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Friday, August 28, 2009

MBA's Seeking Health Care Jobs

I got the idea for this post from a question that Marquis received on his blog. By got the idea, I mean, pretty much am writing the same post that Marquis did. With health care at 17% of the US GDP and a global industry, it will attract attention from MBA's with both long-term interest and those whose only health care experience is flossing. If animal husbandry was 17% of the United State's GDP, MBA's would be discussing bull semen and breeding techniques.

Digressions aside, one does not need a healthcare management degree or prior health care experience for most post-MBA positions in health care. Most health care sectors are very interested in techniques from other industries, such as financial services, manufacturing, and retail, so non health care experience will actually be appreciated. Any process improvement skills, such as Six Sigma or the methodology of the week, will be appreciated. Additionally, direct to consumer marketing, communication, or even talking will be in demand as health care is moving from a whole sale model to a retail model. Consulting or finance is the exception where you probably need health care experience to distinguish yourself from all the others and well, asking why they call it an Emergency Room when it has more than one room, won't impress anyone.

As an MBA, you probably won't be performing a colonoscopy or prepping someone for surgeries so what kind of jobs do people do in health care?

  1. The pharmaceutical or biotech marketing is still the #1 source of jobs. And I'm not even including the growing number of medicinal marijuana dispensaries. Whether it's brand management or business development or old fashioned four P's marketing, MBA's are generally hired to explain why someone should buy a drug. The difference between the pharmaceutical and biotech industry is that the pharma is a more corporate environment while biotech is more of a start-up environment. As a result, more MBA's tend to gravitate towards biotech because anything associated with the word start-up sounds cool.

  2. Health insurance has the biggest range of MBA jobs. There are product manager, business development, strategy, marketing, finance, and operations positions. Companies range from national carriers like United, Aetna, and Cigna to local carriers like Harvard Pilgrim to integrated delivery systems like Kaiser Permanente. Health insurance probably looks more like a typical business in terms of organization and understanding of the MBA background.

  3. Health Care IT opportunities are always growing. For the last 10 years, people tell me that knitting is really starting to just become popular with guys. This has demonstrated that something can be up and coming and ready to burst on the national scene for a very long time. Biotech is like that as well as opportunities to use IT to improve health care delivery. Lots of promise that hasn't quite been delivered yet. GE has a suite of health care IT products ranging from imaging to Electronic Medical Records (EMR). EMR is the most established opportunities with Cerner and Epic being the largest players in the field. Personal Health Records (PHR) represent the next wave. Google is involved with a version of PHR's which is really more a data depository and doesn't have the consumer-driven aspects that let someone manage their own health which is a key part of the PHR. Web MD is the best known company in this field. Another part of the Healthcare IT sector is vendors that help hospitals, health plans, and physicians do their billing or claims processing more efficiently. Trizetto is a big player in claims processing systems for health plans and Athena Health is the one company that I know that's involved in physician billing. Essentially, there is a lot of IT opportunity to help the health care players bill more efficiently. Finally, social media is hitting health care led by media darling, Hello Health which uses social media in care delivery at a physician's office to supplement traditional ways of seeing your doctor.

  4. There actually are not a lot of MBA opportunities in care delivery even seniors. Organizations that deliver health care like hospitals, physician practices, or anything that serves the elderly have maybe one position in the entire organization for an MBA. Most are run by nurses or doctors and look for either direct operations experience or a clinical background. These organizations understand the value of an MBA but can't support the position within their administrative structure. Either a lot of networking or some background in health care delivery is really needed to get a position in one of these organizations

  5. Get familiar with government funding. Those that are trying to stop the government from taking over health care tend to forget that the government already funds a lot of health care. The funding for Federally Qualified Health Centers (FQHC) or community health centers increased during the Bush administration and will sky rocket during the Obama administration. These are clinics that make up the safety net by being paid whatever they need by Medicaid and using that money to see as many uninsured as possible. Next, state and local government look for private contractors to provide health care for everything from prisons to pregnant women. Organizations like Liberty Healthcare have made a business around this outsourcing. Finally, health plans can get additional funding for Medicare members who qualify for assistance programs so some organizations like Social Service Coordinators have created a business around signing up health plan member for these programs. An MBA who keeps track of legislation around health care funding and understands funding mechanisms will have no shortage of opportunities.

Tuesday, August 25, 2009

The Highest Paid Healthcare Stakeholders that No One is Talking About

Every major stakeholder, think tank, blogger, and every congressional committee with the exception of an Agriculture Subcommittee on Agrarian Holidays and Pagan rituals has submitted their health reform proposal. We've blamed the insurance companies, pharmaceutical companies, and than spent August introducing "Death Panels" to our nation's vocabulary so we could find more people to blame. We even started blaming the Russians for bringing communism to our health care system.

Most thought that we've scrutinized the health care system more extensively than Mark Sandford scrutinized his Argentine mistress's tan lines. However, we missed one of the highest paid non-clinical intermediaries in the health care system. They wisely have kept out of the debate and kept a lower profile than Joe Biden until one of these organizations recently released their 4 page position paper.

This highly paid intermediary is health insurance agents or brokers. Selling health insurance can be as lucrative as selling real estate with a larger customer base. To become a health insurance agent in Oregon, it just takes 40 hour of class, $75 application fee, and 70% on the final exam. Barriers to entry are low and there are numerous options like selling health insurance to individuals only, small businesses, or joining one of the larger firms like Aon, Mercer, or Hewitt.

Health Insurance companies generally pay 10% of the premium to a broker. The group or person buying the insurance pays nothing and the broker gets paid as long as the person or group keep the insurance. If a broker helps 500 people buy a health insurance plan that costs $300 per person per month, their 10% would be $180,000 per year. There's a lot of money out there. Anyone who works in health insurance periodically asks themselves why they didn't become a broker given those numbers and we all see it as our post-retirement job. To be fair, you have to be good at selling insurance to be successful and sales is not easy. Deciding to sell health insurance to get rich is kind of like becoming a teacher for summer vacations. However, if you got your insurance license to help your 20 friends and family members buy insurance, that's $7,200 per year. That's a pretty lucrative potential side job. If I get laid off or dooced, I'm definitely getting an insurance license.

The broker industry does face some risk with health care reform, especially under the public plan scenario. The public plan would be sold through a health exchange, a site that provides information about the public and private health plans and allows someone to purchase insurance without a broker. Other reform efforts have introduced health exchanges so this is a consistent threat to the industry. Additionally, the public plan's administrative savings will come through not paying brokers their commission.

Brokers have stayed out of the public debate until recently when Mercer released their position paper (click on the July 13 US Health Reform: Our point of view pdf). Not surprisingly, brokers are against the public plan or any state mandates for benefits at all. They seen the employers as the source of innovation through as purchasers of health care. Additionally, there should be an individual mandate so more health insurance will be purchased. Mercer's view of employers as sources of health care innovation represents a skewed view. Clients who will retain Mercer, pay them a hefty price to issue proposals that rival government grant applications and push health plans to come up with new ways to demonstrate their value or cut their price. But these clients represent employers who are engaged in health care, join purchaser coalition, and see health plan purchasing as a competitive advantage or key part of attracting and retaining . They do not include small businesses, employers who just want a fairly priced plan, or anyone who would rather focus on their business instead of benefits administration. In summary, the level of change in Mercer's proposal is similar to the level of change when a guy wears a green shirt with khaki chinos as opposed to a blue shirt. It's not even at the pink shirt level of change.

The larger question is whether or not brokers provide a valuable service or just earn lucrative fees as a low value adding middlemen. Brokers have the done the best job that I have seen of keeping health insurance companies honest since they understand what is important to offer in an insurance plan, have enough historical knowledge to gauge a fair price, and what services are a good value. Brokers who serve smaller groups or individuals do a very good job of helping them understand their health insurance options and advocate for their clients when they are being treated unfairly. On the other hand, I've mentioned massive proposals and the low barriers to entry. That means anyone can call themselves an insurance broker and I haven't always worked with the most inspiring cast of characters.

Reform is causing every part of the health care system to be examined for quality and cost. The broker industry will face additional scrutiny and its margins will be squeezed. I do anticipate the dental industry getting a round of scrutiny shortly as it's days of 6%-8% margins may be numbered. And don't get me started with the reinsurance industry where brokers sell insurance to insurance companies.

Friday, August 21, 2009

Healthcare Reform needs a Llama Herder

I'm disappointed. Not disappointed like when you get rejected from a graduate program where you spent a solid 4 months completing their application and you promptly open a bottle of whiskey disappointed. More like the disappointment when I realized that my junior high wrestling coach was a terrible coach. He brought me into the sport and gave me the Most Improved Wrestler Award. However, in high school, I realized that all he did was yell to give someone a half nelson. When we gave attitude to other coaches, they would threaten to have him coach our matches.

I'm disappointed because I saw another health care reform post from physicians that says they want things to be like they were in the 1950's. It was from Sermo.com, a social media site that is for physicians with 11,000 contributors.

Before I get into the details of the post, I'm reminded of my encounter with a physician at a rural hospital. I had just started working in hospital administration, was touring the hospital, and a physician approached me. We did introductions and he asked me what I would do if physicians unionized and we had to make all kinds of changes. I responded that we would listen to every single demand and probably make every single change. However, that would never happen because physicians are too inependent and too split along specialties and practice setting to ever form a union. The physician admitted that I was right and it would be easier to herd llamas than physicians. Llamas are even harder to herd than cats since you can't pick them up and they get mad and bite if you annoy them too much.

There are inspiring physician leaders in health care reform, like Atul Gawande, Don Berwick and Mark McClellen who have put forth good initiatives that address the core issues of health care reform such as 10 steps to better health care in the NY Times that focuses on coordination, collaboration of care, and use of electronic medical records. However, other physician organizations have not followed their lead. As a result, I'm still disappointed.

Instead, the Sermo.com offered the Physician Appeal (my response is in bullet points below):

1. Reducing unnecessary tests and procedures through tort and malpractice reform.

  • I agree that malpractice is out of hand but there is no data that it is the principle and main driver of costs and quality in our health care system. Texas enacted strict torte reform 3 years ago and it didn't change the cost trend. Probably because 7,000 physicians have moved to Texas which has contributed to high medical costs.
  • This is a similar argument that most companies make to protect themselves from law suits. We could argue that unnecessary law suits are a bad thing that for the purpose of this discussions, physicians should have no more or no less liability protection than anyone else.
  • Again, the main question to ask is, has torte reform in 21 states, lowered medical costs? The answer is no, it has not. Malpractice insurance premiums have dropped but not medical costs. It is more noise than a serious driver as it probably accounts for less than 2% of the rise in health care costs.
    • 2. Allowing doctors to spend more time taking care of patients by making billing more transparent and streamlined (creating an alternative to CPT codes).

    • I interpret this as doctors don't like 15 minutes visits, coding, and figuring out insurance claim forms. This billing information is used for a lot of research so it does have value. However, there are a few simple options already available that physicians have not completely embraced.
    • One option is capitation. A physician is given 85% of the heat insurance premium and uses that for the patients medical care. If the patient never gets sick, they keep it. This is an old HMO concept that physicians have previously rejected.
    • Another option is risk share. This is an easier form of capitation where the providers will get a share of the profits left over from the insurance premium. They could lose some money if they don't manage care but only to a point. For example, a doctor would be paid a base rate of $115 per unit. If they manage care really badly, it would go no lower than $100 per unit. If they manage care really well, it could be as much as $180 per units.
    • Some physicians will accept those options but most like to paid per unit because they control their income better by doing more units. However, the principle can be met in today's environment if the insurance company is fair with the payment arrangements. This doesn't have to be anything new.
      • 3. Insurance reform to ensure that physicians are making medical decisions with their patients, not insurance company administrators.

      • Insurance administrators make decisions about what physicians will get paid to do or not paid to do but the ultimately medical decision is with the physician and the patient. Let's separate the payment from the actual medical decision.
      • When physicians make medical decisions that follows evidence-based guidelines, there is rarely a problem. Insurance companies use their claims data, national guidelines, and Medicare guidelines. When insurance companies behave badly and don't, they tend to get national press and that behavior is corrected.
      • Administrators get involved with physicians' medical decisions because there is a lot of unexplained variation in those decisions. Government and insurance administrators also have access this data that physicians do not have. One health plan noted that based on national research and data, expected C-section rates for all pregnancies was something like 35%. However, their claims data showed huge variations within the local practice. Payment became based on being slightly above the national rate and the rate of C-section for their contracted providers changed dramatically. So, it's not necessarily a bad thing when insurance administrators get involved in payment decisions.
        • 4. Revising the methods used for calculating reimbursements so that there will be enough qualified physicians to provide patient care.

        • Generally, specialists get paid $250,000/year (as high as $500,000 for some), and primary care physicians get paid $150,000/year. Option include: 1) Every physician could get paid the same regardless of specialty or 2) lower specialists payment and increase primary care payment.
        • I interpret this as stop underpaying primary care which is true. However, if the increase in primary care isn't offset somewhere, we'll just have a more expensive system. Given what specialists get paid, there's plenty of money to be shifted.
          • In summary, I read these principles as leave us alone and pay us better. Now I agree that physicians face an almost unfair amount of scrutiny but this is not exactly a transformative vision of health care.

            This is my second post railing physicians for regressive visions of health care. Although it may seem like I have some issue with physicians or some bitterness that I didn't go to medical school, some of my best friends are physicians! In fact, I went climbing with a physician today and not only did he not drop me but he agrees with my post.

            Physicians are smart, well-trained, and can be good at using data to change their decisions. That's why it continues to disappoint me that they have not seized leadership of health care reform. Hospitals, health plans, and the pharmaceutical industry have all negotiated arrangements. However, physician groups and the American Medical Association continue to produce proposals to say leave us alone and maybe pay us a little better while you're at it.

            Monday, August 17, 2009

            That's Deep: the Anti-MBA View of the Economy

            At the end of my summer reading list post (or for 1st year MBA's, their "move to a new state and try to understand statistics on 4 hours of sleep" reading list post), I mentioned that I was starting to read Deep Economy: the Wealth of Communities and the Durable Future. It's about how to think of economics in terms of sustainability and climate change rather than just economic growth and return on investment.

            As I have mentioned before (and probably not a surprise given the Grateful Dead song references on my right hand navigation bar), prior to an MBA, I was a long-haired, tofu eating, knitting, frisbee-playing, hippie who wanted to give everyone health insurance. Actually, the only thing on that list that has changed is that I cut my hair. However, post-MBA my mindset changed and I've presented a lot more business cases to CFO's. As a result, I initially found some sentences in the book to be appalling.

            The principle offensive phrase was repeated a few times when a group from Vermont (where the author lives) commented that they would like to build a small scale tofu maker or oat grinder but they can't find anyone who will accept a return of 3% instead of 15%. A return of 3% is appropriate for very low-risk investment like government bonds but high risk investments like a community grain grinder do not. That's not a reasonable request of an investor.

            The author also rails against the efficiency of larger farms or other large companies since they only make us marginally happier. The happiness of buying $5 eggs from a local farmer and being able to discuss the names of his chickens is greater than the happiness of 99 cent eggs at WinCome and Go super market. That's because after a certain level of income, social interactions make us happier than having more money. I'm a regular at the farmer's market and there's only so much meaningful conversation you can have about strawberries when there's a line forming.

            Additionally, he loves the local Vermont radio station of WDEV that plays everything from left and right wing talk radio to girl's basketball to jazz to stock car racing. The author holds up that radio station as a perfect example of community since you get to hear all aspects of the community. I call it a perfect example of something that will cause me to change the channel 4 out of 5 times.

            The author's final dogma is around local farming and growing food locally. I've occasionally helped out on small scale farms in South America and it is tough work. I lasted half the day during the sugar cane harvest. There is not a lot of the population that can physically be a small scale farmer.

            I was almost done with the book and discussing how I thought that Howard Dean was no longer the craziest person in Vermont with my father in law. My father in law teaches classes on sustainability and gave my rants a skeptical look as though he was trying to remember why he thought his daughter had any taste in men. In response to my comments about how the author is anti-economic growth, he simply said, "The planet can't take too much more economic growth."

            I thought about it. There has been enough scientific research about our unsustainable impact on the planet and climate change that it doesn't need any further explanation. However, economic growth models call for the GDP of all countries to grow and move up the value chain of production. China started out with cheap manufacturing than will move into more specialized technologies and Vietnam will become the source of cheap manufacturing jobs. As a result, incomes will rise in countries and eventually more people will be able to afford cars and air conditioners. But the connection between with climate change and stability is what will turn this model on its head.

            When the middle class composition of China alone reaches a level of consumption that matches the western countries, there will not be enough oil and steel on the planet to support it. For every growth there is a plateau. While I generally skimmed the author's accounts of the history of oat grinding in Vermont, I understand his connection between economic growth and climate change. We cannot continue to grow anymore economically without changes.

            Now those changes could be an increase in the price of cars, gas, and air conditioners so they are still out of reach of the developing nations' middle classes. But that price shock would hurt everyone so the other option is incorporate sustainability into the economic process. My favorite study the author was mentioned was that for the world population on average, money has a direct correlation with happiness up to $10,000 in annual income. For example, someone is very happy when they have enough money for food, then more money for meat, and finally some money for shoes. However, after $10,000 there is no longer that direct correlation with happiness. That extra money just buys stuff and at that point social interactions or community are bigger drivers of happiness (I would include street drugs in some cases but that's a bit off topic).

            The idea of limiting economic growth is a paradigm shift for how I would think of the economy. Every party has been sold on the idea of growth and you need the economy to grow with the population. Once I got over my irritation with some of the author's stories, I began to understand the connection between sustainability and economic growth. That connection is counterintuitive to my business-case driven MBA thinking. Ways to change my thinking could be to have a sustainability discount factor that could factor in paying for pollution licenses in a cap and trade program. The sustainability question may replace the outsource question for Venture Capitalists' assessments of business plans. Right now, the bigger question on sustainability is "What's the ROI on that solar panel?" I realize that question may no longer be relevant at our current pace which is the antithetical to the frameworks that MBA's use.

            Saturday, August 15, 2009

            Forget Town Halls, it's time for a Battle of the Bands

            The health care debate has degenerated into a pro wrestling match in the last few weeks. Bloggers are increasingly disappointed that we don't have the attention span or the bladder control to focus on the issues.

            NPR asked foreign correspondents what they they thought of the American steel chair and cage match approach. They are still at the beginning of the debate and completely befuddled that not all Americans have health insurance and that health care is so expensive. With that context, it makes negative comments about European medicine kind of like the pleasure someone receives when they stop hitting their finger with a hammer.

            Since we can't discuss health care as a country, we need a different framework that's easier for us to understand. I propose a battle of the bands that's mockumentery style. Embed policy in song lyrics that are catchy enough to stick in our heads until we understand the words.

            The moderate point of view will be represented by Death Panel, a folk band with long, elaborate songs that tell a story in order to describe all the complicated changes that are proposed. For example, "Stuck inside of the Emergency Room because I lost my insurance again". Dylan's "Hurricane" will describe the evils of the insurance companies and just be called "Insurance". The Who's "Pin Ball Wizard" will be about someone denied coverage.

            The left won't be represented in this battle of the bands just like their principles have steadily been dropped. Single payer was taken as seriously as Spinal Tap's mini-Stone Henge, and the public plan will spontaneously combust at any moment like their drummers. Personally, the song that I always had in mind for the public plan was Madonna's "Like a Virgin" because the government has always outsourced heath insurance administration. The public plan would be their very first time running a health plan.

            The right's band will be called Socialized Distortion Medicine and I think that name is self-explanatory. This guitar-heavy southern rock band's songs would include turning "People are Strange" from Echo and the Bunnymen to "Obama is Strange", "I Fought Health Care Rationing", and "Keep your hands off my Medicare." Or it could be named Government Takeover and the Socialist Company and sing Janis Joplin songs. They could have all kinds of fun with the Me and Bobby McGhee line "Freedom is just another word for nothing left to lose." Joplin's "Piece of my heart" would be turned into a song about taking away insurance from those who like their insurance with, "Break it, take another little piece out of my benefit package."

            If Bob Dylan can venture into unknown territory with a Christmas album than we can use bands to debate health care.

            Monday, August 10, 2009

            Some additional MBA reading material

            As I continue my nascent book club, there are 2 websites that fill a content niche for MBA's. I heard about these websites when they contacted me about linking and providing content. After reviewing their sites, I felt they covered MBA programs in a way not covered by mainstream content and was happy to be affiliated with them. Well, let's be honest, I get flattered when anyone contacts me about my blog.

            MBA Channel covers MBA programs as if they were the professional athletes and provides updates about their activities, rankings and methodology, changes in programs, and anything they do that might trigger a press release. It looks like their program directory is their staple feature. There are even scandals like false claims by Indian Institute of Planning and Management (IIPM) of relationships with US business schools that do not exist. In other words, it really is just like the coverage of professional athletes.

            I appreciate how they show both sides of an issue. For example an article about the newly named Jack Welch business school at Chancellor University in Ohio conveys the excitement about the partnership and Welch's legacy. However, it's balanced out by questions about if the Jack Welch school will try to turn out min-Welches? Would there be classes on "How to fire people in large numbers" and "Maximize your executive pay" as the linked Economist article proposes? "How absolutely not to cover up an affair" would be one class that could be taught with guest lectures from John Edwards and Mark Sanford.

            Another new site is Business Because, a new venture started by journalists with a background in the financial sector. It's niche is like the MBA Jungle or call it Maxim for MBA's. It combines some serious news but doesn't take itself too seriously with tales of MBA's behaving not badly but blowing off a lot of steam. It accepts that we don't have to be extremely dorky when talking about business or that a tone of self-flagelation (or self-flatulence) goes far.

            It's version of "How to lose your beer belly" advice does not contain overly serious diet regiments or tear down your self-esteem. Instead, the advice would be, "Put on a large jacket, hit the bars, and go get 'em tiger!"

            Given some of my previous posts, this is more my approach. For example, rather than suggest that someone take accounting or statistic classes before starting the MBA program, I would point out that's kind of like masturbating in order to become a better lover. Your MBA program will do a better job of teaching you accounting than you would be able to do on your own. It's not a good use of your time and much less pleasurable.

            Thursday, August 6, 2009

            Summer Reading list for Non-traditional MBA's

            I was a non-traditional MBA and I don't mean non-traditional in the sense of I just wasn't a consultant or banker. Nor a non-traditional MBA like someone who worked in an intense quantitative field like engineering or as an actuary. Six months before entering my MBA program, I decided to work in a commune for developmentally disabled adults. Prior to that I taught knitting to the homeless mentally ill. I was a non-traditional MBA in the sense that I thought Excel was a new anti-anxiety medication.

            Despite the orientations for incoming MBA students around the corner, this is summer the reading list that I would recommend for the really non-traditional MBA. They are interesting enough to keep the attention of someone who would probably rather be reading a David Sedaris book and clear enough for someone who never read the Wall Street Journal. They are relevant enough for those whose careers will probably be non-traditional and have no desire to mimic the management style of Jack Welch or investing career of Warren Buffet (and think that both men are kind of strange. Welch due to his intensity and Buffet because you think anyone who lives in Nebraska is strange.)

            Here are the 2 best books about Wall Street in the 80's for a good foundation of where good old fashioned greed all began.

            Barbarians at the Gate: This described the frenzy around a corporate takeover of RJR Nabisco. It reads like a Grisham novel, introduces powerful firms like KKR, and shows how the movie Wall Street's Gordon Gecko is not an exaggeration. You'll learn about how exactly someone tries to take over and buys another company when that company is not the slighest bit interested in being bought. Kind of like the dynamics between men and women after last call at the club.

            Den of Thieves: This will introduce the reader to Michael Milken and Ivan Boesky who were the Larry Bird and Magic Johnson of Wall Street in the 80's. I found that this book to be more informative of what investment banks do. This also describes the emergence of some of the financial products like junk bonds and mortgage backed securities that even the most non-traditional person has probably heard of.

            Non-traditional MBA's may hear about hedge funds for the first time at business school and notice the quiver of excitement in classmate's voices when they talk about them. Hedge funds involve using a lot of math to make money. When Genius Failed tells the tale of Long-Term Capital Management, a hedge fund that almost caused the financial system to fail in 1998. The book explains how hedge funds work and later spectacularly don't work. It's also a good reference point for near financial system collapse of Fall 2008.

            All non-traditional MBA's will think about a career in consulting since there is no specific background that anyone needs to be a consultant. Consulting firms also promote projects with non-profits or have their own non-profit consulting arms since they learned it's a great employee retention tool. As a result, they seem like the perfect place for anyone from a math teacher to a yak herder to work. I know that I went throgh the consulting company recruitment process, got rejected everywhere, and thus really liked: Dangerous Company: Management Consultants and the Businesses They Save and Ruin. It's a very detailed look at the history of consulting firms, how someone came up with the idea, and consulting projects gone badly. It's also intended as a guide for industry managers on how to properly work with a consulting firm so there is a balance of objectivity. It's a great book to take the sting off being rejected during an interview by the smug, glib, well-dressed consultant and much more productive than drinking a six pack. Some recommend House of Lies: How consultants steal your watch and tell you what time it is but I found that book to be more of a depressing tale of a really bad corporate job that just happened to be consulting.

            For an understanding of today's economy and financial markets (or lack of financial markets), I recommend American Theocracy: The Peril and Politics of Radical Religion, Oil, and Borrowed Money in the 21st Century. The same author also wrote Bad Money: Reckless Finance, Failed Politics, and the Global Crisis of American Capitalism which may seem like a more specific business book. Bad Money is really just a long drawn out version of last chapter of American Theocracy so you might as well read the Oil chapter for some Middle East and global history. I skipped the "Radical Religion" chapter because after a while it seemed like a repeat of "There are a lot of preachers in America. No, seriously, there are a lot. I mean really a lot. Take the number of preachers that you think there are in America and multiply it by 100."

            Every MBA will eventually read a Michael Lewis book and usually that book is Liar's Poker about his transition from non-traditional London School of Economics grad to bond trader in the 80's. I really wanted to hate Michael Lewis since he seemed like the most stereotypical Princeton graduate. However, he's a really good writer. The content of Liar's Poker will be covered in Den of Thieves and When Genius Failed so I would recommend Blind Side: Evolution of a Game. It looks like a book about football and the reasons that players at one particular position that most have never heard of are now getting paid as much money as successful bond traders. However, it's really a book about society, low income African-Americans relationship with sports, transitions from black ghettos to white societies, and a main character Michael Oher, who you can't help but really like and want to meet. It talks about the "soft" side of business decisions like ethics, complex decisions, and what's really important in life rather than the "hard" quantitative side.

            I just got Deep Economy out of the library based on a recommendation. It was another non-traditional MBA's favorite business book and it's about the importance of local economies. If I can put down my Henning Mankell Swedish detective novels, I'll find out if I want to add it to list.

            Update: This post provides another addition to the blue ribbon standard of the non-traditional MBA reading list. This post was awarded the blue ribbon by competing in a category that includes no one else. How many non-traditional MBA reading lists have you seen and even if you do find one, I can always claim that mine is much less traditional.

            Tuesday, August 4, 2009

            Sort of Playing the Game: Republican's Health Care Proposal

            Three months ago, the Republican released their health care reform principles which pretty much amounted to disagreeing with the Democrats, a lack of understanding that government is pretty involved in the health care system right now, and how they also liked ice cream on hot summer days. I've realized more and more that Republicans truly don't think that anything is really wrong with the health care system. I've heard phrases like:
            • Polls point out that 75%-85% of people rate their health insurance as good or excellent. Therefore, only 15%-25% of people are unhappy and this is not a big problem even though people will not start businesses in order to keep their employer health insurance.
            • Everyone access to health care through the emergency room so this is really a health insurance issue. There's a reason we call it a health care system. Using the Emergency Rooms is not a very efficient approach and is kind of letting someone else worry about the problem.
            • Their plan is "patient" focused. I would like health care to kick in before we become patients or sick. It kind of nicely symbolizes how they don't think about health care until it's really a problem
            Their latest proposal which came three month late at least had numbers and at least they're paying attention. Here's my the good, the bad, and the ugly take on it.

            The Good:

            • The proposal spreads the employer tax break to those who purchase individual insurance. Rather than eliminate the tax break for employers who buy insurance, they widen the tax break. It does level the benefit playing field and is a fair idea to consider.
            • There is also an idea for employers to take that same tax breaked or tax broken health insurance benefits and give it to employees as cash. Employees could decide if they want to buy health insurance or spend it on crystals and herbs. This could provide a real opportunity for health care providers and plans who can explain their value proposition well.
            The Bad:
            • While the plan will prohibit insurance carriers from denying individuals based on pre-existing conditions, the individual insurance market still has its dysfunctions. Given this proposal is making employer-based insurance less attractive, it needs to ensure a functional individual market.
            • States are given grants to improve high risk pools for those cannot purchase private insurance. This further underscores that the individual market will not be expected to provide coverage for all but there will need to be a safety net that is not planned to be sufficiently funded.
            The Ugly:
            • It weakens the Council for Comparative Effectiveness Research by requiring approval from medical societies. This Council was part of Obama's first stimulus project and is inteded to promote evidence-based care and ideally allow cost-effectiveness to be a criteria for evaluating treatments. Why would the Republicans want to weaken this clinician-led Council? There is no apparent reason to me other than to be cynical and assume that it's helping pharmaceutical and medical device companies who are the most vocal opponents of comparative effectiveness research.
            • The proposal does focus on medical malpractice reform by limiting jury awards which isn't a bad idea. However, it proposes setting up a new court system to evaluate medical cases. What's wrong with the exiting court system? It befuddles me why we would create a new judicial body unless it's so everyone can get free drugs during the trial.
            • Some of the savings will come from reducing Disproportionate Share or DSH payments to hospitals that see a high number of uninsured. I hope that this cut is tied to a reduction in people without insurance rather than a theory that a hospitals should not see any benefits for seeing more patients without insurance. However, if a proposal was really serious about reducing the uninsured rate, why not assume that this payment will not be necessary?

            I prefer to be political in my comments on other's posts rather than bring politics into this blog. I'm not that interested in debating for the sake of debating since we won't change each other's minds. The Republican's lack of effort on health care reform arouses my blogging ire because well, claiming they're ignorant, out of touch with reality, or nasty isn't really a better way of saying it. Actually, I'll go Sonia Sotomayer on them and accuse Republicans of a lack of empathy.

            The bigger issue for me is that the goals of their proposal is tort reform and tax breaks as opposed to any vision of what a future health care system would look like. It's clear that they don't feel a need to reduce the uninsured rate, have no provisions to improve quality of care, or help make better decisions about how to use health care dollars. I can almost hear the yawn from the proposal writers as they write it.
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