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Permalink Reply by Steve Stuck on May 5, 2008 at 9:00am

I agree with the online records..........a very much needed step in the right direction.

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Permalink Reply by Charles Shinaver on May 5, 2008 at 4:56pm

I can't give an answer as to how to overhaul of the heal care system. I am a psychologist-coach.

If you were on the other end of dealing with insurance payments you would want out. When you run a private practice and spend most of your resources on attempting to get payment it is not much of a business. As a matter of fact I have seen many mental health providers sapped of their passion to help by getting bogged down in dealing with health care companies.

Separately, but related is prevention. I actually have a good friend who is a personal trainer and he and I started a social network on Ning just a week or so ago. We are focusing discussions on various health related topics. The name of the social network is yourexcellentlife. Check it out and join if you are interested. We could start a discussion on a topic like this.

Anyway, I am getting to know other health care providers, but as yet I do not have a network or even a networking group, only an informal network, kinda. I do wonder if, over time, that we could become more formalized and provide more of this oversight care you suggest. From my point of view it would be voluntary. We would have to start it ourselves. And, I think this would not meet the needs of many of the people you are trying to help, because I would not want to involve insurance companies.

That is all I have for now.
Charles Shinaver, Ph.D.

Thanks

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Permalink Reply by Kristina Frazier-Henry on May 6, 2008 at 12:17am

Hi Charles,

Just recently, I have found a handful of medical professionals who have completely cut the insurance complication - out of the equation - and they are flourishing quite well! I'm going to send you a private message with some of the names of some awesomely decent mental health providers that I know personally or am aware of - heck - maybe I'll get them to join here.

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Permalink Reply by Charles Shinaver on May 6, 2008 at 12:21am

Thanks Kristina. I have been up late working on a revision of my website.

I need to go to bed!!!

Charles

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Permalink Reply by Steve Stuck on May 6, 2008 at 8:48am

John Stossel did a report on Universal Healthcare compared to our system. He did both pros and cons. One thing he did was show doctors here in the states not using insurance but cash only. Grant it, this was a check up office, but the guy still made the same amount compared to when he took insurance. Office visits $40, stiches in the head $150, etc.

WalMart is taking this approach in their stores and their first survey was something like 92% satisfactory rate. They are setting up small offices and hire a physician and a nurse. More hands on approach and lets people get checked up for the basics.

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Permalink Reply by Bruce LaDuke on May 5, 2008 at 10:56pm

Kristina,

The healthcare issues are indicative of a 'thinking' problem. The entire world has changed around us, but our thinking hasn't changed with it. Because we think like good capitalists, we tend to only be concerned about how what we do impacts our own interests. We need to remake communities from the ground up and make them more focused on concomitant good, integral solutions, and change-readiness. Community transformation is no longer an option, it is an imperative. Here are a couple of resources on integral futuring:

1) Integral Futuring Manifesto

2) An Integral Futuring Presentation I gave at Pecha Kucha.

The problem of huge disconnects between patients, payers, providers, and billers in healthcare is just one of many examples of 'silo thinking' in our communities and government. When people think in silos they also do in silos. And the end result is an overtly complicated and expensive approach to what would be simple solutions.

As Steve has said, our 'solution' to this today seems to be throwing government bureacracy at these problems. This propagates and intensifies the same issues. Unfortunately, government isn't thinking right either. We need a total transformation (a paradigm shift), not reformation.

If you look at Smaller Indiana as an example, there are a lot of people collaborating and connecting, but I see very little 'integrating.' That's common across the entire Internet. Of course, it is very hard to integrate because you have to be patient with people and share experiences and work at achieving mutual comprehension of various issues so you can move them forward together.

In my opinion, three main things are needed before we try to fix anything else:

1) Create a State of the Future Index (SOFI) for Indiana to establish a unified and emergent vision (people and institutions) for our state. Here's an example of what that might look like => http://writer.zoho.com/public/knowledgemachine/Indiana-SOFI-Delphi. This needs to be a living document that gets updated regularly.

2) Organize integral dialogue groups to begin to come together in areas where the community is fragmented. Model this after Betsey Merkel's open economic development Mid-Town Brews concept. This is deeper than a 'town hall meeting' and needs to be facilitated by people who are trained in community transformation. A few folks have expressed an interest in this and I'd be willing to train people that want to help in small groups.

3) Create a central information resource to use as a directory for our community. If I can get some traction around this, I'd like to start this up at a domain I've purchased at http://www.communitieswiki.com (setting this up now). It's hard to even visualize what integral looks like until you see it all together as a single directory and knowledge resource. This can't be a traditional marketing approach as the interests are too narrow to serve the entire community. It has to be a not-for-profit resource that people can tie their for-profit ventures into. It can't be owned by an elite little 'club' but rather, needs to be owned jointly by everyone in the community.

The living vision will serve as a target, the dialogue groups will integrate people and groups and create 'do' synergies, and the information resource will serve as a central hub for what is integrating.

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Permalink Reply by Steve Stuck on May 6, 2008 at 8:43am

Bruce,
Here is an example I have thrown around in my head and others can share their thoughts as well. I don't use this website much, but what about WebMD. You can go look up common symptoms yourself. Now the danger in this of course it is not like a regular check up, but you can at least get some general ideas. Would you create something general to this, but not necessarily their approach?

We travel to see an herb specialists. This guy has people all over the US flying and driving to see him. Not only is his expertise in herb and natural healing great, but he has a caring approach with his clients. This is one aspect doctors need to get back too instead of just looking at the chart.

You are absolutely right, you can have doctors tie into a non for profit system and still make a living (very good one). The reason being is that word of mouth of how a community based network would spread. In a sense, it would set up a sense of bonding and both the patient and doctor can go after the same goal, better health.

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Permalink Reply by Bruce LaDuke on May 6, 2008 at 8:04pm

Steve,

Great points, as always. Since we're getting really specific to health care here, I need to first put out a disclaimer that I'm representing myself in this conversation and not my company. And before I talk about healthcare specifically, I need to lay a little ground work.

Increases in knowledge are pushing everything higher at faster and faster rates. More knowledge => more technology, more complexity, more volatility, more change, more risk, more political instability, more unrest, etc...faster and faster and faster.

Healthcare is just one aspect of society affected by all of this. Energy, environment, education, government, etc. are all being affected in exactly the same way healthcare is.

I did a Google search about a month ago for industries that are in the process of trying to transform themselves and I stopped counting at appr. 30 industries. Rail, air, computer mftg., telecom, pharma, tobacco, automotive, automotive suppliers, education, defense, NASA, etc. are all trying to transform because they have to.

So then it's not just a healthcare issue, it's a lack of capacity to absorb change, volatility, complexity, etc. in all aspects of society. When I hear the director of NASA talk about his problems, they are virtually the same as down the line as those expressed by the CEO of my company, and the same as expressed by our government leaders, and the same as the family that lives next door. These same issues are universal today.

In a nutshell, the problem everyone is having is that their 'top down' management structures and cultures can't handle that much change, volatility, complexity that fast....they were never designed or built for that. The only way to handle it is to simplify the machine, which demands integral approaches....and to starrt dialogue so we're all changing together.

So then, specific to health care as an example...patient, insurance payers, medical billers, regulators, care providers, information providers, hospital administrators, etc. have grown up on their own silos and really don't talk much across the aisle. The care providers don't talk to the payers much and the payers don't talk to regulators much and the regulators don't talk to billers much, etc....And patients have to deal with all of them together as a discombobulated whole. And the bigger that machine gets (like in the U.S.), the worse the problem gets.

The only way to simplify for the patient is to start integral dialogue or wait for the patient to elect a more nimble and adaptive system through their consumer purchasing power/decisions. Healthcare is on the cusp of this crisis right now...they need to start integrating and simplifying and dialoguing or patients/consumers are going to find other options.

And if they don't start to come together in terms of information, there will be new players step in and simplify information for the consumer (as in your WebMD example). That's really just survival of the fittest in action. If industries can't adapt, someone else will step up and take their place. As you said, they need a unified goal of better health, or someone else will provide it.

Community health centers are one way to provide this integral approach--insurance, medical doctors, fitness, alternative health approaches, mental health, dentistry, etc., all rolled into a one-stop shop. This is essentially what Walmart is starting to provide with on-site physicians, pharmacies, etc.

If you think of it from the consumer's perspective, they don't have time to go all over town every day of the week to meet different needs. They badly need a one-stop shop. They can work-out, get their meds, figure out their insurance, and get their teeth cleaned in one evening...and talk to one person to get it all scheduled. In my opinion, that is the wave of the future...and that simply because it is local, integral, and less complex for an already way overloaded consumer.

The average person needs to start to think hard about engaging in integral dialogue and not to wait for these archaic enterprises and institutions to hand them an integral solution. At least half of all issues can be solved at the local level with local dialogue. It's not that hard to manage a local community, but it's terribly complex to manage an interconnected global villiage. Granted, to really fix it there needs to be local, regional, national, and global participation, but it all starts with communities starting to talk with one another and to move in unison. And the funny thing about fixing one community is that it tends to catch on in neighboring communities. People are really hungry for integral solutions.

Mid-town Brews is a great example of this in action. They dialogue about all kinds of issues from energy to culture to business. I'm hoping to get this same kind of thing started here in Indy and then network it together regionally with Chicago, Cleveland, Columbus, Louisville, Lexington, etc. I've got contacts in these and other regional communities with basically the same interest as I've described above.

It all kind of died with the death of the front porch. I think there is a book along those lines. People stopped getting to know their neighbors, stopped dialoguing and started trusting hierarchical institutions to feed, clothe, and shelter them. Well, it was nice to have a corporate babysitter while it lasted, but those days are unfortunately over and we need to start taking personal responsibility for our own communities again.

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Permalink Reply by Steve Stuck on May 7, 2008 at 11:03am

Of course, if you remember from a previous conversation, one of the quickest ways to drop healthcare costs by 22% is what? Something to do with imbedded taxes? Remember.......

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Permalink Reply by Bruce LaDuke on May 7, 2008 at 9:10pm

Steve, I guess my bottom line is that I think people get behind conversations a lot more than they do electronic conversations like here in Smaller Indiana. There's something about face time that helps people connect, understand, and get behind good things moreso than they would in otherwise.

What I'd like to see happen is the establishment of an open forum where participants agree to disagree and where speakers are brought in to set context for an open dialogue about some topic, like revamping the tax structure. Folks on this forum have a lot of strong ideas, but I don't think they'll really go anywhere till we start to connect face to face.

I guess I've seen a lot of these and seen positive results every time. We might, for example, as one of many monthly discussions, present two speakers: One on bigger government and one on smaller government (and maybe even one on anarchy ...smile) and then open it up to the group for dialogue. Arguments tend to stand or fall on their own merit.

Instead of dumbing down, people will become more informed about why they have certain stances and opinions.

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