Archive for the ‘healthcare’ Category

Structuring the healthcare ectoplasms

Friday, October 2nd, 2009

The art of co-creation lies in structuring the right exchange platforms at the outset of the debate. For having forgotten this simple fact, the Obama administration is now in the unenviable position of having to extract  common themes across five different bills generated by five different committees, and trying to cajole enough senators and house representatives into rallying around some kind of consensus bill still to be developed. The administration’s challenge is now to hang five ectoplasms on a common skeleton it still has to anatomically define, and get the ectoplasms not to slime in the process.

Imagine if eBay had had the great insight that there are lots of people with stuff in their attic they want to sell, and buyers who want to buy it, but had somehow forgotten to structure the market in categories such as cars, computers, or– my personal favorite  — “dolls and bears”. Imagine also what would have happened if eBay had forgotten to establish rules for its bidding system, including how long an item is put up for auction, how buyers and sellers establish or judge each other’s credibility through a rating system, how buyers and sellers can communicate and how the commissions get levied by eBay on both buyer and seller. If eBay had just said: “go out and co-create”, we’d have a real mess. That’s the healthcare debate so far.

Co-creation is not a free-for-all. It is an organized way of engaging different parties in a different kind of dialogue by structuring new platforms that create transparency between the various points of view. As a result, the process enables a better optimization than would have been possible under the old, non-transparent system. Absent this structuring, the healthcare debate has naturally reverted back to frozen, partisan characterizations of the other camp,  as either bleeding heart liberals or insensitive capitalists, not to mention absurd slogans such as “not letting anyone come between you and your doctors” – as if insurance companies were not already there!

As Business Week pointed out in its August 6 issue, health insurers have stepped into the breach and structured the debate on behalf of the administration. Not only have they framed the platforms, but they have used their considerable lobbying firepower to present actuarial evidence in favor of their proposed solutions. In a debate between free-form, idealistic regulators wishing for a better world and business legionnaires armed with scores of data, who do we think is going to prevail in the end?

Out of this mess, perhaps a new policy-setting process will arise in Washington, where regulators view themselves not as partisan advocates of a point of view they try to impose on others, but as architects and implementers of a new democratic process where issues are framed along citizen-centric lines. When regulators learn to design debate platforms rather than a priori outcomes, a new form of democracy will emerge.

In the meantime, it’s back to chasing ectoplasms. Whom you gonna call? Ghost busters.

Healthcare co-ops as co-creation

Wednesday, August 19th, 2009

There have been so few new ideas on either the Democratic or Republican side of the political debate since the advent of the Obama administration that we should welcome the arrival of the healthcare co-op idea recently floated by the Senate Finance Committee.

Of course, the idea has already been ridiculed by politicians on both sides of the aisle, because it is neither a true public option nor a fully private-sector enterprise. But let’s remember that being mocked on both sides is often the beginning of bipartisanship. So far, co-ops have been viewed as a sort of union where consumers would come together in a nonprofit structure, negotiate with doctors and healthcare providers, and compete against traditional private-sector insurers. I can’t get too excited about this concept because it does little to reduce overall cost, which is the real issue here. Eliminating some of the costs associated with the high salaries of private-sector management and the remuneration of third-party investors is not that big a deal. Also it’s hard to see the self-replicating nature of the enterprise that would allow the co-op to rapidly reach a scale where it can compete against private insurers.

But if doctors were allowed to become part of the co-op, then the game would become interesting, because both sides would have a vested interest in lowering costs and could engage in the co-creation of unique solutions to get there. Imagine you’re a middle-aged, overweight person belonging to such a co-op and you’re facing your general practitioner for your yearly physical. Further imagine that you both are members of the same local co-op. Your motivation to lose weight increases if you know your extra pounds not only create a health risk but also impact your premium. Because the doctor is a fellow co-op member, he is no longer a dispassionate dispatcher of “I don’t care if you listen to me” advice. The doctor is now more likely to put pressure on you to shape up, since he personally suffers the financial consequences of his patient’s bad habits. Both doctor and patient now have skin (or pounds) in the game. The royal “we” in “Now, how are we going to lose weight?” becomes a true “we.” And that’s harder to ignore. In this intertwining of the doctor’s and patient’s fate lies the true opportunity to reduce costs, and the chance for the co-op to effectively compete with health insurers.

It also becomes easier to see how co-ops with joint memberships of patients and doctors could scale up rapidly. There is an eBay quality to this marketplace of buyers (patients) and sellers (doctors) coming together to organize an efficient healthcare exchange. I’ll bet you could find quite a few doctors and patients in many communities willing to put up $5,000 of capital to get a local co-op going. Before you know it, you’d have a respectable amount of capital that would allow the co-op to set up shop, buy a few computers, and hire some people. If we truly want healthcare reform, let us put our money where our mouths are. The interests of doctors and patients are objectively aligned. A few successful, early communities could trigger a rapid proliferation of the concept at the national level. If doctors became excited about co-ops, they in turn could redefine their own relationship with their hospitals and bring them to the negotiation table with the co-ops.

This democratization of healthcare through co-ops would bring healthcare back to the people who care the most about it: patients and doctors. Let’s give them a chance to shape the concept.

Hey Barack, why haven’t you called?

Saturday, July 18th, 2009


I’m disappointed. I had you down for a web 2.0, co-creation type. I saw you double-task like a 12 year-old: Blackberry in your left hand, conducting a live town meeting with your right hand. During the campaign, you were so organized that three of my friends asked me to vote for you and I’m not even a citizen (one of them even offered to do the paperwork for me, but TSA talked him out of it). You had me blogging, participating in neighborhood parties and urging others to give money.

But since you’ve been elected, I haven’t heard from you. O.K., that’s not exactly true. I’ve seen a lot of you on TV. But it’s all about big top-down programs like TARP, stimulus packages and universal healthcare, driven out of D.C. I don’t live in D.C. I live in Concord, Massachusetts. You’ve stopped calling on me. What happened? I never bought the “war as a metaphor” thing when it came to drugs and terrorism. But the economy, man, that’s a real war. Some of my friends have been laid off or have lost their house. I also have a small business and I know how tough it is. So I’m ready to fight. Why aren’t you calling?

You tell me what to do. If you want to do healthcare, I’ll work something out in my little circle. I’ll start with cost. I’ll get everybody to lose weight and become healthy in my small business. I may have to start with myself on this one. I’ll go negotiate a special deal for my company with my local doctors and hospitals. Better yet, I’ll enlist the other small businesses from downtown Concord to come with me and we’ll wrestle out a new arrangement from both care providers and the local insurance company (they don’t get along too well anyhow, so we’ll teach them how to co-create with us at the center). Maybe we’ll start a citizen’s initiative that finds out who’s been denied coverage locally and we’ll force the insurance companies to include them if they want our business. But you gotta give me direction, Barack. Provide me with legitimacy and tools to engage these doctors, insurance companies and left-out people.

If your agenda is jobs, I’ll hire a few kids out of college, just to help. I’ll organize internships for high-schoolers. With the other businesses in Concord, we’ll put together summer programs (“learn to be a CPA, a grocer, a consultant, a garage mechanic, all in one summer”). We’ll discover who’s really good at what and we’ll hire them (I say this with the smugness of the guy who thinks he can outbid the local Jiffy Lube, but I might be in for a surprise). Their parents will want to come to our shops and buy services from us because we’re nice to their kids. I’ll stop treating my home town like a stopover place on my global itinerary. But again, Barack, you gotta give me leadership and support.

I know you’re going to say I could so some of these things on my own: volunteer at the hospital or recruit a couple of kids. But I want to be part of a BIG THING. I want a vision, a massive mobilization, an inspiration. I’m thinking “going to the moon” forty years later. If you do that for me, Barack, I may even start feeling good about your hitting me for more taxes. Just call me. I’m shovel-ready.