sector health care jobs now account for nearly 11 percent of total employment. Since the recession began in December 2007, health care employment has risen by 6.3 percent while employment in other industry sectors fell by 6.8 percent.

[I love this next paragraph...]

But there’s a darker side. Health care’s ever-increasing revenue growth has come at the expense of individuals and firms that pay its bills, directly, through health plan premiums and through taxes, often instead of buying other goods and services. It transfers wealth to health care from everyone else. Like the finance services industry, health care has become a disproportionate “taker” industry, sapping economic vitality of America’s communities.

[Yep.  And it's time for state hospital associations everywhere to change the basis for their "economic benefit" calculations - calculations that still trumpet employment and purchasing data when it's clear the marginal benefit is negative.  Locally and nationally, we'd be better off spending more on education, infrastructure and innovation than on more health care.]

And it is also clear that a sizable part of health care cost is inappropriate and unjustified. It is related to procedures that are done unnecessarily, markups that are hidden, and a thousand ruses to make it cost more. The prestigious National Academy of Sciences Institute of Medicine recently estimated this waste at 30 percent of total health care expenditures, or about $765 billion/year. But any number of health care professionals I’ve spoken with agree that, based on their experience, the number must be significantly higher. Other estimates have suggested this. In 2008, the consulting firm PwC issued The Price of Excess, which calculated that about 54.5 percent of health care cost, or nearly $1.5 trillion annually, focused in every sector – supply chain, health information technology, care delivery and finance – provides no value.

Read the whole thing, here.

2:12 PM

Diabesity: What if our best practices are the wrong practices?

The Daily Beast:   "...what if we are coordinating the wrong kind of care? What if our best practices are the wrong practices? Our toxic industrial diet, our sedentary lifestyle, chronic stress, and environmental toxins cause diabesity and its attendant downstream ills (often mislabeled as something else, such as hypertension, cancer, heart disease, dementia). Drugs and surgery are feeble, ineffective, costly, and often harmful treatments for lifestyle-induced illness. They are misguided efforts at best, dangerous at worst. Mounting evidence proves that the solution to lifestyle- and diet-driven obesity-related illnesses won’t be found at the bottom of a prescription bottle; they will be found at the end of our fork."

[...]

"Health it seems happens outside the clinic, where people live, work, play and pray. We need to rethink how we treat chronic disease. It is not only better medical management, which often just barely if at all staves off complications and death, but with high science, low cost, high touch innovations. A comprehensive integrated strategy can solve this problem. Start with revised screening guidelines to identify the 90% of pre-diabetics and the 25% of diabetics never diagnosed. Build new practice models and reimbursement for group visits to deliver lifestyle medicine in more effective and cost efficient ways. Support and scale proven community-based peer-support models of lifestyle change. Over 20% of Americans are out of work. Train a new army of 1 million community health workers like the barefoot doctors of China who can support their peers in creating health. Set a national goal for America of losing 1 billion pounds in a year."
Read the whole thing.  Then go outside and get some exercise!

6:44 AM

MedCity News: What happens to healthcare reform if the individual mandate is overturned?

Try this: things continue spiraling downward until 2020, when a Republican President signs national health insurance into law.

12:33 PM