I’ve written several posts focusing on healthcare, starting with the newest way to screw the un/under insured (which I sincerely hope you’ll forward to your federal and state politicians), a series focusing on why US healthcare is an oxymoron and one on doctors’ conflicts-of-interest, so it’s nice to be able to offer up the story of a large medical organization that seems to do it if not right, better than many.

In an interview (free registration) with two senior McKinsey people, Cleveland Clinic’s CEO Delos “Toby” Cosgrove covers a wide range of topics focusing on current and future healthcare.

For those who aren’t aware, Cleveland Clinic is one of the 500 pound gorillas in healthcare with annual revenues in excess of $4.4 billion and more than 37,000 employees, although “some observers believe that a number of these physicians have a conflict of interest.”

Cosgrove himself holds more than 30 patents and “is not your usual executive; he spent 30 years at the clinic as a cardiac surgeon before being promoted to CEO, in 2004.”

Cosgrove’s focus is on prevention, education, transparency and accountability.

He tends to focus on the stuff he can actually do something abut, as opposed to that which he can’t.

“The things that I do have control over—the culture of the organization, a few strategic decisions, and probably most important, the selection of people—I do worry about. It’s not very hard to decide if people are bright enough to fill a role, but if they don’t have the cultural fit or the work ethic, they just won’t last here.”

Do you have direct or close experience with Cleveland Clinic?

Would you go there if you could?

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I received and email from Amy S. Quinn suggesting that I would be interested in a posting about Wal-Mart’s in-store clinics—I wasn’t. I assumed she was a flack of some kind and that she sent it because I’ve written several not very complimentary posts Wal-Mart.Here’s the email

Hi Miki,
We just posted an article (title and link deleted)
I thought I’d bring it to your attention just in case you think your readers would find it interesting.
Either way, thanks for your time!
Amy S Quinn

I googled Amy and the results certainly confirmed the flack/spam connection.

Who is Amy S. Quinn?

Is she an enterprising virtual assistant who helps promote stuff? Is she the leading edge of a new PR approach? Is she the blogging fairy, inspiring new posts for bloggers in totally diverse fields?

What do you think? Have you received an email from Amy?

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The article is fascinating, the implications terrifying and I hope the quotes are enough to get you to read the whole thing.

“Should research scientists who have financial stakes in the products they are writing about be forced to disclose those ties?…”

“More than 60 percent of clinical studies–those involving human subjects–are now funded not by the federal government, but by the pharmaceutical and biotech industries…”

“…studies published in scientific journals like Nature and The New England Journal of Medicine…are increasingly likely to be designed, controlled, and sometimes even ghost-written by marketing departments, rather than academic scientists.

Companies routinely delay or prevent the publication of data that show their drugs are ineffective. The majority of studies that found such popular antidepressants as Prozac and Zoloft to be no better than placebos, for instance, never saw print in medical journals, a fact that is coming to light only now that the Food and Drug Administration has launched a reexamination of those drugs.”…

“…Increasing numbers of studies that get published are actually written by PR firms, “medical communications” specialists, who then go out and recruit an academic willing to put his name on the paper, for a fee…”

” In 1997, when Sheldon Krimsky, a professor of public policy at Tufts University, surveyed 61,134 articles in some 181 journals, he found that only 0.5 percent disclosed a conflict of interest related to the topic of the article, an impossibly low number…”

“By the time medical residents enter private practice or the lab, the gifts from industry no longer seem like gifts, but entitlements…”

” When industry has penetrated every level of medicine from the lab bench to the FDA advisory panels, from the pages of the medical journals to your doctor’s prescription pad, how are physicians to make decisions about treating their patients?”

What now. This isn’t just a dirty little corporate secret—or even a big one that can crash the economy like the sub prime mess.

This problem is legal, pervasive and grounded in the self-delusional arrogance of some of our most respected citizens.

What will you do if faced with the need to evaluate a drug for your child, loved one or yourself? What information can you trust? Whom can you trust?

What can we do?

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The difficulty of getting an appointment to see your doctor (wait time) is the bogyman thrown up to defeat universal healthcare, but the statistics don’t back that up. According a Business Week article citing a study by the Commonwealth Fund,“If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the U.S., and up to 73 days if you live in Boston…a knee injury… the average time needed to see an orthopedic surgeon ranges from 8 days in Atlanta to 43 days in Los Angeles. Nationwide, the average is 17 days.”… only 40% of U.S. doctors have arrangements for after-hours care, vs. 75% in the rest of the industrialized world… 51% of sick Americans surveyed did not visit a doctor, get a needed test, or fill a prescription within the past two years because of cost. No other country came close.”

In the Washington Monthly Kevin Drum cites the BW article and also mentions that “…the numbers are inflated because we don’t count the people who can’t get nonemergency surgery [such as hip replacements] because they’re uninsured…,” while the comments left by readers put real stories to the statistics.

Not all physicians are against a universal health program, which is smart since many Americans of more modest means are traveling in order to off-shore their healthcare needs—surgical and otherwise.

“Gary Hulmes, a furniture store manager from Florida who went to New Delhi to have spinal surgery done and paid a total of $9,000 including airfare, a five-day hospital stay, and a total stay of three weeks in India (with some sightseeing thrown in). If performed in a US hospital, the same procedure would have cost $36,000 – 50,000.”

In Europe healthcare is measured, evaluated and reported publicly by Health Consumer Powerhouse Euro Health Consumer Index 2007.

The report makes for interesting reading.

“All the 27 EU members are of course included in this year’s index as well as Switzerland and Norway.”

‘The 2007 Index is, just like in 2006, built up as a “pentathlon”, with indicators grouped in five sub-disciplines. After having had to surrender to the “lack of statistics syndrome”, and after scrutiny by our expert panels, 27 indicators survived into the EHCI 2007.

The indicator areas for the EHCI 2007 thus became:

Sub-discipline Number of indicators

• Patient rights and information 9
• Waiting time for treatment 5
• Outcomes 5
• “Generosity” 4
• Pharmaceuticals 4″

Dr. David J. Brailer is point man on the Administration’s “…effort to remake the $1.9 trillion U.S. health-care business by using information technology to save money and lives…Paying for the network will be the first major hurdle. Many cash-strapped hospitals and small-practice doctors have no interest in footing the bill for a medical Internet. One key reason is the mismatch between costs and savings: While health-care providers bear the cost of tech investments, Medicare and private insurers reap almost all the savings.”

Then, of course, there are all those cute, educational consumer ads for drugs to help things along.

Of course, any discussion of healthcare wold be incomplete without some reference to the insurance industry. An industry, to my mind, far more committed to executive compensation and investor profits than service to its policy holders. Rather than add to the thousands of commentary already out there, I thought I’d leave you with a visual that, to me, says it all.

So what comes first?
Finding a way to pay for healthcare or knowing what we’re paying for?
Would the money being spent on pork and corporate subsidies be better spent on healthcare for all Americans?
If not, should the companies that currently pay no, or little, tax be the focus as opposed to small business?
What do you think should/can be done to fix this mess?

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Matt Weeks has held various management positions in the financial services/banking industry, started, ran and sold a small business, ran a successful consulting practice and currently is CEO/founder of stealth mode startup eyeTmedia.

“The idea of some sort of assessment or tax on businesses to fund health care for those citizens who are otherwise not covered is a bad idea.

While I agree that ER room medicine is not smart preventative, wellness-based medicine and is not good social or fiscal policy, we have to find a different approach other than force-funding it on the back of business. And take note, it will primarily fall on small businesses.

Most of the businesses in our Great Country are “small businesses.” When I was at Intuit, makers of QuickBooks, Quicken and TurboTax, my team launched the Online Payroll Service. In the course of understanding what our customers wanted, we discovered that most of the “small business” enterprises were in fact sole proprietors, or very small companies with fewer than six employees, counting the owner(s).

Now let’s reconcile that fact (check with the SBA and DOL -Department Of Labor) with the other reality that most “workers” in The United States are employed at these small businesses. Not huge corporations. Thus the main “driver” of employment as well as productivity in the country are these small businesses.

One final step: If we believe the Fed, when they tell us that the driver of our economy is spending in the retail sector, then we must look directly to the bulk of the employees and their families for that spend, presumably coming from disposable income. So it is circular, as the small business employees spend their disposable income at other small businesses. Thus we still live in villages to a greater extent than we may believe.

However, small businesses have a devil’s bargain. If they are burdened with an additional expense in the form of a tax or assessment (like an extra payroll tax), they will have to lay off employees, or drastically reduce their pay, or their pay increases, absent some dramatic increase in productivity or other business growth. I cannot connect the dots between less cash in the company and dramatic growth. Less cash is not a driver of business health and expansion.

So the net effect of this well-intentioned but ill-thought-through idea will be less cash in the economy, lower net wages for employees, and questionable coverage, which is not mapped-out.

You might say that this will not impact these “small businesses” and that we’ll focus on the large businesses. The problem here is that those large businesses that do not already provide a reasonably sensible benefits package are, by definition, stingy and mean-spirited. They are unlikely to have some epiphany about “doing the right thing” and are more likely to just move offshore. As in moving all the jobs they can move offshore. Not a good thing either. That just leaves us with fewer employed people to pay for this whole idea.

So large companies who are bad actors are not likely to be the source of this cash (and will likely cut and run), and the bulk of employees in the country who work for small businesses are likely to be in even more pain if their companies are forced to make meaningful payments to some centrally managed health care superfund. And who among us believe that such a superfund will be efficient or effective?

So I say “yes” we need to approach the problem, and keep the value of covering the non-covered. I just suggest thinking it through a bit more. Many people think “business” is the big bad corporation. In fact, our economy is based on small businesses, and perhaps the only true ethical accountability for “doing the right thing” exists there, at the local, in-person level. Let’s dig a bit deeper and find a more effective approach.

It’s a hard problem. I don’t have answers… But I do know that a blanket “tax” or “assessment” on a monolithic “business” category is wrong-headed and overly simplistic given the complexity of the problem.”

Does the US really need to raise taxes to fund healthcare or is the money actually there, but being incorrectly spent via pork, earmarks, etc.?

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The next response is from Al Negrin, a retired CEO whose career ran the gamut from giant multinationals to startups.

“First of all, to provide a social safety net of the type most European and Scandinavian countries do, it is necessary to increase taxes on both businesses and individuals. This of course is a disincentive for both aggressive managements and aggressive employees. Why work hard to further your company’s prospects or your own prospects when any gains are largely taken away in taxes?

That’s why European companies are large, stable and slow moving, and European employees are satisfied to live a middle class existence without fighting to achieve higher paid positions and prefer to balance work and family by taking 5 weeks vacation every year. Election after election has shown this social position is favored by the electorate all throughout Europe (except in the UK).

The United States has achieved the pre-eminent world economy by taking a contrary social position. I don’t see that we want to give up aggressive business and personal challenge by converting to an all-embracing social safety net. That said, however, the Constitution provides that the government shall be empowered to “promote the general welfare.” Having tens of millions of citizens without access to appropriate health care is not “providing for the general welfare.” Thus I favor some sort of universal health care, without however extending it so far as to impede personal or ” business incentivization.”

Do you think that some form of universal healthcare
is possible in the US?

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I constantly hear people say that they’d like what Europe has, but don’t want to pay the increased taxes, business or individual, necessary to provide it.I asked a friend who lives there and she says that it’s not that simple.

She explained that in fact, taxation in the US is higher in absolute terms, Healthcare costs are one of the highest costs for a US employer, but are ignored in terms of taxation.

She says that when considering Europe’s taxes you need to consider that in Europe no business pays healthcare.

From an individual perspective, no one pays for health or for education, including higher education.

Of course, many US corporations, such as GE, pay little to no taxes anyway.

“Eighty-two of the 275 companies, almost a third of the total, paid zero or less in federal income taxes in at least one year from 2001 to 2003.

In the years they paid no income tax, these companies earned $102 billion in pretax U.S. profits. But instead of paying $35.6 billion in income taxes as the statutory 35 percent corporate tax rate seems to require, these companies generated so many excess tax breaks that they received outright tax rebate checks from the U.S. Treasury, totaling $12.6 billion (see box). These companies’ “negative tax rates” meant that they made more after taxes than before taxes in those no-tax years.”

Then, late last night I received the following email. The sender is an executive with a major insurance company. He apologized for requesting anonymity, but said that his comments could cost him his job.

I think what he offers is of vital importance to this discussion.

“Firstly, increasing tax on business is obfuscation of the issue. Providing universal healthcare is a question of prioritizing the enormous tax revenues that the government receives. We can choose to prioritize healthcare and education, or we can prioritize military spending that makes it difficult to do business internationally at the tune of $18 billion per month.

Now, it is clear that the level of taxation in the US is not significantly lower than in countries that have universal healthcare. What differs is that healthcare costs are significantly higher per capita in the US than in all other nations. In addition, the results of healthcare in the US, as measured by infant mortality or life expectancy, is lower than in all comparable nations. Infant mortality and life expectancy is as low as former Soviet republics such as Latvia or Slovenia. It cannot compare with Western Europe, Canada or developed Asian nations. Clearly, since the costs in the US are higher than in any comparable nation and results are lower, it is possible to both improve healthcare for all Americans while reducing the expense. This, however, will affect the profits of very powerful interests.

Rather than focusing the discussion of taxes, maybe we should focus the conversation on why it costs more to deliver less in the US.”

I think that focusing this discussion on who pays may be missing the boat. Maybe along with who pays we need to look at what we’re paying for and why it costs so much. What do you think?

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Healthcare is on everybody’s mind these days. In a recent conversation I had with KG Charles-Harris, CEO of startup Emanio, we touched on the possibility of a tax increase on business to fund health care.

KG said, “It’s clear that the US healthcare situation needs to be improved. However, there are so many different views as to how we may improve healthcare, that the HOW question is completely open. Is increasing taxes the best way of doing it? Or is reforming the system better? America is a great country and we must as a great country do what’s necessary for our people. However, I am unsure that increasing taxes is the best way of doing this.”

In his column, Paul Krugman credits John Edwards for “introducing bold policy proposals — and they were met with such enthusiasm among Democrats that his rivals were more or less forced to follow suit…Edwards plan…giving people the choice of staying with private insurers, while also giving everyone the option of buying into government-offered, Medicare-type plans — a form of public-private competition…”

For the rest of this week (or longer) I’m going to post commentary from business people I know. I asked this question, “Should the US increase taxes on businesses in order to provide universal health care for its citizens as other countries have done?”

I suggested that they look at the question broadly—not just the tax issue—and from whatever prospective they chose.

I’m hoping that you will weigh in also. If you feel your response is more a full post than a comment email it to me along with a short introduction and I’ll give it post status—as long as it’s not just a blatant political statement.

Is healthcare an important issue to you?

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Kelly, my editor here at b5media and author of Tax Girl, pointed me in the direction of an interesting post at Law.com.Written by Harry A. Valetk, a new media and privacy attorney in New York City, it focuses on where to draw the lines regarding employer attitudes towards employees off hours use of social media.

“A 2007 Pew Internet & American Life Project study found that 60 percent of Web users aren’t concerned with how much information is available about them online. And only 4 percent had a bad experience because of embarrassing or inaccurate information posted about them online.

But what happens when these intimate details spill over into the workplace? Should our legal, off-duty, off-network online activities jeopardize our jobs? In our reputation-based economy, what are the appropriate boundaries between work and our private lives?”

He goes on to discuss current instances of the overlap, legal attitudes and what may happen down the road.

“…some states have strong protections for employees engaging in legal recreational activities off the clock,” while “California’s Labor Code protects legal off-site conduct during nonworking hours.”

There are already laws that protect from all kinds of employment discrimination, yet the discrimination persists.

I’ve written in the past (here, here and here) about the fact that what is posted in cyberspace stays in cyberspace forever—once it’s posted it never goes away.

As difficult as it is to prove that a person wasn’t hired because of skin color or age, how much more difficult will it be to prove that he wasn’t hired because the manager saw something online of which he disapproved?

Do you Google your candidates? How much does what you find influence you?

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Over at Mapping Company Success Friday I wrote No reading = poor writing with a sample email that would be a lot funnier if my bank manager hadn’t told me that she received a similar one from an applicant.

I didn’t know it at the time, but the same day Diversity, Inc. posted R Yr Biznes E-mails Hrting Yr Career? citing an email that said, “I am chking 2 see if we have someone available to assist u with this r u on deadline if so what might that be?”

Believe it or not, it was sent by a professional accountant in response to an interview request and it sure doesn’t inspire me with confidence.

Emails are like clothes, they make a statement about you, how you see the world, and your attitude towards other people.

If common sense was still common things would be great, but since it isn’t they offer four email rules to keep you from disaster.

No.1 – Keep It Short But Clear

No. 2 – Adhere to the Culture

No. 3 – Avoid Religious References

No. 4 – Always PROOFREAD (and use spellcheck)

Simple, painless and almost foolproof.

What about business emails drives you nuts?

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