'I wish none of this had happened'

As I was lying on the couch one day last month, feeling very sick and doped up on azithromycin, Tylenol, Sudafed and Robitussin, I came across an article by Robert J. Samuelson, Newsweek's resident economic curmudgeon. It doesn't matter what is going on in the world (a bull market, low interest rates, growing exports, etc.), Samuelson always manages to see the glass as half empty. And when the news is bad, look out. That's when he is at his best, sowing seeds of gloom and doom that make you want to hide under the covers.

He can be a bummer, but he's usually right.

In this particular article, Samuelson extrapolated Greece's precarious financial condition to the rest of Europe and to the United States. Greece has piled up mountains of debt, mostly by over-committing to social programs, and could very well default on its debt payments. Every advanced society, Samuelson writes, faces a similar problem: "burgeoning costs as populations age, an over reliance on debt financing and pressures to reduce borrowing that create parallel pressures to cut welfare spending. High debt and the welfare state are at odds."

As I read Samuelson's Greek Tragedy, I thought about the HME industry--really, all healthcare providers. Everyone has been lobbying and working like crazy to minimize the impact of healthcare reform. But in the long run, this work will only buy providers time--time to change their business models to accommodate a new era of austerity. In some cases, lobbying may preserve the status quo a bit longer, but if you accept what Samuelson is saying, deep cuts to Medicare, Medicaid and Social Security are inevitable.

All this reminded me of a line from "Lord of the Rings." In a perilous moment, when all looks lost, the good wizard Gandalf and the hobbit Frodo Baggins, have this short exchange:

Frodo: "I wish none of this had happened."

Gandalf: "So do all who live to see such times, but that is not for them to decide. All we have to decide is what to do with the time that is given us."

Fast forward from Middle Earth to 2010. At an industry event last fall, I talked to a provider who about four years ago invested heavily in non-delivery oxygen technology. Since then, he's reduced his delivery costs 62%. He also recently opened a new location. Given the challenges the industry has faced recently, he seemed a little sheepish about his success. "I would not say this out loud," he said, "but business is great."

I'd say this guy made good use of the time given him.

The moral of this story is, I think, that the changing healthcare market does not have to signal the end of your world--just the end of the world as you know it.