Health Insurance will get worse before it gets better

While the US is the only wealthy western country without universal health care (even Brazil has it), and the number of uninsured continues to climb, it will continue to get worse until far more middle class people feel the pain. Most of what has been proposed simply applies Bandaids to the problem. Few are prepared to blow the current system up and start from scratch. Few are prepared to take on the very strong lobbies of pharmaceutical companies, health insurance companies and health care providers simultaneously. Whether the country uses a single payer system like the UK and Canada do, or a tightly regulated insurance company managed one as in France or Germany, it will require major change. Even in France and Germany, insurance companies cannot turn anyone down, vary price by pre-existing conditions or age, or refuse reimbursement, which makes them the same as a single payer system in effect.

The "black hole" of leads management

In every industry, in every company, it is difficult to track the progress of leads through the sales process to closing. However good the CRM system, the issue is always a human one. While it may be in the company's interest to track leads, for most sales people it is not in their best interest to complete the data entry. They have little to gain and they lose time and perhaps information which they would rather keep for themselves. In many industries, a sales person's Rolodex is their biggest asset, so they would rather build their own personal database than the company's.

The Education Business

Visiting colleges with my daughter this summer has been an educational experience. It is clear that higher education in the US has become more and more of business, much like health care. While this change is happening in other countries - just note how aggressively they court foreign students who tend to pay higher fees - it is less so. The reason is that as in health care, the US is the only Western country in which higher education is so divided into private and public. Even Universities like Oxford and Cambridge, which American perceive as private, actually receive about one third of their funding from the Government. This enable the Government to exert much more influence over them than it can over a US private university. So the salaries of star academics, star administrators, and star fund-raisers continue to climb as do the fees.

Insurance guy moves to CMO of Coke

I regularly hear that nless you fit the spec precisely, you will not get the job interview. What the client wants is "someone who has done the identical job for the leading competitor for the past ten years - but can think outside the box." Yet, I see regularly that companies hire Chief Marketing Officers, and indeed CEOs who have quite eclectic backgrounds.

What you measure drives what you do

Sometimes we see a particular standard being used to measure quality. The result is that the provider begins to focus on that. For example, horse power tends to be the measure of performance for cars. Yet in fact, torque is a better predictor of acceleration (more important for most us in an age when top speed is academic). While many people can tell you the bhp of their car, few can tell you the torque, or even the units of measurement.

Similarly, most people judge the speed of their broadband connection by downstream speed. Few realize that in some situations, such as sending large files, or IP telephony, upstream speed is more important. As a result, few know the upstream speed of their connection, and few providers advertise it.

Doctors the last hold-outs to the Internet

Today, we make airline and restaurant reservations online. We work with lawyers, priests, ministers and mullahs by email. Email and the web pervades our work life and personal lives. Except when it comes to doctors. With rare exceptions, you cannot make appointments online or ask questions by email, even though the evidence suggests that it improves efficiency as well as effectiveness. It seems that the structure and psychology of medicine drives it to waste time and money. Just one of the many things which has to change, but I wonder why the industry has this mindset.

I suspect that doctors are still very much of a producer driven mentality. While they do want to serve patients, they believe that they are the experts on how to do that, not the patients. Also, most doctors are not completely comfortable with technology.