The Trump administration stated agenda is antithetical to the precepts of the World Economic Forum, which is committed to the expansion of free trade, more open borders, more international cooperation and action on climate change. Still, there were many attendees who are looking forward to the potential impact of Trump's promises on their businesses:
- Many businesses, especially agriculture, petrochemical, and developers, hate government regulation - and they are counting the regulations they want to see gutted
- The pharmaceutical industry is hopeful that rhetoric about controlling costs will give way to enthusiasm about decreasing barriers to new (and likely expensive) drugs. From a value perspective many new drugs are of marginal incremental value, so this bodes ill for controlling health care costs. (Here's one press account)
- I listened to some financial service industry folks decry Dodd Frank- and look forward to a lighter regulatory hand of government.
I learned a lot this week about "The Future of Work." My Willis Towers Watson colleague, Ravin Jesuthasan, has written booksand articleson this topic. The general idea is that artificial intelligence (AI) and automation are likely to make many current white collar jobs obsolete - and this will cause the same kind of social disruption that the loss of manufacturing jobs has caused in the US. This won't just affect lawyers and accountants - even software coding is better done by machines (they are fast and make no mistakes once the humans have established the underlying goals and rules). We know that some of the work that physicians do can be made easier with AI - so this could even come to medicine.
This isn't the terrible dystopian outcome that "robots are taking over the world." This move toward more automation should lead to a dramatic increase in productivity, and should free humans to be more creative. But how will we distribute this productivity? If all of this goes to shareholders, inequality will get worse, and the angry populist wave that is spreading across the globe could get far worse.
Many predict that workers will move from having jobs to having "gigs." This will allow people to have more of a diverse portfolio of work -- but the current social safety net and the way we provide benefits and retirement to US residents doesn't support this very well at all.
There is a lot of talk at Davos about Basic Income - which would provide a certain amount of noncontingent income for all- with no strings attached. Many studies show that the poor will use this money reasonably wisely, and this should not diminish entrepreneurship since there is no penalty to making more money. Even Paul Ryan has suggested he could support basic income. Here's a good read on the topic from Vox, Of course many want to add more requirements to programs for the poor.
Some interesting sessions I attended:
- An AARP- Foreign Policy Journal session on keeping people in the productive workforce as they age. Michael Rothkopf,editor-in-chief of Foreign Policy, introduced the concept of "Gross Knowledge Product," and Jo Ann Jenkins, the CEO of AARP, noted that 50% of babies born this year will live to 104. Employers in the US should economically be even more avid for earlier retirements given that their self-insurance plans pay
- Communicating on health with the underserved -- I was surprised that social media ranked lower in impact than health plan web sites - and I'm a bit dubious. In any event, there's no question that we need better ways to communicate health care with everyone. I'm most encouraged by research on community health workers - they have been key to acceptance of HIV testing and treatment in South Africa, and hiring community health workers is a "two-fer" in that it gives members of the local disadvantaged communities good jobs while making communication more culturally relevant.
- Putting individual health data in an electronic lockbox so that only those patients can give anyone permission to access that for research purposes. The data from claims and electronic medical records could be married with data from mobile phones, which will make it more valuable than having large de-identified databases . The deidentified data can never be merged with other data sources because of the deidentification. I'm skeptical. I think there will be huge selection issues regarding who will give permission to use their data, and the friction of requiring this step will substantially delay research. It's certainly interesting technology though. (midata.coop)
- A NY Times reporter wrote about attending as a spouse with his wife who is (literally) a clown in Lebanon who does humanitarian work in refugee camps. She talked briefly at one of the sessions I attended, and told a moving story of time passing and growing hopelessness in those refugee camps.
- Gender discrimination: The Female Quotient offered a series of seminars - eBay has achieved 100% gender pay equity - but it is an outlier. Women continue to be underrepresented among engineers. Although some predict more future success with the "female way" of having more empathy and treating all with more respect (unlike classic male hierarchy), all the speakers recounted being advised not to "treat the admins with such respect' and to avoid showing emotions at work.
The confluence of people from many walks of life at Davos also means I got to talk to participants about many subjects outside of health care, with potential implications in health care.
- The future of construction - Apparently China assembled a 57 story earthquake resistant skyscraper with almost entirely prefabricated elements last year. 3D printing in construction is finding its way as well; a pedestrian bridge in Amsterdam is using the technology now. Some medical device solutions are the equivalent of prefabrication- and hopefully we'll be printing organs some day.
- I talked to the CEO of a foundation seeking to accredit orphanages, which currently house over 8 million kids. The best answer is always for kids not to be put in orphanages, but there are good evidence-based approaches that lead to far less emotional damage. This foundation raises money to help fund the transition to a more home-like environment.
- I talked to a Swiss entrepreneur who develops agricultural chemicals and does all the efficacy and safety testing before selling or licensing these to the agro-chemical companies. He describes the importance of "derisking;" established companies are looking to purchase "sure things." Much like the Pharma industry.
- There was a lot of talk in Davos about the Indian government's recent ban on all large currency bills - which should dramatically decrease economic friction (AND bribery and tax evasion). I heard amazing stories of those with black market money hurriedly converting this to goods (sometimes with plans to return those goods for digital currency). Toll booths also were apparently stripped of their small bills, too. Because many Indian industries were largely in the 'informal' market and the pure cash economy , though, this move has meant that many businesses found themselves unable to sell goods for a number of months. This will likely lead to a decrease in GDP in India this year. The lesson to medicine- think carefully about implications of major system changes!
Back to the usual "managing health care costs" topics over the next few days!
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