Is Obamacare Good For Innovation?- It’s All in What You're Asking For

In a recent Forbes article (http://www.forbes.com/sites/robertpearl/2014/03/06/malcolm-gladwell-on-american-health-care-an-interview/)  Malcolm Gladwell sat down with Robert Pearl to discuss healthcare.  Although not thought of as an expert in this area, I’ve also found Gladwell to be one of the most creative minds in America.   One of Gladwell’s books on innovation (Tipping Point) is something of a roadmap for a new paradigm, showing how the crowd can be delivered to solve problems; it also outlines a role as an accelerator for the individual.  I’ve written (pleaded) about this call to action (http://alanpittmd.blogspot.com/2012/12/why-i-use-linkedin-and-hope-you-do_20.htm). In the interview Gladwell asks where Obamacare is good for innovation, and how to “nudge” the system forward.  For me, innovation responds to a problem.  Obamacare has redefined the ask for innovators.

Since the last great change in healthcare (Medicare/Medicaid in 1965), America embraced something of a losing battle, a war on death.  Like every country, our healthcare reflects our traditions, We value the trailblazer over the settler, the surgeon over the internist, heroic care over chronic care.  We’ve paid for ever increasing breakthroughs at the margins (end of life) while largely ignoring less costly, and less sexy gains in quality of life.  This has left us with the most expensive system in the world with limited success for the average citizen.  We don't live longer than other developed countries.  And one could argue whether a country that ruins their citizen's fiscal health when they get sick is not very civil. 

Obamacare is a required shift.  The current system, something of a snowball of stakeholders, is not sustainable.  We are moving from volume (fee for service) to value based care, from heroic to chronic care management.  As with many transitions we are now moving through the 5 stages of Kubler Ross's scale, caught somewhere between anger and depression.

In terms of innovation, it's all in what you ask for.  This is one of the most chaotic times in American Healthcare.  However, in chaos there is opportunity.  We are seeing the beginnings of innovative strategies focused on new forms of care delivery.  Both large and small opportunities are nudging their way forward.  Americans are the world's greatest innovators.  Fear not Mr. Gladwell.  We are processing the new rules of the game.