Over at the Kauffman Foundation’s entrepreneurship blog, Jonathan
Ortmans has
a post about “unlocking entrepreneurship through health care reform”
wherein he writes about how the employer-provided healthcare system constrains
entrepreneurialism, as it’s too expensive to provide for employees and
generally too expensive for employees of small firms to buy on their own with
after-tax earnings. Ortmans rightly talks about decoupling health insurance
from employment, a suggestion made by many groups that support small
business-friendly policies. I agree.

But I misread the title of his post at first and expected it
to be about something else, namely how innovative entrepreneurs will be the
ones who truly transform health care. Ortmans wrote about how we shouldn’t
discourage entrepreneurship through
health care reform—I think we should also be talking about not discouraging
entrepreneurship in health care reform. Since he didn’t go there, I will.

Unlike the attempt that was made in 1994, something will be
happening with health care this time around. What exactly that “something” will
be is still to be determined, but there are billions and billions of dollars
from the American Recovery and
Reinvestment Act committed to various health care and health IT (HIT)
projects, including a national healthcare IT infrastructure.  As these things are developed, though, we
need to repeat important messages: Small firms are some of the most innovative
in the country, create the most jobs, and the public overwhelmingly supports
giving entrepreneurs incentives to innovate as opposed to allowing the
government to create new jobs (directly or through large companies).

And because small firms are so essential to economic recovery
and growth, let’s pledge to do a couple of simple things to keep the playing
field level when it comes to HIT solutions. First, the government should remain
technology- and business model-neutral. That means that the government should
compile a list of goals and allow everybody—big and small and in-between, all
varieties of intellectual property rights holders, well-known companies and new
innovators—to offer solutions.  And while
cost is obviously an issue (though it barely seems that way when we’re talking
about 30 billion bucks), decision-makers should account for solutions’ total
cost of ownership. Basically, the government should not pick market winners and
losers by narrowly defining the specs, or outright creating preferences, for
HIT solutions–the fundamental principles of promoting economic growth and
healthy competition should apply to this process.

As Ortmans alludes in his article, there isn’t a
one-size-fits-all solution for this (or any) problem.   We should keep in mind that HIT goals,
including interoperability, can be achieved in many ways and don’t just
magically happen on their own. It takes smart people creating innovative
answers to problems to build sound solutions that will flourish throughout the
healthcare industry. And since almost 80% of people don’t think that the
stimulus package supports entrepreneurial activity (with
33% believing that it outright inhibits entrepreneurialism), this would be
a nice way for the government to show its support for the innovators who are so
crucial to economic growth.