It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way – in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only. 

Tale of Two Cities – Charles Dickens


As a general rule, I avoid discussing political issues in this space.  I am interested in political ideas and their authors, but unfortunately, we have entered an era where the political discourse is filled with noisy talking (read: shouting) points, some accurate, many not.  The noise is frustrating to me because it rarely involves substantive conversation.  For the vast majority of people who are paying attention to the campaign now, accuracy and truth regarding a candidate’s ideas, or critiques of their opponents, do not seem to be that important.  Hell hath no fury if those ardent activists read something they disagree with.

fearThose voters who are fueling the current political discourse apparently are angry about unsettling changes in the nation’s security, its strategic and economic course as well as the shifting demographic profile that they seem to have no power to control.  Some conservative pundits, trying to put a better spin on this phenomenon, explain that the voters are anxious, not angry, and that this anxiety is growing.

I am neither pundit nor political advocate and I am certainly not a savvy political operative with super intuitive skills to predict the outcome of this primary election cycle, but I would be willing to bet that the underlying issue that is driving this anxiety or anger — you choose — is fear/anxiousness of the unknown.  That is a universal truth I believe that affects corporate leaders as well.

In terms of politics I am, for the time being, in the tune out mode, but to be honest Charles Dickens’ amazing first paragraph of the Tale of Two Cities does resonate, not only about this primary campaign cycle, but the state of the healthcare industry.

Healthcare leaders, if they are really honest (and most are), will tell you that they, too, are anxious and that their anxiety is driven by the same thing — the unknown.

Most health systems, hospitals, and other providers are currently holding their own, some are even doing very well, but the political and economic climate concerning healthcare costs and healthcare reform that are driving tectonic shifts in our reliable and inefficient old business model, is creating enormous uncertainty about the future.

When we have these periods of uncertainty and the attendant anxiety, executives, regardless of the industry, can convince themselves of the viability of all manner of survival strategies, some good, many self-limiting.  The most popular in healthcare today is to merge, to find a strategic partner that will ensure an organization’s survival, to provide capital for expansion, to share the risk of population health management pools, etc.

What amazes me, as was the case with one recent mega merger, is the emphasis that was placed on access to capital for future expansion.  If there was any focus in that particular merger discussion regarding the new Holy Grail of healthcare —  goals to lower costs, improve quality of care, enhance patient safety or improve customer satisfaction, there was no mention in the press reports.

If history is any judge, merger announcements that include statements about lowering costs and improving quality and patient access were more about icing on the cake than a substantive reason for the deal.  Typically, healthcare costs increased and quality of care and patient safety — and shocking numbers of preventable patient deaths — remained the same.

As healthcare reform evolves, some of the new, well intentioned mergers, like many in the 1990s, will turn out to be either marginally beneficial or will be problematic.  For consultants who specialize in turnarounds, workouts or “refocusing on core business lines” these mergers will probably become another full employment act.

But for now, while history tends to be an accurate predictor, we are left to read Mr. Dickens and wonder what the ultimate benefit, or damage, will be.