Thoughts on Health Care Reform

Although looking for government involvement/intervention/deep regulation to solve a problem is usually a last resort, the problem of ravenously increasing healthcare spending does not appear to be an ordinary problem. This has been considered a major problem for pretty much my entire adult life (20+ years). It only seems to have gotten worse. I am afraid, now, that Republicans/conservatives have completely ignored this situation too long, to their detriment.

However, I dearly hope we will not just dump more $ into system that we already agree consumes too much money and resources. Let's experiment with some kind of alternative, much leaner systems. Some ideas:

• Employ salaried doctors, not independent contractors, like the famous Mayo Clinic does
• Implement super, super aggressive management of prescriptions. It goes without saying that only generics should be used, where they are an option. In all cases, have a bias toward starting with the most cost-effective medicine, before escalating to the latest and greatest.
• Pass special tort reform, to eliminate defensive medicine.
• Consider aggressive, HMO-style gate-keeping. For instance, perhaps patients should always have to call the "nurse line" before coming to the doctor's office, to eliminate visits for routine colds, etc.
• Make aggressive use of the most cost-effective skill-set: don't use LPNs for stuff RNs can do, don't use Physician's Assistants where RNs can do, etc.
• Make aggressive use of wellness coaching--participation is not optional.
• Implement disciplined regionalization of procedures. Patients have to go to the approved, efficient facility in the region, not the one they might find most convenient.
• Keep some element of the first-dollar motivation that HSAs provide, even if it has to be on a sliding scale.
• Obviously we want to look at streamlined administrative options.
• Use expensive infrastructure 24x7.
• Take a very tough line on necessity of treatments. Just in my extended family, I know of a number of cases where prescribed treatment has been unnecessary or useless. This article that suggests most TMJ suffers might do best with no treatment is a good case study. Or back surgery!

Niche PC Ideas

In general, the Windows PC is ultra-commoditized. It is very hard to do anything to earn a higher margin. My ideas for carving out a niche would be:

• Crapware (aka, Trialware)-free (because right now Best Buy is getting some people to pay an extra $75 for this)
  
• Built-in backup (software, but also a mirrored hard drive)
• One or two very modest design and engineering touches--such as the Mac-style magnetic power cord
• The crowning glory would be easy-to-use virtual machines (VMWare), so that you could always roll back to a pristine install

Toaster Feature: Lever to Push Out Short Slices

I hate it when I have put a short slice of bread in the toaster (such as the end slices from a tapered loaf of rye), and can't get ahold of it to pull it out. This has to be a pretty common second-order design problem for toasters--even English muffins are problematic.

The solution I envision would be a pivoting lever, attached to the bottom of the bread carraige, that could be pressed on to push up the slice higher.

Run Capital Intensive Industries Round the Clock

The WSJ had a good article, written by a report hospitalized for a week with pneumonia, for a cost of $100,000+, on effective but expensive hosptial medical equipment. One observation was that, unlike other industries, new medical equipment seems to augment, rather than obsolete, old equipment, so the capital bill just rises and rises. It seems to me that this expensive equipment absolutely should be run around the clock. Shift-based discounts could be given if you were willing to come in for a CT scan at, say, 3 AM.

Likewise for airplanes and airports. Given all the problems with airport congestion, why are there no flights between 10 PM and 6 AM??

Strategy: iTunes Influence in Music Industry

The WSJ has an aritcle discussing the influence of iTunes in the music industry. The part that sticks out for me is how they don't follow the simple, obvious, somewhat crass business model of promoting whoever pays the most. While they are hardly "pure"--they definitely want something in exchange for front-page promotion--it is much more subtle and thoughtful than "payola". They look for exclusive material instead of cash.

So they are much closer to pure in terms of being a reliable taste-maker, instead of just another purveyor of unwanted commercial messages. Very effective strategy.

Google Bus System

Google is running its own bus system. Very interesting stuff. Of course most companies would never even think of doing this, but if they did, fleetingly, entertain the suggestion, they would instantly dismiss it as having nothing to do with their core competency. Google's ceaseless innovation mindset, not confined to products, but extending to process and culture, reminds me of Wal-Mart and Toyota.

As much as it is a generous fringe benefit or an environmental gesture, the shuttle program is a competitive weapon in Silicon Valley’s recruiting wars.

A secondary advantage a Google has is the "Disney effect" of providing a pleasant, upscale, "people like us" ridership, thereby mitigating one hidden objection to mass transit. No risk of having gun-toting, anti-social co-riders.

When I was at Otis Elevator 20 years ago (1988), it hadn't been so long since full-time working mothers had become a totally mainstream phenomenon. Child-care was a big issue. I remember at some kind of employee HR meeting, someone noted that it would be really convenient to have on-site child care. HR, in a somewhat typically condescending way, responded by first agreeing, in a pseudo-empathetic way, that yes, that would be nice; but, "you know, we're just not in the child-care business", so it can't be done. Within 5 years, on-site day-care started to become somewhat common. Not run by the employers, but by co-located out-sourcers.

EXCERPT:

In Silicon Valley, a region known for some of the worst traffic in the nation, Google, the Internet search engine giant and online advertising behemoth, has turned itself into Google, the mass transit operator. Its aim is to make commuting painless for its pampered workers — and keep attracting new recruits in a notoriously competitive market for top engineering talent.

And Google can get a couple of extra hours of work out of employees who would otherwise be behind the wheel of a car.

The company now ferries about 1,200 employees to and from Google daily — nearly one-fourth of its local work force — aboard 32 shuttle buses equipped with comfortable leather seats and wireless Internet access.
...
As much as it is a generous fringe benefit or an environmental gesture, the shuttle program is a competitive weapon in Silicon Valley’s recruiting wars.

Automatic Backup-to-Net

Here's a business-technology idea...a background feature that automatically backs documents up via the internet, as you work on them. Just as MW-Word, Excel, etc can auto-save in the background, this would auto-save to your personal backup repository in the "internet cloud". A key feature would be that no configuration or filing would be necessary--it just happens automagically.

Another important design consideration is the "find, don't file" metaphor Gmail uses. So no need to specify where to file.

Of course, this feature would be a slam-dunk for Google...

Postscript--just tried Google Docs and it essentally has the feature, of course--including the no-file-folder option.