Subtitled: in which I offend my tech friends, healthcare friends or both
I synergize, it is what I do. (for those of you playing business jargon bingo, drink!) I am also an unapologetic Apple fanboy (for those playing internet buzz word bingo, drink!) I've long thought that Apple makes bold decisions, and, since Steve's return, calculated long range decisions. Yesterday Apple held their "Back to the Mac" event. They unveiled the next iteration of their OS X operating system along with a new Mac Book Air. To the consternation of technocrats, Apple continues to make moves away from traditional computing paradigms (drink) towards something that is more like an appliance. It occurs to me that healthcare in the United States is undergoing similar changes. If that is the case, what can we learn from watching Apple and its consumers?

First a little watered down techie background. Computers have long been the domain of nerds. Hey, I'm a nerd, I can say that. How many people know that person…scratch that…kid in their family who is the computer person? Put your own memory in? Nope, save it for thanksgiving and they'll do it. (Let the record show that I am that person, and actually quite happy with the mantel). Not everyone knows how to open the command line, clear the cache, defrag the hard drive or replace a motherboard. What happens when that window gets minimized to some new place, or you can't find a file? Today's computer-savvy youth have learned an entire skill set and vernacular that is frankly transitional at best.

Apple is moving computing in a new direction. Will it frustrate those of us nerds who actually enjoy changing our digital motor oil? Of course. There will always be people who want to build a RAID 5 array of hard drives. But most people just want the computer to be like an appliance. Turn it on and it works.

Healthcare is not much different. There are those of us who work in the trenches. We understand what payor mix and covered populations are. Should most people really have the words "explanation of benefits" in their vocabulary? Isn't that the IP Address of the healthcare world? Healthcare reform is a great example of this. Ask ten people what is broken with US healthcare and you will get 10 different answers. Ask that same lot what defragging a hard drive means and I'll bet you get an equally ambiguously and unqualified set of responses. Most people can't articulate much about healthcare because we have a convoluted system that is difficult to unravel.

Where is the Apple of healthcare? Where is the App Store that shows us what apps to buy and automatically installs and updates them? Apple have a much lambasted screening process for apps that make it into the iPhone and iPad store. Some call it closed or a dictatorship. Maybe. But my mother can use her iPhone and never calls me with questions like "how do I get this pop-up window off my phone's screen?" In Apple's world, it just works.

We are moving towards a reimbursement model that is focused on wellness and health. Over the next few years, computers will have a lot more in common with a toaster than the huge beige box from yesterday. Healthcare in ten years may look a lot more like a public utility than the what we have today. There are a lot of us who have been ensconced in the existing healthcare world. We're the nerds who like to drop into the terminal and type cp ~/Desktop/blog.txt ~/Volumes/Server/www/post.txt to copy a file. We're the ones who know how to tweak our reimbursement process to get the most out of medicare for an office visit. Yet there is a huge, increasingly vocal majority of the public who are asking: "where is my healthcare app store?"

Is the answer accountable care? Is it a public plan? Is it a public/private split like our school system (and like the Australian health system)? I don't have that answer. I do know that Apple is on to something when they make their devices more layperson friendly. It may frustrate the old guard, but isn't change always painful for those who can't keep up?

And... for a little light humor regarding accountable care: