Monthly Archives: August 2009

Toxic Assets Take a Back Seat to Health Care Reform

WASHINGTON - MARCH 31:  (L-R) TARP Special Ins...
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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.

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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

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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.

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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.

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