A user’s guide to Donald Trump and the future of Australian Healthcare

Donald Trump's victory has a few lessons in it for those guiding the future of Australian Healthcare

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Hitting rock bottom is sometimes a good thing. Australian health isn’t there yet, but it’s heading that way

1. Tears and whisky

I was having a quiet Laphroaig Islay with a global luminary of digital health a couple of weeks back when in the background the TV unceremoniously announced the presidency of Donald Trump. The luminary literally burst into tears with grief.

He had some good points. Obamacare, though a poor start, was a start. To the dream of universal healthcare in the largest, most powerful and most influential healthcare market in the world. Barely born, it is almost certainly headed for the scrapheap, and with it, pretty much all hope for this concept ever being resurrected in the US.

And this might not be such a good thing for Australian healthcare in the long run. Outside Europe, we have one of the few universal healthcare systems working reasonably well. Having the US make a U-turn at this delicate time of our healthcare systems evolution, is very probably bad for us.

Believe it not, the US is a vast hub of healthcare innovation and thinking on viable models of care, especially models integrated via technology. But apparently all those people are leaving the US already – taking to boats like the soldiers at Dunkirk.

And the execs at the large hospital and patient management software vendors – Cerner, Script, CSC, Fusionsoft and the like – are all leaping (metaphorically) from tall buildings as the uncertainty and mess come down the tracks. The rescinding of Obamacare and introduction of  Trumpcare (whatever that is), does not bear contemplation in these circles apparently.

All these vendors and more have businesses and systems in Australia. The ripples from the US election in healthcare, might end up being waves. My luminary friend went to bed muttering to himself and sobbing. I suddenly felt sober.

2. Politics (and health) in a digital world

Trump’s mastery of digital communication in the world of politics was his single biggest differentiating advantage in this election. He bypassed powerful centralised traditional media who weren’t supporting his agenda. He used alternative social media channels and ended up having once powerful old media, play to his tune. In fact, he changed the election playbook paradigm, probably forever. And he spent a fraction of what his competitors spent doing it. He disrupted.

There are many lessons here for Australian Healthcare, which is deeply bogged in a digital swamp. We created that swamp and walked right into it. We treated digital as an end not a means. We aimed for “digital health” not “health done better in a digital world”. We also aimed and promised way too high. We saw the transformation in markets like travel and finance and thought, “we can do that”. We couldn’t.

Now in Australia, we need to fix it. Because as Donald Trump has mostly certainly taught us, digital can achieve things no one imagined feasible, if managed with skill, intent and focus. This time around however, we hopefully get that Healthcare is like no other market that has started to transform with digital technology.

Healthcare has fundamentally different market dynamics around factors such as supply and demand, information asymmetry, and regulatory framework. Change in this sphere is not going to be the big bang Trump promised his supporters. It’s going to be incremental – evolution not revolution.

Clinton, not surprisingly, was an incrementalist, and look how that worked out for her. Expectation and desire are unruly beasts. Everyone wants shiny digital stuff that makes things cheaper and better now. But we are going to need to be more patient.

3. Don’t it always seem to go…

You’ve got to suspect that millions of Americans will be thinking “you don’t know what you’ve got till it’s gone” in about two years. The Australian Healthcare system is in reasonably good shape today, but it simply can’t stay that way on its current trajectory.

Defying gravity is a strategy that probably only Donald Trump can sell. Our healthcare system will start demanding a higher and higher percentage of GDP in the very near future. Although, theoretically, we should have a lot of give if you compare our percentage of GDP spending to other developed countries, especially the US, saying that we will just accept paying a lot more for health is both unrealistic and still an equation with an eventual hard stop. Which means we need to start doing something effective now.

Australian healthcare has a lot of issues: state versus federal jurisdiction and funding; state versus state on interoperability of hospitals and systems; a funding model that literally sucks (volume not outcome); private versus public disconnect; a lack of communication between primary and secondary care and, a digital landscape and strategy that you could argue has seen us get less efficient, not more.

Full federal control of health and a better funding model, if done properly, would be our biggest bang for buck.

But the obstacles here are massive. Digital stands out as the one thing we can do and which has the potential make a big difference. But it’s going to involve a lot of leadership, a lot of sacrifice, a considerable amount of risk-taking and suspension of belief (see below).

4. Great expectations

When Obama came to power, the US was a mess. There were very high expectations about what he could do. And he did surprisingly well; America has recovered from a near death experience in two long-running wars and the GFC. But you wouldn’t think so from what commentators say.

Now Donald Trump has set the expectation bar somewhere just beyond Mars, and been rewarded for it; at least for now. Back in Australia, we were sold digital healthcare in a manner not dissimilar from how Donald Trump sold his policies. We misled clinicians by selling them outcomes that were never achievable, not in the timeframe we gave them. The disappointment and resentment are palpable. So starting the process of digital strategy all over again is all the more difficult. But out of a hard bunch of options, it’s the most achievable. Many issues will require revised and clever leadership. One of the biggest will be selling doctors the idea that they need to do a lot of work for which they may never see any clinical benefit for their patients in their working life.

Monetary incentives will be important and will end up being offered. The government will need to wake up to the fact that they can’t expect overworked and underpaid GPs to pitch in for no remuneration.

But it’s still a hard sell if you’re unlikely to see the fruits of your work in better clinical outcomes for your patients. Yes, it’s very likely that if digital health is going to get up, someone is going to  have to tell you the cold hard truth to keep your expectations in check, and you are going to have to take one for the team (future generations of doctors and patients).

All of this is a hard sell. Politicians like Trump aren’t in power long, which is why they sell hype. Selling hype doesn’t work in healthcare. It’s too important.

5. In adversity is truth

That the US is going to be run by a reasonably shonky reality-TV personality has taken a few people by surprise. For those who argue this is what the majority of Americans wanted, we know this isn’t technically correct. One wonders what would happen if the election was re-run next week. You’d have to expect a few more people would turn up at the voting booth, understanding better the peril of complacency.

In the real world of Australian Healthcare, let’s hope people now realise things are so thoroughly stuffed that they need to stop fighting among themselves, stop being passive, and work together to turn things around. Rock bottom sometimes is a good thing. As things stand, the system as it has been constructed and managed to date is akin to watching a slow-moving train wreck.

We are probably stuck with health being funded and administered by the feds, state and local levels of government, and won’t be able to change funding models quickly enough to avert a crash. It’s clear our
go-to option is digital. But all stakeholders need to take a deep breath and know there will be a lot of uncertainty and pain.

Clinicians, government, medical service providers (such as pathology labs, in particular, but others also), private insurers and the owners of private hospitals will all have to make some sacrifice. If they don’t things will end up bad for them anyway. All of them.

6. Timing

A large part of Donald Trump’s success was down to timing. Can you imagine him succeeding four years ago? And who knows what will happen four years hence. The single most important factor in the success of new businesses is timing. Not the idea, the funding, the team or the market.

Australian Healthcare leaders – private and public – should stop to consider the confluence of factors occurring in the sector today which might present a window of opportunity to make systemic change for the better:

• Legislation for a national medical health record is in place, something which we constantly under value for some reason
• Infrastructure for a national health record, but probably more importantly for other digital efficiencies, especially around cloud-based technologies, is in place.
• The government is getting its act together.

– The ADHA is making the right moves and getting things done.

– The leadership of the AHDA has more experience and skill than ever before, and a lot of intent.

– There is acknowledgement you can’t make overworked underpaid doctors do additional work without paying them. Funding is starting to shift to this realisation.

– There is going to be less tolerance of stakeholders such as pathology providers who use interoperability as a commercial wedge to keep making money by keeping the system inefficient.

• Private sector stakeholders are going to be similarly held to account by government – witness the recent change in medical devices pricing to the private hospital sector
• Doctors are ready. They have been for a while. They aren’t the digital laggards they are commonly tagged. They are just head down bum up trying to make a living without much leadership or support in giving them the right context to affect change. The most obvious change is we need to pay them to help affect change because they are already busy and they aren’t about to drop more income for something that is so intangible at this stage.
• Key connecting technologies are being rolled out – specifically, all the major patient management systems are racing to get off the desk and into the cloud. Secure messaging providers are rationalising for interoperability as they are going to be pushed by the government if they don’t. Some start-ups are banging on the door of slow and complacent incumbent providers.

The time is right now.