Commentariolus Medicus

As legend has it, while being arrested for his believes (based upon evidence) that the Sun, rather than the Earth, was the center of the universe; Nicholas Copernicus said of his captors:  “I cannot admire enough those who accepted the heliocentric (earth as the center of the universe) doctrine despite the evidence of their senses.”

The difference between this statement of 5 centuries ago and today is simply the issue to which it is applied, and the date.  For Copernicus it was aimed to those who held on to the notion that the Earth was the center of the universe, today the same could be applied to the notion that government ownership, specifically health care will produce efficiency.  If this past century has taught us anything, its that governments don’t do healthcare well, still despite the evidence of our senses, our congress seem committed to its treacherous course.

Based upon the evidence of your own senses, what remains true, self-evident, observable and non-controversial is that no one else but you does your healing for you, or your dying for you.  Only you live with the results of medical practice, good or not.  There is no outsourcing, no cost-shifting, or possible means by which you can personally enjoy the benefits of healthcare while pushing the risk of its individual consequences on to someone else. You own it.

This makes the current healthcare debate personal.  It would take a delusion of universal magnitude to believe for one minute, that a greater involvement of the government into our personal healthcare is in any way be an improvement.   Of course, you are free to believe that government healthcare is better, but that would be foolish and you would be wrong.  What is being proposed is about a few people feeling good about doing something they hope may be good, knowing in the end, they personally can no’t bear the full cost of any decisions they have made.

There are many more simple though less glamorous reforms that would be so much more effective, but they lack the flamboyant appeal of what is being proposed today.  Lowering the deduct-ability threshold for out-of-pocket healthcare expenses, interstate purchasing of healthcare insurance and personal savings accounts that roll forward and accumulate over time allowing individuals to claim higher deductibles, and in so doing enjoy lower insurance premiums.  But this is about theater, not reason.

Thomas A. Coss, RN


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December 13, 2009 | garrett | No Comments »

Repricing in America

I’ve been bothered in the best possible way by a comment made by Richard Davis, President and Chief Executive Officer of U.S. Bancorp. In almost a throw away fashion Richard told an audience of business executives in Orange County California, that the economy is going through a process of “repricing ” downward.

Clearly we know this to be the case in the housing industry, as those of us with houses have seen about 25% or more of the assessed value of the house disappear.  As troublesome as this has been for many people, it has not stopped there.  Just look around and you’re seeing it in the automotive business, grocery stores, and restaurants offering significant discounts. In the labor market, those getting new jobs are doing so at often dramatically lower salaries.  Everything it seems is ratcheting down, finding a new market clearing level.

This deflation, or to be more positive, repricing, has consequences which favor highly efficient, low fixed overhead companies over those with large superstructures of bureaucracies.  As we’ve seen, some companies can relieve some pressure by laying off labor, but those companies (I’m thinking GM) with lots of large buildings and large fixed expenses, can’t adjust sufficiently and quickly enough.  For these large companies, it is exceptionally difficult to accommodate to downward price adjustments, hence they fail.

Companies which do succeed in these environments are new ones.  These companies benefit by being new and not around so long as to have large fixed expenses, these are the entrepreneurs.  The best way to grow our economy is for the US to have a brisk entrepreneurial bias in its policy decisions.   In this Economy, as serial entrepreneur Ken Forbes, CEO of AppointYou in Aliso Viejo, California told me, it is easier to create a job than get one.  This is the best time for the creative among us to leverage their comparative advantage of being lean, to get their products and services into the economy and make wonderful things happen for us all.

Thomas A. Coss

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October 3, 2009 | Tom | No Comments »

Public Option: Do You Feel Lucky?

Here’s the facts:

  1. Not all hospitals, clinics and physicians are equally talented and knowledgeable in the delivery of healthcare services; here are some which are simply better than others, and experience matters.
  2. It’s actually pretty difficult to kill someone.  The human body is amazing in its ability to adjust to changes, whether it is the loss of a limb due to trauma, or the loss of the function of a kidney or part of one’s heart due to a heart attack.  We adapt very well, but sometimes it’s not pretty.

For example, the difference in one’s quality of life when their heart is functioning at 50% capacity verses 20% capacity is astounding, as is the effect of the loss of function of both kidney’s rather than just one.  In both cases, the effect upon the individuals quality of life  is non-linear.

The challenge with healthcare is that neither the payer nor provider of services have to live with the results, that is solely left to the patient and their loved ones.

So then, what do we have with the current healthcare reform?  Well it pretty much looks like this:

  • It may provide coverage to more people (but we don’t know this for sure nor does it mean that you can go anywhere you want for care).
  • It won’t save money (virtually no one believes otherwise).
  • It doesn’t address the means by which we will have enough physicians and nurses to go around.
  • It will not improve effieincy in the delivery of care delivery.
  • It won’t address the cost of defensive medicine (which is huge).
  • It won’t make you better off.
  • It will lead to more taxes.

Is there anything I missed?

Thomas A. Coss, RN

Improving Labor Efficiency in Healthcare

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September 9, 2009 | Tom | No Comments »

Improving Labor Efficiency in Healthcare

This site is focused upon efficiency as a contributing solution to the cost of providing healthcare services. Efficiency alone won’t carry all the water needed to address the cost of healthcare, but it will make a profound difference in the scope and amount of services provided per dollar spent.  Last year I began a study based up some data going back over two centuries.  In the early 19th century, over 80% of the US population was involved in agriculture…. they were farmers.  By the beginning of the 20th century, that percent fell to 40%, and by the beginning of this century it fell to below 2%.  This astounding increase in per worker productivity freed people to go into manufacturing at the beginning of the 20th century, leading to an amazingly robust century of innovation and improvements in the quality of life.

In 2008 I began looking into capital investment in heatlhcare as compared to other industries and found some interesting results.  As expensive as healthcare has become, investments into improving the efficiency of the labor that provides those services has been poor.  Per worker capital investment in healthcare is about 35% lower than it is in general manufacturing.  How can we hope to lower the cost and expand the availability of healthcare if we insist on providing those services the same way they’ve always been done? 

A more detailed explanation is available here until I hear: Improving Labor Efficiency in Healthcare.

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September 5, 2009 | Tom | No Comments »

Texting and Efficiency – This is Just The Beginning

“This message of twenty four words and 138 total characters takes you less than five seconds to consume, that is why texting is popular.”

According to a University of Pennsylvania study, the speed with which we consume information from our eyes to the visual cortex in the brain is approximately 10 megabytes per second, we hear at roughly one tenth that speed or a rate of about 102 kilobytes per second. 

Just think how drastically communication has changed over the past 35 years.  The first email went out in 1971, still it would take nearly 30 years before email became pervasive in society.  In the mid 1990’s business still depended heavily upon voice mail, a slow and often annoying means of sharing information with colleagues in a time shifted manner.  The annoying part came when people, seeking to gain favor with superiors, would copy everyone on the message.  That copying continues today in email but in that there is hope.  

In December of 1992 the first text message was sent via SMS or Simple Messaging Services. During the second quarter of 2008, AT&T reported that more text messages were sent from cell phones than actual calls.  Texting is becoming a preferred means of communicating short messages from person to person. On June 9 of this year the US Senate held hearings from the major telephone operators in regard to pricing of texting services offered customers, and it is from those hearings that this story unfolds.

Though providers charge 20 cents per text when the individual has not chosen a texting plan, those people represent less than 1% of users.  The average price per text is around a penny.  The cost of providing that text is estimated to be about 0.0325 cents per text, providing the carriers with a very handsome gross margin of nearly 70%.  Still, what really matters is that texting is growing at a rate approaching 50% per month and that texting is seen as fast and efficient.

This past 4th of July weekend I spent some valuable time with my daughter (16) and five of her friends.  For a few minutes I was able to discuss with them their texting behavior, preferences and general insights into text messaging.  Texting, it turns out, has a lot of benefits besides being efficient or quick to consume.  It’s private for one, often more priviate than email, and it can be consumed discretely “even during church” according to one of the girls I interviewed. Texting has perseverence, it stays on ones handset and can be accessed at a later time.  This is an added value to texting not commonly considered and from a marketing perspective, holds great promise.

The point of all this is that texting is more than the electronic version of sending notes among young kids in high school.  Texting is important because it is succinct and so very quickly consumed.   Character length constrictions force a succinctness that is greatly needed in communication, while also improving upon the speed by which the message is consumed. That same message above could be re-written:

“This msg of 24 wds & 138 characters takes u less than 5 secs to consume, thats y txtng is popular”

This version is now down to 21 words and 95 characters, a character reduction of 32%, while still clearly conveying the same message, only instead of taking you 5 seconds to consume, you consumed it in about 3.  With the abundance of information thrown at us on a daily basis, anything that eases its consumption is good news indeed.

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July 8, 2009 | Tom | No Comments »
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