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.

A bunch of stuff has hit my desk recently. It all seems related somehow. See if you can find the thread that connects them:

While cleaning out old magazines I found the October issue of Darwin magazine, which published its “Fittest 50” list. Yup — there was Enron. Still, Darwin is a fine publication. Lots of others fell for Enron’s buzz, too.

Speaking of magazine articles, one in Twin Cities Business Monthly by Burt Cohen caught my eye. It wasn’t the first article I’ve seen excoriating the common business practice of placating Wall Street by focusing solely on this quarter’s results no matter how much you mortgage your future, but Cohen did say it well.

Which leads us back to Enron. How? Among the many guilty parties identified in the ongoing blamefest is Wall Street. Turns out that many of those analysts who insist on great this-quarter results looked at Enron in more friendly terms. Why? Their employers wanted Enron’s investment banking business, that’s why. With luck, Wall Street’s analysts will lose some of their clout and we can all stop being deliberately stupid just to please these geniuses.

USA Today printed something useful, too: A piece by Stephanie Armour about companies that refuse to lay off employees just to make the numbers. In it she cites a study by Watson Wyatt (www.watsonwyatt.com) showing, among other happy conclusions, that excellence in recruiting and retention results in increased shareholder value – nearly 8% more, in fact.

Back to Twin Cities Business Monthly, which profiled Joel and John Schwieters, who own eight local companies in the home construction industry. They frame and finish houses twice as fast as most construction companies; their projects lack the debris that usually litters construction sites, they’re known for exceptional quality, and they’re growing by more than 20% per year.

How do they achieve these results? Unlike nearly every other construction company, they don’t subcontract their workforce — they employ their builders, paying them a regular salary, excellent benefits, and a shared bonus pool. Even more interesting is that they’re expanding into their supply chain. Where the popular core/context theory applauds companies that prefer outsourcing any activity that’s “non-core,” (that is, not a marketplace differentiator) the Schwieters understand that controlling the supply and delivery of doors, trim, pre-built staircases and such will improve their margins.

I suppose I should mention — they’re innovative in their use of information technology, too.