I’m out in San Francisco at the California Healthcare Foundation’s conference this week. I’ll be speaking tomorrow with Susannah Fox of the Pew Internet and American Life Project, David Williams of Patients Like Me, and Amy Tenderich of Diabetes Mine. It should at least be interesting considering the context of being in Kaiser Country. KP is of course trying to implement as many Hello Health-like concepts into their own system to manage patients in a more intelligent way. Unfortunately, they’re working within the traditional culture trying to convince salaried doctors to change their behavior, even though changing their behavior doesn’t change their salaries.
Susannah is moderating the discussion. I’ve been asked to provide her with two questions:
What is your most skeptical question you get about Hello Health?
I’ve had to think long and hard about this. Is it that Hello Health is cherry-picking? No. Everyone needs a doctor. Is it that we’re taking people out of the insurance pool? Yes, rightly so. Their high premium, low deductible “product” is an unsustainable, inefficient, unfair, uncompetitive, oligarchical business leeching off the strained wallets of the American people. Is it that Hello Health will not work outside of NYC? No, it’ll work any place we are competing against the status quo. What are you going to do when your Williamsburg practice can no longer see new patients? Recruit more doctors from the 700 who have contacted us asking how they can be Hello Health doctors. Do you really expect people to pay for health care? Yep. There are 47 million people who have to pay for health care and there’s a $75 billion dollar per year out-of-pocket doctor fees market (revenue for Microsoft is about $50 billion and Google is about $12 billion). How does this help the less fortunate in America? It pushes the current industry to adapt more efficient processes and communication so that someday care can be coordinated and delivered via the internet in a post-digital divide world.
What is your most enjoyable question you get about Hello Health?
Well, I love any question about Hello Health. But one question I’ve been getting a lot of lately has been asked twice on my blog in the past week. It comes in multiple flavors, but I’ll just quote the last one:
I am just curious about your support of Obama. Your Hello Health company is a free market response to the insurance industry. What do you do if Obama gets his way and implements a socialist health system?
There is this assumption that Obama’s socialist health care system will occur overnight. If Obama tries to pull a Hillary circa 1993, the dogs that profit heavily from the $2.3 trillion industry will eat him alive, just like they ate Hillarycare. They will protect their profits at all costs and they simply will not go down without a fight. Remember, health insurance companies are more profitable than oil companies. After dealing first with the economy, the war, and then maybe health care, it’ll be a long time before this “socialist” health care system is begun.
But the real question is this…do you really want our government running anything? What does our federal government run well? The government sure isn’t the definition of efficiency and cost-saving. Doesn’t FedEx do a better job than the U.S. Postal Service? Doesn’t Toyota do a better job managing processes than the IRS? If a low income person’s health care can be taken care of by a lean, internet-enabled, well run business for $1500 per person per year, governmental bureaucracy will do the same thing for three times as much.
Obama is mostly talking about increasing the numbers of insured individuals. The insurance companies and managed care organizations are salivating. More revenues and more revenues. It’s a win-win for both groups. It’s a losing situation for us, because we’re simply throwing money at horribly inefficient, antiquated processes.
Obama may change how doctors are paid and start implementing more pay-for-performance measures. But of course, this is like putting the cart before the horse. How can doctors measure how well they’re doing when all of their records are written on paper? That’s sort of like doing a statistical analysis in a xerox machine.
All of this can be summarised by what happened in Massachusetts when they passed legislation that led to 97% of all residents having insurance. See here, here, and here. Without increasing the number of primary care doctors through various measures (policies that should have been put into effect 10 to 15 years ago), people will be mandated to purchase health insurance they simply cannot use to find an accessible doctor. They’ll flock to the ERs because insurance will cover it and ERs will be inundated with insured patients paying $900 for a $75 visit.
Having health insurance does not guarantee access to a doctor.
And therein is the answer to that question. If Obama is stymied and does nothing, our premiums will increase 100% just like they’ve done in the past 8 years and we’ll all be paying over $25,000 a year eight years from now for our family’s health insurance. Obama’s current solution of increasing the number of insured people but being powerless to change the number of primary care physicians (because he’s 15 years too late for that), will create a huge number of people looking for doctors. Unfortunately, they’ll realize they can’t use their insurance they were forced to purchase and they’ll be stuck. They’ll still need doctors and we’ll be the only accessible ones around.
But we’ll be able to manage just as many patients as traditional doctors, if not more. Because multiple studies show that over 50% of all office visits are unneccessary if good communication is present. That means we can see the necessary office visits and manage the unnecessary ones over the internet. So we’re not stealing crucial primary care physicians out of the system and worsening the primary care crisis, we’re simply reducing the total number of necessary office visits within the system.
Remember, you as a patient aren’t your doctor’s customer. Their customers are the people who pay them – insurance companies. And docs today are providing the best customer service they can possibly provide. That’s why they hire 4.6 employees per doctor to help them get paid from the insurance companies. They’re only hiring those employees so they can whip through more patient widgets. Unfortunately, it’s not their fault. Every primary care doctor I know became a doctor because they wanted to help people, not insurance companies.
Hello Health allows them to once again start helping people.
Because Hello Health is:
Doctors.
Email. IM. Video. Text. Office.
You.
Your neighborhood.
A new business model involving just local doctors and their clients. Very reasonably priced accessible health care paid for by people who are treated like customers at the Apple Store. And if we don’t do our jobs to your satisfaction, you should immediately stop paying us and take your hard earned money elsewhere. And that’s Hello Health’s promise to you – that we will satisfy you, our customer. It’s simply in our best interest.