Saturday, December 12, 2009

The Tale of Jonathan Bush: Will He Turn Out to be a Free Market Man or Just Another Oligarch?

Joseph Rago in today's WSJ has a fascinating interview with Jonathan Bush (Does not appear to be any relation to THE Bushies). Bush is president of Athenahealth, an information technology services company for physicians. He truly gets how government is and will continue to muck things up in health care. He explains in the interview about what it is like to visit DC and talk to politicians:

'It's a little bit like talking to a young prince," says Bush."'So—tell me about this market thing that your people use,'" he says, mimicking the political royalty with a grin and extending his forearm. "'Wait: I must catch my falcon!'"...And these princes, they mean well and they're lovely," he says, "but they're living in this alternate universe where there's no such thing as a market in health care and they don't understand why one might be remotely useful."

He pauses. "That's weird to me."

Mr. Bush is an outlier in the generally buttoned-down world of the health industry. He's exuberant, hyperactive, speaking in frenetic running monologues; it's not hard to see why the political class might be taken aback: "I still have to keep going to Washington and sucking up," he says, switching metaphors. "Because the problem is when you have a baby with an Uzi, right, they might accidentally mow you down. But here's the thing . . . they're brilliant people. It's just that the idea of a market in health care never occurred to them.
I mean, this guy really, really gets it:
As Mr. Bush sees it, the profound problem with U.S. health care is that there's "no landscape of choices, or choosers." Due to the complexity of America's third-party laundromat for health dollars—your doctor's clerical staff bills your treatment to an insurance company picked by your employer, and it pays him with your money via premiums or foregone wages—"few doctors in America know the actual value of the services they render."...

Yet for all the talk about expanding coverage, Mr. Bush says the real problem is that "You can't buy what you want." Another way of putting it is that "America will have one car. Everyone will have access to transportation, which means that everyone will have a black Escalade, with spinners. That's it. There's no Hyundais, no bicycles, no nothing."

And it's scandalously unfair. "These poor people who clip the things off the backs of cans to make the tomatoes cheaper are subsidizing the hypochondriac who gets his shoulder done with an arthroscope because it clicks when he serves at tennis."

Under ObamaCare, Mr. Bush says, "everyone is going to get health care according to the wise-men benefit panel, who will tell you exactly what it is, and then they'll run out of money, so every year the wise panel will just squish the benefit a little."

He is a bit optimistic though of what will happen when the benefits get cut. He says:
"People will start to say, well, that's not going to work for me." For this reason he doesn't think central health planning will have any longevity, and eventually people "will start leaking out into the [private] market once we run out of Obama energy."
I think that is a long way off. When people begin to realize Obamacare doesn't work, the immediate knee-jerk reaction will be to blame corporations and move towards even more regulation.

But, in the end, will Bush, who really, really grasps the problem, simply turn into another oligarch. Here's what he says is going to happen:
"It's probably terrible that all this new bureaucracy is being created," Mr. Bush says. "But there's going to be 50 new Medicaid-type plans in these insurance exchanges, run by the same insurance commissioners, these same sort of glazed-over-looking state secretaries of health. You know, just not really the brightest bulbs in the chandeliers of the world. Medicaid, the worst payer in the country by a factor of four! Mother of pearl! So I feel a little bit like a robber baron. I am going to make oil money dealing with them."
Read the entire interview here.


  1. Another Oligarch...if he's lucky.

  2. Sounds like a faith based approach to me. Government run health care just somehow magically works in other countries? When are they all goig to trash their government plans and go back to private? Never - that's when. Canada has had national Health care for something like 62 years. Peop-le are happy with it. Very happy. This man is a liar selling snake oil.