Ever wonder why the healthcare industry is such a mess?

Here’s one reason — the customer, consumer and wallet have no interests in common.

Customers, you’ll recall, make buying decisions. So who makes the buying decision in a typical healthcare transaction?

It’s like this: The germ made you ill — which pretty much decided that you needed to see your doctor — and your physician decided on your treatment. Think you’re sick? In the healthcare industry, its vendors and germs that are the customers.

Mass media is almost as weird. When you watch network television or read the newspaper, you are neither customer nor consumer. Advertisers are the ones making buying decisions, because it’s advertising that pays the bills. When you “buy” a newspaper, at most you’re paying for the raw materials.

Which also means the newspaper or television show isn’t the product, since a product is something you sell to make a profit. In mass media, the entertainment or information isn’t product — it’s bait. The audience is the product, of which advertisers are both customer and consumer.

Which brings us to Microsoft’s Passport service, Sun’s Liberty Alliance, and the whole idea of micropayment services. Micropayment services — which allow companies to profitably charge for low-value transactions — are supposed to transform marketplaces such as mass media by turning audiences into customers. The social consequences are highly desirable: Customers have far more impact on product quality than product has on bait, which is why we expect HBO to be superior to CBS.

Here’s the problem: The only economic beneficiaries are sellers. If we become the customers, the current customers — advertisers — lose an important way to buy access to us. Media consumers — that’s us, the product — not only have to pay for content we used to get for free, but as Clay Shirky pointed out a couple of years ago in his well-reasoned article “The Case Against Micropayments,” we now have to make lots of buying decisions instead of just the one we make when we buy a subscription, or the zero we make for sponsored content.

If you’re CTO, or otherwise involved in evaluating which business model will work for your company, you might be considering a micropayment-based strategy. Before you do, consider that consumers would rather get a sponsored newspaper than pay a nickel for each article.

Although I’m sure you’d be more than willing to pay much more than that to receive this column each week.

Bad news for BIG/GAS.

BIG/GAS (Business Is Great/Government and Academics are Stupid) is a ridiculous but popular theory of How Things Work. The bad news: According to the University of Michigan’s American Customer Satisfaction Index (ACSI), not only are consumers just as satisfied with the federal government as they are with the private sector, but the federal government is improving, while private sector scores are in decline.

Your response to my recent column describing my broadband ISP’s approach to Customer Elimination Management (CEM) — customer relationship management’s evil twin — bears out this wretched state of affairs. In fact, readers accused every broadband ISP in America of the same behavior. You have to wonder if these guys all went to the same customer disservice school.

The ACSI shows a clear positive correlation between customer satisfaction and business results. Sure, correlation doesn’t prove causality, but business decisions are driven by best available evidence, not rigorous proof. They have to be, because rigorous proof always arrives after opportunity has passed.

Which is what makes this sorry situation bizarre: Business, which is supposed to care about profits, return on investment and shareholder value, is shrewdly marching in exactly the wrong direction. How can that be?

We all know the answer. A colossal accumulation of evidence shows that trying to please Wall Street analysts gains a few years of improved stock prices, after which the company crashes and burns. Many business leaders don’t care about the crashing and burning. They focus on this year’s bonus, which is pegged to stock performance, so they naturally consider Wall Street analysts to be more important than the customers who buy their company’s products and services.

Not too many years ago, readers of this column would have had this reaction: “Gee, what a shame!” Now, CIOs and CTOs actively participate in strategic planning. You help shape the dialog. To the extent you do, suggest this highly innovative, post-new-economy strategy: Increase profits by retaining customers, which you can do by treating customers like they’re important to you while offering them excellent products at competitive prices’.

The evidence favors this approach. It also suggests your competitors aren’t using it, giving you an advantage.

Follow the federal government’s lead. While we’re told it’s run by faceless bureaucrats who know nothing about what we citizens need, it’s acting like it really is of the people, by the people, and for the people.

Imagine that.