Let’s look at what Wired editor-in-chief Chris Anderson is saying in his soon-to-be-out new book, FREE! — as discussed in this issue of Wired – and reflect for a moment on the implications for healthcare. Anderson argues that there’s a number of models or trends as to why things on the Internet are going to be, well, free.

• Freemium: A basic web service or software is supported by payers of the premium version of that service. One percent of the subscribers pay for the other 99 percent;

• Advertising: Free content, services, or software that’s accompanied by advertising geared to interested audiences;

• Cross-Subsidies: You get something with the intent that it gets you to pay for something else. Get the music free, now you want to go to the concert;

• Zero Marginal Cost: Somethings are so cheap to produce — again music is an example — that people offer it up for all kinds of reasons that have nothing to do with money;

• Labor Exchange: Using a web service, in and of itself, creates value for somebody else. The user is providing information that is worth more than the band width to get it.

• Gift Economy: It’s just altruism and it’s free — Wikipedia, Craigslist for example.

Can we see healthcare in here anywhere? Absolutely. It is everywhere flowing through all these models. There are many examples. But let’s not just list all the sites that you could point to. Let’s just say they are legion.

The real and most interesting question has to do with the impact of free healthcare on those aspects of healthcare for which we pay dearly. Healthcare on the internet is in some ways like the music industry — get the song free, then go to the concert and pay through the nose for the scarce experience of seeing the real thing (or band).

Sure, you can see the many forms of health information, advice, education and peer support, as recruitment strategies for the more expensive real deal — the physician visit, or the drug de jour, for example. In this view the internet creates even more demand for high cost care, and thus higher cost for the rest of us. Nothing in healthcare can really be free. Far from it. It is just a sophisticated bait and switch marketing strategy where the healthcare information, in itself, is a teaser of little value for some other product or service. So back to square one.

But there are some scenarios that move more in Anderson’s direction. Anything that is not tied down can be distributed through the internet under the above models. By this I mean, that anything which does not involve the laying on of hands can go on the net. With all of the interactivity possible now, especially with video capabilities, that inherent limitation — while still quite substantial — is getting smaller and smaller. And if it can go on the net, it will, and thus it will be on there for free.

In addition, an overwhelming percentage of energy consumers invest in “healthcare” is wrapped up in navigating the complexity of the system, determining their clinical options and planning for the repercussions of what ails you — all of which, the services available on the net excel at.

More important than probably anything else I’ve said so far, is the wedding of the emerging transparency in healthcare — price and quality of care ratings for example — to the internet. Value-based, healthcare 2.0 is on America’s doorstep and clamoring to be let in. It will attach itself and be amplified in a new internet-consumer-driven EMR, PHR, and “comparative-effectiveness” heaven that cannot help but have a disruptive impact on healthcare’s current anachronistic economic base.

But how, and how fast, are the only really important questions now, not if or when. What economic pressures will the net put on traditionally conservative healthcare institutions? How will they respond? Which of their highly valued, on the ground services, will be commodified and then free or nearly so?

Healthcare is a late bloomer when it comes to the information technology revolution, but it will, as they say, suffer from 100 percent of the effects of that technology. Are we prepared and being mindful of the changes all around us? That remains to be seen.