Athenahealth CEO's Book: 'Where Does It Hurt?' - InformationWeek
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David F Carr
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Athenahealth CEO's Book: 'Where Does It Hurt?'

To fix US healthcare, we must embrace the free market messiness of the Internet economy, argues Athenahealth CEO Jonathan Bush.

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User Rank: Apprentice
5/2/2014 | 5:02:12 PM
Re: "Where Does It Hurt?" - good read, BTW

Jonathan Bush is a colorful, interesting personality. Rants or not most of his views are on-target but we can't compare healthcare to internet economy or companies. Internet economy came out of technology industry which is used to devour their own. Technology companies destroy each other with quantum leaps and sometime their own products are cannibalized to make room for next invention. There no vested interest in technology economy except a burning desire to out innovate the next guy/gal. We can only wish but cannot and should not compare healthcare to interest economy.

Healthcare has lot in common with education, energy and few other industries. There is a huge investment in infrastructures of these economies and with hundreds of billions of dollars on-the-line preserving status quo is critical. Simple truth is that vest interests are there to make money in all of these industries and any effort to change will meet a stiff resistance and may be blamed for destroying the noble services they provide. I am not the one to blame any one of these vested interest, they are doing what aligns with their goal of making good living. If someone wants to change it he or she has to find a way to change it.

When it comes to governments, less one says better it is. ONC spent over $250 million for Beacon projects nationally to create local exchanges. A startup like our have achieved it with less than 1/100th of it. May be ONC should use their influence to lobby and counter vested interest or get existing laws tweaked to level the playing field as not everyone has political connections like Jonathan Bush.

David F. Carr
David F. Carr,
User Rank: Author
5/1/2014 | 9:39:32 AM
"Where Does It Hurt?" - good read, BTW
I didn't explicitly say so in the article above, but the book is a good, engaging read. You may or may not agree with all of it, but Bush makes his case with a lot of good examples, sometimes but not always featuring Athenahealth customers. Co-author Stephen Baker apparently did most of the writing, but he does a good job of capturing Bush's style and sense of humor. The Athenahealth origin story is presented in the context of explaining what's frustrating about trying to run a business in healthcare and overall I didn't find the book to be terribly self-serving.

Bush and Baker also devote a fair amount of time to examining different perspectives, at one point including an interview with one of the authors of the Affordable Care Act for his insights about the frustrating compromises that went into turning the bill into a law, the underlying problems that were too fundamental and politically sensitive to tackle.

Book jacket blurbs from people like Atul Gawande (surgeon, professor, and author of The Checklist Manifesto) and John Halamka, CIO of Beth Israel Deaconess, reflect the fact that others see some serious thinking at work here.
David F. Carr
David F. Carr,
User Rank: Author
4/30/2014 | 4:29:37 PM
Re: Market Forces
I'm in a high-deductible health savings account plan, which I would say probably influences my thinking on what services I consume somewhat. Fortunately, I've yet to put it to the test by getting really sick and requiring loads of tests.
IW Pick
User Rank: Author
4/30/2014 | 4:13:57 PM
Market Forces
I agree that the main reason healthcare costs continue to soar is because few insured customers (patients) have an incentive to shop for their care and few suppliers (hospitals, practices) compete with one another on price. The laser vision correction example is an excellent one -- market forces brought the price down only because people started shopping for those uncovered services. When I've questioned the price on a medical bill, I've actually had an administrator ask me: Don't worry, your insurance covers it.

David F. Carr
David F. Carr,
User Rank: Author
4/30/2014 | 1:29:41 PM
Lowe's flying patients to Cleveland Clinic
The Lowe's example Bush cites turns out to be very recent. See:

Cheaper Surgery Sends Lowe's Flying to Cleveland Clinic - Bloomberg 
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