Why Michael Moore is Wrong (Mostly)….and a Hypocrite

In a recent interview on Larry King Live, Michael Moore decried capitalism a complete failure.   While I find Moore’s films thought provoking and funny, and in some cases I agree with the basic premises, I don’t think that I have ever seen anyone in an interview come off as such a simpleton.   He did in this interview exactly what he criticizes others in America of doing….that is speaking in absolutes and in black and white terms.   Economics is neither.

Yes, there was (is) a major economic set back fueled by greed and a sub-prime mortgage crisis.  (Note: We should in fact expect ambition, drive and motivation, which can manifest themselves as “greed”, to be the driving forces in our economy.) But, most economists will tell you that our government failed us here by not providing the proper oversight and keeping a level playing field. Why when government can’t do the minimum would we possibly give it an edict to do more (which is the subtext of Moore’s position.)

Essentially, Moore says he believes that everyone should have a piece of pie.  Sure, sounds good.  But I highly doubt that Moore would apply these principles if they affected him personally.   To break this down to terms he understands, in his world, everyone that makes a movie should have equal time in front of the audience and each movie should be seen by the same number of people and no more, regardless of it’s artistic value or appeal to the viewers.  Everybody who makes a movie makes the same money, no matter how bad or good the movie.  In that world, Michael Moore is probably not a multi-millionaire with significant influence.  (To his credit, in reality he is in fact both of those things.)    I found it quite hypocritical that when pressed, Moore would not admit that he in fact is in the class of people that he believes is most at fault, as if the mere making of his most recent film absolved him of this classification.

I did find a few clips (as shown on LKL) from his latest film dead on.   Specifically, I wished I could have been out front of the several of the financial firms that got bailed out with him asking for our money back and declaring the areas crime scenes.   But, overall Moore seems to miss or refuse to acknowledge that art (eg, a movie) is business, and guess what, BUSINESS IS ART.  :)

Simple Way to Fix Healthcare: Mr. Obama Please Listen

Let’s assume that the “problem” with healthcare is that 15% of the population is not covered.  To solve this problem, we don’t have to compromise the highest quality healthcare system in the world. We can apply the forces of capitalism, free trade, and competition.  

Specifically, we need to set up incentives for healthcare providers to compete to provide services to those who are not otherwise covered by private insurance, Medicare, or Medicaid.   How do we do that?    Simple math.    Require providers who want to be eligible for higher Medicare or Medicaid reimbursement to demonstrate that 15% of their services are provided for those without coverage of any type.  

Make the effective increase in reimbursement enough incentive for providers to not want to opt out of Medicare/Medicaid all together. Yes, we need rules to define how those percentages are calculated and rules to discourage “cherry picking” of particular types of indigent patients.  

And, we need to allow time for practices to ramp up. But those are frankly easy details.    The point is we can leverage the best parts of our existing healthcare system and economy without creating more inefficient government bureaucracy that will certainly reduce the quality of care.    

Those who refuse to look at such an approach have suspect agendas, like increasing the size of government for the sake of increasing the size of government.

USA: (Un)Solvent States of America

While this might sound like blasphemy, consider the facts.  The true costs over time of the current stimulus and other deficit spending is estimated at $24 trillion.  That’s a lot of zeros on the backs of our kids.   Perhaps some think the good news is that the dollar will be so worthless overseas that we’ll only be able to afford to buy US made goods, thereby re-bolstering the US economy.  Only flaw with that thought is that the economy is already globalized and that jeanie can’t be put back in the bottle.   Truthfully, we’d be better off if Obama started signing and auctioning off government property, like the Governator is now forced to do to pay for his states bad spending habits.    But, the federal government has the power to make the problem far worse because they own the printing press.    Let’s hope the private sector can fix the sins of government.   It’s our only hope.    The math doesn’t lie.

Talk of Second Stimulus Plan Shows True Colors

With Supreme Court Justice hearings coming to a conclusion, the big talk coming out DC now is about a second stimulus package.  What makes no sense is that we have barely spent 10% of the first package, making any talk of another simply illogical.   But, it’s illogical only if your true goal is economic stimulus, rather than simply a ploy to expand government.   I’ll let the readers do the math there.

And if you think it makes sense to replace even more of the private sector with bigger government, first think of the Katrina response, ill-conceived bank bailouts, and the fact that you are further empowering and relying on those that let the sub-prime mortgage mess (quite frankly the core of our current economic dilemma) happen to begin with.

What’s an entrepreneurial idea worth?

The early/mid 90s were a glorious time for IT entrepreneurs.   An idea on a napkin (that used the word “web”) might gross you 6 or 7 figures.   Well, those days are gone for sure, and that’s probably good thing.  Now ideas have to stand on their complete merit, and investors are more skeptical than ever.    So, that said, in 2009, what is a good idea (a real idea) worth?  Here is a general guideline formed by the experiences of several in recent months and years:

1.  A good idea, with a business and marketing plan:  5 figures

2. A good idea, with a product prototype and business/marketing plan:  6 figures

3. A good idea, with a product, business/marketing plan, and a few customers to validate:  7 figures

4. A good idea, with a product, business/marketing plan, customer revenues of $1 million/yr or more:   8 figures

The step from 3 to 4 is by far the biggest and can constitute the biggest investment in sales and marketing.  Thus, good small companies and ideas are most ripe for the taking somewhere just at or past #3.  The real point here though is that there are no easy roads any more.   The idea has to be sound.  The execution has to be good.  The market has to be there.  Pretenders go home.  Capitalism at its finest.

Healthcare IT/CCHIT/ARRA: The Free Market Will Win

Significant changes would seem to be on the horizon relative to healthcare IT and the related intellectual property developed by the private sector.  The emphasis on CCHIT in the near term will preserve the field for a select group of vendors, but in the long term there will be government-grown initiatives (or even open source initiatives that are utilized by government) that essentially will become the de facto building blocks around which the interoperability and data exchange functions will function.   It is a natural evolution, particular considering where our current government says it wants to take healthcare, to go from government mandated standards to a government mandated system.    Many might make the case that such a step will be necessary to facilitate a true data exchange/repository.     While this might sound “doom and gloom” when it comes to innovation (and the free market) in healthcare IT, there could be an upside.  Those innovative and nimble component and “niche” vendors that have been all but forgotten in the craze of CCHIT may be those that emerge from the aftermath.  (Think cock roaches after the bomb drops!)  They will be the ones that are writing the extensions, add-ons, and APIs to the government-mandated system to make it bigger, better, faster, stronger.    Practices will again be able to choose items a la carte that fit best for their practice, utilizing the core government platform. Some of the big vendors will adapt, and others won’t.   But, it looks be a much more interesting and innovative time ahead compared to where we are now…..that is having to accept the “one size fits all” approach from one of a small group of vendors.  We’ll waste time in the meantime, but in the end, the free market wins.  It always does.   Just like Mother Nature.  Just like City Hall.

We need more Tesla’s and Less GMs….in Auto and Healthcare IT

I don’t mean to pile on during GMs toughest weak in its long, storied history, but it is a bit hard to feel too sorry for them.    Too much capacity.  Non competitively-priced labor.  Too many gas guzzlers.  Too little innovation, too late.   Meanwhile, they have had the capability to create another Tesla or truly competitive hybrid.   But with all of its vast resources, why couldn’t they deliver a Tesla?   Lack of foresight?  Lack of initiative?   Or how about they were just too damn big to have a truly innovative climate?  Or they were simply intoxicated by the fumes of low gas prices and decent economic times?  Now, we the tax payers and our government effectively own them.   Should we now expect a more nimble GM?   I highly doubt it.  Perhaps a fiscally sound company can emerge (especially when we just erase their debt), but it will be one that will be merely following the government mandate to build more small cars and less SUVs, and a lot fewer cars overall.   Don’t expect a leader, innovator, or trend setter in the automotive industry.  Could we be looking at the same thing in healthcare IT? ARRA/CCHIT could effectively kill the Tesla’s of the EHR industry, those that try to do it better, smarter, more efficiently, and more in tune with customer demands.   Hopefully we won’t have to bail out the big boys in the EHR business in a few years because of it.

EHR Stimulus: Missing the Forest for All Those Trees?

Thanks to EMR Daily News for posting notice. This is the best single post/article that sums up where we are today with the ARRA and push toward EHR. Anyone else think we’re missing the forest for all those damn trees? It sure would have been a lot easier to first develop the infrastructure for an “information exchange” then watch the free market (eg, the software vendors) quickly build to support that exchange. Instead, we are focusing on what buttons need to appear on a computer program sitting in the physicians office. Ug.

http://www.ajc.com/services/content/printedition/2009/05/13/abdelazized0513.html

More Comments from the Peanut Gallery RE: Proposed $2 Trillion in Healthcare Savings

From:  http://money.cnn.com/2009/05/11/news/economy/healthcare_reformproposals/?postversion=2009051113

 

Goal: $2 trillion in health care savings

Industry groups promise to work with the White House on plan to cut costs, with emphasis on preventive care

By Parija B. Kavilanz, CNNMoney.com senior writer

 

 

 

Excerpt: “Cutting health care costs means improving the quality of care patients receive, putting money back into families’ pockets and keeping businesses open on Main Street,” SEIU health care chairman Dennis Rivera said in a statement.

BIA Commentary:  I don’t actually think “cutting costs means improving quality.”  In fact the opposite would generally be true.  Cutting costs would be doing things like holding on to older (in many cases less advanced) technology longer.   The hope of the administration better be that quality isn’t impacted in a negative way by the cuts.

Excerpt:  The pharmaceutical industry maintained that proper use of medicines can be one of the most effective ways to achieve better health outcomes and reduce costs. The Pharmaceutical Research and Manufacturers of America (PhRMA) said in a statement Monday that non-adherence to prescribed medicines has been estimated to cost $100 billion to $300 billion annually, including costs from avoidable hospitalizations and nursing home admissions. Addressing this issue is part of a quality-focused way to lower healthcare cost growth, the trade group said.

BIA Commentary:  I didn’t see any indication of “sacrifice” on the part of the drug companies.   How are they going to lower their costs and will these savings be passed on through the healthcare delivery chain?   I read this statement as “If you other guys would do things right, you would save some money.”    That should be happening anyway.

Excerpt:  “The coalition also recognizes the importance of encouraging medical innovation as a key element in both improving patient health and reducing the growth of overall health costs,” PhRMA president and CEO Billy Tauzin, said in a statement.

BIA Commentary:  Ok.  But ARRA/CCHIT effectively does the opposite as it has no provisions to cover open source technologies and does not properly recognize the best of breed component or niche vendors.    How is the innovation encouraged?   

Excerpt:  For its part, the American Medical Association (AMA), said it has initiated a program to improve “medication reconciliation.”  “Patients with multiple conditions often see several physicians,” J. James Rohack, AMA president-elect, said in a statement Monday. “Every physician that comes in contact with a patient needs to be aware of all the drugs the patient takes to avoid drug interactions and eliminate unnecessary prescriptions.”

BIA Commentary:   A “certified EHR” will have to have e-scribing functionality that should address this in a significant way.     But, equally important to improving medical outcomes is access to a complete patient history between these several physicians.    That points to real “interoperability” and data “portability.”    I don’t see real headway there.  We pretty much have a list of features to work with.

Obama Plans (Hopes) to Save Trillions in Healthcare Costs, But

…there are a lot more questions than answers at this point.  Here is an excerpt from an article on thehill.com:

Obama, interest groups to launch health reform plan

By Jeffrey Young

Posted: 05/10/09 09:01 PM [ET]

President Obama will announce an initiative Monday that the administration says will reduce national healthcare spending by $2 trillion over 10 years.   A coalition of six interest groups representing healthcare companies and a labor union are behind the plan. Their chief executives will meet with the president Monday to present him with a written commitment to cut the rate of growth in healthcare spending by 1.5 percentage points each year for 10 years.

The rest of the article can simply be paraphrased with “No additional details available,” which really shouldn’t be much of a surprise.    I think we can all agree that the intended push to EHR and the incentives as part of the ARRA can help in the effort (provided that we don’t achieve the opposite effect by continuing down the path of eliminating the free market forces that keep prices down.)   And, I would expect to hear about a renewed concentration on preventative medicine, but this is a lofty goal.   Here are the issues. We have an aging population.  Many hospitals continue to struggle and find themselves in the red.   Rural areas are still largely under served.   We have a growing population that will most likely be less affluent overall (thus relying more on government funded healthcare.)

The idea (not enough information to really call it a plan) itself would seem to assume that someone (insurance companies, physicians?) will carry the extra weight.   I’m not sure there is much room to give by anyone.  Thus it seems, to accomplish the plan without more taxpayer money, we could be looking at a serious reduction in services and overall quality of care.  I’m not sure the American public is ready for this yet.   The devil will most certainly be in the details with this plan.     Maybe Joe Camel will make a come back to encourage us all to smoke again.   That ought knock an extra 1.5% of us out each year.  Overly cynical?  Perhaps.  But healthcare being 20% cheaper in 10 years?     Sure.  It’s fun to talk about, but I suggest a little more substance prior to a press conference.      - BIA Agent #1