OP-ED

Government (Or, How My Cousin the President Nearly Killed My Company)

Screen Shot 2014-05-14 at 8.03.26 AMI WAS NOW the CEO of a rising medical data company.We built automated systems to handle the administrative chores for thousands of medical practices. They didn’t buy anything from us. Instead, they subscribed to a service on the Internet.

This was what would later be called a cloud-based service, but in these early days of Internet era, we were still searching for a name for it. My partner Todd used to say in speeches that he would give Polynesian fruit baskets for life to anyone who came up with a single name for the combination of software, knowledge and work that we were selling. We had moved back east and had a new headquarters in a historic brick armory building along the Charles River near Boston.

Our future looked fabulous, except for one problem: My cousin, the 43rd president of the United States, was about to sign a bill that could destroy us.

This bill, like so many governments initiatives, stemmed from the best of intentions. The idea was to encourage the migration of the health care industry from cumbersome binders full of paper to electronic records. How was this to be accomplished? Well, hospitals and doctors were forbidden by so-called anti-kickback laws from exchanging services, information or products of value with each other. (It’s a law that infuriates me, for reasons I’ll go into later.) The bill before Congress in 2004 offered a regulatory safe harbor for hospitals to provide doctors with all the digital technology the bureaucrats could think of: servers, software licences, and training. That was absolutely the right answer . . . for 1982. The long and short was that hospitals could buy all the old stuff from our competitors, but none of the new still-to-be-named services from us. As often happens, the technology was advancing much faster than the law.

I caught the shuttle down to Washington and commenced lobbying with the fervor of a man with a gun to his head. I raced up and down the marble halls Congress, looking for someone, anyone, who would take the time to learn why this bill was so very wrong, so backward, so devastating, so lethal—at least to athenahealth.

But let me tell you, if you walk into Congressional offices sputtering about a clause in a bill that practically no one has read, something that has to do with hardware and software and online services, people tend to hurry away, or point you toward the door. I could find no one to pay attention. And as I grew more frantic, I started talking louder and faster. That didn’t help things.

Some might find my frustration strange, considering that during this drama my cousin was sitting a mile away, in the Oval Office. Wouldn’t a Bush, facing legislative trouble in Washington, contact someone in the White House entourage? The answer is no. Placing a call to him was not even a remote possibility. For starters, it’s unethical. It is also politically foolish. It would place him, me, and my company in scandal and bring shame upon our family. I would be much more willing to climb the steeple of the tallest church and bungee jump naked in the middle of the night than to call my cousin. And even if I were dumb enough to make the call, I trust George would have the good sense to tell me to get lost.

At the time of this drama, my fast-growing company employed hundreds of people in Massachusetts. But I could not get anyone on the state delegation to hear my plea. (It’s conceivable that my family name was working against me.) Finally, I located a congresswoman who would listen to me. It was Nancy Johnson, a Republican who had been representing her Connecticut district since 1983. She chaired the health subcommittee of the powerful House Committee on Ways and Means.

I walked into her office and saw the 69-year-old congresswoman sitting behind a desk. She was paging through an enormous sheaf of papers. That was the bill. Embedded in that piece of legislation were hundreds, if not thousands, of amendments, earmarks, and wrinkles added by one interested party or another, along with thousands of other details that just landed there by dumb luck. Other items, like the all-important clause “and Internet services,” were simply missing. It struck me as I watched her paging through this bill that my drama was only one of thousands, or even millions, that would result from this mountain of legislation. A single detail can throw lives, or entire companies, into a tailspin. It can reroute billions of dollars, turning winners into losers, and vice versa. Government is like the giant with an uzi. It means so well, but if it gets scared or sad or confused, it can squeeze off 80 rounds without even noticing the bodies falling around it. One single law can put technologies that should have disappeared a generation ago onto eternal life support and close the door on their superior replacements. Now, in the last day or two before the bill becomes law, Rep. Johnson was committed to limiting the damage. She was gamely attempting to filter out dangerous bits and pieces. It was exhausting work.

She asked me what I needed. I started my spiel. I went on about hardware and software, and the future of Internet-based businesses, and the importance of medical data traveling across networks. It was the key to efficiency, fairness, the economics of health care, research . . .

“STOP,” she said. “That’s too much for me. What words on what page?”

I pointed to the clause where it said “computers and software,” and asked her to add “and Internet services.” She did.

Danger averted. Our company would survive this bill.

But let’s consider this process for a moment. It has nothing to do with innovation or satisfying customers or delivering great results. It has everything to do with cultivating influence among politicians and regulators. To create a modern, caring and efficient health care economy, we have to create more spaces where entrepreneurs can compete in the marketplace—and not in the corridors of Capitol Hill.

Unlike many entrepreneurs, I had reason to feel comfortable in Washington. Even though I couldn’t call my presidential cousin for help, I had my political name, fancy venture firms behind me, and my equally fancy business degree from Harvard. That gave me the confidence—or hubris—to assume I could get in there and make a difference. I was an outsider with insider status. I’d guess that 90% of businesses that get blown up by government mis-steps, or even prevented from being born, are run by outsiders with outsider status. That is why it’s so hard for an activist government to be effective. It works with known players—while the future should be in the hands of unknown players working to make the household names obsolete.

The government, by regulating industry, actually ends up protecting the incumbents. Here’s how. Let’s say the news comes out that insurance companies are taking advantage of customers in an especially awful way. Because this a service that society views as vital, the government comes in and says, “Whoa, what’s going on in here?” Now the best thing to do at this point would be to make it as easy as possible for new entrants to come into the system and disrupt these guys—clean their clock, kill them, or at the very least force them to change. But instead the government looks to control them. They do this by writing up cumbersome regulations. These discourage newcomers from the market. Many of the best would-be competitors don’t employ a single lobbyist or lawyer. They take one look at a market regulated up the wazoo, and conclude, wisely, that they’re not built to play that game. They’re better off building a new video game or a dating app. So instead of making the bad incumbents vulnerable, the government leaves them fat, lame and stupid—but with formidable lobbying power. Since these companies employ a lot of people, they become untouchable.

This brings me to my favorite paradox. The industries we care about least innovate at the highest speeds, while those we hold deepest to our heart innovate hardly at all.

Jonathan Bush is Chief Executive Officer, President, and Chairman of the Board of Directors of athenahealth, Inc. This post is an excerpt from Chapter 4 of Jonathan’s new book, Where Does it Hurt? An Entrepreneur’s Guide to Fixing Health Care.

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  3. It is worse, far worse than most people grasp. We are in the iron grip of Bureaucracy that Max Weber wrote about. The reason that entrepreneurs can thrive is hardly ever because of their brilliance, or the magic hand of Shopping, but that it takes a few years for classical 19th century business practices to catch up with them and drown them.
    The culture killed the USSR as certainly as Len/Stal did. In fact, Lenin was a HUGE advocate of American 19th century business practices – he really put them into effect! Our traditional bureaucratic and business ingenuity made the Soviet Army and its Mili/Ind complex what it is today.
    It is the same force that killed obsolete and stale business civilizations throughout history. Read Max Weber.

  4. FROM THE AMAZON “LOOK INSIDE” SAMPLE

    I used Dragon to transcribe this little excerpt.

    “In the lumbering healthcare industry that we have come to know in the last half-century, information is a scarce resource. Patients rarely have access to the records. No one can hazard a guess as to what an operation, a medicine, or even a Band-Aid might cost. Keeping this information button and up benefits the incumbents, who thrive within what we might call and ignorance economy. Some, as we’ll see, are still attempting to control their local markets by limiting access to data. It sooner or later, data promises to turn this status quo on its head, ushering in a slew of new digital startups and — most important — delivering vital and timely information to the patients, or customers.

    And what will they do with this information? It can be summed up in a single word: shopping. This has to do with making choices. We weigh countless options in the rest of our lives, but not nearly enough of them in healthcare. Shopping, whether it’s driven by an individual, a retail buyer, or a wholesaler, creates the market, and the market responds with choices and innovation. What’s more, in markets driven by shopping, losers figure out how and where to change their fortunes, or they disappear.

    We need shopping, I believe, not only to fix healthcare, but also — and I know this may sound strange — to express our own humanity. Think about it. We shop for clothes to express our tastes and personality. We do the same for music and food. Some of us trick out our cars, put them on mega wheels, or hang big, fuzzy dice from the mirror. We express we are with these choices. And yet for the care of our bodies, for some of the most important decisions we make in life, we rely on a handful of menu options and lists drawn up by bureaucrats. What I want is for people to have a dizzying array of options in healthcare, so they can care for themselves and their loved ones in a way that suits them best, that makes them happy and proud. Some of the choices will be simple, of course, others delightfully convoluted. But in my vision, each of us will fashion the health care we want and deserve. We’ll express ourselves.”
    __

    Go shopping? Where have we heard that before? Right, health care purchases are no different from buying clothing or CDs or cars. We don’t want actual health care, we want “choice,” via which to make fashion statements?

  5. HIT is not fixing why is broke, and may be making it worse.

    That the HIT vendors have been devoid of surveillance and regulation for the life of that industry, the level of innovation that we users see at present is pathetic. There is not any. EHRs and CPOE and CDS are impediments to individualizing care.

    Regulation and surveillance can only improve the quality of the devices and up the ante for innovation.

  6. Vik – the proverbial glass is half full or empty. I haven’t given up yet. I think it is up to us to create a consumer health experience that is engaging and appealing to the mass market. There is no getting around the issue, the fact, that if you have the means you can access any level of healthcare. However, unless we can find a way to engage the average John and Jane Doe – to minimally be “health aware” – then we will put everything at risk.

    The tools are at our disposal – we “simply” need to package the 21st century health experience. Does that experience include every persistent cough ending up in a physician office visit – probably not. But what consumer has the time and what physician should spend their time processing routine health issues. We’ve got to move beyond applying 18th century delivery models in a 21st century world.

  7. There is a series of steps, very logical, that starts like this.

    Greedy doctors make a lot of money.

    Slash the pay and we will get rid of the Gordon Gekkos and enrich the profession with Dalai Lamas.

    Perhaps. But the action is at the margins where you will find doctors who want to earn and do a good job.

    So what happens is you neither get rid of enough Gekkos (because you over estimated how many were around) nor enrich with enough Lamas (because you severely over estimated how many were around).

    You’ve driven the middle of the road non-Gekko non-Lamas.

    But you have concentrated the profession with Gekkos who are not fit for anything else.

    One other thing. Have you seen the pay differential between ABMS regulators and the physician? It’s on a factor of 9.

    So you have a new cadre of Gekkos who want to be regulators when they grow up!

    You seem to have a finely tuned BS radar Vik. How can you fall for this perfect society through regulations clap trap?

  8. I submit that it is not fixable. At all. All we are doing, writing about and arguing about are band aids on a hopelessly broken system in which, like everything else in nearly all cultures around the world, if you are connected, educated, savvy, and affluent (like many if not most THCB devotees) you will (almost) always get what you want. Everyone else. Well, they get what they get.

    Until we are willing to fix the tax code, campaign finances, Congressional pay and perks and other foundational issues, we are just tinkering.

  9. Good. Let’s hope the ones who tune out fastest and permanently are the ones like the ortho guy bragging in an essay a couple of years back that he makes $330,000 a year via referrals to an x-ray facility he owns. He doesn’t mention whether the films were medically necessary, added value, improved outcomes, enhanced the patient experience or anything else that a thoughtful reader might conclude was useful. But, it sure is nice to make the equivalent of six new S-class sedans every year for exposing your patients to radiation they didn’t need and then boasting about it.

    The reality Saurabh is that your profession could use a good house cleaning and if aspects of systemic frustration drive some of them away, so what? Yes, we will lose some good ones, but if they are driven by beneficence and altruism maybe they’ll puruse other good works. There are many things worth doing besides medicine. As for the ones like Mr. $330K, good riddance. You couldn’t do enough things to drive him out, as far as I am concerned.

  10. I have one word for that Brian: culture. Not culture as in eating chicken tikka masala, but professional culture, safety culture, work culture.

    What I see and really fear is that physicians are beginning to tune out. Call it regulation fatigue, a bit like alarm fatigue, physicians are losing their sense of proportionality, their sense of granularity.

    I tune out as well when my wife reminds me of the chores I repeatedly dodge. But that’s temporary. Physician tune out, I fear, might become a permanent thing.

  11. God I love the dialogue! Entrepreneurism and innovation is happening in pockets of health care – too small of pockets, but it is happening. Whether the entry is easy or difficult, find your way into health care. There’s too much broke not to fix. See you on the frontier folks.

  12. I am going to exercise uncommon (for me) restraint and refrain from commenting on the nexus between chiropractic, science, public policy, logic, and common sense.

  13. Well said. I recently told a chiropractor (not treating me) that I felt I was my own doctor in the sense of having primary responsibility for my health through what I eat, exercise and the like. I think the idea of using the expensive sick care system to promote health makes no sense nad is expensive to boot. The real drivers of health are in the public policy arena, something we recognize for example alchohol and cigareete laws, taxes and regulations.

    He got mad at me

    Yikes…….

  14. Thank you, Mitch. Most of the people I know are lucky enough to be generally healthy, and they HATE the national obsession with the healthcare system. It’s a sorry substitute for a national obsession with HEALTH.

  15. Vik your observattion about most not being involved with health care, and those who are being captive is spot-on and rarely recognized. More important, you get and explain the impact. Thank you!

  16. My comments were not pro or con regulation. Regulation is necessary and we can probably all agree that healthcare is the most regulated industry. I suspect we all also agree the current track of healthcare is unsustainable. We spend more than any other country and from an outcomes and efficiency perspective get less.

    With that said, it is unlikely regulation = efficiency or stimulates innovation. For all the regulations within the industry a report issued by Journal of Patient Safety in Sept 2013, estimates that more than 400,000 people die each year due to preventable errors within hospitals. That’s the equivalent of two jumbo jet crashes per day. Is more regulation the “cure”? Or is regulation with innovation the treatment?

    http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx

  17. Of course it’s not that simple in practice.

    The large players want more regulations, because they know they have the economies of scale to overcome the bureaucracies of scale, and others don’t.

    The frightened mobs want more regulations to keep them safe from the monopolists.

    This is Greek Tragedy 2.0: the American version.

  18. “1. Regulations are necessary. 2. Over regulation is dangerous.
    Really, it’s that simple.”

    If only it was that simple.

  19. “Regulations attempt to keep us safe, you’d be the first to reach for a lawyer if you were hurt by someone not following regulations.”

    Actually, people blindly following rules and craving more rules scares the living daylights out of me! And the trouble is that you might not be able to sue someone for messing up for following the rules and suspending judgment and common sense.

    100 % oxygen leads to blindness in neonates. This doesn’t mean oxygen is useless.

    Yet, if one responded to the caution that 100 % oxygen is dangerous with “what, you want to die of hypoxia?”, it wouldn’t elicit very much, how can I put it, faith that the person understands the issue.

    These two statements are not contradictory:

    1. Regulations are necessary.

    2. Over regulation is dangerous.

    Really, it’s that simple.

    Law of marginal returns is a fact of life with very few exceptions. And in many cases law of negative marginal returns kicks in.

    The real question is where on the curve does US healthcare fit at the moment.

  20. “The bottom line from this piece is that regulations hurt the entry level entrepreneurs.
    You won’t hear the CEO of Goldman Sacks complaining about regulatory complexity.”

    That’s just a fact of life – those there first always have the advantage. Would you disband regulations for newcomers to level the competition?

    Your assertion that “regulations” hurt is meaningless. The discussion is what regulation and why and who would it hurt if not in place.

    Regulations attempt to keep us safe, you’d be the first to reach for a lawyer if you were hurt by someone not following regulations.

  21. It is you I’m trying to flatter. Although I can see how you might feel damned by faint praise.

  22. “It was actually Nasty, Brutish, and Short”

    It was that as well.

    “Point me to where I said that.”

    Two can play the game.

    The bottom line from this piece is that regulations hurt the entry level entrepreneurs.

    You won’t hear the CEO of Goldman Sacks complaining about regulatory complexity.

    You may disagree with the premise, and I would be eager to hear a well thought out argument why so, one that doesn’t descend in to you’re with me or the the Tea Baggers and birthers (they get a painfully boring after a while) but surely you get the premise?

  23. “And to think there was once a frontier spirit!”
    __

    An imaginary romantic, bucolic time long gone. It was actually Nasty, Brutish, and Short, by all objective historical accounts, as has been the bulk of recorded human history.

    “evil capitalism”?

    Point me to where I said that. And unlicensed blog commentary psychoanalytic imputations don’t count, Saurabh.

  24. I didn’t feel the need.

    There again, I veer towards over estimating the intelligence of the discussants, rather than under estimating.

  25. “Moreover, this is what is known as Snarky Rhetorical Pushback, not literalism.”

    You have a generous supply of unintended irony! And it certainly helps as I’ve just been subjected to a miserable movie for the last couple of hours.

    I like hyperbole.

    By evil capitalism I assume you mean those rapacious start ups dodging the employer mandate that’s no longer a mandate.

    Government deliver us from such evil!

    And to think there was once a frontier spirit!

  26. “The only premise to be debated here is whether the intensity of regulations have any negative effect on innovation, or is it just more the merrier, ad infinitum.”
    __

    Perhaps you should have stated that at the outset.

  27. “Yeah, you’re right. Let’s just do away with all regulation. Private markets, as we have all seen yet again recently, are utterly self-regulating.”
    __

    Moreover, this is what is known as Snarky Rhetorical Pushback, not literalism.

  28. There’s either willful ignorance or constitutional ignorance. I’m going to give you the benefit of the doubt and assume the former.

    The only premise to be debated here is whether the intensity of regulations have any negative effect on innovation, or is it just more the merrier, ad infinitum.

    (if the Bush name is giving you a Pavlovian reaction, I can link to other thought leaders in the field).

  29. You’re the one who made the unequivocal assertion and hyperbolic extrapolation. Not me. Talk about “binary.” Don’t put words in my mouth, kindly spare me the False Dilemma fallacy. You haven’t summed up anything. Sorry.

  30. JHC! How hard did you have to suspend cerebral activity to totally miss the point here!

    “Your either with 100 % regulations or Genghiz Khan.”

    That sums up the gist of your sentiment!

    I lost my binary approach to thinking shortly after losing my Babinsky reflex. Actually, I envy your Manichean approach to thinking. It does make life a little simpler!

  31. Yeah, you’re right. Let’s just do away with all regulation. Private markets, as we have all seen yet again recently, are utterly self-regulating.

    And, courts? We don’t no need no steenkin’ Unelected Judges interfering in the productive, unfailingly beneficent miracle of free markets, indulging all these “frivolous” torts and criminal actions.

    Seriously? That’s the most naive thing I’ve read all day.

    Human affairs get regulated one way or another. By the peoples’ government or by corporations (oh’ scuse me, I repeat myself these days), or at the point of a weapon.

    What have I missed? Those ARE in fact the choices.

    You can let commercial entities “roll the dice” with your OWN life and wallet.

  32. Great piece. This is basic epistemology that some people don’t ever understand.

    Regulations not only raise the fix cost of business, they dull imagination.

    They reduce the space in which intractable knowledge can operate.

    They reduce the frequency with which the dice is rolled, which is the key to creative destruction.

    If they had been present to this extent in 1903, the Wright brothers would have probably been in some planning commission, charged with planning the next plan to plan the working committee for the development of the first flight.

  33. Peter1 – of course the question “half dozen companies” was rhetorical. The reality is one company cannot change the course of the industry – but hundreds or more will. Innovative companies across the industries many sectors are stepping up.

    Those, like athenaHealth, that do not step up will be disrupted by the masses that do.

  34. Will the disrupter crazy Athenahealth step up?

    “Are a half dozen companies “neutral” enough to shape the information future of healthcare?”

    Seems the FCC has to consider if giving a “half dozen companies” control over internet access speeds is “neutral” enough” You can’t run a political campaign on neutral companies – how are you going to run a health care system and satisfy “neutral” donors.

  35. Rob – the challenge is the inefficiency is everyone’s problem but no one’s responsibility. If athenahealth compromises they risk a perceived competitive advantage. The CommonWell Health Alliance was established in 2013 to promote system interoperability. A year later Carequality was launched with a similar mission. But that is akin to the fox guarding the hen house. Has the entire three trillion dollar health industry abdicated the future of the industry to electronic record companies – and then only the largest companies of the sector?

    Are a half dozen companies “neutral” enough to shape the information future of healthcare?

    My company – vitaTrackr has invited 76 companies across ten sectors to collaborate, level the playing field so that data access is neutral and competitive advantage accrues to those organizations that provide the greatest value in their product/service/application. It is fascinating to see which sectors stepped right up and which companies within those sectors understand that the need is to improve the efficiency of the entire industry, then adapt business and sector strategies. We have invited all companies serving the industry to get on board. I do understand that healthcare is “different” – but there will be a tipping point in the industry where those that compete just on data they control will become the stuff of business school case studies.

  36. Interesting stuff. This is why I gave up looking for answers within our health care system. It has become increasingly plain that constructive change cannot happen from the inside; it must come from the outside – i.e. Outside the system that strangles both patients and doctors. It’s sad to see, but it is a well-worn path for anyone in power to remain in power. Those with the best connections and resources will have the best advantage with the existing system. We cannot rennovate our system to make it somehow stop being the leviathan it is; we can only find disruptive innovations that will upend the things that give those in power the leverage they can, using political means, continue to hold.

  37. Yes indeed, where have we heard THAT, “Go Shopping” phase before – after a crisis? Seems to be a family rallying cry.

  38. Yes Bobby, the real “disruption” will occur when we rid ourselves of proprietary software (government legislation) where ALL “crazies” have access to build a better system where it all talks to each other.

  39. I also can’t help but wonder what proportion of the “millions” of Tea Baggers supposed to descend on DC tomorrow to “forcibly remove Obama from Office” (“Operation American Spring”) are on SS, Medicare, and/or Disability.

    Rumor has it that, post-revolution, they’re all gonna meet at Shoney’s for the Early Bird Special Federal Overthrow Celebratory all-you-can-eat Buffet.

    Free Hoveround parking and AARP discounts.

  40. “The data show clearly that the typical American engages relatively little with it. That, in fact, is one of the reasons it has innovated so slowly; the people who really need it, such as the chronically and seriously ill, are essentially captive, and everyone else drifts in and out episodically.”
    __

    That really nails it in one short statement. Plus, “data show” is very pleasing to this pedant. Not the incorrect “data shows” that has taken over discourse. Kudos.

    Just read the Amazon preview on JB’s new book. Get out there and “SHOP,” America. That is the panacea.

    Where have we heard that before?

    (I asked them for a review copy for my blog. They’re not gonna grant the request.)

  41. As frustrating as regulations are in healthcare they fill the void left by a dysfunctional industry.

    In healthcare more than any industry information/data is life or death critical. Yet we all recognize that healthcare is generations behind in the area of data automation. Is government regulation responsible for this dysfunction – or does the industry have culpability?

    We know regulations will not solve the data challenge in healthcare – but whose responsibility is it? Physicians; health systems, payors, EHR system providers, Pharma? The list of sectors that support the industry is extensive; each sector has its own unique competitive characteristics. While everyone would benefit – who leads?

    One answer is the “consumer”. As consumers shoulder more financial responsibility for care – through premiums and deductibles – consumers will respond. Their response will be in the form of more self-care, alternate points of care – convenience, low cost, automation. A lone consumer may be written off as an annoyance; a consumer “movement” – a sea change. What can we expect? Zero tolerance of inefficiency.

    Leadership is required; sector silos – a historic relic; collaboration cross sector/within sectors is the future. The consumer will benefit and the industry will undergo a Darwinian evolution. It is only a question of when and how it begins. Once it starts it will likely happen faster than anyone can imagine. (It is likely already underway.)

    Either the industry steps up or the vacuum will be filled; and ten years from now we will be at THCB complaining about the unwieldy regulations – how could the government do this to us?

  42. This post is a good insider’s look at the policy sausage factory in Washington. And, not unexpectedly coming from a business leader, it is a lament that the government is often either not paying attention or unduly intrusive. Broadly, I agree with both those claims.

    But, there is a flip side to problem. Entrepreneurs, precious as they are (I am one, too) are generally doing things that benefit them and their industry/product. As Al Lewis notes above, the wellness industry is basically a confederacy of dunces aided and abetted by government fumbling at policy.

    Isn’t this really just a lament that this Mr. Bush was not one of the protected incumbents at the precise moment that he wanted to be one? When the timing and purposes are right, it would not surprise me to learn that Mr. Bush will use his incumbent status to keep the next generation of innovation, which may become the wolf at his door, from gaining a policy foothold. That’s how the legisltive and regulatory environment works.

    I also disagree strongly with the last sentence. I don’t think Americans give a flip about the healthcare industry, if the metric is some kind of deep existential concern about it. The data show clearly that the typical American engages relatively little with it. That, in fact, is one of the reasons it has innovated so slowly; the people who really need it, such as the chronically and seriously ill, are essentially captive, and everyone else drifts in and out episodically.

    The healthcare industry’s entitlement mentality (including ‘hey, add my interests to this bill, but maybe not the next guy’s) is deeply engrained. Industries that live and die by consumer engagement, such as the retail tech industry, relentlessly pursue innovation in everythng from product development to customer service and it shows. I would much rather talk to a customer service rep at Verizon Wireless than anyone in my son’s pediatrics office.

  43. Usually its the patients who get to crash and burn while all the providers lobby for government protection and inclusion in legislation.

  44. Peter1 – While I hope I never have enough power to truly crash and burn anything on my own I do believe that healthcare should have room for a few crazy ones to try something new – even if some crash and burn …

  45. I can’t help but wonder what proportion of their dazzling revenue is directly attributable to the Meaningful Use initiative Mr. Bush never passes up an opportunity to malign? (“…schtimulating a bunch of losers…”)

  46. Bubba, I think the solution to government missteps can be found in the Hippocratic oath “first do no harm,” or even better and both of “only do no harm.” The problem with when government forces everyone to go down a one-way road is that no one gets to try another direction.

  47. “The clipboard is an absurd waste of our time (and an infection risk to boot).”

    The time is the same filling in a paper form or an email form. I guess you’d also have to electronically sign the email – more time than simply signing.

    Walking out your front door in the morning is an infection risk.

    Does Athenahealth EMR talk to other EMRs?

  48. Peter-

    The doctor could send us a secure email asking us if there’s any change in our financial information or health status and simply incorporate that new info into your record. The clipboard is an absurd waste of our time (and an infection risk to boot).

    athenahealth is frequently the highest rated MD office EMR. it is affordable, cloud-based and bravely targeted the small practices that could never have afforded Epic. Jonathan is a breath (no, actually a gale) of fresh air, and his company changed the industry in a positive way. (BTW, I have no ties to his company and have never spoken to its users).

  49. “Where else but the doctor’s office do you have to fill out a form on a clipboard?”

    Well how else is the doctor to know what your medical history is and if it has changed and up to date, let alone any other life changes that might matter?

    “Bush calls for disruption of the status quo through new business models, new payment models, and new technologies that give patients more control of their care and enhance the physician-patient experience. More choices, freedom, power and information, and at far lower prices.”

    WOW! Our savior is here, although I don’t see any of those always elusive “lower prices”.

    He’s selling his EHR, you know the stuff that physicians complain about all the time here on THCB. They complain about the cost, the function and the requirement to enter information.

    Get ready for yet another Bush to run for President after his book promotion here on THCB. The last Bush crashed the economy, will this new one crash health care?

  50. Sounds like you’re the guy to ask then. (And yes, I’ll read the book. You got me.) How do we get government to stop getting in the way? I personally don’t think it’s possible. But if it is, how do we start?

    And follow up question: what should we take away from the Meaningful Use / HITECH experience ?

  51. This happens all the time. In wellness, an entire industry of charlatans has developed (and several worthy companies likely killed, though we won’t know because they are dead) because no one thought to add a simple clause — as simple as “and internet services” — saying that “wellness companies shall do no harm” as measured by concordance with established guidelines and literature.

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