Tam Harbert

I wonder how much difference the new healthcare legislation is going to make in a system in which doctors are indifferent to costs and in fact often favor expensive and elaborate treatments over individualized patient care and common sense.

When I see a doctor, I pay attention to prices. My high-deductible insurance plan means I pay for the first $2,600 of my health costs every year. Often, the healthcare system doesn’t like it when I insist on knowing what things cost. This story is an extreme but telling example.

I went to a specialist for treatment of my herniated discs. The specialist was highly rated by a local magazine, so I expected top-notch care. What I found was a practice that seems designed to minimize contact with the patient while maximizing the amount of insurance money it can extract.

When I made the appointment and asked how much it would cost, the response was: “insurance will cover it.” When I explained that I would be paying for it and asked again for the cost, they claimed they couldn’t give me a price because it would be based on the doctor’s diagnosis after our consultation.

My first appointment was hardly a consultation. In fact, the doctor and his staff barely talked to me. I had been asked to fill out a 10-page questionnaire in preparation for our meeting. When I arrived, I reminded them of my concern over cost, and the receptionist assured me that I’d be presented with the price after the doctor had determined my treatment. I waited 45 minutes to see the doctor, who finally breezed in and spent all of 10 minutes with me. He then explained the procedure he recommended, and something about the way he said it made me think it was the exact same recommendation he would give to the 35 other patients he would see that day. Then he handed me a printout of the other things I should buy to treat the problem: a prescription pain patch, a back brace and a home transcutaneous electrical nerve stimulation (TENS) machine to relax back muscles and reduce pain. I wonder how much of a kickback he is getting from the manufacturers.

Again I asked what all this would cost. Again the standard response: “insurance will cover it.” He brushed me off when I tried to explain why that wasn’t an adequate answer.

No one ever gave me a list of the costs. I went ahead and had the procedure, because I was in pain and desperate (I later found out it cost more than $2,000), but didn’t follow the rest of his recommendations right away. I checked with my pharmacist and the pain patches cost $200. Each. When I went back for what turned out to be a five-minute followup, the nurse practitioner chided me for not following the doctor’s orders. And when I tried to explain to her my concern about cost? You guessed it: “insurance will cover it.” When it was clear I wasn’t buying, she yanked the info sheet on the TENS machine out of my hands and told me I could wait on that, but insisted I get the back brace. It came in the mail the other day. It looks expensive, but I won’t know how much it is costing me until the doctor bills my insurance company, and the insurance company in turn bills me.

My primary care doctor doesn’t even take insurance. I find that liberates both of us to cut through the insurance bullshit. He’s straightforward about costs. His rate is $90 per half hour. Period. He’s not trying to push more tests, procedures or pills on me. In fact, when I needed an MRI for my back, he gave me two different labs to call. He advised me to call both, explain that I was a “self pay,” and then dicker with them on the price. The first lab wouldn’t come down on the $1,100 sticker price. The second one dropped the price to $500.

Why is there such a lack of transparency, not to mention logic, in healthcare prices? Somebody in this system is making a lot of money from the fact that “insurance will cover it,” and those people have an obvious interest in obscuring costs. Until more patients have to pay more directly for their healthcare, which will in turn force all the players to be more accountable, I doubt that the system will change.

A story of mine in this week’s Electronic News reports on a trend that many in the U.S. high-tech industry find disturbing. The latest 10-year jobs forecast from the U.S. Bureau of Labor Statistics says that U.S. semiconductor manufacturing is going to lose 146,000 jobs, or more than 30 percent of its workforce, by 2018. That’s the second highest job loss of any industry, just behind retail department stores. It even beat out such passé industries as printing and newspaper publishing (projected to lose 95,000 and 81,000 jobs, respectively.)

The fact that manufacturing jobs are moving offshore is old news. On close examination, however, the BLS statistics indicate a flight of high-level jobs. Not only research and design engineering, but also top management functions, are leaving the country. In fact, in the management category of semiconductor and electronic component manufacturing, the BLS projects a 35-percent loss in the number of jobs. For chief executive officers in particular, the projection is 41 percent.

Some will quibble about how the BLS arrives at this forecast, but anecdotal information from a few executive recruiters backs up the trend. Tim O’Shea, group leader for the semiconductor industry practice at Heidrick & Struggles, has clients asking him to find executives willing to move offshore. “Management is being displaced,” agrees Al Delattre, global market managing director of technology at Korn/Ferry International.

The recruiters are alarmed about the trend. The semiconductor industry warns that the United States is losing its competitiveness. My livelihood is threatened. The industry that I’ve covered for 25 years might disappear from this country, taking with it a lot of the trade and technical publications that are my customers.

But if you take out the jingoism and think in terms of pure capitalism, it all makes perfect sense. Twenty years ago, manufacturing jobs moved to places where costs were lower and labor plentiful. Now, it looks like knowledge workers are going through the same transition. Anyone who’s read Thomas L. Friedman’s “The World is Flat” shouldn’t be surprised. The Internet and telecommunications technology make it possible to do many types of knowledge work from anywhere, so knowledge workers in low-cost areas are going to get a good portion of these jobs. Recognizing this, companies are starting to shift their knowledge workforce, not only by hiring offshore workers, but also by moving their current workers to low-cost regions. Last April, for example, I reported on IBM’s Project Match, whereby the company offered to hire laid-off North American workers for jobs in India and other low-cost countries.

The flight of U.S. executives will continue. After all, how many good reasons can you think of for keeping these executives in the United States? Most of the semiconductor industry’s customers are in Asia. Even if the CEO lives in the States, he spends most of his time traveling to visit customers, business partners and suppliers. Thanks to Wall Street’s meltdown, American finance is increasingly owned by foreigners. Plus, as semiconductor industry lobbyists love to point out, U.S. tax law and regulations make this country a less and less attractive place for business. In fact, one recruiter tells me that the executives of at least one chip company are thinking about moving its headquarters to Singapore because of the high costs of being a U.S.-based public corporation.

Maybe I should move, too. From a business point of view, there’s no reason to stay in this country. It’s not like I have to report to some green-eye-shaded editor wielding a pencil and shouting at the typesetter. I already work with all my clients via the phone, e-mail and Internet. Less and less of my work is actually printed on paper in a factory. It’s all online. U.S. newspapers and news agencies already outsource some of their journalism work to India. To remain competitive, I should move to a low-tax nation in a good climate with excellent Internet and telecommunications service.

The world is changing – quickly and dramatically. I don’t think there’s any stopping this. Businesses are recognizing this. Journalists, accountants and x-ray technicians are recognizing this. Government and industry leaders around the world would do well to recognize these forces and work with them, rather than raising fears and fomenting unrest about the offshoring of American jobs.

In late June, a U.S. District Court judge denied IBM’s attempt to bar one of its former executives from working at Dell Inc. (See Court Denies Preliminary Injunction Sought by IBM Because Former Employee Signed Non-Compete Agreement in Wrong Place.) Read the rest of this entry »