HBS: Can the "Masks of Command" Coexist with Authentic Leadership?

Bill George, former Chairman and CEO of Medtronic and now a professor at the Harvard Business School, thinks he knows the answers.

George lays out the elements of "authentic leadership" in his book of the same name. They are:

"(1) pursuing purpose with passion: Authentic leaders must first understand themselves and their passions;

(2) practicing solid values: values are personal, but integrity is required of all leaders;

(3) leading with heart: it means having passion for your work, compassion for the people you serve, empathy for the people you work with, and the courage to make difficult decisions;

(4) establishing enduring relationships: people insist on access to, as well as openness and depth of relationships with, their leaders;

(5) demonstrating self-discipline: this requires accepting full responsibility for outcomes and holding others accountable for their performance."

Gallup: "Americans Consider Crossing Borders for Medical Care"

Hmm ..

WASHINGTON, D.C. -- While domestic healthcare costs are expected to increase to an estimated 21% of GDP by 2010, some Americans may be interested in taking their healthcare spending elsewhere. A recent Gallup Poll finds that up to 29% of Americans would consider traveling abroad for medical procedures such as heart bypass surgery, hip or knee replacement, plastic surgery, cancer diagnosis and treatment, or alternative medical care, even though all are routinely done in the United States.

FYI: AMA medical tourism statement

The AMA advocates that employers, insurance companies, and other entities that facilitate or incentivize medical care outside the U.S. adhere to the following principles:

(a) Medical care outside of the U.S. must be voluntary.

(b) Financial incentives to travel outside the U.S. for medical care should not inappropriately limit the diagnostic and therapeutic

More patients looking at home before going abroad for medical procedures

F.U.D. -- fear, uncertainty, doubt

Galichia Heart Hospital in Wichita, Kan., recently decided that it could break into a market monopolized by overseas hospitals—and offer high-quality, more-convenient care to patients.

In conducting research of medical tourism options in other countries, “we visited hospitals in Singapore, India and the Philippines—the biggest areas drawing Americans,” says Steve Harris, the 85-bed hospital’s CEO.

What the hospital’s administrators found was that the travel experience to these countries “was awful,” Harris says. Recovering from heart surgery or hip replacement, then having to sit for 20 hours on a plane back to the U.S. from some common medical-tourism destinations, isn’t an ideal situation for many patients, he says.

FYI: this week's call list

A start-up's life is never dull. On the sales call-list this week --

• Major SE tribe
• Major SW tribe
• Major GP tribe
• Major provider in India
• Major provider in Thailand
• Major provider in South Korea

1,000,000+ "MedOn" customers?

Today's news: one of the USA's largest, most-trusted member-organizations has agreed to review Medical Onshoring (patent-pending) for usability. If given a positive review, insurers (e.g., Blue Cross/Blue Shield) and venture capitalists would be suitably impressed.

WSJ: Would Developing World’s Low-Cost Strategies Work in U.S.?

In my patent application for Medical Onshoring, I cite the work of Mother Teresa and C.K. Prahalad in India.

I'm not a genius -- I just try to use common sense.

BTW: about the WSJ's concern that being one S.D. from mean is issue -- getting no treatment is right off the chart.

Can cost-effective health-care measures that have worked in poorer countries be applied to in the U.S.?

That’s the question the WSJ asks amid the debate over how the U.S. can reign in health-care costs. It’s become clear that many stakeholders in the debate are in favor of figuring out what treatments and tests are most effective for patients but not limiting care based on cost. Read J&J CEO William Weldon’s letter on this topic in the Washington Post this morning.

One example the WSJ cites is a program run by an AIDS clinic in Alabama that improved its no-show rates dramatically by giving patients prompt appointments and conducting interviews to help determine what factors might make a patient less likely to come back, which mimicks a similar program set up in Zambia.

But many Americans believe that more expensive care is better than cheaper care, says the WSJ. And, there is also the question of whether speed and simplicity — qualities of care often valued in developing countries — mean as much in the U.S., especially if a trade-off is accuracy. For instance, will an $8 device that conducts “a critical blood test” in six minutes time with 90% accuracy, which will be used in India, Brazil and several African nations, supplant the $50 machine used in the U.S. whose accuracy is 97%?

“In the developing world, people are willing to make the trade-off in accuracy for simplicity and low cost,” William Rodriguez, who founded Daktari Technologies, makers of the low-cost device, told the WSJ. “In the U.S., that kind of trade-off is a hard sell.”

WSJ: Parsing the Health Reform Arguments

Some of the shibboleths we've heard in recent weeks don't make much sense.

The health-care debate continues. We have now heard from nearly all the politicians, experts and interested parties: doctors, drug makers, hospitals, insurance companies, even constitutional lawyers (though not, significantly, from trial lawyers, who know full well "change" is not coming to their practices). Here is how one humble economist sees some of the main arguments, which I have paraphrased below:

- "The American people overwhelmingly favor reform."

If you ask whether people would be happier if somebody else paid their medical bills, they generally say yes. But surveys on consumers' satisfaction with their quality of care show overwhelming support for the continuation of the present arrangement. The best proof of this is the belated recognition by the proponents of health-care reform that they need to promise people that they can keep what they have now.

Day 1 -- how the Missionairies of Charity (M/C) began

If there had been a Twitter from M/C Day 1 (October 1950), it might read like this --

Day 1: One donor. Two souls.

After twenty years as a teacher and principal at a Catholic girls high school in Calcutta -- neat, clean, professional middle-class -- Mother Teresa had a vision. A vision to serve the "poorest of the poor," in a world where human waste runs down streets to open sewers (think "Slumdog Millionaire" and "Angela's Ashes.")

With her vision -- she asked for, and received permission from, the Vatican to begin her religious order. And so --

Day 1: One donor. Two souls.

Two clients. Not 20, or 200, or 2,000. Just two.

Today -- 520 M/C offices in 100 countries. Following the break-through 1974 BBC series about the M/C by a self-admitted "dispirited war correspondent" in need of renewal.

The journey of a thousand miles starts with the first step. A balance of resources, belief, and faith.

How Mother Teresa operated worldwide

Per previous, once upon a time, someone whom I befriended volunteered for a year with Mother Teresa in Calcutta. I supported those efforts with many in-kind services (e.g., fund-raising, donations).

How was "Mom T" able to work in 100 countries, some of them Communist and anti-Catholic?

What I learned: she focused on hospice work. She did not make political statements, or criticized anyone, which would have led to confrontations.

Just focused on her hospice work for "the poorest of the poor."

IMHO, good advice. In this field, focus on caring. Politics and power are different issues.

WaPo: 2009 Health Care Reform -- good luck

A cautionary note ..

Because Congress has passed bill after bill on Obama's wish list and because Democrats hold overwhelming majorities in both the House and Senate, some may think there can be no repetition of the fiasco of 1993-94, when Bill and Hillary Clinton saw their effort at health-care reform die without a whimper.

Insiders know better. Last week, I went to see the four top officials of the National Coalition on Health Care, perhaps the broadest consortium in the field, including labor, religious, professional and medical groups and a smattering of businesses. It has long advocated the kind of comprehensive overhaul of health care that Obama aims to achieve.

These advocates applaud administration efforts to engage the players in the insurance, hospital and pharmaceutical industries in their talks -- and the willingness of those groups to "stay at the table."

But once there is specific legislation, they say, each of these groups will start bargaining hard to protect its own interests. And some of them -- local hospitals, for example -- have real clout with members of Congress ..

Obama will have to carry much of the burden of advocacy himself -- if outside events don't intrude, as they did on Bill Clinton. The president has shown his willingness to bargain, signaling, for example, that he would now consider taxing some employer-provided benefits, an approach he denounced when John McCain endorsed it during the campaign.

But it will take much more than that to win what promises to be an epic struggle.

What my family learned, working with the Cree of Canada

My family served the Cree community as accountants, pre-gaming. What we learned:

• Shared spirituality -- different, yet shared.
• Working together - fairly, forthrightly.
• A love of nature.
• Self-governance -- as a separate, unique national entity that works cooperatively with other such entities.
• Awareness of the global community and the need to work together.
• Respect and forthrightness with others.

MedOn operating idol: Cleveland Clinic

What I gleaned from Cleveland Clinic's CEO about performance standards: either you're doing top-level work and giving 100% -- or you're preparing to leave.

And he points that goal at himself:

Tensions are so high that when Clinic leader Delos "Toby" Cosgrove was asked recently about possible layoffs, he responded passionately, banging his fist on the table.

"We have agonizingly thought this through," said Cosgrove, whose hospital system is one of the largest employers in Ohio with about 39,000 workers. "Our posture is we're going to do everything we possibly can to avoid layoffs here."

URGENT: "MedOn" pat-app @ USPTO.gov

At uspto.gov --

http://preview.tinyurl.com/chien-uspto


As PDF --

http://tinyurl.com/coxare

How will MedOn (p.p.) operate?

In a nutshell -- with most of the goals outlined in Porter & Olmstead-Teisberg's 2006 book on health care --

http://harvardbusinessonline.hbsp.harvard.edu/b02/en/common/item_detail.jhtml;jsessionid=WMYRKFHW0JUE2AKRGWDR5VQBKE0YIISW?id=7782&_requestid=128898

The U.S. health care system is in crisis. At stake are the quality of care for millions of Americans and the financial well-being of individuals and employers squeezed by skyrocketing premiums--not to mention the stability of state and federal government budgets. In Redefining Health Care, internationally renowned strategy expert Michael E. Porter and innovation expert Elizabeth Olmsted Teisberg reveal the underlying--and largely overlooked--causes of the problem and provide a powerful prescription for change. The authors argue that participants in the health care system have competed to shift costs, accumulate bargaining power, and restrict services rather than create value for patients. This zero-sum competition takes place at the wrong level--among health plans, networks, and hospitals--rather than where it matters most: in the diagnosis, treatment, and prevention of specific health conditions. Redefining Health Care lays out a breakthrough framework for redefining health care competition based on patient value. With specific recommendations for hospitals, doctors, health plans, employers, and policy makers, this book shows how to move to a positive-sum competition that will unleash stunning improvements in quality and efficiency.

To paraphrase Warren Buffett -- our goals are value, value, value.

Not buck-passing. Not bureaucracy. Not work-avoidance. Not herky-jerky treatment systems.

If it don't get the patient better -- if it does not create value -- dump it.

MedOn (p.p.) began as a logical response to medical tourism -- why burn all that CO2-producing jet fuel?

The short-coming of medical tourism -- still mired in buck-passing. Who's responsible for what?

MedOn's goal is to create 'caring circles of community." To operationalize systematically, and not with the awful, wasteful, and soul-crushing SNAFUs that plague health care today.

To those who say that the Porter/Olmstead approach is unrealistic and unworkable -- we have read your comments.

Our reply: the beauty of MedOn (pat. pend.) is that, at this point, it is a "clean sheet."

No embedded culture of SNAFUs and FUBARs. And a clear, strong vision -- affordable medical treatment for the working-class, to provide authentic patient value.

So .. to those AMA-types who call MedOn "provocative" --

If providing affordable quality medical-care options for the working-class is "provocative" to you, we wish you well.

We're trying to work with others to make things better for patients.

My "MedOn" professionals

What kind of professionals are needed for Medical Onshoring (patent-pending)?

Oh .. like these guys .. from the HBO movie "Taking Chance" .. professionals for whom "responsibility" and "honor" are more than legal theories.

Working with Mother Teresa

An important step towards Medical Onshoring (pat. pend.) ..

Once upon a time, someone whom I befriended volunteered for a year with Mother Teresa in Calcutta. My friend's letters were very gripping -- how, at the moment of death, the very great and mutual gratitude between patient and caregiver that fairly glowed. Pretty intense stuff. (And yes, Calcutta was like the Mumbi of "Slumdog Millionaire").

When my friend, age 34, returned to the U.S., many questions arose about what to do next. After long -- and sometimes pointed -- discussions, my friend decided to apply to medical school. Fifty of them. I suggested 10 was probably enough. At least 15 applications went out.

As a "Public Ivy" master's graduate, I explained what was required. I edited the admissions essay.

Accepted at Northwestern. Accepted at Harvard. Dang.

This was just another step in the process of developing Medical Onshoring (pat.-pend.). And doing what you can, with what you have.

Not politics. Not power and turf-wars. Not just money.

Just doing what has to be done, 110%.

The Indian Health Service of the USA & us

As the inventor of Medical Onshoring (patent-pending), one of the first questions I get is, "what about the Indian Health Service (IHS)?"

My response: "I welcome them as a partner in trying to make health care worldwide better. We're national -- IHS is local. We should work together, not at cross-purposes."

Plus -- I've already improved conditions for IHS (see following).

MedOn (pat. pend.) began as a logical alternative to "medical tourism" -- why burn all that jet fuel?

Knowing our logical, caring beginnings -- to think MedOn (p.p.) would want to directly compete with IHS is "illogical," as Star Trek's Mr. Spock would say. And wasteful and financially-crippling for everyone involved.

MedOn (p.p.) wants to work with IHS -- not get into a zero-sum game with no winners.

MedOn (p.p.) is national -- IHS is local.

We're different. Really different.

Now .. back to caring for patients ..

------

Did MedOn spur federal action for a new IHS facility?

Well ..

First this on 5/15/08, in the "Minot Daily News" --

CHAPEL HILL, N.C. – An engineer in North Carolina has filed a patent for a new medical-care system that he says would be a good business fit with the Minot area.

C. Alex Chien said Wednesday that Minot has the technology, transportation and environment to host a prototype “medical onshoring” clinic.

Chien, a self-employed engineer, is a former rural economic developer with RochesterTel, former owners of Minot Telephone Co. SRT purchased Minot Telephone Co. in 1994.

Then this on 11/11/08 in the "Minot Daily News"

NEW TOWN, N.D. -- The design plans for a $20 million health-care facility for the Three Affiliated Tribes on the Fort Berthold Reservation are moving forward.

"We're looking at a groundbreaking next spring or early summer, with a completion of 2010," said Jim Foote, project manager for the Three Affiliated Tribes' Elbowoods Memorial Health Facility.

In September, Sen. Byron Dorgan, D-N.D., announced that the U.S. Army Corps of Engineers had awarded a $1.48 million contract to launch the design phase to build the health-care facility on Fort Berthold.

Nice coincidence that a long-delayed IHS project accelerates -- or separate matters? You decide.

USA health care -- how much pain?

Why Medical Onshoring (patent-pending)?

Consider the existing alternative -- the $2.4T (trillion) U.S. health care system.

• High costs, putting tremendous financial strain on patients, families, employers, health plans/payors, providers, and taxpayers.
• Uneven coverage and quality -- even with single-payer groups like VA.
• Ruinous medical-malpractice costs, driving up (1) costs and (2) resulting in mostly-wasteful "defensive medicine" to deter malpractice lawsuits -- between $250B (billion) and $500B in wasted costs.
• High administrative costs due to poor management and billing practices -- between $750B (billion) and $1T (trillion) in wasted costs.

This is on top of the USA's self-inflicted medical problems -- smoking, poor diet, alcoholism, drug abuse, and dangerous lifestyles -- as much as $750B (billion) in wasted costs.

Fixing half those issues would free up hundreds of billions of dollars spent on health care now -- wouldn't it?

Editorial note: as a new company, Medical Onshoring (patent-pending) is not shackled to the past. By requiring top performance and med-mal reforms, we will provide the maximal surgical service possible.

Better medicine via medical-malpractice controls?

What makes Medical Onshoring (patent-pending) so promising is the goal of restraining runaway medical-malpractice costs and defensive medicine, via special rules and regulations that call for prompt and reasonable compensation for the very rare medical error and mandatory arbitration. The alternative? Read the following ..

Xiao Xu, a research investigator in the University of Michigan Health System's Department of Obstetrics and Gynecology, won the 2008 BCBSM Foundation McDevitt Excellence in Research award in the area of policy research.

Xu received the award for a paper that was published in the American Journal of Obstetrics and Gynecology, examining the effects of medical liability risk on the availability of obstetric care in the state. The study by Xu and her co-authors found that many obstetricians, family physicians and nurse midwives in Michigan planned to discontinue delivering babies or reduce their provision of high-risk obstetric care in the next five years.

The award comes with a $10,000 grant from the Blue Cross Blue Shield of Michigan Foundation.

Xu discussed her findings with reporter Gary Gosselin.

Business Review: Hasn't tort reform helped mitigate malpractice liability some?

Xu: A variety of tort reforms have been adopted by states, such as caps on damages, abolition of joint-and-several liability, elimination of prejudgment interest, amendments of the period of limitation of actions (statutes of limitations), caps on attorney contingency-fees ... Overall, the literature finds limited impact of state tort reforms on the size and number of paid medical malpractice claims. Only certain tort reforms, such as caps on damages, collateral-source rule reforms, and reduction of the statutes of limitations, have generally been shown to increase physician supply and reduce malpractice premium rates and severity of medical malpractice payments.

BR: Since malpractice insurance rates dropped this year, wasn't Michigan's reform enough to help obstetrics?

Xu: Obstetrical providers are one of the groups most affected by the increasing medical liability insurance premiums and malpractice litigation risk.

Despite the various efforts made to constrain malpractice insurance premiums and claims costs, concern among obstetric providers remains widespread.

For example, data from the 2006 American College of Obstetricians and Gynecologists survey on professional liability found that nationwide, 65 percent of obstetrician-gynecologist respondents had made some changes to their practice over the previous three years for fear of professional liability claims or litigation.

This ACOG survey showed that, for District V - in which Michigan is situated - almost 9 percent of obstetrician-gynecologists had ceased practicing obstetrics and 34 percent of obstetrician-gynecologists had reduced the number of high-risk obstetric patients since 2003 because of risks for medical malpractice claims or litigation.

'Universal Healthcare' -- panacea or pipe-dream?

Will "universal health care" solve the USA's medical-care crisis?

Hmm .. consider these case studies ..

Case 1: Bill Clinton. An MD on duty, 24x7 between 1992-2000. In 2004, has to be rushed to heart surgery. Hecka' job, universal healthcare.

Case 2: David Letterman. Medical/health insurance for a multi-millionaire. In 2000, emergency heart surgery required.

Case 3: Tim Russert. Medical/health insurance for a network VP. Died suddenly of a heart attack.

There's a myth that 'universal healthcare' will solve everything.

It won't. It never will. Get used to it.

All we can hope for, is for people to their best. People treat patients -- not bureaucrats.

---

More details ..

What will health reform do for the unhealthiest Americans?

.. Consider the shoppers at the Save-A-Lot supermarket in Hamlin, West Virginia. At the beginning of the month, when the food stamps arrive, they snap up buckets of lard so big that the label says: “Warning—Children can fall into bucket and drown.” The manager, Key-Ray Adkins, shrugs: “People now say lard isn’t good for you. But it’s what we grew up with.”

Thinking and "developing policy" are not the same as knowing, engaging, and authentically teaching.

---

The Cost of Smoking

What does a pack of cigarettes cost a smoker, the smoker's family, and society?

This longitudinal study on the private and social costs of smoking calculates that the cost of smoking to a 24-year-old woman smoker is $86,000 over a lifetime; for a 24-year-old male smoker the cost is $183,000.

The total social cost of smoking over a lifetime—including both private costs to the smoker and costs imposed on others (including second-hand smoke and costs of Medicare, Medicaid, and Social Security)—comes to $106,000 for a woman and $220,00 for a man. The cost per pack over a lifetime of smoking: almost $40.00.

The first study to quantify the cost of smoking in this way, or in such depth, this accessible book not only adds a weapon to the arsenal of anti-smoking messages but also provides a framework for assessment that can be applied to other health behaviors.

The findings on the effects of smoking on Medicare and Medicaid will be surprising and perhaps controversial, for the authors estimate the costs to be much lower than the damage awards being paid to 46 states as a result of the 1998 Master Settlement Agreement.

Does "universal healthcare" make smoking a moral hazard?

Yes. By attaching no direct penalty for smoking (sin taxes do not always count), in effect non-smokers subsidize the medical cost of smokers. Logical, clear and simple.

---

Cost of obesity

Six in ten people in the United States are overweight, with a third crossing the boundary into obesity. The extra weight leads to at least 100,000 deaths annually. Obese people are at a much higher risk for heart attacks, strokes, diabetes, arthritis and some cancers.

Doctors call people obese if their weight in kilograms is more than 30 times bigger than their height in meters squared. This is known as a high body mass index, or BMI.

Even kids are getting fatter. Nineteen percent of children between the ages of 6 and 11 are overweight, up from 4% in the 1970s. Doctors are turning to intensive behavioral therapy to try to keep these children from gaining more weight.

The economic cost of all this extra fat is immense. Direct medical costs are easiest to calculate, coming in at $93 billion, or 9%, of our national medical bill.

---

Cost of Alcohol Abuse

Your boss might want to forget about making you wear that BlackBerry and take away your bourbon instead.

Businesses spend big bucks on both the little, addictive wireless e-mail gadgets and programs that screen for and treat problem drinkers. Both make back the cost of investment.

But searching for alcohol abusers brings in $2.15 for every dollar spent, compared to a mere $1.62 for keeping workers connected with Blackberrys.

In fact, just by surveying employees and offering counseling sessions of 30 minutes or less, employers might be able to put a big dent in the $35 billion that excessive drinking adds to health care coverage annually, according to the George Washington University researchers who came up with the comparison.

What is striking is that the GWU researchers don't recommend counseling only alcoholics, who require years of treatment, but also people who aren't addicts but simply drink too much.

"Since there are so many more people who drink in hazardous or harmful amounts, about 60% of the costs of alcohol to society are from people who are not dependent," says Eric Goplerud, who heads an alcohol abuse program at GWU called Ensuring Solutions.

"There are people who drink even though they have sore stomachs, or drink and get into a fight and get hurt or engage in unprotected sex."

Each year, alcohol abuse costs the United States an estimated $185 billion, according to the National Institute on Alcohol Abuse and Alcoholism. But only $26 billion, 14% of the total, comes from direct medical costs or treating alcoholics.

Almost half, a whopping $88 billion, comes from lost productivity--a combination of all those hangovers that keep us out of work on Monday mornings, as well as other alcohol-related diseases. People who drink too much and too often are at greater risk for diabetes and several kinds of cancer, according to some studies.

---

Cost of Drug Abuse

The economic cost to U.S. society of drug abuse was an estimated $97.7 billion in 1992, according to recent calculations. The new cost estimate continues a pattern of strong and steady increase since 1975, when the first of five previous cost estimates was made.

The current estimate is 50 percent higher than the most recent previous estimate - which was made for 1985 - even after adjustment for population growth and inflation.

The parallel cost to society for alcohol abuse was estimated at $148 billion, bringing the total cost for substance abuse in 1992 to $246 billion. This total represents a cost of $965 for every person in the United States in 1992. The per-person cost for drug abuse alone was $383.

" .. the economy will eventually recover 'despite' these policies, rather than 'because of them ..'

" .. In this relatively favorable scenario, we may follow the path recently sketched by Federal Reserve Chairman Ben Bernanke, with the economy recovering by 2010. On the other hand, the 59 nonwar depressions in our sample have an average duration of nearly four years, which, if we have one here, means that it is likely recovery would not be substantial until 2012.

"Given our situation, it is right that radical government policies should be considered if they promise to lower the probability and likely size of a depression. However, many governmental actions -- including several pursued by Franklin Roosevelt during the Great Depression -- can make things worse.

"I wish I could be confident that the array of U.S. policies already in place and those likely forthcoming will be helpful. But I think it more likely that the economy will eventually recover despite these policies, rather than because of them."

Joke about economists -- nice young lad, afraid of blood, who still wants to be called "doctor."

"Moral Hazards" while traveling

http://www.economist.com/research/Economics/alphabetic.cfm?letter=M#moralhazard

Moral hazard

One of two main sorts of MARKET FAILURE often associated with the provision of INSURANCE. The other is ADVERSE SELECTION. Moral hazard means that people with insurance may take greater risks than they would do without it because they know they are protected, so the insurer may get more claims than it bargained for. (See also DEPOSIT INSURANCE, LENDER OF LAST RESORT, IMF and WORLD BANK.)

Per the Fannie/Freddie disaster -- when Americans travel overseas in questionable areas -- who bears the cost of saving them? As in this case --

http://www.inthenews.co.uk/news/autocodes/countries/south-korea/taliban-free-more-hostages-$1127908.htm

Taliban insurgents released all remaining South Korean Christian aid workers held in Afghanistan today.

The remaining seven hostages were released in two groups on Thursday, one day after 12 of the hostages held since mid-July were freed.

Agreement had been reached on Monday between the Taliban and South Korean negotiators to end the hostages' ordeal.

South Korea will remove its 200 troops and all missionaries and other civilians from Afghanistan by the end of the year in return for the release.

The 23 South Koreans originally captured were abducted as they travelled from Kandahar to Kabul on July 19th.

Two male hostages were subsequently killed after Taliban gunmen said their demands were not being met, while two female missionaries were later released as a goodwill gesture.

The world is a dangerous place. Obviously.

Warren Buffett on the economy: "America's best days lie ahead"

From his most recent shareholders' letter --

• The sub-prime SNAFU/FUBAR was so bad, "strong and immediate action by government was essential last year."
• All the government bail-outs makes inflation likely.
• "Moreover, major industries have become dependent on Federal assistance, and they will be followed by cities and states bearing mind-boggling requests. Weaning these entities from the public teat will be a political challenge. They won't leave willingly."
• ".. Amid this bad news, however, never forget that our country has faced far worse travails in the past. In the 20th Century alone, we dealt with two great wars (one of which we initially appeared to be losing); a dozen or so panics and recessions; virulent inflation that led to a 21 1/2% prime rate in 1980; and the Great Depression of the 1930s, when unemployment ranged between 15% and 25% for many years."
• "Without fail, however, we've overcome them. In the face of those obstacles - and many others - the real standard of living for Americans improved nearly seven-fold during the 1900s, while the Dow Jones Industrials rose from 66 to 11,497 .. "
• "Though the path has not been smooth, our economic system has worked extraordinarily well over time. It has unleashed human potential as no other system has, and it will continue to do so. America's best days lie ahead .."

Medical care -- more than the surgeon's fee

Much has been made about the cost of medical care and "the benefits of medical tourism." Well, to quote an old professor -- "it is a little more complicated than that."

The price/cost? That's getting easier to find. Here's the reported cost of a heart transplant --

http://wiki.answers.com/Q/How_much_does_a_heart_transplant_cost

Is that enough?

Of course not. So many other factors -- pre-surgery, your GP, after-surgery.

Complicated. Not atom-splitting. But not simple, either.

A cautionary tale: Harvard's financial hubris

Stocks were tumbling last fall as the new school year began, but at Harvard University it was as if the boom had never ended. Workers were digging across the river from Harvard's Cambridge, Mass. home, the start of a grand expansion that was to eventually almost double the size of the university. Budgets were plump, and students from middle-class families were getting big tuition breaks under an ambitious new financial aid program. The lavish spending was made possible by the earnings from Harvard's $36.9 billion endowment, the world's largest. That pot was supposed to be good for $1.4 billion in annual earnings.

Behind the scenes, though, a different story was unfolding. In a glassed-walled conference room overlooking downtown Boston, traders at Harvard Management Co., the subsidiary that invests the school's money, were fielding questions from their new boss, Jane Mendillo, about exotic financial instruments that were suddenly backfiring. Harvard had derivatives that gave it exposure to $7.2 billion in commodities and foreign stocks. With prices of both crashing, the university was getting margin calls--demands from counterparties (among them, jpmorgan Chase and Goldman Sachs (nyse: GS - news - people )) for more collateral. Another bunch of derivatives burdened Harvard with a multibillion-dollar bet on interest rates that went against it.

Res ipsa.

Personal: a note on venture capital, post-Fannie/Freddie

"Life is hard," wrote M. Scott Peck, M.D.

SHEESH! No kidding! Just a year ago, so many things seemed possible. Now -- VC for bio-tech appears lifeless.

But yesterday, an MBA/JD of the HSW variety (Harvard-Stanford-Wharton) said "for the right opportunity, there's still capital. If the opportunity is big enough."

Medical Onshoring (patent-pending) is my mission in life. With a budget as large as the French economy, U.S. health care has plenty of assets to attract investors.

I decided to return full-time to health care for a lot of reasons. A key one: in technology, you get used to people, running into your office with their hair on fire, every other hour. At this stage of my life, I decided I needed to do something more meaningful and purposeful.

The meaning and purpose of MedOn (pat. pend.):

• to provide working people with affordable, high-quality medical-care options;

• try to help contain the frightening rise in medical-care costs; and

• raise the standard of medical care for working people, worldwide.

A lot better than people running around with their hair on fire, eh?

The need for accreditation: a cautionary tale

What goes around, comes around ..

Lawmaker Urges Regulation Of Dental Restorations To Protect Patient Safety

21 Feb 2008

Florida Rep. Stan Jordan, R-Jacksonville, announced that he has filed legislation backed by the Florida Dental Laboratory Association to implement more stringent regulations to protect patients receiving the dental restorations affixed into the mouths of millions of Americans each year.

Dental-restoration products - the porcelain crowns, dentures and bridges that American dental patients have permanently seated in their mouths - are currently under-regulated, with few legal requirements for technicians to be certified and no mandates for dentists to document or disclose the source of dental work to patients, Jordan said Tuesday.

Although dentists prescribe the type of device they need for a dental patient, the product is actually manufactured by a dental technician employed by a dental laboratory, which could be located in the United States or anywhere in the world. Due to the growing number of Americans seeking dental restorative treatment and the growing pressure by some dentists to cut costs and increase profit margins, much of the dental work Americans carry in their mouths is now imported from countries such as China, Pakistan, the Philippines and India.

Jordan's legislation, HB 923, will require all dental laboratories to disclose to dentists where a product was manufactured and what materials were used, and provide certificates of authenticity. It further requires dentists to include these records in a patient's dental chart so patients can request the information and so health officials can track and trace a dental restoration to its source should a health problem later emerge. Finally, the bill requires dental laboratory technicians to maintain continuing education every two years.

State of the Heart: A Medical Tourist's True Story of Lifesaving Surgery in India

The story that helped kick-start "medical tourism" ..

In 2004, at the age of fifty-three, self-employed contractor Howard Stabb learns that a leaking mitral valve in his heart needs to be repaired. Left untreated, his doctors tell Stabb, his condition may kill him at any moment. The procedure to repair the heart valve costs at least $200,000 at the Durham Regional Hospital near Stabb's North Carolina home-if there are no complications.

This gripping memoir describes Stabb and Grace's experiences from the initial diagnosis through their trek to India, the operation Stabb undergoes, and the chilling dangers he faces after the surgery. In an afterword, the book offers resources for readers considering overseas health care, including hospital recommendations, visa and inoculation information, and things to look for when choosing an overseas health care provider. In all, the memoir alludes to the collective story of the more than 43 million uninsured Americans who face, everyday, the very real possibility that their lack of health insurance may either bankrupt or kill them-if not both.

Medical Tourism & Patient Data

Under "statistics, damn statistics and lies" ..

http://travel.nytimes.com/2006/10/15/business/yourmoney/15care.html?sq=thailand%20hospital&st=nyt&scp=4&pagewanted=print

In Bangkok, Bumrungrad International Hospital counts 55,000 American patients a year.

McKinsey & Company's report on medical tourism, using a very rigorous, very conservative data-approach --

http://www.mckinseyquarterly.com/Mapping_the_market_for_travel_2134?pagenum=1

"Between 60,000 and 85,000 people annually travel abroad for inpatient hospital care, a number .. far lower than commonly assumed."

Probably some of the difference is between elective and acute situations.

Harvard's Michael "Healthcare" Porter in Israel

America's best in Israel ..

"No, No , No" exclaimed Michael Porter, chastising the Associate Director of a major medical center in Israel, "You have to raise your hand." Such blatant breaches of HBS etiquette were relatively frequent over the course of the week long IXP, which drew a wide range of participants, many of whom were unfamiliar with the peculiarities of the typical HBS classroom.

The Value-Based Health Care Delivery IXP, co-led by Professor's Porter, and Elizabeth Teisberg (formerly of HBS and currently a professor at the Darden School of Business at the University of Virginia), was a multi-disciplinary immersion program based on the framework presented in the book, Redifining Healthcare. The book, which diagnoses the problem of competition in the modern healthcare system, introduces a broad set of strategies which providers, payers, employers and the government can use to improve value. The immersion program was designed as an extension of the book, and involved case studies and subsequent discussions of companies and organizations who have implemented strategies that demonstrate the principles outlined by Porter and Teisberg.

Program participants came from all corners of the healthcare sector. In addition to 17 HBS MBA students with prior healthcare experience (10 of whom were MD MBA's), there were students from Harvard School of Public Health, Kennedy School of Government, and Harvard Medical School. Participants also included many medical residents and practicing physicians, most of whom were affiliated with hospitals in the Boston area, including several heads of departments and several senior surgeons and administrators. Finally, there was also a significant international contingent, with participants flying in from Ireland, Israel, England, and Canada.

Mumbai, India attacks

In a terrorist attack -- not even a hospital is off-limits --

http://en.wikipedia.org/wiki/Cama_Hospital

The 2008 Mumbai attacks were ten coordinated terrorist attacks across Mumbai, India's financial capital and its largest city. The attacks, which began on 26 November 2008 and lasted until 29 November, killed at least 173 people and wounded at least 308. The attacks drew widespread condemnation across the world.

Eight of the attacks occurred in South Mumbai: at Chhatrapati Shivaji Terminus, the Oberoi Trident, the Taj Mahal Palace & Tower, Leopold Cafe, Cama Hospital, the Orthodox Jewish-owned Nariman House, the Metro Cinema, and a lane behind the Times of India building and St. Xavier's College. There was also an explosion at the Mazagaon docks, in Mumbai's port area, and in a taxi at Vile Parle. By the early morning of 28 November, all sites except for the Taj Mahal Palace had been secured by Mumbai Police and security forces. An action by India's National Security Guards on 29 November resulted in the death of the last remaining attackers at the Taj Mahal Palace, ending all fighting in the attacks.

EDITORIAL: USA medical costs -- next speculative bubble to burst?

AN EDITORIAL

Since the Dutch "tulip bulb" bubble of the 17th century, many speculative bubbles have exploded in the faces of the oh-so-smart. After Enron, Fannie Mae/Freddie Mac -- will U.S. medical costs be next?

IMHO, the rate of growth of USA medical costs is unsustainable. Left unchecked, with the aging of the baby-boomers, it could grow to 35% of U.S. GNP (now 16%). How can the "stimulus" be repaid, if that happens?

Medical Onshoring is dedicated to attempting to restain medical costs, while maintaining Joint Commission International standards.

And medical care and health care is more than just technology, money, bureaucracy, and politics.

It is about creating "circles of caring communities," that patients receive maximal service, with the resources available. From a simple physical exam -- to the final, precious moments of life.

Most of those in the medical-industrial complex are pushing for growth, growth, growth. Per previous -- that's unsustainable, IMHO.

Trying to restrain costs in a quality environment -- especially with so many pushing for "more, more, more" of medical services -- is a huge operational challenge. Not political -- operational.

Well -- I enjoy big challenges.

USPTO to publish patent app 4/29/09

U.S. Patent & Trademark Office (USPTO) has notified yours truly that the patent application of Medical Onshoring (pat. pend.) is scheduled for publication on the USPTO web site on 4/29/09.