First, a general comment or two about our discussions going forward: As I've said more than once already, Summer Term is compacted. Our discussions are an important part of our time together, but where I might "normally" allow 1.5-2 weeks for a discussion, we only have a week for each of our discussions (6) this term. I promise to scale the scope of what is expected around that shortened time frame….no long cases, no lengthy assignments, etc.

This first discussion is built around a very brief blog piece from Forbes…make a mental note please that this was written in 2013….a lot has changed in the healthcare marketplace in the five years since. Here are some suggested conversation starters based on my read of the article. These ideas and questions are "thrown out there" just to stimulate discussion….please don't feel limited to or restricted by them…feel free to come at this in your own way.

• On problem #1, one reason (some would say the primary reason) for unnecessary care is what is commonly referred to as defensive medicine, i.e., practices and procedures motivated, at least in part, by the fear of litigation down-stream. The Affordable Care Act did NOT contain any significant movement in the area of tort reform….a disappointment to many, and a victory for others. Why has tort reform proved to be such a difficult (impossible?) step in health care?
• Problem #2 avoidable harm to patients. Insights here?
• Problem #3 cites a report from the Institute of Medicine, suggesting that a third or more of health costs are wasted. This problem is almost certainly connected to the issues touched on in problem #1, but others as well. Recommendations?
• Problem #4 uses a very interesting phrase: "perverse incentives" (I hear the echo of Dr. Michael Porter here!). What are some of the perverse incentives that you've observed or studied, and what can be done about them?
• The final problem mentioned is the lack of transparency. What ideas do you have that might improve the cited lack of transparency in health care?

Again….the questions/ideas above are mine…you're not restricted by them. Also note that the blog piece is largely focused on early elective deliveries in childbirth, but the cited problems are not restricted to that practice alone. Do you disagree with the author's promotion of these as the five biggest problems in health care? Agree? Offer suggestions?