Toxic Assets Take a Back Seat to Health Care Reform

WASHINGTON - MARCH 31:  (L-R) TARP Special Ins...
Image by Getty Images via Daylife

Elizabeth Warren made an appearance on  Morning Joe this morning and woke me up at 5 AM PDT with the force of a revelation: those toxic assets are still on the books of the banks.  The banks, which have taken so much of our children’s futures in the form of TARP money and similar bailouts, have won — not by asking for money, taking it, and using it to fix things, but by taking money and doing nothing.

Remember the good old days, before we got sidetracked by euthanasia, pulling the plug on granny, and letting illegal immigrations hijack our health benefits and take them back to their home countries? (Yes, I heard that all being discussed in the Town Halls I watched yesterday.) Well, we were talking about boring stuff like mark-to-market, an obscure little accounting rule that says you have to call your pig a pig when you take it to market and you can’t call it a Ferrari.

The banks are still accounting for their piles of pigs (or maybe pig droppings) as Ferraris, because Congress now allows them to do so. And they will not sell those assets, even to the government, because to do so would mean they’d have to acknowledge them on the books as pigs, throw away those glamorous photos of  Ferraris that adorn their annual reports, and quietly slink away with their pig tails between their legs, giving the field over to newer, smarter banks.

I was with the conservatives on this issue.  I didn’t want us to bail out the banks. But we did, because we thought the system would collapse if we didn’t. OK. So we put off the collapse for two years, but–my fellow Americans — while you are all worrying about death panels and tax-supported abortions, don’t take your eye off the world around you. Multi-task if you can.

Because 30% of the homeowners in the country are now under water.  Job losses, while not accelerating at such a rapid rate, are still happening, and more and more people can’t pay their mortgages.  The gigantic economic re-set is not over, as the next wave of adjustable mortgages come due in 2010.

This means more foreclosures, along with the imminent collapse of the commercial real estate market as well.  Who needs office space when you are laying off workers and can’t get a credit line to keep your business alive?

What will happen? Bank failures at long last. I’ve got my bets on who goes down first as Congress, now threatened by its constituents with full scale revolt, fiddles with health care while the financial underpinnings burn. One set of lobbyists has replaced another.

At least when we spend money overhauling the health care system the money will reach individuals. Following Elizabeth Warren on Morning Joe was Joe Califano, who was around when Medicare was passed. What he said? No one could have predicted forty years ago the revolution in medicine that led to the explosion in life expectancy. We can’t predict what will happen when the next wave of innovation in neurology and cancer research make life even longer. So the only way to control costs is to keep people out of the sick care system.

So let’s put our eye back on the ball. Focus on ourselves. Let the banks fail, but the people succeed. Survive the re-set in the economy, which is believe is permanent, by getting in shape. I will see you at the gym.

Reblog this post [with Zemanta]

Leave a comment

Filed under Business, Current Affairs, Health Care, Politics

Facebook, Friendfeed, the Real Time Stream, and RL

Today’s big news, in case you are — let’s just say — a surgeon in the operating room or the President in a Summit–is that Facebook acquired Friendfeed. I have several minor insights to contribute to the conversation about this:

1)Only the unemployed or underemployed even know about it yet, because they are the only people with the time to participate in the real time stream. The folks who spend their lives in corporate meetings, teaching children, or walking police beats probably will find out later. The real time stream is a nice idea, but there are entire days when I can’t dip my toe into it until dinner time. It is, therefore, of minimal utility to most people.

Today I happened to be down for routine maintenance (manicure, pedicure, hair colored) so I was available for the stream, which soon became a tsunami, to wash over me.

2)There has been a firestorm of sadness (what a mixed metaphor) from Friendfeed early adopters, and a mass of questions from pundits about what Facebook is going to “do” with Friendfeed.  Do They don’t know what they are going to do. They bought it because it was doing some things they felt were important and they either wanted to remove it deftly from the market or get a look at it up close and personal so they could knock off its features better.  Or both. But it’s like when you buy a sweater.  You think you know what you will wear it with, but it doesn’t become a worthwhile purchase until you find something absolutely unexpected in your closet that it updates and improves.

3) Or maybe they just wanted to make an acquisition, because they can. And because companies that make acquisitions get noticed by investment banks and maybe get to go public and cash out more early investors and employees.

4)At any rate, this is typical echo chamber news — fascinating to the people in Silicon Valley and of little consequence to global warming, health care reform, or Afghanisan. Or is it?  Can we use it to share breaking news? Naaaah, that”s Twitter. So what are these two platforms, now joined in unholy alliance, good for?

5)Community and conversation.  That’s what they have in common, how they differ from, and probably don’t even compete with, Twitter.  And that’s why they probably belong together.

Time to get the color rinsed out of my hair:-) The real time stream is the gray going down the drain and the blonde replacing it.

And boys, it’s only business.  Friendfeed wasn’t your baby. Get over it

Leave a comment

Filed under Early Adopter Stuff, Entrepreneurship, Social Media

Will “Free” Work in the Electronic Health Records Market?

Health records want to be free. At least that’s what PracticeFusion, a two-year-old company that makes SaaS  electronic health records (EHRs)  and practice management software thinks. Never mind that people might be scared to put their health records on the internets, PracticeFusion’s hypothesis was that doing a deal with Google to put ad words on medical records would allow the company to offer its product free to physicians, who were not adopting EHRs because they couldn’t afford the investment of time, money and support.

Fast forward a couple of years, during which EHRs have still not been widely adopted (about 17% of doctors have them, most of the market leading products really suck, and docs say EHRs actually slow them down) and stimulus money has come into the picture to incentivize physicians to automate.

Marc Benioff, the king of Saas, has decided somehow health care will be a market for him, and has invested an  undisclosed amount of money in PracticeFusion.  According to the press release, the patient health record will launch on Force.com, Salesforce’s enterprise model.  This makes sense, because of HIPAA compliance, secure servers, etc.

The press release also announces this as a “cloud computing initiative.”

Oy, the buzz words have changed mightily in the last two years. But what will the doctors do now? Except for the free part, nothing has changed.

2 Comments

Filed under Early Adopter Stuff, Health Care

Why You Want Health Care Reform

In March, the Coastside Family Medical Clinic, a local clinic serving the population of Half Moon Bay and its surrounding area, abruptly closed its doors, leaving 8,000 patients without a  primary care doctor.  The Clinic ran out of money because 1)insurers took too long to re-imburse for services, 2)many patients had no insurance, and 3) the Clinic didn’t have adequate financial management systems to weather these storms, which hit all medical practices from time to time because insurers delay payment to maximize profit.

But it also left the patients without their medical records, and without a way to get them back. The Clinic went into bankruptcy, and the medical records are stuck in legal limbo. Remember, it’s now August.

By law, a clinic that goes out of business is required to make sure its records find their way either to patients or their doctors. But how to do that without funds? And within the boundaries of the Privacy Act regulations.

It takes an extraordinary amount of labor and resources to go hunting for records. It’s time consuming,” [the bankruptcy trustee] said. “This is a hot potato … There’s a lot of people who want to volunteer for a few afternoons, but no volunteers are willing to step up and take responsibility.”

This case doesn’t lend itself to an easy fix,” the judge said. “We’re a bunch of bankruptcy people suddenly becoming health experts.”

The trustee went further to explain that there were 37,000 total records, representing 8,000 patients. Only 3000 are actually active, but how do you know which ones without the doctors and nurses?

How would you feel if those were your records? You’d feel that it would be nice if they had been online, and you could have easy access to them to pass them on to the next physician. It would also be nice if there were an entity that had the power to step in and make it happen, like a Regional Health Information Organization. Read up on RHIOs, which are part of the National Institutes of Health’s plan to modernize health care delivery.

After all, those are your records. And it would be nice if you still had a doctor to take them to, especially if you were a mom and your children were treated at the clinic.

Yes, it would be nice if we had a system for continuity of care, in which clinics didn’t go out of business, or insurance companies refuse to pay. That’s what health care reform is REALLY all about. It’s not about costs, or about public plans, or about rationing, or about any of these other bogus red herrings.  It’s about you, your health, and your ability to see a doctor, own your own records, and get the right care. No matter who pays.

Right now, a combination of the profit motive, late payments from insurers, uninsured people needing care, rising costs, and probably mismanagement can leave you and your children out in the cold,  whether you are with or without insurance.

Leave a comment

Filed under Health Care

Who Makes Money in the Cloud?

This is my seventh AlwaysOn Stanford Summit. I thought it looked a little smaller, but Tony Perkins told me at lunch that they had 850 people on the register, and that they had sold out of CEO Showcase spots.  I can see that, because the showcases seem packed.  There are many startups in the world.

Here’s my friend Rafe Needleman, CNET Editor whose writing I’ve been following for ten years through various incarnations as a tech journalist,  moderating the next panel on Rainmakers in Cloud Computing. The participants are Kenn Comee, CEO of Cast Iron Systems, Monica Lam, Co-founder of MokaFive, Juan Carlos Soto, VP, Sun Microsystems, Chip Hazard, General Partrner, Flybridge Capital Partners, Michael Stein, CEO of Darkstrand, Michael Peachey, Chief Architect & Dir. Cloud Computing, TIBCO.

Over lunch, several people talked to me about cloud computing.  Most didn’t know what it meant. Some language: “outsourcing,” “the mainframe is back and it’s sexy,” “hosted applications,” “pay as you go,” “software subscriptions.”

There has been a technological shift in the last five years that has changed “utility computing” to cloud computing and in ten years the software business and the cloud will be synonymous, some of these panelists say. Desktops have been virtualized, and almost all desktop apps can be put up in the cloud.

We can now “pay by the drink.” It’s the mainframe all over again, shared computing power with a “thin client” that looks like a browser. But will enterprises want to shift all their digital data to the cloud? Not quickly, and not to the public cloud. But private clouds will run in ways that look like the public cloud.

What are the big opportunities for making money on cloud computing? Infrastructure is actually one of them, and new kinds of apps enabled by the cloud will help the business user who doesn’t know how to deal with IT.

What’s the next new Salesforce.com? The landscape of horizontal software-as-a-service is pretty built out. But there will be needs for new infrastructure that will help IT departments run apps in a private cloud. The side benefit is that the cloud is an enabler of application development, as Dave Winer can already tell us. Disaster recovery and backup will cross the boundaries from the enterprise to the cloud.

Issues?  Quality.Rafe says all these web apps can be built for next to nothing, because they’re built on Amazon Web Services and running in the cloud. But many of them aren’t making any money. So there will have to be a rationalization to optimize how clouds work (Ken Comee). Then many things running in the cloud will die, but the best ideas will percolate up.

Infrastructure. Michael says that GE is trying to deploy a SmartGrid for utilities, but it can’t figure out how to run that in the cloud because the backbone of utility companies has data rates that will bog down the traditional internet. The cloud will get too crowded, and there won’t be “room” to put everything on the internets. Moving a terabyte of data on Amazon Web Services is no fun. So Sun has tried to bring many of the concepts of running your own  datacenter into how you would run your own cloud so you are not on the public cloud.

So the networking side of cloud computing has a lot of opportunity.

Security. How far can people in the enterprise go with an app before the iron hand of IT comes down on them? That depends on the application. People will then develop private clouds for niches like HIPAA compliance. There will be many clouds ooptimized for different market segments.  That would be happening today but for interoperability issues — which will be solved. Security is the number one reason enterprise apps are afraid to go to the cloud. 75% of enterprise people  wouldn’t move their apps because of it.

To what extent do security issues like the break-in at Twitter undermine the premises of cloud computing? Most of the apps Twitter used were in the Cloud, like Google docs, and the hacker came right in and got all their data. But the panelists agreed that security policies at Twitter have been lax, and that even if the docs had been on internal servers, a hacker could have gotten them given Twitter’s security policies.

There are no HIPAA compliant clouds out there today, although there are SAAS-based EHRs. As a user, I’m not worried about someone taking my medical information, but I am very worried about Google mining my data, or my insurance company. This is a reason for a private cloud and locked down security.

Return on Investment. From a VC standpoint, it takes a long time to run a subscription business past the Valley of Death.  Time to revenue for a cloud business is very long, because revenue comes in a stream, not a lump. Driving sales has to be very swift and very focused.

1 Comment

Filed under Early Adopter Stuff, Enterprise Software, Health Care, Web/Tech

Who’s Making Money in Mobile

After listening to Paul Jacobs of Qualcomm talk about where they are focusing, which unsurprisingly includes health care  and remote patient monitoring, the panel at the AlwaysOn Stanford Summit on who is making money in the mobile space went off into much more  interesting business models. They convinced me we have only begun to see money made on mobile platforms — ANY mobile platforms.

Moderated by Mark Newhall, co-founder of IdeaWave Solutions and INmobile.org, the panel consisted of Bart Decrem, CEO of Tapulous,, which develops social games for the iPhone;  Simon Khalaf, CEO of Flurry, a mobile analytics firm; Matt Murphy, a KPCB partner in the space; Dorian Porter, CEO of Mozes, a text company; and Purnima Kochikar, a VP at Nokia.  Yes, I knew mobile was coming, and has been coming for a decade, but a lot of my assumptions were outdated.

First of all, as you may have expected, the iPhone changed everything. People now pay for things they wouldn’t pay for before on the web. Music was obviously first, but Bart Decrem said that although he thought a million users in a year was an audacious goal, Tapulous is now in its second year and has 15 million unique installs and about 10 million users. Its revenue has doubled every twelve months. And that’s “just” a gaming application–TapTap Revenge. He thinks he will get to be a $100m company.

He also noted an amazing engagement on the Apple platform, which means people actually keep the apps on the phone and interact with them. That’s important because it makes way for in-application ecommerce and advertising. And every time he releases a new product now, his revenue spikes.

So clearly mobile is a disruptive platform, and application developers are already making money. There are 64,000 apps in the App store now, and $.99 can be a profitable price point. The app store is actually growing at 25x the rate of iTunes, and even the paid apps part is growing at 7X ITunes. A lot of money will be made in software.

Who is not making money right now? Carriers. Formerly in control of the show, they are now buying business, hoping to make it up in volume later, as big brands enable online marketing strategies and they can take a piece of the revenue. That kind of direct marketing through mobile devices is still in its infancy.

After all the talk about iPhones, it was fascinating to hear Purinima talk about Nokia.  She’s got the global view outside of smart phones, and she said Nokia has realized two areas that people will pay for, even in developing countries whose populations do not have smart phones.
1) Complete indulgences – games, efarts, etc.  Ads work here, on premium game content.  Video ads inside gaming content are much better targeted, and pull good CPMs and different CPMs. So different that the Army uses in-game ads for recruiting tools and find them extremely effective. The Army’s entire business process has been altered by its use of mobile gaming applications.
2)Self-improvement – the bottom of the pyramid really wants to pay for this, and they are the long tail. There are entire
populations discovering things on the phone instead of the PC. Their three high priority needs: Get ahead in life, get more money, get a wife.  They will pay for this, usually on a cash subscription model. Smart phones are only 10% of the market globally,  the rest still being feature phones. Feature phones can be enabled to give access to lots of apps through proxy browsing, and that will teach many young people in developing countries to move up to smart phones, which are aspirational to them today.

FCarriers, out of power in the new environment, are now interested in supporting multiple app stores. Similar business interests around mobile ads, mobile marketing, mobile payments will encourage carriers to move fast and participate in direct-to-consumer economy. They can participate by setting up open stores. They can’t control anything. (Decrem: For iPhone, Apple controls the carriers and app developers don’t even have to deal with carriers anymore.)

Final words of advice to would-be successors to Tapulous: develop first for the iPhone, and then for Android. Blackberry’s a distant third that needs to get its act together, and for Palm, it’s too early to tell. It is, however, a land grab right now in the mobile space.photo-6

1 Comment

Filed under Early Adopter Stuff, Entrepreneurship, Games, Web/Tech

Friend, Follower, Fan, or Fake?

It’s a beautiful morning to think about what’s happening to the winning social network sites as we early adopters all get what we thought we wished for: mainstream acceptance. Well, now here came everybody and we have to deal with it.  Chris Brogan has a great post about this called Quid Pro No, which deals with unwelcome reciprocal friend/follow requests, and Brian Solis tackles the problem of “sponsored conversations,”  over on Tech Crunch. Ugh. The mere fact that the FTC is getting involved with how brands use Twitter means we’ve got problems, no matter which way it shakes out.

Here’s Brian: As you could possibly imagine, the reality of mass-sponsored tweets will raise a Tweetstorm that will immediately trigger a blogstorm, which will ultimately escalate into a full-blown Category 5 media hurricane. But the reality is, whether you agree with them or not, sponsored conversations and paid tweets are already here.  The question is how to use them correctly and responsibly.

And here I am, participating in the blogstorm.

Like many people who have been on all three major sites, I face the problem of potential “relationships” with both people and brands every day, because once people get on social media and figure out why they are there, they all become brands, even me.The same people who teach courses like “Advanced LinkedIn” teach “Growing Your Personal Brand.” I am, of course, throwing up in my mouth as I write this. I’m both a victim and a perpetrator.

As a person, and as a human-brand, I finally decided to treat online relationships like I do IRL. My brand is authenticity. I am fond of saying “I am transparent.” Well, I am. For example: I have quit following back on Twitter, am deleting people I followed back in the beginning when Twitter was smaller, and only follow people I have something in common with, know, or who post great content that can teach me something. I also have separate accounts for health care (ushealthcrisis) with @Karoli and @azentrepreneurs for my startup conferences. I’ve announced this on Twitter multiple times, and will continue to do so. It was getting so I couldn’t see the tweets of my guru, my daughter, and my business partner. Not to mention breaking news and other interesting links I want to follow, posted by people I respect.

On Facebook, I now actively friend only people I’ve already met IRL. I accept friend requests, but if I don’t recognize the name I don’t add the new people to my feed. I have several different lists, too. And I don’t become a fan or join a cause except in exceptional cases of true belief. I have also announced that. I spend one day a week hitting ignore. Events are a different story; I still want to know about them so I can decide to attend if I’m in town. If your event is in Cleveland, don’t invite me. I can’t come, and I probably won’t even RSVP, which will throw off all your food counts:-)

On LinkedIn, a site I hate, I maintain a public CV for speaking engagements and accept connections as a courtesy if I know the people.  I don’t spend much time there, because I find it an awkward site to manipulate. To me, it needs a total makeover. But I stay there because I want to connect people I value when they need my help. Having been there a long time I have a large network. I actually WANT to make that useful in the right circumstances. But I get to choose. Reputation is all I have. And connecting people is like fixing them up on blind dates. If they have a lousy time, they blame me.

It’s very hard to get me to write a recommendation for you, though, even if you write one for me:-) unless I mean it. I’m not a person who feels compelled to reciprocate about anything. People who have repeatedly invited me to dinner would starve if they waited for me to invite them back. (I don’t cook.)

These curious curations and apparently frivolous filters allow me to be authentic without relinquishing the joy of discovery or my “privacy.”

And thank you Chris and Brian for forcing me to collate my thoughts around this crucial subject. I would friend you both anywhere:-

1 Comment

Filed under Current Affairs, Daily Living, Early Adopter Stuff, Social Media