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The ultimate innovation challenge comes to America’s doorstep. It’s knocking, banging, kicking and screaming. Someone give that kid a lollipop and get to work.

But there’s so much to do!

Hmmmm…

• the economic crisis has destroyed banks, jobs, academic endowments, homes and more;
• there’s massive (and growing) federal debt;
• the education system is painfully failing (19th in the UN’s 2008 Education Index just below Lithuania);
• military spending is outrageous (more than $700 billion annually, about 50% of worldwide expenditure);
• the Social Security program is massively criticized (currently the most expensive government program in the entire world);
• the penal system puts 1 in every 18 men in the US behind bars or under surveillance (the highest incarceration rate in the world, about 1 in 30 or ~7.3 million adults are in prison, on parole or on probation);
• and let’s not forget about the impending doom of climate change that is inevitable at the current rate (or lack) of attention.

Wow. Just writing all that was seriously depressing. There’s a lot more of course, such as privacy, significant issues at the Pentagon, corruption in agriculture and gay rights, but I’ll stop here because it’s almost impossible to be exhaustive and frankly it’s a lot to stomach, even for a Canadian. What’s worse is that I haven’t even gotten to healthcare yet. While all of the problems noted above are big (astronomical?) challenges, healthcare is everything.

Last week, Obama held a “town hall-style” event to discuss and address critical healthcare issues. While I’m not a big fan of such functions, I know that they can serve important purposes. I usually object to the ruse, assuming that nearly every detail was planned and designed only to simulate the appearance of impromptu discourse. But it did not bother me this time. The reasons are two-fold: first, healthcare is such a serious topic right now for the US (and a growing fascination of mine), that I’ll accept anything to help the medicine go down (pun intended). Second, I agreed with a lot (not all) of what Obama had to say. Much of it was aligned with progressive thinking on the issues, borrowing ideas from many leading thinkers, both foreign and domestic. A lot of things were said, and overall his perspectives amounted to value-based improvements in healthcare through strategic reinvestment and innovative restructuring. Will it work? Time will tell. It’s massively complicated. But I liked that he is asking new questions and approaching the problems with innovative and integrative solutions. I like that Obama is making healthcare the centerpiece of his domestic agenda. Mr. Change needs to sprinkle some change-dust over the country right now as it braces for impact. Long overdue, “healthcare reform” ought to be relabeled nationwide healthcare rethink.

Without your health, everything fades and becomes somewhat insignificant. Just think of one of the issues noted above, and then consider it in light of a cancerous tumor, heart or Alzheimer’s disease. Sorry to be crude, but it would be tough to buy stocks online, play with your children, grill a hamburger or steer a Ford F250 pickup truck if you can’t lift your arms.

Take care, healthcare!

US healthcare is in shambles. About 50 million people don’t have insurance, which is an embarrassing statistic for such a wealthy country. Unless you’re helpless, a child, or above 65, there’s really nothing you can do but get insurance at an average of 18% of your income. And if you think that’s bad now, just wait a bit. Some estimates predict that 1 in 3 of the next generation of Americans will develop early onset diabetes. That’s 1 in 3. And don’t forget about the baby boom generation of 76 million people born between 1946 and 1964. They are quickly approaching their golden age and will make current socio-economic difficulties seem relatively trivial. The scale of operations that will be required to accommodate their healthcare needs is nothing like what the US has now, and the boomers have just begun retiring. We’ll see how things result thirty years from now. Be sure to read (or upload to your brain) my thoughts on this issue then!

The problems with healthcare are multi-dimensional. Costs are rising, everywhere; files are often poorly maintained; preventative behaviors are barely supported and often countered by adjacent industries; many reports show that pharmaceutical companies spend far more on marketing than they do on research and development; physicians endure malpractice lawsuits at a troubling rate; patients hesitate to get checkups and depend more on the advice of friends than their doctors. These are just brief examples of many pains in the industry. Serious action needs to be taken within all divisions of the US healthcare ecosystem to not only remedy today’s troubles but to properly anticipate what lies ahead. Practitioners, insurance and pharmaceutical companies, public health bodies, patients and the FDA all have work to do. It’s time to step up.

Culture correction: a return to value-based investment

We’re not doing anyone a favor by mincing words. Without clear and accurate language, we will have trouble making progress at our true potential rate (whatever that is). What I’m driving at, is that real healthcare is everyone’s business and is integrated into every aspect of life. The US needs to deploy multifaceted resources to support the rethinking of healthcare. It’s not just something for the politicians to talk about, or insurance companies to sell. healthcare is something to be discussed with children and the elderly alike. It’s something to teach in school, where the insights of prevention and early detection – the golden bullets of treatment – can be instilled in young Americans. Healthcare requires sensitivity training for all, not just industry-related practitioners. It is complex and involves a diverse cast of characters that serve critical roles in an evolving ecosystem.

Some people say that creating real change requires a paradigm shift within a generation of conscious, aware and determined individuals. By facilitating positive and productive discussions of healthcare throughout society, people will be better equipped with the energy and resources required to make the impacts that are so badly needed. Innovation will be required around products, services, business models and organizational structures, and someone’s got to do it.

So Adam, a lot of stuff on this topic is being spoken about, what’s wrong with that? Well dear reader, we often forget the real end-game, so to speak, of healthcare: patient outcomes. This isn’t spoken of enough. This is the notion of real value, as Obama correctly alluded to in his event last week. He spoke of many modern ideas that I heard Michael Porter describe last June at Rotman (the University of Toronto’s MBA school).

For those who don’t know, Porter is a famous business strategist who co-founded Monitor Group, teaches at Harvard Business School and contributed the significant “five forces” model used by academic (and professional) institutions all over the world, among many other notable insights. In his talk, he explained that there is not enough focus on real value when it comes to healthcare. There’s a lot of talk about lowering costs, central patient indices, and universal coverage. However, it is rare that the question is framed properly, taking aim at what the true goal ought to be: improving patient outcomes per dollars spent. This is real value. This is a real goal to strive for. Would we permit (even welcome) higher costs if cures were reliably effective and lasting? Probably. To be distracted by other issues and not focus on illness prevention, reduction, treatment effectiveness and quality is to make a huge mistake for everyone. Twenty-first century thinking about healthcare in the America ought to begin with asking the right questions.

Is that your final question?

Here are a few very wrong questions, in my opinion, as put forth by Karen Tumulty for Time magazine in her article “The Five Health-Care Dilemmas”. (I picked three.) These questions illustrate the misplaced attention that exists on this topic in the US today. (And I’m not going to say anything about her misuse of the word “dilemma”, because life is short and I have to pick my battles.)

“Will there be a big, new government system?”

Oh no! Run for your lives! It’s the big bad government wanting to give you an affordable alternative to private insurance coverage! Ruuuuun! Just the way her question is phrased makes me cringe. This is a great example of a wrong question. It focuses on partisan nonsense that does not address or call attention to the real issues. Here’s my version: Can government-run systems improve the value of healthcare for Americans? Again, value being patient outcomes per dollars spent. Now that’s a real question. I’d like to see that kind of question be asked in Time magazine instead of one that instantly evokes chatter of socialist motives and such.

“How can a nation already deeply in debt afford healthcare reform too?”

Here’s my revised question: How can a nation already deeply in debt not afford healthcare reform? A 2006 article in the Health Affairs journal reports that from 2007 to 2017, total annual US spending on healthcare will grow an average of 6.7%, insurance costs are rising faster than wages or inflation, and about half of bankruptcy filers in the United States cited medical causes in 2001. Healthcare reform ought to lead to lower costs in the long run. The goal is to invest more soundly, more thoughtfully, into better technologies and better structured systems. Rethink the question.

“How will we bring down costs?”

Ouch. I knew this one was coming. There’s no point trying to lower the cost of healthcare that isn’t effective in the first place. I don’t have just one way of rethinking this question, I have several other questions: Do the experts even know which costs to bring down? Why are the costs so high in the first place, and are the reasons valid? Are public expectations of real costs skewed by lack of correct information? Is the current system designed to best meet actual contemporary needs? If a bit more was spent to create more positive patient outcomes, would that lower costs in the long term? Similarly, would benefits be earned in the long run by compensating practitioners based on actual outcomes instead of the quantity of prescriptions filled or patients seen in a week? Why are the administrative costs of private insurance companies so much higher than those of Medicare as a percentage of expenditure if government is so inefficient? Any one of these questions would do. I could go on for hours, but you’ve come far enough. And I thank you for that.

If there’s one thing that I know for certain, it’s that I don’t have all the answers, nor all the questions on this topic. If there are two things for certain, it’s that change is possible, necessary and inevitable, all at the same time. Innovation will erupt of this mess, although it may require considerable investment, deep risk and many mistakes along the way. Obama and the rest of the system won’t be perfect, but I like that they are asking new questions.

Why not see this issue for what it really is? Why delay in making healthcare the defining triumph of the early 21st century? The US has incredible capacity to achieve successful value-adding healthcare reform, but before that can happen, the nature of how it is thought of and discussed needs to be refined and retooled. Healthcare is a complicated issue and ought to be respected as such. Nobody in the world does it really well, but some do it better than others. Americans love competition, and I believe that with some solid rethinking, frank discussions and deliberate investment, they’ll meet and exceed the challenge.