website is the prototype of a book, Health Care: 11June2050, that I am writing about the U.S. health
care system. It
is the culmination of thirty years
of involvement in health care at many levels as a management consultant and policy analyst.
So, why me? What could anyone hope to accomplish in an area already over-trodden by so many (wo)men of achievement?
have arrived at the 'observation-point' of my life; that proverbially rock ledge
climbers encounter half-way
up a mountain. From this
point I can now see clearly and feel it is the proper time to
enunciate and defend some long-held views about what it is really going to
take to reform
American health care.
Life seen from the Observation Point
FROM THE OBSERVATION POINT
is little argument that our current health care system desperately needs to be
reformed. For thirty years, it has riveted the attention of some of
the brightest in
our society; yet, for all the
debate, we seem more polarized than ever before. Dangerously close to the tipping point of no return, we lack perspective and, it has paralyzed us politically. Incremental solutions at the margins are now a day late and a dollar short; the really big, omnibus changes seem too risky to take with a social and economic system that affects us all.
Before you read too far, you need to know that I
hold several views which are contrary to conventional wisdom, including;
a) the future role for health care in our economy must be the cornerstone in our 21st century economy, as a global export industry, not as the domestic overhead of an indulgent society;
b) holding the fire line on rising costs can occur in the short run through tighter regulation, but transformation will require imposing external forces sufficient to precipitate a disintegration of the old health care system's structure, allowing a new system to flourish;
c) health care costs should not be hyper-inflationary; average unit prices should be falling; and
d) labor cost and lack of productivity, particularly management and, not technology, is the dominant reason for health care costs rising.
I strongly believe that the consequences of doing nothing will be catastrophic and threaten our very way of life and political system. Left unattended, health care is well on its way to becoming a 20% overhead-burden in the US
domestic economy. That level of burden will be unsustainable when trillions of dollars of unfunded liabilities
arrive as baby boomers retire. Policy-makers can temporarily deny reality by suggesting that a health care job is just as good as a manufacturing job, and they can argue that dollars spent on health care are just as valid as dollars spent on food and clothing but, "domestic overhead" does not create wealth; it is people exchanging dollars with each other and at best leads to a subsistence living. It is the sure path down the slippery slope to serfdom, if I may paraphrase Frederick Hayek.
The health care cost component of the industrial products we Americans produce is already a major impediment to our being able to export goods in the global market; it is an underlying cause in the drive to offshore production and bring in cheap immigrant labor. Health care must somehow be transformed and it must become sufficiently efficient and of high quality to become an
economic "export engine";
to partially replace our aged and permanently declining agricultural and industrial sectors.
This is our challenge in the 21st century. To achieve this
vision, health care must have a "positive" cost-experience-trend,
average-unit-costs steadily decline as a result of productivity
gains. And, the use of technology must begin to contribute mightily to accelerating that downward trend, not be used as an excuse for cost increases.
I realize that most of you will recoil at the notion that health care could ever be subject
to Moore's law, as we have come to expect from personal computers. But, I firmly believe that if, over the past thirty years,
key disciplining forces in the health care market had not been neutralized by a series of public
policies that precipitated hyper-inflation in the sector, health care's
average-per-unit costs would now be declining, instead of increasing.
I will further argue that the use of traditional insurance as a means
to lay off risk for group health plans now needs to be supplanted with market-based 'futures-contracts'
traded on a commodities exchange, in the same way we hedge risk
for currencies, carbon
credits, and agricultural commodities. Agriculture, our best example of sustained productivity increase,
was reformed at the turn of the 19th century by government encouraging
formation of cooperatives. It is also how we electrified and gave rural
America telephones. We should do the same for small businesses and
consumers by allowing them to create member-owned and governed health
All in all, I will outline my vision and strategies which, as an integrated totality, should go a long way
towards reforming the health care market. Most importantly to me, personally, I am going to use this discussion of health care as the opportunity to unveil an idea I have been laboring over for two decades; my "process of positive disintegration" which addresses the fundamental dilemma of how to transform post-industrial social and economic structures that are hierarchal and resistant to change. This concept was first conceived in the late 1980s, presented as a graduate school paper in 1990, and now, in this book; it is applied to the health care system.
From my perspective, if I was lucky enough to have you, the reader, buy-in to my "vision" and even a handful of the strategies outlined in the book, the overriding problem would still be how to get them implemented, a seemingly impossible situation in a polarized political environment. I have long subscribed to the belief that when faced with an impossible situation one must find a "finesse" option. The 'process of positive disintegration' is that finesse and is really the overriding thrust of the book. All else is prelude.
Hyper-inflation; Costs doubling every 5 years; domestic overhead destroying our global comparative advantage; Unsustainability leading to collapse.
Health care needs a cost experience trend where average-unit-costs are declining and should be subject to Moore's Law
A deficit Balance-of-Payments and collapse of our industrial exports must be replaced by health care and education as export sectors
ABOUT THE AUTHOR
M. Miller has been an advisor to government and business for nearly thirty years.
During the first leg of his career he worked with four Fortune 500-sized
organizations, including: Philco-Ford, Unisys, Deloitte Touche and KPMG. Shortly after launching his own boutique strategy and
turn--around firm in the mid-80s, he became heavily involved in health care
reform at the policy level with business coalitions and government health agencies. In 1996, after he received a degree in health policy from
the University of Colorado's Graduate School of Public Affairs; he
became Senior Fellow at the Independence Institute in Golden, CO. Miller also has bachelor level degrees in accounting, mathematics and economics from Montana State University. He is the founder of three organizations: Lone Tree Consulting, a strategy firm; White Dwarf Communications, an internet- based publisher; and, The Tobacco Root Institute, an eleemosynary organization dedicated to public policy issues. For further information, go to the companion websites: www.lonetreeconsulting.com or www.frontrange2050.com
CONNECT THE DOTS
my years as a management consultant I spent most of my time developing strategies and doing turn-arounds of troubled organizations. To get beyond instinct and intuition, I eventually crystallized a creative problem-solving process that involved
gathering massive amounts of information and then forming an
impressionist view, similar to what an abstract artist might do.
Stand close and all you see are dots; stand back and you will see patterns that comprise a bigger picture. Then, the job of interpretation begins.
The genesis of my ideas in health care emerged throughout the 1990's as a fragmented set of hypotheses. I now attempt to present them as an integrated totality.
A LIFETIME TO PROVE A POINT?
We all have pictures of our heroes on the wall. Mine are Isaac Newton, Albert Einstein and Buckminster Fuller.
Between 1643 and 1727, Isaac Newton enunciated two essential theories of physics: conservation of momentum and angular momentum. Nearly 250 years elapsed before Albert Einstein set forth the theories of relativity and mass-energy equivalence, E = mc2. Both men spent the remainders of their life proving their theories.
Einstein said of Newton, on the 300th anniversary of his birth, ". . . you found the only way which, in your age, was just about possible for a man of highest thought and creative power".
Tensegrity and synergy
SPILLOVER EFFECTS OF BUCKMINSTER FULLER
The geodesic dome has been with us since the Pantheon and Leonardo daVinci. But, it was Fuller who enunciated the principles of energy flows and tensegrity. He carried it to a level of elegance and devoted his life to its possibilities. I stumbled across Fuller back in the 1970s at John Denver's Winstar Foundation in Aspen, Colorado and have never been the same since. You will see the geometry of the dome and sphere in everything I do.
A BOOK OR A WEBSITE?
We are in a period of transition from the 'high-touch' printed book moving towards 'high-tech , interactive, web-based, digital media. This book is being prototyped on a website, but can be "printed-on-demand". This material is copyrighted and the author asks for citation of his original material whenever it is used. Readers are free to use the material and incorporate into their own works as long as credit is given. Anyone who feels they deserve credit for material presented here should contact the author.
Red giant as sun
WHITE DWARF OR RED GIANT?
Metaphors and analogy have always helped me understand and communicate. One of my favorites is the White Dwarf star. A star, such as Earth's Sun is usually a "Red Giant" which is a
constant giver of light using nuclear reactions. Eventually, though, a star, like a human who has aged, begins to wind down. At some point a process of accretion begins,
whereby the star is forced by necessity to rob energy from surrounding stars. After
becoming a white dwarf, the star is destined for death, but still burns
brightly for a time.
White dwarf in accretion
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