by Lola Butcher
August 25, 2008 at 2:24 pm · Filed under Uncategorized
I was lucky to interview Stuart Guterman, senior program director of the Medicare’s Future program at the Commonwealth Fund. A couple of things that caught my attention:
Butcher: How should value in health care be measured, and do we need more measures or fewer?
Guterman: That’s really the crucial issue. There has been a lot of discussion about paying for outcomes, and certainly one can make a strong case that how the patients survives the health care, what the health status of the patient is in the long run is really the bottom line. But I think we are where we are on being able to pay for quality because we’ve developed a set of more reliable process measures, that is measures of how services are provided that are expected to lead to better outcomes. So we now can put together a list of things that are pretty much accepted as ways health care should be provided that will lead to better outcomes.
In terms of more measures or fewer, there are arguments for fewer measures because a long list of measures is thought to present the prospect of confusion. I think that actually if you have a longer list of measures and if you really are comprehensive in the list of measures for what you pay for, then you’re really transmitting a broader message that the objective is to improve quality and improve the value that you get for the health care dollar. I think that’s really the message that needs to be sent in value-based purchasing, not doctors should do this or doctors should do that. Doctors should really do a broad range of things that lead to better health for their patients.
Butcher: How should providers be rewarded for value?
Guterman: There are different ways to approach rewarding for value. Certainly you want to reward providers that provide the best care. There have been studies that found, however, that if you rely only those kinds of measures, then you end up basically making most of your bonus payments to providers who already are at the level that you’re looking for. If you’re really trying to improve the system, then you need to provide incentives for providers that aren’t where you’d like them to be to get where you’d like them to be.
So I think at some point you need to be able to reward improvement over time, and I think you also, when we have more information and we’re able to be more confident about setting levels of acceptable care, that we might want to pay on that as well. I think a good pay for performance system will basically incorporate measures of all three types of good performance so that we can have rewards for the folks who do it right, incentives for the folks who aren’t quite there yet but are improving, and then some more explicit recognition of the fact that you really need to be at a certain level in order to be considered a top-notch provider.
by jsidorov
August 22, 2008 at 8:11 am · Filed under Uncategorized
The World Health Care Blog welcomes Jaan Sidorov as a regular contributor. Dr. Sidorov writes the Disease Management Care Blog, where this piece 1st appeared.
I recently had an interesting lunch conversation with the Chief Medical Officer (CMO) of a regional health plan. After investing more than a million dollars in per year in ‘pay for performance’ (P4P) over the last few years, progress has stalled. As a result, the focus in this organization has shifted from P4P to the Patient Centered Medical Home (PCMH). This health insurer, like many others, is planning to invest in a PCMH project in the coming months. The CMO I spoke with cited two reasons why the PCMH was in many respects displacing P4P: a) the emerging realization doctors ‘can’t do quality alone’ under 1st generation P4P only — even if considerable economic incentives are available — and b) the PCMH promises a reduction in claims expense for persons with chronic illness within 1-2 years.
One would think that P4P would have led to local investments in practice redesign required to achieve the outcomes (performance) necessary to achieve the added revenue (pay). In this CMO’s experience, that simply didn’t happen. Apparently, the physicians’ pay wasn’t used to buy EHRs, hire additional care managers, or invest in decision support. Instead, the docs simply ‘added’ quality activities whenever they could in the course of business as usual. Perhaps the added revenue was used to offset the declining primary care payments we’ve been reading about. Another interpretation is they kept the P4P money and ran.
Has P4P’s less-than-perfect track record added to the growing luster of the PCMH? While any association between P4P’s disappointment and PCMH’s acclaim may be spurious, I wonder if there is more to it. In fact, I’m struck by an underlying similarity between P4P and PCMH. Much like P4P, PCMH involves additional ‘pay,’ but the performance measures have changed from process and outcome measures to ’systemness’ measures: for example, it’s not LDLs but referrals, not A1cs, but registries, not medication management but self management and it’s not cancer screening but clinic teaming. For the average CMO, those underlying similarities and available money make the transition from P4P to PCMH intellectually and operationally easier.
There are some interesting messages here:
1) while advocates of PCMH may suggest that managed care organizations should consider redirecting resources away from disease management to the PCMH, one has to wonder if the monies being used are being redirected from P4P and,
2) once again, much of the hope for PCMH is riding on its ability to reduce health care costs. If PCMH is going to survive in this CMO’s health insurance plan, it better deliver and quickly.
by David Harlow
August 21, 2008 at 5:30 pm · Filed under Hospital and Health System CIOs, Consumer Engagement, Health IT, Business of Health, Electronic Medical Records
A week or so ago, I read a disturbing article in the NY Times about Dan Kaminsky’s talk at the Black Hat conference: he’s been beating the drum for a while now, warning of what sounds like a serious security hole in Domain Name Server software offering an open door to hackers of websites containing confidential information and into email (which could allow phishing for usernames and passwords for otherwise protected sites). The technorati seem to agree that he’s identified a serious problem, and it seems that not all affected parts of the internet infrastructure have applied patches or upgraded their software.
Yet another reason to be wary of assurances that if the internet is safe for banking then it’s safe for health care information. Even the latest compact on privacy doesn’t count for much in the face of a technical issue of this magnitude.
Providers that have not adopted EHR systems to date could use this sort of news as an additional excuse to try to delay the inevitable. A study published in the NEJM a couple of months ago found that the reason most often given for lack of EHR in a practice is cost. (One commentator takes issue with that conclusion. I’ve also posted in the past about issues other than cost that stand in the way of EHR adoption.)
On the PHR front, this sort of news could scare off many people from uploading their health data into Google Health or Microsoft’s HealthVault.
However, the bottom line is that there is clinical value to using electronic health records and personal health records, and to the extent that providers and patients see that value, the benefit can be weighed against the cost of a potential security breach. The cost-benefit analysis will vary from person to person, depending on a variety of factors ranging from EHR considerations like the short-term effect of EHR adoption on productivity vs. the clinical benefits that can accrue to patients, to PHR considerations like tolerance for junk mail, a snowbird’s desire to keep doctors in two locations up to speed on conditions and treatments, and concerns about being denied employment due to a genetic predisposition to an occupational disease. (I know that’s supposed to be illegal, but, gee, do you think that might happen sometimes anyway?)
Would I prefer to stand firm and insist on perfect online privacy protections for financial and health care information? Of course! Is that practical? Of course not!
A few years back, my credit card information was inappropriately released by a vendor that apologized semi-profusely and paid for a year’s worth of fraud monitoring and reporting. Have I stopped using credit cards? No. The cost would be too great. Am I concerned that my physician’s EHR system could be hacked into? Well, my thinking on that is that hackers with limited resources probably want to go after something with greater interest, or at least greater value in the marketplace (e.g., Britney Spears’ medical records) so I am willing to continue to be part of the online system.
I am resigned to living with some of the burdens of modernity. Having completed my own cost-benefit analysis, I am not willing to live “off the grid.” Some of you out there may be willing to do so — you’ll maintain your privacy, but you won’t be able to read HealthBlawg any more.
– David Harlow
by JMoore
August 20, 2008 at 4:27 pm · Filed under Uncategorized
August 18, 2008
Adam Bosworth made quite a name for himself in the healthcare space while he was leader of the Google Health initiative. All got quite strange, however, when while on vacation late last summer, Bosworth decided not to return to Google Health. And while Bosworth went into stealth mode to develop Keas, Google chose not to replace him (a mistake) and Google Health fell under the tutelage of Marissa Mayer.
Bosworth has kept a very low profile since leaving Google, but Matthew Holt was able to get an interview with him, which Matt posted today. Roughly 35 minutes long, it is a good interview to listen to if you have the time. If not, here are my take-aways, with some commentary in italics:
Despite Holt’s prodding, Bosworth gives tells little of what happened at Google that led to such a sudden departure. Bosworth claims that he decided he wanted to work in a small, entrepreneurial environment that was nimble without a lot of “processes”. This rings hollow as he worked at Microsoft and BEA prior to Google, both very big companies. I’m not sure what happened at Google, and not sure anyone will ever know the full story, but clearly, more happened than Bosworth is ready to divulge.
His new company, Keas, has 15 employees, is about 6 months old and is looking to provide consumers with the personalized information they need to better manage their health. Boy does that ever sound familiar and I could probably rattle off about 15 Health 2.0 type companies claiming to do the same thing. Bosworth will be at the upcoming Health 2.0 conference so maybe he’ll divulge more there. Right now, all I see (should I say heard) in this interview is a company with another me to product. Barriers to entry for such products are quite low, but risks are high. Just look at the Health 2.0 poster child Xoova, which appears to have gone up in flames. This whole Health 2.0 stampede takes me back to the glory dot com days when everyone was talking about how all procurement was going to move on-line and multipleon-line markets were created for various industres. There was a land-rush and the spectacular bust. We may be seeing the beginnings of something similar occurring now in the Health 2.0 market.
Bosworth sees a clear need for better consumer tools to manage their health, tools that leverage Personal Health Information (PHI). Surprisingly, he thinks there is enough digital data today (labs, medications & images) to provide significant value if it is leverage correctly. He praised the efforts of Google and Microsoft, particularly Microsoft, (hmm, that’s odd) for their efforts to collect this type of data into a consumer-controlled data repository. He also sees biometrics playing an increasing role as well. I believe this is where Keas will focus its attention - creating a solution that leverages PHI for structured search and presenting actionable information for the consumer to take preventative actions.
He sees the big adoption hurdle as not being the consumer, but the physician. Bosworth believes that a compelling motive for physician adoption and use of HIT has not been presented. Bosworth and I both agree that eVisits may be the silver bullet. Concurring with my recommendation to Sec. Leavitt in July, Bosworth stated that CMS can take a leadership role here by aggressively supporting eVisits, which may kick-start physician adoption. Gets back to the old, ‘Show me the money!”
Bosworth also commented on the privacy concerns surrounding a Google Health or Microsoft HealthVault. Some consumers will be comfortable with these offerings, others less so. He foresees more such platform plays entering the market to serve other segments of the market that do not want their PHI in a Google or Microsoft type entity, e.g., a non-profit. He also stated that for Google and Microsoft, a breach in privacy would be a disaster, thus they take extraordinary measures to insure that PHI is secure within their repositories. As I’ve stated before, I am in total agreement with his perspective on privacy as it pertains to Google and Microsoft. Do disagree on his belief that there will be a proliferation of platform plays. Simply makes no economic sense as these are expensive to build and pull a critical mass of data into, let alone establishing the multitude of partnerships to create a viable and vibrant ecosytem of Personal Health Applications (PHAs) layered on top of the platform. There will ultimately be 3, at most 4 platform plays, and that is being generous.
by jsidorov
August 13, 2008 at 9:38 pm · Filed under Chronic Care, Health IT, Disease Management, Electronic Medical Records
The World Health Care Blog welcomes Jaan Sidorov as a regular contributor. Dr. Sidorov writes the Disease Management Care Blog, where this piece 1st appeared.
Goodness gracious. If you think you have a good idea when it comes to solving the twin dilemmas of cost and a quality for chronic conditions, ‘tis the political season. While the Disease Management Care Blog thinks the short term prognosis for meaningful health care reform is poor, that doesn’t mean it’s not smart to get your proposal out there and on the table before November 4. Just in case.
As a public service, the DMCB would like to offer these two Rules for Promoting Your Good Chronic Condition Care Idea:
1. Cast It As A Leading Domestic Policy ‘Silver Bullet.’ Yes, we know chronic illness care is an impossibly obscure tangle of insatiable demand, State and federal regulations, complex actuarial principles, relentless demographics, burgeoning technology and county-by-country variation. That complexity combined with an impatient hunger for reform is the perfect setting for the simplistic Good Idea that offers to cut through the clutter. For examples outside the health policy sphere, think ‘school vouchers,’ ‘flat tax’ or being willing to ‘take a paternity test.’
Examples of Chronic Care Silver Bullets: The electronic medical/health/personal record, pay for performance, single payer system, disease management, health savings accounts, patient centered medical home and an individual insurance market.
2. Do Not Mention Shortcomings (other than cost): Not only will you tarnish the Good Idea and diminish its chance of adoption, we all have a limited attention span that is simply unable to tolerate it. It is OK, however, to mention the cost of [insert a number from 1-100 here] [insert prefix of bil, tril or gazil here] lion dollars because we’ve become used to similar-sounding amounts being spent on Iraq, mortgage lenders and botox.
Examples of shortcoming to not mention: that electronic records can introduce new types of errors, P4P can incent processes not outcomes, single payer systems are notoriously difficult to modify, disease management may not work for all populations, ‘cost sharing’ may really mean ‘cost transfer,’ patient centered medical homes are being piloted (research), not adopted (covered by insurers), many persons with chronic illness are uninsurable and that cost effectiveness studies rely on unfamiliar concepts like QALYs. Mention these and your Silver Bullet will be tarnished.
Examples of excellent SBNS (Silver Bullet, No Shortcomings) rhetoric:
From the McCain campaign:
‘By emphasizing…..the use of information technology, we can reduce health care costs.’
‘Those obtaining innovative insurance that costs less than the credit can deposit the remainder in expanded Health Savings Accounts’
‘Families should be able to purchase health insurance nationwide, across state lines.’
And in the cost is no object category:
‘…establish a nonprofit corporation that would contract with insurers to cover patients who have been denied insurance and could join with other state plans to enlarge pools and lower overhead costs.’
And from the Obama campaign:
‘Support disease management programs. Seventy five percent of total health care dollars are spent on patients with one or more chronic conditions, such as diabetes, heart disease and high blood pressure.’
‘Providers….will be rewarded for achieving performance thresholds on outcome measures.’
‘…establish an independent institute to guide reviews and research on comparative effectiveness.’
And in the insert number, insert prefix category:
invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records
by JMoore
August 11, 2008 at 12:08 pm · Filed under Uncategorized
Last year I attended the Healthcare Quality and P4P (Pay for Performance) conference put on by the World Health Congress. This was my first healthcare conference and it provided me a great opportunity to gain a better understanding of the healthcare market and critical issues therein.
Well, its been a year now and once again I had the opportunity to attend this event. Unlike last year, I knew a lot more about the industry and market trends, thus did not get as much out of the event. But having been to more conferences than I could ever count one thing I have learned is that conferences are much like panning for gold - you have to sort through a lot of fool’s gold before you come across a nugget of the good stuff.
Following are gold nuggets I walk away with from this event.
P4P is out, gainsharing is in
Presenters, particularly payers discussed how they were using gainsharing (share the savings across all stakeholders contributing to quality improvements). A presentation by Howard Beckman of the Univ of Rochester was particularly insightful as he outlined three key terms of quality (underuse, overuse, and misuse) that were used when conversing, in a non-judgmental fashion, with physicians. By using these terms, backed with metrics from internal studies, they were able to gain much quicker buy-in among physicians into their quality improvement initiatives.
Another “hot” term was Value-based measurements - this may become the new P4P mantra for the coming year.
Future will see multiple forms of tiering
All payers are looking much more closely at stratifying populations for risks and becoming much more like disease and care management companies than just straight ahead insurers. This has been occurring for some time but the change here will be bringing in quality metrics to the equation and stratifying providers and payment schemes as well. During the medical home session, John Tooker of the American College of Physicians talked about a future where payment will be divided into three distinct categories (tiers): payment for procedure/service, another for care coordination and the third for meeting quality metrics/objectives.
There will be losers
Spoke to Dana Gleb Safran of BCBS-MA about the P4P initiative at BIDMC and asked what about radiology at BIDMC that saw a drop in business as a result of that program - will there be any gainsharing with them. She replied simply: No, we will not pay for unnecessary services, period.
Clearly there will be winners and losers as quality initiatives permeate the healthcare sector, but with numerous powerful and entrenched interests therein, even payers will struggle to get complete buy-in. One of the big problems they will face is defining what quality metrics to use, how to balance these measurements against such mitigating factors as population served and more broadly, coordination across multiple entities (local, state and federal government, internal operating procedures, employer-driven initiatives, specialists’ guidelines, etc.). It’s still a rat’s nest and it may take a while to untangle.
CMS moves at a snail’s pace
CMS presented their plans for a trial quality initiative to manage chronic care cases in a number of communities across the country. Plan is to provide an additional monthly payment to physicians providing care management with ongoing evaluation across a number of categories (e.g., value add, quality improvement, patient satisfaction, physician satisfaction, savings, etc. All good but it won’t be until sometime in 2010 that they actually begin the demonstration. That seems like an awfully longtime for just a demo. Are we in academia?
Another odd thing about that CMS demo is the requirement that the physician use IT to manage the care but there was no definition as to what that technology may be. Completely open-ended which makes me wonder how valid their results will be at the end of this demonstration as I have no idea how they will account for that variable.
Other Tidbits:
Group Health doc told me that PHR adoption at Group Health is now about 50%! That’s the highest percentage I have ever heard quoted. Hat’s off to them! He told me he loves it, his patients love it and that he has been doing email communications with his patients while sitting in on the various sessions. Hmmm, I hope those were just simple consultations and appointment reshedulings.
United Health executive told me that they have signed an agreement with Google Health and another will be signed with HealthVault any day now that will allow members to export their records into these personal health systems (PHS). As UHG is the second largest insurer in the country, this is some pretty big news and could give a substantial boost to these nascent platform plays.
Despite the success that BIDMC and BCBS-MA have seen with the deployment of SafeMed and subsequent savings, John Fallon, SVP at BCBS-MA told me they have no plans to replicate this success anywhere else. They are now focusing all their attention on the MA eHealth Collaborative program. Talk about odd! Not that I am against such programs as the MAeHC, but with literally millions of dollars saved per year at BIDMC coupled with the well-known issue of run-away imaging costs one would think that they would want to see that program replicated. Oh, how those political winds do blow…
Everyone talks about the patient, almost no one spoke about the consumer, nor did they take a consumer’s perspective on what all this means to them. In many respects presentations came across as distant and disconnected from the reality of the consumer. Many at this event are in for a very rude awakening.
Another good event by the World Congress Group. I am always impressed with the level and quality of speakers and attendees they attract. I may not always agree with what is being said, but I always find a few sizable nuggets of gold. This event was no exception, which is more than I can say for quite a number of other events I have attended
John Moore is principal of Chilmark Research a healthcare-centric, industry analyst firm focusing on personal healthcare technology that will enable the home to become the future center of health. Chilmark is based in Cambridge, Mass.
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by jsidorov
August 6, 2008 at 8:48 am · Filed under Uncategorized
The World Health Care Blog welcomes Jaan Sidorov as a new contributor. Dr. Sidorov writes the Disease Management Care Blog, where this piece 1st appeared.
Is there potential for future combined versions of both ‘disease management’ and the ‘patient centered medical home?’ DM brings remote multi-channel coaching, scalability and an understanding of performance guarantees in an inflationary insurance market. The PCMH leverages the physician-patient relationship, ‘high touch’ engagement and is one of the ingredients in the resuscitation of primary care. It can be argued each makes up for the weaknesses of the other. Accordingly, combining both makes a lot of sense.
Yet, the PCMH is in ascendancy: numerous pilots underway, the support of academia and policy makers is deafening and a big Big BIG Medicare demo is in the chute. Feeling confident, PCMH advocates appear to be in little mood for modification of their care model. Who can blame them?
Just wait. The PCMH’s life cycle is about 5 years behind disease management and rapidly reaching the red dotted Peak of Inflated Expectations. After the pilots demonstrate blunted quality improvements and just how difficult it is to reduce claims expense, disillusionment will give way to dialog that is focused on building better and combined approaches to population care.
We’re only weeks away from the college football season and its lesson that there is nothing like early season losses to bring players and fans back to the reality of planet earth. Our colleagues on the PCMH ’side of the aisle’ believe well intentioned doctors and nurses, because they ARE doctors and nurses, can ‘educate’ patients into doing the right things. The disease management organizations and their nurses moved beyond this years ago. Once gravity intrudes, all stakeholders interested in population-based care able to focus on new approaches to chronic illness that focus on even more effective versions of patient coaching that interlock across the care delivery spectrum.
If you haven’t read this fascinating article by Linden and Roberts, you should. This is DM’s greatest strength, the ace in the hole that cannot be easily imported into primary care medical homes. Think about taking these approaches and industrially mixing them with the kind of consumerism described in books like Buying In and its abundantly clear that we’ve only begun to scratch at the surface of patient behavior change.
by World Health Care Blog
August 4, 2008 at 10:00 am · Filed under Uncategorized
The World Health Care Blog is pleased to welcome Jaan Sidorov as a new contributor. His many writings have appeared in Health Affairs, the American Journal of Managed Care and Disease Management and he’s now authoring The Disease Management Care Blog. Currently working as an independent consultant, he brings a unique primary care physician and managed care medical director perspective to the topics of disease management, chronic care improvement and prevention.
by Fred Fortin
June 5, 2008 at 2:15 pm · Filed under Uncategorized
Mark C. Taylor’s intriguing book, The Moment of Complexity: Emerging Network Culture, is one of those brilliant boiling pot examinations of social theories and philosophy which forces one to think and re-think where we are heading in this new flat world. Of course, when confronted with such intellectual challenges, my initial thoughts are always to line up the questions good authors generate and put them to the test in health care — my personal anchor to all things real and important.
The processes of globalization and proliferation of information technology, according to Taylor, is “creating a new network culture whose complex logic and dynamics we are only beginning to understand.”
Falling between order and chaos, the moment of complexity is the point at which self-organizing systems emerge to create new patterns of coherence and structures of relations.
Poised between too much and too little order, the moment of complexity is the medium in which network culture is emerging.
Taylor is studying that site between chaos and catastrophe, where boundaries are shifting, power relationships are becoming quite shaky, but order has not been overthrown - at least not just yet. And in theory it is never quite eliminated because “separation is always incomplete, for we remain entangled with that from which we struggle to escape” as Taylor puts it.
So a question that this theoretical assault raises for health care could be this: Will there be a “moment of complexity” where the ‘grid’ that structures health care — the systems, hierarchies, roles, science, authority and the rest of it — gets, well . . . torqued. As he describes,
Whereas walls divide and seclude in an effort to impose order and control, webs link and relate, entangling everyone in multiple, mutating, and mutually defining connections in which nobody is really in control. As connections proliferate, change accelerates, bringing everything to the edge of chaos.
One could argue that the brewing excitement in US health care — the crisis of health care costs, the catastrophe often proffered by futurists and economists, the explosion of health 2.0 and beyond, the perplexity of the public will — all speak to our hapless entry into this unnerving social space: health care’s very own ‘moment of complexity.’ The future may well indeed already be here.
One of the problems of being in this space, says Taylor, is the issue of whether the noise, the information glut, and the “confusion and debilitating sense of vertigo” it engenders will overwhelm the controls. For health care, that possibility could have both liberating and devastating consequences.
One response is to simplify and strengthen the stranglehold of the authority structures that govern and control medical practice and information distribution. Yet, if complexity is inevitable, then these attempts although well intentioned, will be more or less futile. No, the question really revolves around focusing our intellectual attention to this changing landscape, its “fluid dynamics” and how we adapt to its effects.
Taylor argues that education is the currency of the realm in network culture. If that is the case, then how we train our physicians, nurses, allied health professionals, technicians and the rest will be of critical importance in confronting this emerging challenge.
by Fred Fortin
May 29, 2008 at 8:07 pm · Filed under Policy Makers, International Best Practices, Business of Health, International Health
Fareed Zakaria argues in his new book “The Post-American World“, that the problem America faces in the new emerging international sphere is not so much domestic decline, but rather more “the rise of the rest.” By this he means that countries all over the world “have been experiencing rates of economic growth that were once unthinkable.” This is resulting in shifting of the balance of power, the movement from a unipower world with America at the center, to a world of “many actors, state and non-state” where there is no center. The challenge in such a world, according to Zakaria, is “how to stop the forces of global growth from turning into the forces of global disorder and disintegration.”
In this new “Post-American World”, Zakaria asks “will international life be substantially different in a world in which the non-Western powers have enormous weight?” Will Washington be able to “adjust and adapt to a world in which others have moved up?” And can we thrive in a world we cannot dominate? In America, “new thinking about the world is sorely lacking” and our isolationism has left us quite unaware of the world beyond our borders.
We also suffer from a “dysfunctional politics”, Zakaria writes, one characterized by gridlock and partisanship, which prevents us from beginning “a generous effort to engage the world.” The future is already here.
The task for today is to construct a new approach for a new era, one that responds to a global system in which power is far more diffuse than ever before and in which everyone feels empowered.
And organizing coalitions has become a primary form of power. Real solutions require,
creating a much broader coalition that includes the private sector, nongovernmental groups, cities and localities, and the media. In a globalized, democratized, and decentralized world, we need to get individuals to alter their behavior.
Now here is where health care begins to enter into the “Post-American” picture.
While Zakaria complains that health care costs “have risen to point that there is a significant competitive disadvantage to hiring American workers,” — and will not be an easy fix — he strongly believes that “America will remain a vital, vibrant economy, at the forefront of the next revolution in science, technology and industry — as long as it can embrace and adjust to the challenges confronting it.” The United States “has been and can be the world’s most important continuing source of new ideas, big and small, technical and creative, economic and political.”
In fact two of the industries he cites as examples are nanotechnology and biotechnology.
So where does Zakaria’s analysis leave those of us in health care. Here are a few thoughts.
- Health care reform in the US is not just a domestic priority but an international one as well. It is both part of the problem and part of the solution to America’s future position in international affairs.
- As I have argued a number of times before( here, here, and here ) American health care can become a stronger component of our international ’soft power’ because it is a valuable and desired center around which international coalitions can be formed.
- The world (and the US) has yet to full advantage of the emergence and development of Health 2.0. What an opportunity for a technology which emphasizes social networks to bring the world a bit closer together around a major concern of all countries– health care.
- The time to bring America’s involvement in world health care to the next level is now.
Health care can help to renew America’s legitimacy to act, in Zakaria’s words as an “honest broker’ in world affairs. It is time for US health activists to think global and take leadership in this important challenge.
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