Much as I respect the entrepreneur's talents and necessary place in crafting a better world, it's time to balance that myth a little. By this point, the dreary rundown of facts about America's healthcare system is known: skyrocketing costs, far too little access and an overall ranking stunningly low among the world's industrialized countries. Those facts, as well as a number of proposed solutions, have been repeatedly highlighted in the contentious debate over recently passed healthcare legislation here in the United States, and have invited comparisons, often unfavorable, with the rest of the industrialized world.

 

Despite that, there are “islands of excellence” to use a term everyone from the White House to a number of analysts have used in trying to figure out a way to fix a tottering behemoth. 

 

Yet, some of those very islands might well suggest that the entrepreneurial approach isn't a panacea. 

 

The writer Atul Gawande, in analyzing the most- and least-expensive healthcare systems within the United States, found that giving physicians control to set “market” charges for their services, something that might be considered entrepreneurial, actually backfired. Systems that did that often had lower quality but higher-priced care. The Mayo Clinic, by contrast, one of the “islands” and world-renowned for its service, pays its doctors a boring old salary (albeit a generous one), whatever the price of the treatments they recommend.

 

Part of this is because healthcare, like a number of fields, doesn't necessarily allow business tactics to translate easily. If I'm shopping for a computer, for example, or even a service, I can consider how much I'm willing to spend

 

If I'm sick, on the other hand, or have a chronic condition, I have little room to bargain-shop. Being in dire need of care leaves one little leverage, and a great deal to those that control the care. This skews the basic supply-and-demand dynamics in such a way as to distort the effect of entrepreneur-style solutions in many basic areas of healthcare.

 

At its worst, applying the market to healthcare can represent the legends about the Roman tycoon Crassus, who ran a private fire department and would only agree to put out a blaze if the property owner would sign up for an exortionary insurance policy on the spot. Indeed, even those who have insurance often find that it covers far less than it should.

 

I've only had health insurance for a few years. Before that time, any sort of serious illness or injury would have strained my money severely and often. In the last six months, I've had to loan a friend — who works full time and then some — money to pay for antibiotics because he had no insurance. 

 

When my friends overseas, or just across the border in Canada, hear such stories, they're often shocked. While other industrialized nations have taken a variety of approaches to ensuring universal healthcare access — from state-run to mostly private — most measures show that the United States' has not kept pace by comparison.

 

Indeed it hasn't, and while wrestling with treating a population of 300 million people is a titanic task, my friends' (and my own) experiences converge with the many damning statistics to reveal that what they need is more basic than innovative. By and large, they don't need newer services, or flashier data, just basic care delivered in a way that doesn't cause serious problems to their working-class finances. 

That's it, in many cases, and the quest for innovation shouldn't lose sight of that pressing need, for which many possible solutions already exist.

 

This isn't to say that there aren't places for the entrepreneur in tomorrow's healthcare. Medicine is evolving so quickly that, while finding some way to insure basic access remains vital, existing systems must become more adaptable. Specifically, in gathering (and sharing data), as well as creating incentives for cutting-edge research and testing new organizational methods for wider adoption, the market can prove quite useful. 

 

But there are more approaches than the business approach, and, as in medicine, more than one type of cure required.