Earlier, I had blogged about how business travelers can take advantage of free time and how hotels could benefit from a networking service I dubbed “hotelmingle” (link to blog).  Well, I just happened to find an adaptation of that idea from Stacey’s restaurant in Dublin, California.  They describe the service as:

 Make it easy for luck to find you. Sign up here and we’ll randomly select five other local professionals, in a variety of fields, to join you for lunch (at 12:00 noon). You might find a new customer, business partner, employer, mentor, golf partner, or more

The screenshot below describes the service in more detail.  I would love to hear from Stacey’s or anyone who has tried this service.  I am curious to see how it is working from the restaurant’s perspective as well as anyone who has actually tried it.

What are some of the innovative healthcare reform policies being proposed by the candidates?
Let me start by clarifying that when speaking of health care issues, all three of the candidates are focused on America’s uninsured population which is currently estimated to be about 47 million people and includes about 10 million children.  The notion that our Presidential candidates would focus their health care platform on the uninsured is in itself somewhat surprising.  Historically speaking, this group of people has not been well represented politically or economically.  However, as health care cost becomes a significant portion of America’s struggling economy, the middle-class American, who was previously unaffected, is fast becoming the poster-child of the uninsured.  Unlike the historically disenfranchised uninsured population, middle-class Americans are powerful voters and can decidedly affect the outcomes of this election.  In addition, the cost of paying for health care, from the nation’s employers, is affecting the global competitiveness of US companies.  This, in itself is, cause for concern for the presidential hopefuls.  All three candidates have plans that would decrease these numbers but their emphasis and approaches differ significantly.  A few of these ideas may even fall under the innovative category. 

So let’s take a look at the proposals coming from Clinton, Obama, and McCain.  What’s innovative and different about their proposals?
Clinton’s healthcare platform is called the “America Health Choices Plan” which it claims will provide coverage for every American.  The basic thesis is that all Americans will be mandated to purchase coverage.  Coverage can be purchased or provided through employers, public programs (such as Medicaid, or Medicare), or through a new Health Choice Menu that contains both public and private plans.  What is novel about this idea is the notion all Americans will be required to have coverage regardless of the individual’s economic or employment status.  Remember that historically health insurance is obtained through employers; or if you are poor, or old, through Medicaid or Medicare respectively. 

One State, Massachusetts, is undergoing a similar experiment as we speak.  The State of Massachusetts enacted the coverage mandate in 2006 and provided the State Health Connector with the authority to provide a menu of health plan options to Massachusetts residents who cannot afford to purchase insurance and cannot qualify for public programs.  Another innovative angle of Clinton’s plan is the opening of the Federal Employee Health Benefits Plan to the public.  This plan is currently only available to Federal employees like members of the Congress.  (How is Clinton’s plan financed?  See next question)

Now, onto Obama’s healthcare platform that also promises universal coverage.  One key difference is that Obama will not require all Americans to have insurance, except children.  Instead, his proposal is to push health insurance premiums down low enough that every American will be able to afford to buy insurance. (How is this plan financed? See next question).  Americans who currently have access to health insurance through employers would continue to have access as they have.  For those without access currently, Obama proposes the creation of a National Health Care Exchange through which individuals can purchase affordable health coverage.  Obama’s plan will require all children to be insured.  His campaign is committing to revamping and expanding of public programs including Medicaid and State Children’s Health Insurance Program (SCHIP). 

The McCain plan is to provide a free market consumer-oriented approach to insuring Americans.  This plan would use the private market to stimulate competition (much like today).  Americans would be given incentives through tax credit to purchase insurance.  Although employer-sponsored plans will still available, McCain is proposing that the tax benefit of providing employee insurance be removed from business. 

Do their “innovative” proposals have anything in common?
There are commonalities that cross all three proposals including the candidates’ agreement that all people should have access to health insurance regardless of their health status and the portability of the insurance plan from job to job.  The most important commonly shared view among the proposals is the fundamental recognition of the importance of quality standards in the care delivered.  We (U.S.) spend more than $2.4 Trillion annually on health care and yet we rank lowest amongst industrialized nations in the most common health indicators.  As an example, US scores a lowly 39% out of 100% on infant mortality rates compared to best practices in other industrialized countries (study by Commonwealth Fund, Sept 2006).  It makes no sense to provide universal coverage and spend precious resources if the care delivered results in the poor outcome that it does today.  Hand in hand with quality standard is the need to have process innovations.  Today, patient safety error is the dirty laundry of the healthcare system.  It alone caused 240,000 potentially preventable deaths.  Setting clinical quality standard without accompanying processes that enable its success would be akin to asking a pro racecar champ to compete without outfitting him with the right equipment and gears – a mission that is impossibly ridiculous to achieve regardless of the skills and talents of the driver.

What is the impact of these policies on the everyday working man/woman and their family from a financial, time, and quality of care perspective?
Ahh…this is the heart of the issue and the answer depends on who you are.  Are you a working middle-class American without insurance?  Are you a small business owner?  Or are you an executive at a large company struggling to compete globally?  Are you healthy or are you struggling with a chronic condition?  The $2.4 Trillion that is spent on health care today is a lot of money and any proposal to reduce or subsidize this amount will meet significant resistance from interest groups.  Who wins and who loses depends on, well, who you are.  Let’s take a look.

First, let’s start by examining what these policies will do for the every day middle-class American.  Clinton’s plan to mandate insurance coverage will be funded by rollback of the tax cuts provided by the Bush Administration to the wealthiest Americans (those making $250,000+) and also by “savings” that are accrued as a result of practicing good medicine (this is much more esoteric).  So, if you are a middle-class American currently insured through your employer, not much changes.  If, however, you are uninsured, Clinton’s plan will offer you a menu of affordable plan options (including what is currently available to members of the Congress).  But the catch is, you have to buy it – no ifs, ands, or buts.  Overall, this works out pretty well for the middle class American.  Not so for the wealthy person making in excess of $250,000, because your tax just went up to pay for the coverage of the guy who lives in the next (poorer) town.  By the way, if you are a small business owner, Clinton will provide tax credit for covering your employees.      

If Obama becomes the Democratic nominee and it is looking more like this might be the case, you will be in a different situation.  Again, there is not much difference for the middle-class American worker who currently receives health coverage through work.  However, the same person who is uninsured will also have the option of purchasing from a pool.  Unlike Clinton’s plan, you are not mandated to buy a plan if you don’t want to.  Sounds good?  Well, maybe.  In this situation, people who are healthiest are more likely to “opt out” whereas those sicker will likely want to purchase coverage.  What is likely to happen over time is the insurance options available will become more “narrow” in their benefits and more expensive.  This is a natural phenomenon that has been observed and tested over and over again in the free market.  So, if you are healthy and do not need insurance, you may be in luck.  If you should ever need it, however, well, we hope you have some money stashed away.  Obama is likely to fund the coverage in the same way as Clinton, and that is through tax cut rollback of the wealthiest American.  In addition, Obama has said publicly that he will ask all but the smallest business to assist in the payment of his plan.   A likely effect of his plan is that employers may push their employees to purchase health insurance on their own and provide just the “subsidy”.

McCain is staunchly opposed to any tax increases.  He is for a private market mechanism and competition.  And since the majority of insured Americans are already in the private market (besides those in public programs such as Medicare, Medicaid), what McCain is proposing is not so different in philosophy from where we are today.  One thing that will be noticeable is the tax credit that will be given to individuals and families as incentives to purchase insurance.  Since McCain’s plan would remove tax credit given to employers for providing insurance, many Americans might expect to see their employers stop offering health coverage altogether.  This is great for employers because it gets them out of the game of health insurance entirely.  The flip side is that individuals are able to choose whatever they want to buy with their tax credit.  Under the McCain plan, we are likely to see many more Americans opting out of insurance altogether since it is not mandated.  We might expect the hospitals and doctors to have to “write off” on care they delivered to people who have no ability to pay.  McCain is also for what is called a Health Savings Account – a “401k” type account for health care introduced by the Bush Administration.  This type of account typically benefits wealthier individuals because it can be used as a tax exemption and investment vehicle.  For the common man, however, we might be finding ourselves in the shoes of shopping for and comparing health plans, premiums, benefits, doctors, etc.  Are you ready?    

Which candidate do you think is really looking at the problem from a fresh perspective?
Clinton and Obama are pushing toward policies that will truly move the US to become a nation that promises health coverage to all of the people.  To execute on what they are proposing, however, will require significant collaborative effort, political will, populace and interest group support, and adequate revenue.  That is to say, both plans are far from a slam dunk.  That said, this is the first time in a long time that universal coverage has become a centerpiece of the candidates’ domestic platform.  It goes to show that America is ready to take on this issue and do something about it.  Will we get to universal coverage?  My prediction is that we will see a lot of tweaking in the first 4 years and depending on the success, we might see an expansion (or abandonment) in the subsequent term. 

Which policy seems to be the most innovative and yet address the most critical issues?
Clinton and Obama’s policies are both aimed towards the goal of true universal coverage.  However, if coverage is not mandated, we are likely to experience “adverse selection” – meaning that those who choose to buy coverage are those who need it the most and those who do not buy coverage do not anticipate using it.  If this occurs, health care premiums will increase over time (to cover the cost of caring for sicker people) and in the end, fail to accomplish the goal of affordability.  In my view, Clinton’s plan has the best chance of addressing both the universal coverage issue as well as the affordability issue.  By mandating coverage, the healthy people are mixed in with the sick people.  The downside is the healthy people will subsidize the premiums of the sicker people.  To understand this better, let’s use car insurance as an example.  If only bad/risky drivers are insured and all the good/safe drivers are not, the insurance premiums will be much higher.  On the other hand, if the safe drivers and the risky drivers are all required to obtain insurance, everyone gets some coverage but certainly the good drivers will be subsidizing the bad drivers’ premiums.   

What else do you think they could be doing?  Who else needs to step up to solve the issue?
As I mentioned before, what is true of all the plans is the fundamental recognition of the importance of quality standards in the care delivered.

No matter which candidate wins, we as consumers will likely be in the shoes of shopping amongst different plan options.  Think about what happens today when you pick a plan.  You (or your spouse) go to an HR presentation at work, he/she tells you the highlights of the company plan(s) and the premium(s) and bam! you make a decision.  The process repeats itself during the annual company open enrollment.  How do you know that you picked the best plan, doctor, or hospital for your needs?  What if you have a condition that you do not wish to let your HR person know (e.g., depression)?  How can you be sure that what they presented in vanilla fashion to everyone suits your needs?  Today, there is no easy way for the average person to select and compare among different health plan, doctor, or hospital options.  We are either left with no information or, worse, bombarded with the clinical alphabet soup of information.  There needs to be a systematic, logical and user friendly way to compare options and outcomes/qualities of care based on individual needs.  This will require greater transparency by people within the health care system to share outcomes, quality and pricing information, which is largely hidden from the public.  Until these vehicles are available to all Americans, any policy that pushes for greater consumer “control” of health care cost and outcomes will be foolish and irresponsible. 

So what’s the bottomline?
None of the candidates’ plans will be easy to achieve politically nor will any be cheap.  It is also important to acknowledge that important details of their plans are yet to be fleshed out.  However, here are my picks based on what we know today:

Want universal health care?  Choose Clinton. 
Want to strengthen our public safety net?  Elect Obama.
Want to help employers get out of providing health insurance?  Pick McCain.

Also expect more discussion and debate on quality outcomes and its use as a measuring stick for the evaluation and the payment of care delivered no matter which candidate is chosen as our next president. 

About the Interviewee
Dr. Mary Hsieh’s career has been focused on fixing the broken processes in the US health care system.   She is the Founder and President of QualityTip, Inc., a consumer health care decision-support company.  She is a health care leader/entrepreneur with experience in large, complex not-for-profit and fast-paced start-up organizations.  She specializes in health care policy, strategic planning and execution, program development and expansion, and technology and business project management. 

Dr. Hsieh received her Doctorate in Pharmacy (PharmD) from the University of California, San Francisco (UCSF) and holds a Masters in Public Health (MPH) from the University of California, Berkeley in Health Policy and Management.  She is an expert in scenario planning and a professionally trained facilitator.  She is currently on the Board of Directors at The Art Connection, a not-for-profit arts services organization.

The mother of all databases, the relational database, is at the center of everything, which is why prices of databases have stayed the same. Then we’ve got these silos on top of the database — the enterprise resource planning (ERP) silos — which is just more extortion because you need a $100 million SAP implementation to make it work. Then you’ve got this tool called “business intelligence,” sitting on top of the ERP, which is oxymoronic because it’s only a reporting system – meaning it delivers information about what’s happened to your business after the fact, when it’s too late for you to do anything about it, so it’s not really “intelligence” at all. And then you’ve got these incredibly expensive service and consulting companies who try to make this legacy stack work. Put it all together and you’ve got a three-layered conspiracy of aligned interests to extort money from your company, which prevents incentives to innovate.

Something about this interview really hit home with me.  Innovation within Enterprise Software has become a chicken or the egg conundrum.  Because the technologies described above are so deeply ingrained in the resumes and job descriptions of IT hallways, innovation (or change) is met with tremendous skepticism, and outright fear.  Therefore, Enterprise Software providers continue to create technology that IT is familiar and comfortable with.  Who tips the balance first – the Enterprise Software provider that creates the next “great thing”, or the IT department who breaks out of the mold and demands innovation?

I will be attending this year’s Software 2008 conference in Las Vegas.  As much as possible (I will be working one of the booth’s), I plan to see “the future of software”.  Look for updates next week!

Drivers of Innovation

1. Pride (lack of)
2. Realization of a problem
3. Experimental mindset (fail fast and often)
4. Innovation “mindset”
5. Freeing your mind
6. Desparation

Destroyers of Innovation

1. Pride (too  much)
2. Complacency
3. Decision by Committee
4. Excuses
5. Fear