The Supreme Court hearings on the Patient Protection and Affordability Act (Obamacare) last week fascinated me. It is one of the few news stories in recent memory that requires you to think rather than just react. In following the topic, I have tied to compare and look for patterns in other areas of my life to help me understand these complex issues. Maintaining boundaries of the Federal government and the limitation of its powers does not really have a good analog though but I go with what I know best. What if healthcare were like enterprise software?
So one line of thinking may go like this. The idea of the individual mandate would be like requiring everyone to have virus scanning software. Imagine, if when you go to work your employer requires you to pay out of pocket for security software. If you don’t, then they buy it for you and deduct it from your paycheck. Why? Because you use their network (interstate commerce) and when your machine is sick it has a negative impact on everyone else. They might also be able to require to do more than just install it. They might further mandate a wide range of other practices on what is essentially your property. (the broccoli argument)
But wait a minute – why should I have to pay for it at all? Shouldn’t the company (government) pay for it. Well if you are using a company asset that they acquire, control and maintain then that is simple question. Of course they should but with the growing popularity of Bring Your Own Device maybe it isn’t so absurd. Sure you might never have an infected Android tablet but odds are EVENTUALLY you will and doesn’t the company have a right to protect everyone else from the costs that you will bring to the population.
What is missing completely from the healthcare picture is that software benefited from it’s greatest disruptor of the past decade – open source. The community contributing code for the betterment of all. There is no such thing as Open Source Healthcare though.
But could there be? Why does healthcare have to come from either the central government or an individual. Why can’t it come from the community?
Fifteen years ago virtually every CIO in America would argue open source software would never run in their business. Now 100% of them are wrong. Why can’t the government (the company) ultimately benefit by facilitating access to healthcare(software) that is provided essentially free (open source) from the provider for all but the most complex and essentially expensive problems?
There are a million reasons why not still there are are things to consider here. On the negative, software is a static product with essentially no manufacturing or distribution cost as opposed to being a dynamic process (diagnosis) with a complex, expensive and immensely lucrative supply chain. The capitalistic business model hardly disappears with OS. It is alive and well in the implementation services and support structure of open source companies.
For all the bravado around the “free” aspect of open source there is no one out there that gives the services away. For the healthcare analog this means that providers are still being paid. What is comparable is the concept of unrestricted access. Anyone can download it (access to knowledge) and decide on implementation without the vendor. This to me sounds like free choice of provider and the ability to direct funds at will for services. Who ultimately controls those funds? – the departments (states) , central IT (the Federal government) or the individual.
Today as the cloud provides choice for IT’s customers, the business is going elsewhere and IT budget’s shrink. I further wonder about corporate software mandates being charged back to departments because they benefit from enterprise services even if they don’t know it.
Software unlike healthcare lacks a key element in this debate. Constitutional guidance. The framework and theoretical rules of engagement between the three branches of government are well established. Software in the enterprise is only guided by capitalism and hopefully common sense.
Lastly healthcare and software do share a common danger. That decisions about access, choice and funding are far more often driven by political expedience and ego that the long term benefit to the people or even the organization at large. In that regard, I hope that the preservation of the company/country in the face of enormous cost and risk wins the day.