4 thoughts on the hospital, health system, political and economic world + good vs. bad lawyers — a core distinction

This article discusses two different subjects. First, the healthcare, economic and political outlook. Second, a core distinction between good and bad lawyering.

4 Thoughts on the Hospital, Health System, Political and Economic World

1. In the hospital world, things seem to be strangely stabilizing. Merger and acquisition activity is somewhat down and systems mainly seem to be trying to figure out a “stay the course” strategy without huge transformational changes. Healthcare reform talks ebb and flow. Layoffs seem to be at a normal course as opposed to a higher or lower rate than usual. Hospital closures seem to be on the same track as usual.

Healthcare reform seems to be momentarily on pause. It becomes more an issue of healthcare reform implementation occurring in fits and starts given the lack of support from the administration for the Affordable Care Act than actual healthcare reform.

2. The economy and the stock market. The economy, while debt-fueled, still seems to be going okay overall. Unemployment is relatively low, wages seem to be rising a little bit, and things generally seem a little bit more stable. It does not seem that the federal, state or local governments are in much of a mood for “deleveraging,” which would have a serious ripple effect on the economy. At the state, city and county level, the pension deficits and potential long-term problems continue to grow significantly.

As to the stock market, one of the fascinating things I read over the last several months is the reduction in the total number of publicly traded companies. Thus, in some ways, the combination of low interest rates on bonds and other types of savings instruments coupled with the lack of supply of publicly traded companies results in a limited number of investment options for what are huge pools of money in all kinds of pension funds, mutual funds and so forth. Thus, the high valuations may be in part a matter of supply and demand versus any other issue, as well as the lack of alternative high yielding or safe investments that are available. In any rate, I think it is a fascinating subject and, in the long run, can be devastating for the country if in fact there are not enough publicly traded vehicles for people to invest in through mutual funds, pension funds and so forth.

3. Health IT spending growth — it’s not just the EHR. There seems to be again a tremendous pickup in healthcare information technology spending efforts. It is less the total EHR, and far more at another level around cloud, cybersecurity, applications, telehealth, analytics, artificial intelligence and more. There seems to be a new effort to develop and utilize things that can help in operations versus the whole-scale EHR effort. It also seems more and more that there is a growing perception that Epic and Cerner are not the be all and end all to everything.

4. Scaramucci, Priebus, Spicer, Bannon and more; The next elections; Etc. It was kind of the year of Anthony Scaramucci, Sean Spicer, Reince Priebus, Steve Bannon and countless others. The strategic or lead spot at the White House, whether in communications or as chief of staff, seems like a relatively dangerous place to be positioned.

As to upcoming elections, whether next term’s house or senate races or the 2020 presidential election, it is anyone’s guess. Fascinating enough, the more turmoil there is, the less clarity there is about election prospects for almost anybody. We will host speakers at meetings over the next year including Howard Dean and Rudy Giuliani this fall to debate healthcare and politics, as well as Presidents George W. Bush and Bill Clinton in April. We are also trying to get President Barack Obama for 2018. Finally, Tucker Carlson is speaking both this November and next June. There will be no shortage of political commentary.

Good vs. Bad Lawyers — A Core Distinction

I've come to the following conclusion regarding good and bad lawyers.

A bad lawyer often tells you what you want to hear. This happens regardless of whether the issue involves prospects in litigation, attacking the other side, deciding whether a deal is worth pursuing or determining whether or not your position on an issue is rational. Whatever the issue, he or she is happy to appease the client and just keep the process going. He or she is not driven by client results. This lawyer can always chalk his efforts up to lawyering fully for a client.

A good lawyer is willing to tell you what you don't want to hear, even if it means settling the dispute, and doesn't please you emotionally. He or she is willing to tell you, "This is good enough." They will assess whether a point isn't worth a death fight and whether an approach carries too much regulatory risk. They are willing to tell clients, "Don't throw good money after bad."

Good lawyers are high on common practical sense and not just fighting or negotiating to the nth degree. Good lawyers constantly find ways to cut to the chase and provide the information you need to make sound decisions as a client. They try and fight, but also try and solve problems. Often, they do both on parallel paths.

People often don't love their great lawyers and instead applaud their bad lawyers, who cater to client machoism.

It is a fascinating subject to watch play out.

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