TIED UP. How quickly the "tied" turn, too. It’s mildly amusing that many who supported President Bush’s national healthcare IT initiative now are jumping on the "it costs too much" bandwagon. Media are publishing estimates that the federally-promoted migration to a national electronic health record will cost $200 billion, the bulk of which will represent an initial investment in new technology while the remainder will account for ongoing maintenance and management. Well, duh. What did they expect? It was going to be free or government-subsidized? Or wait. Software companies would give the industry a break from shameless profiteering on forced demand. Please. Get real. Those same critics should conduct a thorough cost analysis that examines and accounts for the costs of doing nothing and allowing the existing error-prone paper-based system to continue. But they can’t. That’s because they’re not able to get their arms around, let alone quantify the administrative and operational inefficiencies of the current system. So it’s easy to criticize a potential solution where you can apply financial principles.

The bottom line is put up or shut up. In a capitalistic free-enterprise society like that of the United States there’s no way to prevent the profit-salivating software companies from padding their margins thanks to this new trend – save for not purchasing those culprits’ products. If you don’t believe me then you’ve obviously forgotten about the dot-com silliness during the past five years…or you’re completely delusional.

The real problem is not so much the costs or the behavioral changes needed to maintain an electronic system. It’s going to be what that electronic system reveals about the healthcare industry’s Byzantine and bizarre House of Cards known as a record system. It’s akin to Dorothy’s friends pulling back the curtain to reveal the true Wizard of Oz. Imagine the lawsuits that will be filed over poorly managed records, which will be classified as administrative malpractice and medical errors, as well as the defamation of character/emotional pain-and-suffering lawsuits that emerge because an exasperated public wants revenge for the needless emotional anxieties they’ve felt over the years. All of this, of course, will be supported by John and Jane Q. Public. Let’s hope the Bush Administration simultaneously can manage efforts to push for electronic health intelligence and control over frivolous lawsuits. Otherwise, the balance sheet picture won’t change one bit.

TOONED UP. America Online (AOL) co-founder Steve Case just launched a new consumer-driven healthcare company that will invest in and acquire controlling interest in companies that focus on healthcare information systems, finance management and electronic health records, among others. The new Revolution Health Group will help consumers make decisions about their healthcare as they become more ensconced in consumer-directed health plans. Here’s how it probably will work. Each citizen will receive a colorful CD with a gibberish-sounding password every other month or so that gives them 1,000 hours of access to online information if they download the software. After those 1,000 hours of online access to information and advice is used up you can pay $14.95 a month for that same access moving forward. If you want to upgrade to the high-speed access to online doctor visits and medical record correcting and updating, you’ll have to cough up $39.95. Because history repeats itself (selling AOL to Time Warner), once Case has surfed the consumer-directed health plan-EHR fad/trend as far as it will go he may try to sell the company to Disney or Steven Spielberg’s DreamWorks outfit. Then you can sign up for the Mickey Mouse and Donald Duck HMO plans or the E.T. and Shrek PPO plans.

BORE DUMB. About 35 hospitals around the country are using refrigerator-sized magnets in order to perform certain cardiac procedures, including angioplasties and implants. In these stereotaxis procedures doctors rely on the magnets to guide catheters through the body. In an effort to control costs by not buying the actual magnets the other 5,000+ hospitals in the country are trying to figure out how to unbolt and move their MRI machines into the O.R. and back again.

AUTO MOTIVES. As the Big Three automakers relish increased sales from their perpetually extending employee-family-friends pricing programs, marketing gurus at the Big Pharma and Big Ortho companies must be kicking themselves for missing this great opportunity to put a positive spin on their sales strategies and tactics to physicians. Can’t you just hear the mock (or is it mockingly) sincere testimony on Capitol Hill? "No, no, Mr. Senator, sir (or insert relevant FTC or DOJ official here). We would never engage in paying kickbacks of any kind to our valuable physician customers. They’re just participating in our [drug or implant] ‘Family and Friends’ program. Besides, we don’t classify them as kickbacks. They’re cash-backs."