SilverBulleits

Radical Consumerism

There's yet a another disquieting editorial in today's Times on the runaway costs of US healthcare.  In Less Than $26 Billion? Don’t Bother, Dr Ezekial Emanuel runs down the list of commonly-cited cures, to America's escalating health costs, carefully pointing out that few of them actually make a dent.  Sadly, Dr Emanuel's column seems to have done little more than touch off a fire storm of `it's all those greedy insurance companies' fault' kinds of comments.  These rants come, I'm sure, from many of the same OWS folks that lay all the blame for their troubles upon greedy bankers: i.e., for pandering to us innocent consumers' inclination to over-consume more debt than we should have rationally expected to service.  Why shouldn't the rest of us (a.k.a., the government) pay off all of our loans they ask? `no self-interest or "greed" in that.

Without descending into the depths of Adam Smith logic (that readers nor the writer of this posts cares to wade), let me just say this about insurance companies: IMHO they're no more nor less greedy than any other capitalist (and/or the rest of us for that matter).  To the extent to which health Plans are inadequately responsive to competitive market forces, perhaps more/better Regulation should be considered (see yesterday's post).  But, to suggest that a "single payor/national health plan" would, somehow, make the whole system suddenly more efficient, turns a blind eye to centuries' worth of market experience. Public vs private sector production paints a painfully-clear picture world-wide (think 20th century agriculture in Russia and China; better still, public housing health and education in America!).  The inarguable reality is that free markets, in the final analysis, simply do a far better job managing resources and services delivery than governments--irregular regulatory aberrations notwithstanding.

I'm sure that the arguments will nonetheless persist: Why can't all those health insurance execs' salaries and shareholders' profits be turned upon care for the needy?; and, How is that Socialized medicine in other countries seems to deliver better results at lower costs?  These and other good questions require more space to answer than this post permits. Suffice it say that answers to questions like these also require a little more basic Economics sense and intellectual honestly than many are willing to lend.

The short answers to the two example questions above, however, are these: good Management has costs, and the best management entails proportionate rewards. Given the size of our national health expenses, we spend considerably less managing the complex value chains involved here than in most other industries.  Contentions that government (e.g., Medicare/Medicaid) does it better are highly ingenuous at best: government agencies take a free ride on private plan mgmt—i.e.,in simply discounting the costs that are arduously managed in the private payor space.  And, costs are less in Socialist countries simply because there's not as much healthcare consumed in them! 

Another post could poke into why—why/how other developed countries maintain better health with less healthcare—but the central point that I want to make today is somewhat different. It's this: the ticking US healthcare time-bomb cannot and will not be defused on the supply side: almost every element in the value chain there (aggravated by most all new technology coming down the pike) contribute to more, not less, per-capita costs looking forward!  The ONLY promising place to look, therefore, is on the demand side: i.e., what set of circumstances will cause Americans to consume less healthcare (better still, to become more healthy)?  Think about it.  Given our unique culture, are Americans likely to be more content having government ration care than insurance companies?  Indeed, political forces will mitigate in the opposite direction (government "death panels" are even less palatable than private cost "capitation" policies)! Thus, all other things being equal, an Uncle Sam as the "single payor" will find himself forced to bend net expenditures in the wrong direction.

So, I'll close for now with the same question: What scenarios are most likely to induce Americans at large to assume more direct responsibility for, and more sober judgment applied to, decisions concerning their own health (cum healthcare consumption costs)?

On Micro, Macro and Mega-Trends

By way of once again attempting to get back on "participatory web" topic, I'd like to capture a few more "semi-idle thoughts" on participatory healthcare (a.k.a., healthcare consumerism).  More specifically, this post focuses upon the most participatory (albeit electronically lagging) web of all: public policy.

Yesterday my friend Ed Lovern added a post to his always-illuminating BLOG suggesting that, perhaps, a little more "free market-based" [healthcare activity] may be just what the doctor ordered (pardon the pun). My first reaction was a benevolent...DUH?  Without lapsing back into partisan political positions, I and many others beleive that too much public policy almost always stifles productivity and the general well-being.  In fairness, however, we must also acknowledge that too little public oversight (e.g., regulation) can be just as damaging. For example, it can be argued that we're still having trouble striking the right balance in regulating the Financial Services industry: too little of it undeniably led to the banking meltdown, but too much reintroduced in repsonse arguably threatens to inhibit recovery?

The chart above illustratively depicts other extremes as well as more balanced situations.  And, without further adieu here, I'll cut to the chase and assert that heathcare is dangerously over-exposed to public policy already!  Unless we want to see our health future in the same toilet bowl that public education can be too easily seen, we'll embrace ideas like concierge medicine, CDHP, P4/PCMH and other healthcare consumerism paradigms with both arms.  Yes, even that road will be bumpy; but, unlike public/national health plans, it's not palpably headed off a cliff!

Indeed, why can't we apply some of the consumerism "megatrendes" that Ron Bachman and others admonish us to consider (e.g., individuals, in industry after industry, have productively demanded more direct control over how they consume product/services)?  On an even larger scale, why isn't someone considering strategic scenarios that project healthcare industry evolution on a trajectory followed by so many others before it (e.g., as industries become detached from adequate market force [think natural monopolies] regulation appropriately steps in; conversely too much regulation tends to insulate that same industry from the efficiencies naturally brought by market pressure (think municipal utilities]). 

Here's but one example of the kind of strategic scenario "discovery" that might be found in a more rigorous retrospective/futures-driven look at healthcare consumerism. 

For some years now, progressive electric utility companies have struggled with the apparent conflict of interest brought about by an energy conservation imperative.  Inasmuch as some of them have now found new business models wherein energy suppliers can, in fact, make money by stemming demand (a.k.a., selling energy efficiency), why can't progressive healthcare systems find new business models (call them market-driven ACO's) wherein wellness become a profit center?

tbc...

On Asymmetric Deceit

When I first heard of Paul Krugman's unfortunate comments in yesterday's Times, I was incredulous.  How could anyone (let alone a Nobel laureate) find in the occasion of 9/11/11 a source for American "shame" ? Adding insult to injury, he punctuated his journalistic cowardice by disallowing comments and throwing yet more un-BLOG-like/no-comments-allowed salt in the wound: i.e., by recanting the historically-inaccurate indictment on American leaders' response (in both the wake of 9/11 as well as its 10-year-later commemorations). See More About 9/11

Dealing first with Krugman's (and many others) "historical inaccuracies": America's response to 9/11 was not an invasion of Iraq.  While a different BLOG could argue (either way) what combination of the longstanding problems with Hussein (and the UN), fears of WMD, bad intelligence,...whatever ultimately did (or did not) justify that move later, what we actually did do in the months following 9/11 was demand that Afghanistan's Taliban-controlled government assist in an international pursuit of Al Qaeda; and, upon being stiffed, and with the full support of virtually all other nations (as well as Democrats here), we invaded that country (it was a full year and half later that the world's attention turned back to Iraq).  Indeed, Obama still insists that (Afghanistan) was/is the good war!

Again, rehashing Iraq is far beyond the scope of this particular post.  That said, it has always sruck me as curious how many Americans (and others) seem willing (if not eager) to accept the following contention: that our leaders are, at the same time, capable of the most vile deceit; but, somehow, the same leaders are just incongruously scrupulous enough not to mask it!  For example, how is it that we can believe that the neocon's (Chaney, Rumsfeld et.al) could trump-up a case for WMD but decline to actually plant some?  How easy would it have been for the CIA to drive a tractor-trailer load of anthrax into the Iraqi desert and, then (just in case), tip off Geraldo Rivera and camera crew where to find it?

In short, contentions of Asymmetric Deceit (an ability and willingness to lie big but, then, refrain from covering it up) is ontologically illogical: In other words, it just doesn't make walking around sense when you think about it.  So, why do so many want to think so little about so many of our leaders?

Dialectic Deadlock

“Without contradiction there is no progression. Attraction and repulsion, reason and energy, war and peace, love and hate: they are all necessary parts of the human condition.”                                                                                  -William Blake

Notwithstanding the closing promise of the last post—to return at last to the participatory web—I think that it's necessary to cut the President some slack first.  Not so much because he's earned it; rather, because we tend to credit our leaders with more credit and blame than they deserve. In fact, the larger and more natural world wide web—the collective opinion or zeitgeist—is what actually moves change (and, much more often, resists it).  Inasmuch as the electronic web has dissolved much of the latency of information transfer it has the power to accelerate change; but, inasmuch as the information being transferred conveys no new consensus, nothing really happens no matter how much attention is paid by how many how fast. In other words, unless and until a pervasive new "zeitgeist" emerges, new directions inspire little movement and no leader can synthesize one alone.

"Synthesize" turns out to be a key word here. In a long-ago post, I channeled the timeless wisdom of W.G.F. Hegel. At a time when philosophers were like rock stars, Hegel was at the top of the charts; and, his widely-played dialectic was later used to lay foundations for Communism, Nazism and who knows what other `isms that, doubtless, roll Hegel in his grave.  But, at it's essence, Hegelian Logic tells history in the timeless context of unending confrontation and struggle: a thesis is opposed by and antithesis and, eventually, both merge into a "synthesis" that collapses the best of both positions into a new one.  The synthesis then becomes a new thesis in an unending triadic dialectic. But the somewhat simpler point of this post is what Hegel called the actualization: the dialectic process that ripens only at its own natural pace.  Just as Lincoln did not, and could not have, emancipated the slaves (before or after the broader sweep of the Civil War), just as Roosevelt, Napoleon or Hitler could not have done what they did under any different circumstances that they found, Obama cannot unilaterally synthesize a transformational direction.

Maybe I'm letting him off a little easy; and, maybe we're better off not embarking on "new directions" before their time anyway?

For example: if he had the power (and his Democrat backers held a gun to his head for, say, a new energy policy), doubtless we'd get something only the greenies really loved. And, just has these same renewable wet dreams have helped wreck the Spanish economy, a pile of dis-economic public spending on windmills and such would surely shove us the rest of the way off the recessionary cliff as well. Similar catastrophes would attend even small majorities pushing the public as whole in directions not embraced by most. Witness the Affordable Health (a.k.a., Obamcare) Act.  And, as pointed out in a recent post, even though Obama might like to join us in a conclusive debate on Leftist vs. Conservative policies, we're evidently not quite ready to even consider a new New Deal.

Once again, I'm not suggesting that all this often-painfully-slow progress is either good or bad, only natural.  Then again, when the change comes, when ignition occurs, it can often seem blindlingly fast to those not engaged in the dialectic debate.  And, in our time, the web can accelerate time!

"What is real is rational; and what is rational is [sooner or later] real"                                                                                         -G.W.F. Hegel

  

Working, The Issue

Inasmuch as I've been (or, at least may seemed to have been) off topic in my past few posts, I'd like to conclude the recent discussion by drilling down into the true challenge facing America (and most all other nations as well!).  This same denouement will also help me segue back into the traditional topic of this BLOG: participatory web dynamics.

Yesterday's NYT contained a Tom Friedman editorial that almost tells the whole story in its final paragraph

"We are increasingly taking easy credit, routine work and government jobs and entitlements away from the middle class — at a time when it takes more skill to get and hold a decent job, at a time when citizens have more access to media to organize, protest and challenge authority and at a time when this same merger of globalization and I.T. is creating huge wages for people with global skills (or for those who learn to game the system and get access to money, monopolies or government contracts by being close to those in power) — thus widening income gaps and fueling resentments even more."

As kids, we used to say that "almost" only counts in horseshoes and hand-grenades. So, boys and girls, can you find the one word in Friedman's column that almost entirely undoes his typically sage commentary ?...

Well, it's the first one: the personal pronoun "we."  We, either as individuals as well government as a whole are not the cause, at least not in any accountable sense.  Rather, it's a much larger and more pervasive set of detached and dispassionate agents at work: the quickly-changing nature of work itself!

Friedman ascribes key contributors to IT and Communications (that, from his pronoun selection, I infer are under the control of "we"); and his main point points toward a polarizing population and shrinking middle class. A recent post in my friend Doug Poretz' Facebook offers a complimentary perspective.  He argues that our leaders' futile preoccupation with jobs misses and essential point: what's needed is an evolved appreciation of the nature of work: the way's in which folks collaborate to produce more/better services and stuff.

This Doug would add to that Doug's remarks the following: perhaps, there's still another layer to this wealth of nations' and everyday folks' tale—the real value and nature of the products themselves!  In other words, what new services and different stuff might actually find a materially expanding demand?  What scenario replaces the  patterns of bygone middle-class work (that need more and more labor to get done?): e.g., what's to replace our dimishing need for soldiers, farmers, factory workers, etc?

I, for one, haven't a clue.  But, I am fairly sure that if someone doesn't crack this code soon, the kinds of violence done, by disenfranchised youth erupting all the around the globe, is likely to get a lot worse!  And, FWIW, this is where Poretz, Friedman and I agree: what makes the situation all the more volatile, what's different now than in previous periods of widespread disruption, is the ubiquitous an instaneous communications (a.k.a., social networking) environment that surrounds us.  People are far more able to collaborate, for good or bad ends, than ever before.

In his dense but rewarding The Information, James Gleick elaborates on an emerging belief that Information is not just the real stuff of life (i.e., the genetic code) but that it comprises the third element of everything! Quoting Seth Loyd, Gleick writes

"Earth, air, fire and water, in the end, are all made of energy; but, the different forms that they take are determined by information. To do anything requires energy [and space/time]. But to specify what is done requires information."

It follows, then, that the faster information flows (and as Metcalfe and others note, the larger the network within which it moves), the more happenings happen.  So, isn't it reasonable to conclude that we are, in fact, headed toward what Kurzweil calls The Singularity: a point at which our exponentially-expanding information transitions to the wisdom we need to solve most any problem that we can imagine?

And, on that positive albiet metaphysical note, I'll close for now once again marveling over the potential of the participatory web: i.e., to, at the same time, be the source of concern but more hope for our future.

The Ascent of Rants

Moving from "Primal Screams" to more evolved views—on the dismal current state of public policy and our apparent direction—I'd like to pick up on several other themes: ones that we all learned (or should have learned) at our mothers' knees.  I'll start with the familiar mantra from mom's everywhere: "If you haven't something nice to say, say nothing." And, I'll apply that to a generalized frustration over our so-called leaders' inability to focus on the real issue. Instead of blaming one another, we ask, why can't they help us understand the underlying nature of the real problem (from there, one could hope, they may even begin to frame alternative solutions!)?.

They say that a stinking fish smells from the head down.  So, therefore, it's natural to look first to our head of state.  Regular readers of this BLOG may surprised by this, indeed it sticks in the throat, but I don't see Obama as the villain here.  Indeed, IMHO he's an intelligent and sincere guy doing the best he can with a very difficult situation.  Indeed, IMHO most politicians, pundits, proponents...people on all sides of the issue truly want what they think is best for our country.  The problem is that we have wildly different views of what that is.  But, can't we at least leave all the demagoguery behind for a moment and recognize the profoundly historic issue that's been festering for decades; the one that's been anesthetized in debt but now portentously demanding attention.  I'm referring, of course, to the seemingly unsolvable binomial equation: the one that would resolve the appropriate size of government versus its costs (or, more specifically, who pays for it).

Once again giving President Obama his due, I'll bet that he may have actually anticipated, perhaps even savored, a conclusive debate on the natural tension implied between the upper left and and lower right-hand perspectives illustrated below. What he may have failed to notice, however, is that a more fundamental breakdown of trust in government has pushed too many into the lower left: they've grown to like the taste of the government teat; and, like mother's milk, they expect it to come for free.  Worse, they're too often led to believe that there's a neglectful class of sugar daddies out there that could be made to pay!

Simple math here is somehow, sadly, inadequate: e.g., the simple fact that 5% (the rich) already pay over 80% of all taxes (while collectively receiving only around 40% of all income) somehow seems unfair—to many that pay much less (let alone the 50% that pay nothing at all!).  More puzzling still is the misplaced expectation that government can/should create real jobs (a topic for a different post?)

But, to begin understanding this paradox, let's return to "primal" human nature.

In one of the most insightful (if not most overlooked) books of our time Something For Nothing, Brian Tracy lays out a compelling case for the entirely natural forces behind our yearning to get more (than less) for our work.  Indeed, apologies for oversimplifying Bronowski's Ascent Of Man, the essence of technology, economics and civilization at large centers upon our need to get more (food, security, work done, etc) for less effort.  Taken to it's logical conclusion—one that we're now apparently reaching—too many people think that, by supporting institutions predicted by Plato, de'Tocqueville and others, that they too can "get something for nothing."

Primal Scream

In what passes for leadership, our President once again took to the airwaves tonight with hollow calls for class warfare and desparate calls, for more calls, to congress: presumably to pressure our repesentives to "compromise."  Arguably, compromise is in order; that said, blaming the tea-party, for calling the abject and prolonged failures of our so-called leaders to account, is IMHO misplaced.  If there were more factions with the perceverence to play by the rules and effectively petition their government for rational change, ours would be a better country with a brighter future.

What bothers me most about the current morass is how little attention is being focused on the true underlying issue: ironically, the "balanced (read more taxes acompanying vague promises to cut spending) approach", is really nothing more than a proxy on Democrats' and the mainstream media's limp-wristed embrace of true change.  Specifically,  the left simply cannot fathom retreat from a century-long slide toward socialism: said differently, they just can't bring themselves to believe that a better governement may, in fact, be a smaller one. The 2012 elections, therefore, are likely to be the pail of water that follows an unsuccesful wake-up call.

And that brings me to the point of this post: Republicans seem too stupid to realize that they've got the sure win theme right under their nose!

Preemptively self-editing paragraphs of illustration, I'll just state an obvious aspect of human nature: even though our culture has evolved (or devolved) any number of unscuritably-complex trappings (e.g., government) , under it all we're still dumb animals.  We're still most driven by instincts burnt-in over milenia of natural selection (apologies to the ID idiots out there): we're still captives of Maslow's Hierarchy; and, Richard Dawkins persuasivley argues that our most basic appitites are still shaped by our selfish genes! In short, as a whole and as individuals, we're still more interested in the propogation of our genes than even our own survival.  What parent would't give her own life to save her child?  Indeed, most adults would, in a pinch, unhesitantly risk their life for any child!

So, here's the killer issue: just below our collective conscious is a quite natural revulsion to what we're doing to children and childrens' children. What previous generation has little more than massive debt as its legacy? What will they say about us: they who will, perforce, one day have much less just so that we can have much more than what we actually earn? How can anyone (apart from our President and many in congress) celebrate tonight's "compromise": i.e., an act of faux-statesmanship that leaves them feeling good about adding only $7trillion (as opposed to $10T) to the travesty that is ours?!!!

All that the Republicans need for a landslide next year is to, somehow, distant themselves from what happened tonight (if not claim some credit for what the tea baggers hath wrought).  All things considered, tonight's debt compromise was, probably, the best we could do.  `just sayin...

New-fashioned Participation

Reading my old friend Lawrence Wilkinson's most recent post this morning (with broadcast news of the raging debt crisis playing in the back ground), I'm prompted to scrawl down a few thoughts on a "participatory web" that predates (but not by that much) the internet.

Citing an article in the current Economist, Lawrence points out that 43million—one in every seven Americans!—regularly recieve food stamps.  And, as I was just reminded by my own TV, a big part of the uproar over the arbitrary August 2 deadline (on extending the federal debt limit), centers upon precisely which of the 80million checks that the gov't issues to its own citizens each month, may be delayed.  By my estimation, that equates to over half of all American families have become, to a greater or lessor extent, dependent upon government largesse! 

Somehow, I really can't imagine that the founding fathers had anything like this in mind for their Republic: a nation that has devolved to contemporary politicians routinely pandering to whatever voting block they can identify.  Then, sadly, the very nature of an entitlement makes it all but impossible for the next office-holder to remove these insidious freedom-killing programs. Add in an ever-accreting set of politically-packaged new "rights" (e.g., government subsidized health) and the demogoguery floats on a sea of red ink with ease.  This owes, in part I think, to the unhappy coincidence of a less-than-fully-congruent-different "half" of tax payors: i.e., those that end up paying no tax at all and, therefore, have no percieved stake in the outcome or "skin in the game."

`lest you think that terms like "freedom killing" are just so much demogoguery of their own, consider the direct and indirect impact of chronic deficit spending.  What right do we have to indebt our children and grandchildren, to the tune of $100K's/ea, just to pay for our own current over-consumption?  Fast forward a few years to when more frugal Chinese elect to call our hand and start cashing out: doesn't our best case scenario then involve a kind of subtle servitude?  And, back at home in real time, does anyone really doubt that more/better jobs are inextricably linked to expansionary and successful private business ventures? That being the case, isn't it also obvious that, on the margin, an overly-progressive tax structure most certainly retards new and/or expansionary enterprise?

Idiots like Bill Maher puzzle aloud over how/why folks would "vote against their own interests" (e.g., by not insisting on higher taxers for the rich).  He's also fond of saying that the Ameican people are morons.  He's wrong.  The truth is that more of us than he knows have an, at least subliminal, understanding of economic cause and effects; and, in general, we're more rational and aspiring than the elite left wants to fathom.

So, what's "overly-progressive"? How about the status quo. Do you know that in the US 5% of Americans pay over 80% of all taxes BUT they take in less than 40% of all income! In short, the rich and upper middle class already pay more than their "fair share."  IMHO, Obama's hollow solution to upping taxes on "millionaries and billionaries" is almost as big a fraud as is his pointing to corporate taxation (a practice that does nothing more or less than driving the cost of everything up and the demand for American-made products down).  You could take all of the income of all of the very rich and all you get is less: less new business initiatives and, by a short route, less tax revenue (from the suddenly idle but formerly most productive among us). For more on this line of thought, Micheal Medved has been penning persuasive prose here for a while.

First uttered by Plato (and restated by de'Tocqueville and an assortment of others since) "A democracy cannot exist as a permanent form of government. It can only exist until the voters discover they can vote themselves generous gifts from the public treasury."

Back to Lawrence's original point: a couple of days ago I was standing in the check-out line of a moderately up-scale grocery store and watched as two patrons' selections, including all manner of cosmetics, frozen foods and choice meats, were bagged up.  Call me a tea bagger (which I'm decidedly not) but I could not help but become mildy annoyed to watch them both whip out their EBT (food stamp) cards with nary a notion of appreciation to those out working to pay for their "gifts."

Whither Heathcare Consumerism: whether it withers or weathers?

`forgive the mind-bending, tongue-twisting title.  But, the most ambiguous term in this tortured taunt may be Healthcare Consumerism (HC) itself!  For, while some may see it as a problematic set of ideas, perpetually stuck at the threshold of mainstream adoption, others see scenarios involving more empowered and accountable individuals as inevitable and imminent.

In upcoming posts, I’d like to provoke a “wither HC” conversation: how “inevitable and imminent” is it [or not]? What has constrained early HC antecedents: e.g., consumer-directed health plans, HSA’s, FSA’s, etc?  And what are the trip wires and early warning signs that we can we look to as harbingers of a more rational healthcare future: scenarios wherein the principle cost-causers—individual patients and their attending physicians—are induced to find more cost-effective ways of maintaining their health and/or managing chronic afflictions.

I’ll start the ball rolling with a loose parallel: during the span of most of our lives, we’ve seen retirement and pension planning move from mostly employer and/or government managed plans to the current world where many (if not most) folks have materially-expanded control and responsibility for their own senior-years' savings. IRAs, 401K’s and similar schemes have given us all more incentive as well as flexibility and accountability, in how we provides for our golden years.  And, in the process, we’ve collectively transformed large swaths of the securities industry. Financial professionals have, by no means disappeared; but, many of their roles have changed: from remote portfolio managers to engaged coach/advisors. 

May this tell us something about the future of patient/physician relationships? Maybe, maybe not.  In my view, however, only good things can come from introducing millions more decision makers into a more dynamic healthcare marketplace.

What do you think? Will HC weather the current Heathcare Reform storms? Are key aspects of the Affordable Care (a.k.a., ObamaCare) really HC sceanrios in disguise or merely the preface to an expansionary National Health agenda?  Or, do you share my own belief that all roads lead (wittingly ot otherwise) back to HC?

BTW, for a more expert take on HC, check out Ron Bachman's BLOG at http://www.healthcarevisions.net/page/page/2641658.htm and/or http://www.healthtransformation.net/cs/healthcare_consumerism_video

 

Framing Healthcare Reform Futures

There is more than ample reason to presume that true reform is, by a short route, coming to American healthcare. That said, the precise nature and timing (of the tectonic shifts in public policy, technology, market and industry structure, etc, ahead) are anything but certain.  But now's the time that tomorrow's leaders must be carefully examining alternative scenarios and plotting disruptive strategic courses of their own (or, at least, anticipating others')!

 

 I've been working with a multidisciplined team of experts on a new approach to the issues like Healthcare Reform.  We're calling it FuturesFraming^sm and I'd like to tell you a little more about it.  Please click on this link for a short video presentation.

 http://www.screencast.com/t/MIRvmxpphTI

 Indeed, the first step in our FuturesFraming^sm method centers upon carefully delimiting, and then clearly delineating, the specific Focal Question that’s keeping senior exec's awake at night. The following are but a few examples of Focal Questions that we’ve taken up with early clients.  If you’d like, we’d be happy to take a look at your situation and come back with our thoughts.

• How could Healthcare Reform, and other Key Forces, reshape the chronic care market in the U.S. over the next 5-10 years?

• Could Healthcare Reform expand conventional demand? : e.g., should you double-down on current provider channels, government and other TPM strategies?

• Could Healthcare Reform constrain conventional demand for your product/service?: How could you particiapte in the new/emerging business models  (e.g., ACO’s) most effectivley?

• How will Healtcare Reform interact with emerging technologies? And when should you lock-in on what product strategy?

• How and when should you communicate your current position and post-Healthcare Reform plans?

• Will Healthcare Reform accelerate current healthcare consumerism trends

Speaking of healthcare consumerism, it's likely that individuals and their repositioned physician/coaches will soon find themselves both more empowered and more motivated to make better decisions around their own health strategies. Moreover, within this and other scenarios, a robust "no regrets" strategy involves the rapid evolution of new healthcare ecosystems: electronic syndicates enabled by current and emerging internet technologies. Can you position yourself as a leader and ride the Web 3.0 wave?

`say tuned.  I'll be following up withsome more thoughts on Focal Questions and Scenarios soon.  In the meanwhile, please, don't hestitate to add a few Comments of your own below