Paraphrasing David Hannum (not PT Barnum) there’s a fool born every minute and recent happenings seem to bear that out—only most of the current fools have MBA’s and high level jobs.

And then there are the fools in Washington who for years have told us to trust industry and that self-regulation works to our advantage.

And all of us fools who either believed them or were asleep at the wheel.

So in honor of April Fool’s Day here’s a great explanation of the subprime mess that doesn’t require an advanced degree.

It also proves that Hannum was right.

My thanks to Nick Mikhailovsky at NTR Lab for sending it to me.

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(Part of an ongoing series)

Those Americans fortunate enough to have medical insurance have long known (if they gave it any thought) that their sensitive medical records are frequently sent overseas for processing right along with most other forms of insurance processing.

Now their bodies are following—paid for by their own health insurance.

“David Boucher, 49, doesn’t fit the usual profile for such medical tourists. An assistant vice-president of health-care services at Blue Cross & Blue Shield of South Carolina, he has ample health benefits. But Boucher recently chose to have a colonoscopy at Bumrungrad International Hospital in Bangkok, mainly to make a point about the expanding options available to Blue Cross customers. And his company happily picked up the $640 tab—a bargain by U.S. standards.”

“”All of the largest U.S. insurers are starting to educate themselves or are putting [offshore] programs in place,” says Jonathan Edelheit, president of the Medical Tourism Assn., an industry group formed just last year. Companies that self-insure are also bombarding Edelheit’s group with requests for information.”

India’s not stupid, they know where the money is, as do many other countries and there are plenty of entrepreneurs who know that medical tourism is definitely a growth industry. One such is Value Medicare that offers “First world care at third world prices.”

The fact that most Indians don’t have access to medical tourism’s palatial care isn’t surprising either, in most countries locals can’t pay what foreigners pay and globally healthcare is a profit center.

One result from all this will be stronger financial returns for insurance companies—premiums based on actual US healthcare costs and payouts based on the price tags in countries with much lower costs—a heart bypass in the US costs $130,000, while it’s $18.5K in Singapore, $11K in Thailand and just $10K in India—all countries where the medical staffs are probably better at hand-washing, too.

Another will be more costs on the backs of the working poor and uninsured who have no options—unlike the poor in India where the state pays for the healthcare they do get.

Would you want to go overseas for a needed procedure?

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Aside from tax rebates, has there really been strong economic advances under the Bush Administration?In its current issue, Business Week does a quick roundup of this so-called expansion,

“The expansion almost certainly ended in 2007, seven years after the previous peak in 2000. Unfortunately, this cycle has been lackluster, with real wages falling for many, economic growth slow compared with past cycles, and the U.S. getting a smaller share of the global pie.”

Here’s the pertinent info…

Global output: In order, China, India and Russia were the biggest winners in terms of world output, while Germany, Japan and the US (dead last) were the biggest losers. The US loss was more than three times Japan and four-and-a-half times Germany.

Median earnings: They were basically flat after adjusting for inflation. People with advanced degrees managed a whopping 2% increase as opposed to losses for all others.

Growth: U.S. growth averaged only 2.4% per year, nearly a full point below the average of the last two cycles.

What happened to you during this cycle?

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Yet another article, this one from Australia, bemoaning the fact that women aren’t showing up in the executive ranks.

“How is it that women, who are at least as well educated as men these days, represent only 12 per cent of ASX 200 executive managers? Why have women been appointed as CEOs of just five ASX 200 companies since 2004?”

The numbers are just as bad in the US, even in cutting-edge Silicon Valley where you might expect them to be a bit better.

“Only 9 percent of companies in the county have promoted a woman to a top post, according to a University of California-Davis study of the 400 largest public companies in the state. Only 7 percent of corporate boards include even one woman.”

They don’t improve much in emerging countries, either.

“Women in Sri Lanka are better educated and hold more jobs than ever before. Yet most women continue to suffer from occupational segregation in the workplace and rarely break through the so-called “glass ceiling” separating them from top-level jobs and professional positions…”

So what about Russia, where the sexes have been equally educated for decades

“The number of women holding executive positions decreases moving up the position scale. Women traditionally prevail in the position of Chief Accountant (82%), but the position of Financial Director is primarily occupied by men (78% vs. 22% women). Other positions held by women include: head of Human Resources (62%), head or deputy head of Marketing and Sales (42%), Financial Director (22%). Meanwhile, top managers are mainly men: 96% of General Directors and 86% of board directors. Men have been prevailing in recent appointments to top executive positions (74%), which gives ground to conclude that they will continue to dominate executive positions in the future.”

Say what you will, globally there’s still a glass ceiling; policies are still formatted by men for men—while eliminating the flexibility their wives need to pursue a viable career; and all possible effort is spent talking of improvement while walking for the status quo.

Do you think this will change as Gen X and Y take over?

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In a post about the repercussions of sexual peccadilloes I said, “I’m also wondering how many other patrons of this current sting will be outed. If he’s [Eliot Spitzer] the only name made public then, to me, something else stinks a lot worse than his hiring a prostitute.”

Although I didn’t see the WSJ opinion piece until today, Alan M. Dershowitz, who teaches law at Harvard, provided thoughtful and cautionary commentary on the Spitzer happenings that go a long way to confirming that they do, indeed, stink.

“In this case, they wiretapped 5,000 phone conversations, intercepted 6,000 emails, used surveillance and undercover tactics that are more appropriate for trapping terrorists than entrapping johns. Unlike terrorism and other predatory crimes, prostitution is legal in many parts of the world and in some parts of the U.S. Even in places like New York, where it is technically illegal, johns are rarely prosecuted. Prostitution rings operate openly, advertising “massage” and “escort” services in the back pages of glossy magazines, local newspapers and television sex channels.”

There was a time when Americans had reasonable expectations of their privacy, but no more. European privacy laws run rings around ours, US laws are open to manipulation, and our leaders and courts condone actions here that they condemn in others.

Our infant mortality rates are sky-high, our poverty rate is the highest among developed nations, a new political or business scandal seems to erupt almost daily and the greed and creativity of US financial giants has shattered the global economy.

These are my opinions.

I’d like nothing better than for you to prove me wrong.

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I came across some basic leadership advice (usually the best kind) in an Economic Times article called Leadership through delegation.

What I found interesting is that the Economic Times is a sub group of India Times and the information was adapted from a 2004 article in Entrepreneur magazine.

I found it interesting because as business takes off, India is facing the same challenges as every other population.

But I also found it amusing because delegation has been a problem for centuries—literally.

Giving up control and trusting others to get stuff done doesn’t come easily—especially to leaders and entrepreneurs.

How well do you delegate?

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I normally keep silly stuff for the weekends, but as an example of leadership futility this was too good to pass up.

Cemetery full, mayor tells locals not to die
BORDEAUX, France (Reuters) – The mayor of a village in southwest France has threatened residents with severe punishment if they die, because there is no room left in the overcrowded cemetery to bury them.

In an ordinance posted in the council offices, Mayor Gerard Lalanne told the 260 residents of the village of Sarpourenx that “all persons not having a plot in the cemetery and wishing to be buried in Sarpourenx are forbidden from dying in the parish.”

It added: “Offenders will be severely punished.”

The mayor said he was forced to take drastic action after an administrative court in the nearby town of Pau ruled in January that the acquisition of adjoining private land to extend the cemetery would not be justified.

Lalanne, who celebrated his 70th birthday on Wednesday and is standing for election to a seventh term in this month’s local elections, said he was sorry that there had not been a positive outcome to the dilemma.

“It may be a laughing matter for some, but not for me,” he said.

Got that? Leaders should be buried before the rank and file.

Actually, that’s not a bad idea.

What leadership statement have you said/heard recently that forbids/requests the impossible?

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Healthcare providers’ attitudes towards money often make my blood boil. It’s not just insurance and drug companies and hospitals, but the financial institutions that buy the debt of the un/under insured and then charge exorbitant interest rates on it.

Of course, it’s all excused in the name of capitalism and keeping investors happy, while their advertising presents them as caring, do-the-right-thing organizations wrapped in concern for the well-being of their customers.

Obviously it’s the former that ratifies their practice of charging for errors.

Hopefully it’s starting to change. “Since last fall, hospitals in 11 states have agreed to waive fees for certain rare errors dubbed “never events” because safety experts say they should never happen at all.”

But only 28 events make the grade—here are the top five.

1. Surgery on the wrong body part.
2. Surgery on the wrong patient.
3. Wrong surgical procedure performed on a patient.
4. Object left in patient after surgery.
5. Death of patient who had been generally healthy during or immediately after surgery for a localized problem.

Discharging an infant to the wrong person is way down at number nine.

So what’s the cost?

“In 2006, Medicare was billed 764 times for objects left behind after surgery, resulting in an average payment of nearly $62,000 per event [$47,368,000]. The agency was billed 33 times for patients who got the wrong blood, at an average cost of $46,000 apiece [$1,518,000], and nearly 323,000 times for the worst kind of pressure ulcers, a preventable problem, at a cost of $40,381 [$13,043,063,000] apiece.”

Read the articles and make up your own mind.

If your blood boils send them to your State and Federal Congress people.

If it doesn’t I’d love to hear why not.

Your comments—priceless

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If you haven’t heard it already, here’s a story guaranteed to make you think at least twice before opting for any kind of avoidable surgery or hospital stay.

“…hospital-acquired infections that kill nearly 100,000 people in the U.S. each year, according to federal estimates.”

That’s a very large number, especially when the top culprits are, “Doctors, nurses and other hospital staffers too busy, too distracted — or, sometimes, too arrogant — to wash [their hands].”

Can you even remember at what age your mom started the “wash your hands” ritual? Not to mention all the germ-killing products ads we’re inundated with daily.

How bad is it?

“At best, hospital staffers wash adequately about half the time…” Still worse, “some hospitals post hand hygiene rates as low as 20 percent when they start tracking the problem…”

While a 50% voter turnout is something to cheer, 50% adequate hand-washing, let alone 20%, is the stuff of nightmares.

And did you notice the qualifier ‘adequate’?

“National guidelines say they’re supposed to use alcohol-based hand rubs or soap and warm water for at least 15 seconds before and after every direct contact with a patient, with excretions, or with contaminated surfaces or objects,” moreover, that includes when they’re wearing gloves—strip the gloves and wash.

Of course, the information that washing reduces infections has only been around since 1846, so maybe it hasn’t had time to spread.

“…an August study in the journal Pediatrics that showed that boosting hygiene rates cut hospital-acquired infections by 60 percent in more than 1,000 tiny newborns at a children’s hospital in Switzerland,” and that was with a lousy 13% hand hygiene improvement!

According to Dr. Robert Wise, vice president of standards and survey methods for the Joint Commission, a national hospital accrediting agency, “there aren’t a lot of ways to measure compliance.”

Considering the rise of drug-resistant germs, such as MRSA (Methicillin-resistant Staphylococcus aureus), your best bet if you or someone you care about is hospitalized is to have someone who’s conscious available and always ask your provider to wash—be it your doctor, surgeon, a nurse or someone else.

Keep in mind that this applies just as much to doctor and dentist office visits, lab tests (I still remember ten years ago when I was in San Francisco and the tech refused to wear gloves when she went to draw my blood—needless to say I asked for and got another tech.) or any other setting.

Tomorrow I return to money—a healthcare subject near to all our hearts.

Have you had to ask someone to wash?

Would you?

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On the heels of Tuesday’s post I came to realize that every time I write about anything to do with healthcare I find more stuff that makes me want to scream and throw a tantrum. Rather than doing that (it upsets my cats and neighbors) I thought I’d let the steam off here.

I’ll start with a Forbes article (mentioned Monday on Project Management 411) focusing on the effect of corporate salespeople on healthcare costs.

No surprise if you think of cause and effect—I sell you equipment and to justify the cost you push the service that it performs, which enables me to sell you a replacement version more quickly. Here’s the example Forbes gave.

“Radiologist David Gruen used to spend millions of dollars to replace his General Electric (it could just as well have been Siemens or Phillips) MRI and CT scanners every three years. It was money well spent because the machines were always busy…” but now he waits five years and the poor doctor had to take a 20% salary cut.

What happened?

“A year ago Medicare cut the price it pays for imaging, so Gruen gets paid 15% to 50% less for each order, depending on the type of scan. Health insurers got wise, too, and started imposing a 48-hour review on imaging orders. The doctor hired clerks to battle the HMOs, but his office volume was flat last year, down from 10% growth in prior years.“

Granted “Imaging accounts for only 5% of the $2 trillion in U.S. medical spending, but it has been the fastest-growing component of health care inflation in recent years, climbing 20% annually until last year,” but everybody wants one. Scanning businesses offer specials and run sales just as other consumer products do.

Of course, the drug companies are doing the same thing, “Today drugs are promoted in much the same way as other products. Drug companies devote forty percent of their advertising expenditures — over $4 billion per year — to DTC [direct-to-consumer] ads. The average American views as many as 16 hours of prescription drug ads per year…”

DTC ads are under Congressional review and has been framed as a free speech issue by the drug companies.

I understand that medical products and drugs are businesses and that as businesses they focus on profit in order to keep Wall Street happy—happy Wall Street = rising stock = happy investors—but at what cost to the future of this country?

Come back tomorrow for my take on the dirtiest little secret in medicine.

What are your views on DTC drug and medical procedure ads?

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