HEALTHY ONLINE

Whether you like it or not health care financing is transitioning from payment for discrete services to global payment for value. Whether you agree with this trend, or comprehend its meaning, if it has one, is largely irrelevant in the short term. The government of the United States, the Chamber of Commerce, both political parties, all health care stakeholders, and even your own medical associations are fervently supporting, and actively promoting, paying you for value instead of work. Value is defined by a set of statistical metrics calculated across the spectrum of services you provide, and some that you don’t. So for example, if Starbucks were to be paid for value, they would get say, $2 for a venti latte, plus a fluctuating amount based on the average temperature of their lattes, the ratio of espresso to milk, the percent of air in the foam, the time from door to latte, etc., over a representative period of say 90 days in year one and maybe 12 months in subsequent years. To enable ...

America is spending $3 trillion on health care every year. Does that number include toothpaste? Surely toothpaste is very important to your health. How about baby powder, diapers, condoms, soap, lip balm, nail clippers, detergents, mops, vacuum cleaners, washing machines, smoke detectors, air filters and air bags? How about everything Nike sells, diet books, your gym membership, bicycles, skateboards, everything Sports Authority carries in its stores, and all Weight Watchers products? And then there is quinoa and edamame, spelt, flax, organic kale chips and those scrumptious gluten-free kelp smoothies. You can also count the entire budget of the EPA, the FAA, the CDC, the FDA and the USDA, and while at it let’s not forget the war on drugs, the war on poverty and the war on terror, and of course education and vacation, sunscreen, traffic lights, firefighters, police and those weirdly bluish ice-melting crystals for your driveway. It sure looks like we are spending all our money on carin...

There are close to a quarter million primary care physicians in the U.S., more than any other individual specialty, and about half the total number of all specialists combined. Yet, somehow, primary care seems to lack the power and social influence necessary to chart its own professional course. As the availability and granularity of specialist physicians increased, the value proposition of a generalist primary care doctor seems to have become unclear to those who pay for medical services and to physicians as well. As a result, primary care medicine was forced to price itself lower than specialized medicine, and now it is being forced to compete with a variety of other business models. Primary care seems to be experiencing an identity crisis, unable to decide if it is the cornerstone of medicine, or an antiquated service whose time has passed. What is primary care? The primary care name itself can be understood in two very different ways, depending on how you translate the word primar...

Did you know that the Ford Motor Company which created the first mass produced horseless carriage in 1908 is one of the largest manufacturers of automobiles a century later? Did you notice how cars today look almost the same as the Model T? They are all made of metal, have four wheels, a steering wheel, a dashboard, a windshield, two rows of seats and an engine. Closer inspection reveals that all newer car manufacturers make cars that look and feel just like the cars made by the Ford Motor Company. And they all drive on roads and use wheels, wheels, the hottest disruptive innovation of the Neolithic era. Truly disruptive innovation, unlike its short lived destructive cousins, stretches across millennia of useful applications. Strangely enough, beds and tables and chairs, and the houses they furnish, look basically the same as those used by Louis XIV. Bread loaves and wine look the same too, and so do fishes. Another thing that hasn’t changed much from the beginning of time is the ferti...

If F. A. Hayek were alive today, he would support the revival of labor unions in general and professional labor unions in particular. Towards the end of the Second World War, Hayek wrote a book warning us all that allowing governments to engage in extensive central planning of economic activities is nothing more than a road to serfdom for humanity. F.A. Hayek was not an Ayn Rand sociopath, and he included in his vision reasonable government regulation of markets, strong safety nets, and something that looks awfully similar to the avant-garde “ guaranteed basic income ” discussed nowadays in some European countries. Unfortunately for us, and kudos to Prof. Hayek, seventy years after the publication of his book, we are well on our way to universal indentured servitude. Ordinary Citizens In September 2014, Martin Gilens and Benjamin Page, two Princeton researchers, published the results of a longitudinal study on policy decisions in the U.S. from 1981 to 2002. After crunching enormous am...

You may not be ready to admit it even to yourself, but you know it’s changing. Permanently. Some say it’s for the better. Others say it’s for the worse. Most don’t really care much one way or the other. After all, health care has been evolving and changing over thousands of years, and the experts best positioned to evaluate the health care turmoil of our times are yet to be born. Those of us who are now in the eye of the storm have an understandable tendency to analyze high velocity changes, such as the number of uninsured or the number of hospital mergers, but the slower and more permanent changes are unfolding deep below the surface. Perhaps the most enduring alteration to what we call health care is the diminishment of medicine as a whole, and the fading importance of its practitioners, starting with the outer edges of primary care. The “Looming” Primary Care Physician Shortage We’ve been experiencing a “looming” primary care doctor shortage for several decades now, and so far it so...

The distinguished JASON group of anonymous scientists and academics that provides consulting services to the U.S. government on matters of defense science and technology, just published a sequel to the 2013 best seller, “ A Robust Health Data Infrastructure ”. The new report is titled “ Data for Individual Health ”, and it has two purposes. The first and foremost purpose is to backtrack on the searing criticism leveled at government efforts to promote health information technology, which evoked much angst and indignation earlier this year. The second purpose is to expound upon the exact nature of personal data required to feed the robust infrastructure laid out in the first JASON report, complete with illustrations and examples of breakthrough benefits to humanity, such as helping city planners design bicycle paths . Yes, bicycle paths. And if you didn’t know that the number one health care problem in this country is the layout of bicycle paths, then you are a Luddite, and luckily your...