Sunday and Monday I went to Houston, Texas, for a couple of very important meetings.

It all went really well. It was one of those trips where there’s very little to comment about the trip, but a lot about what I learned.

Perhaps, what surprised me the most was to find out that the largest McDonald’s in Texas is inside a hospital. Sadly, this is not unique to Texas. The reason is, as it is sadly so often the case with US Healthcare: money. The hospital leases the restaurant space, and whomever pays the highest price, sets up the restaurant they want. So much for hospitals being places where patients get their healthcare taken care of! This, of course, has led to protests, but unfortunately we know that many “individuals”, no matter how ‘many’ those “many” are, protesting against the economic interest of a few, doesn’t usually work. Even if they are physicians speaking about their area of expertise.

Another case of money corrupting healthcare in a way that’s ingrained in the system (one of my customers calls it ‘misaligned incentives’): some insurance companies only pay for procedures related to the reason why the patient was admitted. So if they find anything else, even if it may save the patient’s life, or if it means big savings down the road thanks to prevention or early detection, the insurer will not pay for it. So, what do doctors and hospitals do to “help” the patient? Diagnose and treat the first cause of concern, discharge the patient, and re-admit it with a “new” cause of concern. Crazy duplication that drives up cost, but it’s the only way out of a ridiculous ‘catch-22’. And the worse part is that there are hundreds of examples like that one!

Finally, something that I guess is true in most (if not all) industries: the level of endogamy and revolving doors, leading to the ‘good ol’boys club syndrome’. Example: We’re talking with the top executive at a large hospital group, and we mention a University. He says “my wife is the dean of that university”. Then we mention another company, and he says “the CMO of that company was a resident with me”. Then we mention another company, and of course he’s also member of the board at that company… See what I mean? Capitalism, by definition, leads to concentration, which leads to oligopoly, which ends up in monopoly. And we all know how Monopoly ends up.