One way to understand what needs fixing in health care is with a marketing book, Seth Godin’s Permission Marketing.
In his 1999 classic, Godin identifies various levels of permission consumers give businesses, ranging from “transaction permission” to “intravenous permission.”
He urges his readers to climb the permission ladder, increasing the level of permission consumers give them to make more money.
In health care, the right public policy is geared to going down the permission ladder.
Once consumers reach a level of “intravenous permission,” price is no longer an object. When death is on the line the doctor has carte blanche. Our cost problems stem from the fact that too much of our health care is delivered in this way.
Intel CEO Paul Otellini has a different model. The “medical home” concept he pushes today at Politico is all about being pro-active. “Personal health is about shifting the focus from institution to individual and hospital to home,” he writes.
In technical terms what Otellini is talking about is subscribing to medical data, and advice about that data, delivered by a trained professional who understands the consequences of ignoring the data.
Instead of just giving transaction permission to your doctor, in other words, give a clinic subscription permission. As with magazines, subscriptions cost less than the news stand price.
Insurance works through subscription permission — employees sign up for their plans on a yearly basis. But most insurance is geared to selling a collection of transactions or, in an emergency, some portion of the intravenous permission a hospital has for your blood transfusion.
Instead, Otellini suggests, subscribe to services delivered at your convenience. This gives you the best of both worlds. You save the news stand cost of those services, and by engaging in prevention you cut down intravenous permission and its costs.
The difference between insurance as Otellini sees it and as it presently exists is that he wants you to build personal relationships with those who provide you health services, and make the key brand the company you see rather than the one you write checks to.
Thus health care services become more like frequent flyer miles than lottery tickets.
This changes your incentive, toward taking responsibility for what you do on a day to day basis, away from waiting for the inevitable heart attack.
It also changes business incentives, away from selling more services, toward selling services effiiciently.
Thus proper health care lies in the middle of Godin’s permission ladder. You agree to buy services on a regular basis, and in exchange for that increased permission both sides of the transaction see their incentives transformed.
The only difference between business and government, between right and left, in health care lies in how we get to where we are to this permission-based world Godin and Otellini envisage.
