George’s Corner

Interesting Books and More ––>

I read a lot. Everything from emails and text messages to thick hardbound biographies. No novels. My life is already too full of interesting things that haven’t been dreamt up by someone else’s imagination.

Recently, I came across a couple of books that are very interesting and well written. One is about the people who “invented” computers. The other is about the people who “created” Obamacare. Both examine how things get done and how people interact in the process.

I think if you ask the general public, “Who invented the computer?” most of the answers would be Bill Gates or Steve Jobs. Or, “Who created Obamacare?” Obama, of course. Both are wrong answers. Read these books to understand why.

The Innovators
, by Walter Isaacson, is about the people whose individual efforts and, more importantly, collaborations have brought us to where we are and are pointing us to technology’s future. Isaacson wrote the authorized Steve Jobs biography. The Innovators is a collection of brief but thorough biographies of the primary contributors to computer development. It starts with Ada, Countess of Lovelace (1815–1852), and Charles Babbage (1791– 1871), and their collaboration working through the logical and mathematical ideas that are the essence of computers. Ada was able to envision much of what we are experiencing today.

America’s Bitter Pill
, by Steven Brill, chronicles the complicated tangle of forces, intrigue, and big-time political maneuvering that gave birth to the Affordable Care Act, aka Obamacare.

Power, money, money, power, back scratching, money, power. The three big powers in healthcare (insurers, drug manufacturers, and hospitals) got most of what they wanted, and the healthcare reformers got a national health plan. The reformers backed off on cost savings because they could not get system reforms if it cost the “powers” too much money. This book details all of the inner machinations of what it now takes to get something this big off the ground. Who said what to whom in the local watering hole or wherever else. How much it cost (money) to get agreement.

Different Books — Common Focus

There is a characteristic that these books share. Both gather and analyze events, seeking a deeper understanding of the creative processes. Inventions are not “light bulb” ideas that occur all of a sudden. They are cooperative developments that grow over many years and involve many people, each contributing his or her own thoughts and perspectives. We need cooperative development in order to move forward in the provision of healthcare. We need it at all levels. From the highest levels of government policies, to what happens during individual patient encounters, collaborative development is sorely needed.

More — Side Effects of Obamacare, Healthcare Trends

Many people have had difficulty getting into the program. It is complicated and confusing, and has some tricky decisions for people to make. Implementation of what should be simple “fill out the form” applications has been an example of inept planning and programming, as well as of too many different states using different systems — with different motivations and different results.

Healthcare delivery is changing. The focus is changing to knowing and treating the patient, instead of focusing on the disease. “Precision care” is the new buzzword. We will see healthcare providers talking about “John Smith” instead of “the colostomy in 316B.”

Healthcare providers are transitioning from being small business owners to being salaried employees of larger organizations. In recent years physicians have moved from being employers to being employees. Some because they would rather take care of patients instead of employees, others because they could not deal with all of the complicated insurance paperwork. Pharmacists have already experienced the transition from mostly small business owners to mostly employees. Dentists will be the last, probably because they are the least interactive with the other health professions and their systems.

Insurance companies are trying to figure out how to deal with the fact that the principles of insurance cannot be applied to healthcare in the same ways that they are applied to life, home, and auto insurance. Life, home, and auto insurance all have a fixed maximum value agreed to by the insured and the insurer ahead of time. Healthcare cannot have an agreed-upon maximum value. There is no way to know how much it will cost to keep any one person healthy. The insurance paradigms are going to shift. They must.

Hospitals also are going through a huge change. Charging for each aspirin tablet is going away. “Does the patient come back too soon?” is the new measure of poor care. (In the prison system it’s called recidivism — aka patient not cured.) Hospitals are also going through a lot of organizational restructuring in an attempt to find the best mix. Outpatient as well as inpatient? General and/or which specialties to emphasize? Be part of an insurance program or deal with all of them? Stay independent or be bought by or be a buyer of similar entities?

So, want to get something done? Collaborate. Engage others of like or opposing minds. Engage others who have complementary talents. Listen. Think through. Do.


Want to know what the future will bring? Ask those who are making it. Better yet: Be one. CT

George Pennebaker, Pharm.D., is a consultant and past president of the California Pharmacists Association. The author can be reached at george.pennebaker@; 916/501-6541; and PO Box 25, Esparto, CA 95627.