C|Net's Stephanie Condon was at an American Enterprise Institute forum yesterday, where they trotted out the best arguments they could for why the Obama health IT stimulus won't work.
It seemed to come down to fear of losing proprietary advantage. (Picture from Trinity Health System.)
The main speaker was Trinity Health CEO Joseph Swedish, who stated plainly he's not interested in sharing data with other hospital groups.
Now Swedish is no Luddite. Trinity has had its health IT system in since 2000. He wrote just last year in support of health reform, based on "nine principles" which include giving everyone standard benefits and supporting health IT. The group has its own health reform advocacy group, called Find a Way.
But under the present fee-for-service set-up of health care in America, Trinity would lose proprietary advantages by sharing data. If everyone else gets today's health IT, it loses the advantages its nine-year old system now has in the market.
Standards aren't the problem, Benjamin Sasse of UT-Austin told the AEI meeting. Business models are.
Health turns out to have a lot in common with auto mechanics.
Regular maintenance means fewer breakdowns and costs less in the long run. But most people don't do it. We drive until the brakes wear out, or the radiator, or the engine blows and we need a tow. Then we get a new car.
The auto industry depends on this. A repair shop's profits come from the big repairs, not oil changes. Dealers love to lead customers facing a big repair bill out to the lot for a new pair of wheels.
But we can't get new bodies. And waiting until we need a new engine, or radiator, or brakes on ourselves just costs too much.
Thus most health reform plans, whether proposed by insurers or government, are based on scheduled maintenance. This implies a different business model for everyone, with more general practice, less specialization.
To the extent that health IT hastens the dawning of this realization, it's a great investment. Health IT really does drive reform. And those who oppose reform know it.