Conferences, conferences, conferences

November 2, 2012

Patrick Spain

October is "conference season" in America - no less for the healthcare industry than others. As a result, I have seen far too much of American Airlines' older-than-dirt MD80s and that adult version of Disney World known as Las Vegas. And I did not see enough of San Francisco, New York, or my hometown Chicago.

Yet all these venues (excluding those nasty MD80s) hosted fascinating conferences. At all of them I saw unbridled enthusiasm for a new kind of healthcare system undercut by evidence that suggests it will be very hard to change things.

In September, a report came out that indicated that in 2009 America wasted $750 billion in healthcare expenditures. Of the thousands of attendees at these conferences, I doubt you could find a single soul who would dispute this proposition. More amazingly, the healthcare establishment (providers, insurers, suppliers) does not seem to care whether the Affordable Care Act remains in force or is repealed. The problem "“ bloated, skyrocketing healthcare spending "“ will remain the same with or without Obamacare. This must be addressed or the system will implode. What everyone wants is certainty. We may, or may not, have that the morning of Nov. 7.

Some of the more intriguing conference takeaways were:

1 Doctors behave entirely differently as patients than we civilians do. They accept fewer tests and know that more tests do not mean better care. They are far less expensive to serve because of their knowledge.

2 The irresistible force of transparency in healthcare pricing is coming, though perhaps not soon enough to meet the immovable object of rising insurance premiums and deductibles. In five years you will be able to really shop for every health service and product. Problem is that in two years you will more likely than not have a $5,000-plus deductible.

3 There are thousands of entrepreneurs working on making patients healthier and the system more efficient. While unlikely, self-congratulatory products (my favorite: a TV that tells the elderly when to take their meds) abound, that irrational exuberance of many in this crowd does not undercut the real benefits some of them are creating. ZocDoc, Castlight, and others are changing the ability to shop for and acquire healthcare at reasonable and known costs.

4 The young are disproportionately interested in healthcare, an industry that disproportionately serves the elderly. This is not just good, but incredibly great, news.

5 So much of what is "new" is just fixing out-of-date, balky systems to bring them into the late 20th century. Many are trying to create a Mint.com for healthcare "“ a place where doctors and patients can pull together the diverse and incompatible healthcare information systems. This is profoundly depressing, but it is where the money is.

6 The most efficient "insurance company" in the U.S. is "¦ wait for it "¦ Medicare, with 2 percent overhead (private insurers run 5 to 6 times this amount, excluding profits).

7 The healthcare provider with the longest and deepest commitment to electronic health records is, yes, you didn't guess it, the Veterans Administration.

8 Even private insurance companies, perhaps the pivotal players in our dysfunctional healthcare system, are trying to innovate. Aetna has bought a series of companies, e.g., iTriage, in the hope that its insured can use their innovative tools to be better healthcare consumers.

So government and the private sector are engaged in their own seductive and increasingly frenetic dance to improve our most stubborn and vexing of modern business, moral, and social dilemmas: delivering decent healthcare to Americans. Let's hope it doesn't end up like this.

Originally published Nov 2, 2012 10:00:55 AM.