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As a business owner, you know what it’s like to lie awake at 2 a.m. Maybe it has happened when you are excited and full of new ideas for your business. More often, it’s because you are worried about issues you will face the next day. Sometimes, it’s because you just woke up with the solution to a problem. I’ve experienced all those emotions about my businesses over the years. Awake at 2 o’clock? is where I share them with you, and hopefully help with answers that will let you sleep.
John F. Dini, CExP, CEPA
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Small business owners are the Hunters of the 21st century. We are 3% of the US population, and yet we create over half of all American jobs. As Hunters, we may not be inclined to manage by the numbers or stick to systems. Are you a Hunter or a Farmer?
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How prepared are you to exit your company?
The Assessment breaks down the four major categories of exit readiness; Finance, Planning, Operations and Revenue/Profit.
Tag Archives: economy
Atlas Shrugged and the Imperial Presidency
“Atlas Shrugged – Part II” was released on Friday. Those of you who read this column regularly know that I’m a fan of Ayn Rand, although I place myself far short of devout Objectivism. I’ve sported “Who is John Galt?” license plate … Continue reading
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Health Care Costs: Is Medicine a Market?
There is an excellent article in The New Yorker comparing the production and quality control methods of the Cheesecake Factory to certain advances in “Big Medicine.” It focuses on the savings available from large health systems through standardization and quantity purchasing. In reality, … Continue reading
One Response to Health Care Costs: Is Medicine a Market?
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John, loved your post. Here are a few more issues to factor in: most “customers” (folks who actually pay the bill) don’t see the doctor. Why? Because these customers are typically the employers and governments that are paying the insurance premiums. Only those few truly paying “cash” for services, or those in the “individual market,” where they’re paying their own premiums, are the true customers who have a better idea of the actual cost of healthcare.
Of course, the government, through the Affordable Care Act, is trying to give more individuals “greater access” to care. This in turn has accelerated another phenomenom: consolidation. As hospitals hire physicians directly, where they can, or indirectly through Foundations, in the states where they can’t, prices are going up – simply because hospital-based services receive a higher reimbursement.
The other trend we’re seeing is the increase in “direct pay/concierge” physicians. With rates typically starting at $2000/year and going up from there, these doctors “limit their panel” of patients they see, a win-win for the doctor (smaller patient panel for the same or more money) and the patients who can afford this perk (easier access). The only problem is – now that the doctor’s panel has decreased, let’s say, from 3000 to 600 patients – the 2400 Former Patients need to find a new doctor. Play this out, as we hear is happening in Massachusetts, and the unattended consequence of providing for greater access, is greater expense and/or longer waits to see your same (or a new) doctor.
Clearly we need to “bend the cost trend” to bring down the unsustainably growing high cost of healthcare. But who among the 18% making their living from this 18% of the GDP spent in healthcare (the ultimate “service” business), is going to “volunteer” to cut their compensation? After all, when you have burgeoning demand from the Medicare population (and the 10,000 Boomers a day joining it), and a society – starting with our children – increasingly prone to obesity and all its attendant ills, due to their eating/lack of exercise choices, what “magic bullet” is going to bend this trend?
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Employee Motivation: The Effect of the Economy
In 1979, President Jimmy Carter delivered his “Crisis of Confidence” speech, commonly referred to as his “Malaise Speech” although he never actually used that word. To a country reeling from stagflation and an oil crisis, it was an additional blow to … Continue reading
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Politically Speaking: Do Small Business Owners Have a Voice?
The political parties have completed their prime-time convention pageantry, and are buckling down for the 60 day dash to the election. Both profess to be focused on the”little guy,” the middle class backbone of America. One party says that you … Continue reading
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When Independence isn’t Freedom
I owe the idea for this column to my friend Tom Morton, whose Harrowgate blog lends a considerable dose of dry Brit humor and keen business perspective to the issues of small business ownership. Give him a read. Sometimes the … Continue reading
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Great job of weaving together some of the most important and interesting facts regarding the birth of the United States of America. Commentaries like this are what make each 4th of July particularly meaningful for me. Also a reminder that no great undertaking begins perfectly, that virtually every success requires a little luck, and that any institution or process can stray from orignial intent if not closely monitored and reviewed over time.
Government is a business, albeit a monopoly on certain items like defense but it too has all the charateristics of an operating business. No surprise if it should also devour competition to be the sole provider.