#HealthReform 101 [aka ‘health innovation’] – ‘None of the Ransomed Knew How Deep Were the Waters Crossed!’

by Gregg A. Masters, MPH

A “HealthTweep” Pulse Check – UPDATED

But none of the ransomed ever knew how deep were the waters crossed  The Ninety and Nine

This is a story about innovation and the peril’s – both known and mostly unknown – innovator’s face. More often than not, this is typically a cohort of well intended but very ‘green’ (some may say unreasonably certain) in terms of world experience beyond a narrowly defined craft. Given the churn in the innovation space recently, and more specifically the attention given to the shaky ground if not outright descent (in both sentiment and market value) of the three (3) most visible and potentially disruptive [of legacy inertia] health[care] unicorns @Theranos, @Zenefits and @OscarHealth. A tweet exchange on the tech vs. people, process and culture role in innovation with @HiMSS Social Media Ambassador @BTBunting got me thinking…..

So, I thought it helpful to look back at some of the commentary (and noise) associated with the authorship, markup, passage and now relentlessly  labored implementation of the Affordable Care Act (ACA). While originally framed in terms of the health reform narrative, the post speaks equally to the flood of players piling on in the innovation space, from Health 2.0 to a rash of ‘me too’ accelerators, incubators and even institutional nested innovation centers now peppering the U.S. healthcare landscape.

I surf, so the following metaphor occurred to me back in August of 2009.

Have you ever been sucked into the white waters of the Pacific after falling off your board; only to find yourself gasping for air yet unable to surface? It’s kinda frightening, even for the more accomplished surfers’ among us.

Ok you say, I got the visual, but don’t surf and what’s that got to do with health reform? It’s really quite simple. The oxygen (or change imperative ‘momo’) is gone, and the business owner of the reform narrative is desperately flailing for air. What was once seemingly brilliant political positioning, i.e., ‘you (the Congress) give me something I can sign into law, now appears to have degraded into a desperate ‘chicken dance’ in search of a tangible face saving political accommodation.

Yet, the war is over and the health insurance industry has already won. They’ve successfully enrolled us in their ‘faux hope’, yet compelling version of ‘The Matrix’. Never mind the 46 million uninsured, or the expanding ranks of the ‘diminishing returns’ under-insured, the dubious and seedy practices of cherry picking or worse yet retrospective rescissions, while the relentless and intractable ‘evolution’ of the health insurance industry away from comprehensive (true HMO like) coverage to smartly branded (Edward Bernays could not have offered better ‘re framing’ counsel) ‘consumer directed health plans’, essentially re-defines the industry.

Why United, Aetna, WellPoint, the Blues, or their regional derivative iterations et al, so wholeheartedly embracing this dressed up risk shifting charade is not prima facia evidence that they can’t cut it, have patently failed the American public, and despite their scale, can not manage health risk let alone delivery systems is not front and center in the health reform conversation is beyond me. Where is the primacy of the ‘Mayo (collectively speaking of organically baked, physician group culture based integrated delivery systems) v. McAllen” (as proxy for fee for service sweat shops) debate?

To my great dismay, this tektonic healthplan (health insurance) risk shift is in some measure aided and abetted by well meaning, thoughtful and committed ‘health 2.0 entrepreneurs’ who passionately pursue web based technologies with intent to empower consumers in the cross-hairs and rapacious appetite of the ‘resistance is futile’ health careborg.

In the end (and yes, it is over, for now…) that which plays out in Congress will be pure facing saving attempts to ‘put lipstick on a pig with whack-a-mole DNA’. The byproduct and amalgamation of this output alchemized by the forces of unreasonable change, leveraged by the vocal naysayers relentlessly pursuing their culture war agenda to pierce the veil of what seemed to be a Presidential mandate above reproach, will castrate once hopeful visions of the health reform we so desperately need.

In view of this dumbed down pseudo national conversation, I imagine more slack will be cut for the failed architects of the ‘HillaryCare’ initiative. Apparently, the Millennial answer was not to stay above the fray via Obama’s ‘Eight Principles of Health Reform‘, but perhaps pursue a more managed center absent artificial legistlative deadlines, coupled with enlightened curators of the conversation.

So there you  have it….

You may or may not resonate with the notion of ‘unreasonable certainty’ (vs. the ‘reasonable  uncertainty’) often alchemized by life experiencas a driver of misplaced confidence in as yet unproven innovation enabling a sustainable healthcare economy. Yet, in a society that often OVER-values how you say something vs. the veracity of what what you say, we might at least pause to examine the faith we place in certain people, enterprises, even ideologies – but most certainly the ad copy associated with industry cheerleaders.

Finally the tune I wanted to add (again) to @Colin_Hung‘s HiMSS mixtape was the same one as last year, only emphasizing a different verse of the lyrics. That is the Who’s ‘we won’t get fooled again‘, yet the 2016 version is ‘meet the new boss, same as the old boss‘.



Originally posted here on August 18, 2009

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