Monday, January 31, 2011

Health Care System Remains Broken, Neglected

I think the real problem is decades of resistance to fundamental change. The health care system in the USA has been broken for decades and resisted change to bring costs and other burdens into line with other rich countries. Piling on decades of neglect to a system broken decades ago has left a huge (huge - over 17% of GDP, costs twice as high as many other rich countries and results no better than average rich countries) problem. Trying to reform a huge broken system after the crisis point has been reached (where we are now) is very difficult. I think looking for short term causes of the current problems is deceptive. The real cause of the current mess is decades in the making.

The USA health care system is huge. Tons of great stuff has been done for decades. The problem is with such a huge system enormous problems remain and have festered for decades. I think things will get much worse (difficult to deal with the long overdue needed, improvement) before getting better. The system is unimaginably expensive and wasteful. The fundamental brokenness continues to be ignored. Even the good stuff being done now, seems to be minor compared to the fundamental changes needed.

The USA economy has many problems and strengths. The health care problem remains the largest - larger than investment banking, unemployment, unfunded liabilities (which the health care system is by far the largest factor - unfunded retire health care costs), huge jail population, education system needing improvement... The good news is the USA economy, even with all this, has enough strengths to carry the weak parts of the economy for decades to come. It is true however, that even the USA economy cannot carry huge under performing parts of the economy forever and remain strong. Of all the economic problems we face, failing to address the huge problems in the health care system is the most likely to lead to a dramatic decline in the USA's economic future. We have avoided systemic changes for decades. Year after year the problem grows (even with lots and lots of great things being done - which seem large but are unnoticeable within the enormous scope of the problem) - with the health care system not only costing more but a larger percentage of GDP EVERY YEAR for decades (I may be wrong but I think this is true). Dr. Deming pointed out the system was a deadly disease decades ago. And it has gotten worse (costing more and continuing huge economic problems - huge cost to business and people and huge worry, bankruptcies, focus on disease treatment not health care...).

I'm sorry to say I think things will get much more hectic in the coming decades than they have been as the cumulative effect of putting off needed system improvements for decades come home to roost.

Reaction to, Industry in Crisis

Across the nation delivery systems, policy makers, insurers and consultants are searching for new ways to solve problems or create value. Systems are banding together to form Accountable Care Organizations, we are reorganizing around Value Streams, Value Based Benefit plans are getting created to shape behaviors, large hospital systems are buying practices and consolidating the market etc. The list goes on and on.

The good news is that there seems to be more experimentation taking place than ever before and some ideas are gaining traction (just read Atul Gwande’s article last week in the New Yorker or my own organizations work in the Medical Home and Hospital Transitions). The challenge is that so many things are happening all at once that our current management systems are neither disciplined nor flexible enough to effectively manage this change.

Related: USA Heath Care System Needs Reform - CEOs Want Health-Care Reform - Health Care Crisis

Wednesday, January 05, 2011

Unemployment - hidden activity?

I Wonder How Many Unemployed Folks Are Hustling

But the idea here is that "hustling" is any kind of economic activity that you are not reporting to the government; either because you don't want to go to jail or just don't want to pay taxes or for them to know how much you make.
Are my hypothetical self and this real life person the majority of the unemployed? Of course not. But you've got to at least wonder how many of them are out there.

Probably the most important part of that measure would be a measure of the change in that during the employment cycle. If it were say 2% of the population every year while the IRS might want to know it isn't a huge factor in thinking about the state of the economy and employment. If it is 8% of the population today, and was 2% 5 years ago, that would be more interesting and let you know the situation may not be as bad as you think (looking just at employment data). I personally doubt it is a significant macro-economic factor (the variation in it during the employment cycle).

Looking at this rate between countries would probably provide valuable information. Some of the Euro and bank scandals have shown the underpaying of taxes by Europeans and also the rich Americans suing to prevent disclosure of their fraudulent tax avoidance aided by large bailed out banks.

Related: How do I Know What Unemployment Statistics Mean? - Another 663,000 Jobs Lost in March, 2009 in the USA - Can Bankers Avoid Taking Responsibility Again?