Comments on: Government as an Engine for Innovation

By: Kamagra

Kamagra — Tue, 16 Nov 2010 18:39:17 +0000

Let’s be real here, the road to fitness wasn’t exactly fast-going for me. I grew up in Texas, where big means BIG – especially when it comes to food. Think unlimited soda refills, lunch buffets, all you can eat pizza for $7.99. As a result, food (in large quantities and portions) has always been a part of my life. The key—and the hard part—was gaining control. I soon became host to that ever-present extra twenty pounds. In an effort to lose it, I mapped out a diet plan that wasn’t the healthiest and a workout regime that wiped out my energy level. It wasn’t working. A few years ago I made the ultimate decision to change my life and gain the knowledge necessary to propel me into a well-balanced and healthy lifestyle.

By: aaron

aaron — Thu, 29 Jul 2010 19:10:32 +0000

Dennis,
I believe I mentioned the military, thus Los Labs and military research. It is CLEARLY the goal of the military to innovate. We developed the first 5th generation fighter. No f-16 has ever been shot down. We developed the first infrared invisibility cloak. Having worked with LMC, innovation really only comes from the private sector because they can reap the benefits of innovation. Also, there was a Medicare/Medicaid innovation lab before this one. It didnt do much of anything. It is not like a center directed at innovation will have a alternative result. Those that are practicing in the field have the incentive and value driven motive to innovate. It has been shown time and time again that the government struggles with innovation, while the private sector speeds past almost any government competitive body. Private sector individuals understand and account for risk. They get rewarded and punished. Government bodies generally do not feel the same pressures as the private sector to innovate, a prime example is Fannie and Freddie.
patient-centered medical homes – They are having a hard time selling these because patients think it sounds like a hospice and patients like hope more than anything. I cant speak yet if it is a good idea or not, but I thought I would add that to the conversation.

By: dave

dave — Wed, 28 Jul 2010 18:22:56 +0000

Government as an engine of innovation? I havent seen cows flying and giving champagne. Government caters to powerful health care interests and innovation will be more of the same medicocentric palliative biomedical care that has been around for a century. The innovation engine is run by the same experts who created the status quo of poor error ridden health care- they dont believe in innovation or real change.

By: MD as HELL

MD as HELL — Wed, 28 Jul 2010 17:49:31 +0000

Until you change the demands of patients for care they cannot afford themselves and would not buy themselves, you will fail.
Every person cannot access “the system” for a million dollars of reassurring negative tests.
Every doctor will not stop ordering these tests until the legal environment is less toxic.
Bottom line must be to change patient demand.

By: Dennis (Investigator/Negotiator) at Medical BillDog

Dennis (Investigator/Negotiator) at Medical BillDog — Wed, 28 Jul 2010 15:17:26 +0000

Well, aaron and Doc99, the examples you gave weren’t established with innovation as the guiding principle–clearly the case with the CMI. NASA is a government tool and was quite successful as an innovation source as long as they had government attention and government-sponsored goals.
As for the claim about the military not counting, uh, the military are government tools and they account for over 60% of government spending. They count in spades. Sadly, they also have as many failures as successes, but again, their goal wasn’t innovation.
All the nay-sayers aside, I think the best way to get the most bang for our buck will be patient-centered medical homes (PCMHs). Organized teams pushing wellness with the goal of avoiding medical procedures and hospitalization is a proven money-saver. The biggest stumbling block is paying the doctors. We need to get away from the CPT model, which pays based on procedures, and the ICD9/10, which pays based on diagnoses. I think the best payment model is the Harris Berman model (the Matthew Thornton Health Plan), currently an approximation of the Mayo Clinic model. Doctors work for a salary, with every specialty (including GP, pediatrician, and OB/GYN) starting at the same pay grade and getting the same opportunities for advancement. The Berman model disintegrated when he couldn’t find an orthopedic surgeon willing to start at the same flat rate as everyone else. CMI and, ultimately, CMS, needs to convince up and coming medical students that all specialties really are created equal. Just because you have the manual agility to become a superlative laparoscopic surgeon doesn’t mean you rate a higher starting salary than all your cohorts.
For the PCMH to reach optimum quality, efficacy, and value, I think it needs a few other adjustments. I’ve already outlined–at http://ow.ly/2hNcP –some of the adjustments that I believe would help achieve that optimum.

By: Robert Kaminsky

Robert Kaminsky — Wed, 28 Jul 2010 01:08:57 +0000

Innovation is a necessity in healthcare given the striking rise in costs and the declining healthstatus of the American population. However, government is rarely a source of innovation. Also, is radical innovation what we need? There are so many ideas on the table already -- patient-centered medical home, evidence-based formulary management, value-based benefit design to just name a few. The challenge is developing the evidence justifying each idea and determining the best way to implement these solutions. Evidence often takes years and years to develop. Maybe what we need is to focus on sorting through the ideas we have and constantly moving forward. Quantum leaps are great but incremental progress is often better. Remembering back to our childhood, the tortoise beat the hare. Robert Kaminsky, MedSpan, http://medspanresearch.wordpress.com/

By: Doc99

Doc99 — Tue, 27 Jul 2010 20:28:40 +0000

Government? Innovation? As in The Indian Health Service? As in The Post Office? I recall the brouhaha about care rendered at Walter Reed. So far, what I’m seeing is the formation of multiple bureaucracies which promise to function with the efficiency of the Department of Motor Vehicles with the Warm Fuzzy Feeling of the IRS.

By: Vikram C

Vikram C — Tue, 27 Jul 2010 17:54:14 +0000

Refering to Barry’s statement about lobbying issue it may appear that only hope would be people being healthier by their own volition and in their own wisdom.
Like Barry I am not so optimistic. However the best thing they can do is to bring about transparency in dealings and attack the health ignorance that could be the best use of money.

By: aaron

aaron — Tue, 27 Jul 2010 15:12:37 +0000

BTW, the title is a oxymoron. Government is hardly EVER the engine for innovation. It is only when they fund private researchers is there some hope. To me the only successful government innovators, are the military (which do not count as a member of the government) and the IRS (for being the most shockingly “reverse” innovative body in the history of the US government, ha ha.)

By: aaron

aaron — Tue, 27 Jul 2010 15:09:16 +0000

From my Finance/ Economics mindset, I do not see payments or all of these government created problems as the issues. I think there needs to be a study done on the carrot or the stick method of funding healthcare. I am proponent of creating a secondary market in which individuals can invest freely in hospitals. This OTC will be privately held market in which only those who trade know the information, like pinksheets. If hospitals are flush with cash, these small changes in this or that created by the government will matter less, in theory. I am not sure any study or experiment has ever been tried in reversing equation, instead of preventing growth in prices by restriction, open up capital that is there but locked up because of government regulation. The likely hood of someone taking on this free market perspective is limited. The government never lets go of its power, more or less let the “market” determine the life of death of a hospital. Healthcare is messed up because it is determined by government officials instead of doctors and people.