We Americans have been quite smug about our health care, and for a long time with good reason. Everyone in the world comes here when they really need the best care and can afford it. There has even been significant movement by several American health care companies to develop international markets. Well, according to this story from CBS News (via Ben Cunningham) global competition is here in health care.
“A growing number of tourists are…combining holidays with health care. And that’s because a growing number of countries are offering first-rate medical care at third-world prices.
“Many of these medical tourists can’t afford health care at home; the 40 million uninsured Americans, for example. Others are going for procedures not covered by their insurance: cosmetic surgery, infertility treatment.”
Countries such as India and Thailand are leading the way. For example, in these countries heart by-pass surgery costs $12,000 rather than the $100,000 one would pay in the US. These procedures are being done in foreign hospitals that often rate as high as most US facilities. Even with airfare and hotels it can be a huge savings.
Such alternatives may add an interesting twist to the growing trend toward consumer driven health care plans among US small businesses. Watch for active marketing of health care tourism as these plans sweep the nation.

Entrepreneurs ride the waves of change. Over the past 100 years we have seen transportation (automobile, trains and planes) and information (hardware and software) support the economic expansion in America.
What will be the next major wave? That is the sixty four trillion dollar question.
There are some signs that transportation may again shape our economic future. That may sound a bit crazy given that we are now paying $2 – $3 a gallon for gas and the airlines and railroad industries are in disarray. But, we have come to rely both culturally and socially on physical connectedness in this increasing global economy. There in lies the source for possible opportunities. It may be time for transportation to go through another technological revolution that could support the world economy for decades to come.
What shape it may take is not clear. It never really is clear anytime we are in a time of revolutionary change. In the beginning of the information age we had no idea which companies or even which technologies would prevail in the market. Who would have guessed twenty years ago that I would be sitting today on my back porch buy topiramate 100 mg typing into a machine on my lap that through a wireless connection can broadcast my words all over the globe?
The information age is still an exciting part of our world and will be for some time to come. But, it is inevitable that the breakthroughs will begin to slow down enough so that this segment of the economy will no longer be the main engine of growth.
So where might a new transportation age take us? Could it be some variation of the hydrogen cars now being developed by General Motors? Could is be travel in the sky as envisioned by NASA’s Small Aircraft Transportation System (SATS)? Could it come out of the work of Burt Rutan and his group? Or could it be some breakthrough that an unknown group in North Dakota is working on in a garage in Fargo?
I am not sure what the next transportation age will look like, but I am beginning to feel more and more strongly that it will come. Change and chaos creates entrepreneurial opportunity. The potential crisis of supply of fossil fuels and the complete inefficiency of our current transportation systems just oozes opportunity.

Could music row be moving out of the 1950s and into the digital age? Music Row (the heart of the music industry here in Nashville) congregated here at Belmont University yesterday to here about the this month’s version of the future of the music industry. There are some facinating developments in the wings, such as rent-a-tune subscription services. But, change in the entertainment industry is a likely to increase and some of the incremental adaptations tried so far just don’t seem to be making it witht customers. Most of the giants in the industry are looking for a static, one-time fix to make all of the change go away. These are fast times in music, best suited for entrepreneurial thinking and action.
This article from today’s Tennessean has a detailed overview of what Music Row executives heard. Are they listening?

My years in the health care industry taught me many lessons. One that I often stress to new entrepreneurs is to remember that the same changes in the market that give you an opportunity can just as quickly take it away.
Our early growth in the mental health market came from the emergence of managed care in the 1980s. We offered a much lower cost and more effective outcomes than the traditional treatment that involved long-term hospitalization. But the same HMOs that once loved us, had to keep delivering lower health care costs to employers. Eventually, they were able to find cheaper, but this time less effective, alternatives.
Fortunately, we saw this trend coming and had already begun to shift our business away from private managed care companies to working with state and county agencies eager to privatize mental health treatment. While this was a fundamental change in our business model, it was necessary for us to survive.
BizJournals.com offers another entrepreneur’s story of having to make a drastic shift in target markets. Veicon, Inc. had provided Internet access to hotel guests until 9/11 all but ended that market. So they quickly shifted to public access terminals in libraries and hospitals.
Entrepreneurs, by definition, operate in what my former colleague Peter Vaill calls permanent white water. That often requires quick and decisive changes in direction to avoid complete disaster. Someone once told me these words of wisdom; “Never get ‘married’ to your customers.”

eBay has thrown a speed bump on the road to riches that many entrepreneurs are trying to navigate according to StartupJournal.
“Entrepreneurs on auction giant eBay are still struggling to deal with their latest loop on the business rollercoaster after the Web site increased fees Feb. 18. An estimated 430,000 Americans make a full- or part-time living from running a business on eBay.
“‘I’m going to pull everything,’ says TJ Wilson, of Ketchikan, Alaska, who sold Celtic and Gothic jewelry at her eBay store. She closed her store, Reef Media, Feb. 18. ‘One item I listed last week at 60 cents (in fees) will now cost me a buck and a half — and I had dropped the price of the item!'”
Over reliance on a single customer, a single supplier, or in this case a single source of distribution puts any small business at risk.

Convergence in the technology world seems to be continuing to gain steam, and that means new opportunity for entrepreneurs who can take advantage of the changes that convergence creates.
That latest example is reported today at Red Herring.
“Handset makers at this week’s annual 3GSM mobile industry gathering are emphasizing strategies to turn mobile phones into digital music players, technology one analyst predicts could be an ‘iPod killer.’
“On Monday, Nokia took the industry by surprise when it announced that it had inked a deal to use longtime rival Microsoft’s music formats in its handsets, with the aim of allowing cell phone users to easily transfer music from personal computers equipped with Windows XP software. The Finnish handset giant said it would release a music-centric cell phone using an open mobile music platform from Loudeye, which will let users browse, download, and listen to songs, with charges appearing on their monthly bill. Users would also be able to transfer songs between their cell phones, digital music players, and computers.”
Such times are not for the faint of heart. While opportunities abound, today’s star can become a dog in a few short months.

It is getting really competitive and really active in the industry that serves bloggers, and it appears that the blogging phenomenon is seen as having legs. Blogs have moved out from the fringes of news reporting into special interest blogs like this one. And while some aspects of blogging may be seen by some as a fad, corporations are now experimenting with how to use blogging effectively for internal and external communications. Blogging as soft marketing is now well entrenched.
Blogging software was front and center at the DEMO@15 conference. Red Herring, Yahoo Financial News, and the New Mexican all offer good overviews of this conference and the prominence of blogging products at this year’s techie conference.
But as venture capital money and entrepreneurs flow into what was a cottage industry, what will follow?
I tend to agree with David Geller, an Internet company executive, who sees convergence between blogs and web sites in an interview published this morning at seattlepi.com. “Blogging is nothing but really easy-to-use Web publishing.”
Creative minds and lots of money will lead to an explosion of ideas and innovations, and many of them will be looking for ways to bring together web pages, blogs, search engines, e-mail, and who knows what else. We will also see more video and audio being integrated into the mix as the entertainment industry goes kicking and screaming into this brave new world.
For example, imagine the convergence of radio, the Internet and blogging into a new generation of opinion sharing technology that brings talk radio into the new century. Bring this together with the amazing breakthroughs happening in devices that can serve these new markets and who knows what we will happen in the next few years…

This weekend the conference called DEMO@15, which has become the launching pad for many a successful technology gadget, will be held in Scottsdale, AZ. Most of the new technologies are kept top secret leading up to this event, but Red Herring gives a sneak preview.
“Menlo Park, California-based Xfire is working with the next generation of networked multiplayer online games. British company Sonaptic creates 3D surround-sound audio for cell phones, and Palo Alto, California, company Avvenu has a service that enables users to access home-based media content, like music, photos, and video, from a mobile….If you thought liquid crystal displays (LCDs) and plasma display panels (PDPs) were the upcoming display technology, Irish company Ntera makes nanochromatic displays (NCDs), which are low power and flexible. Israeli company VKB makes an optical-based virtual keyboard….Australian company Digital Monkey has a software system, ‘In the Chair,’ which enables a musician to immerse in an audio orchestra setting.”
It all makes a Luddite like me want to curl up in a corner….but, progress marches on. After all, I don’t write this blog with a typewriter.

Fortune Small Business reports how an entrepreneur named Howard Berke and his company Konarka is using nanotechnology to potentially revolutionize solar power.
“Berke’s vision is to use nanotechnology to make photovoltaics—the process of turning sunlight directly into electricity-cheap, lightweight, and widely available. Imagine molecules embedded on material as thin and flexible as plastic wrap, converting indoor and outdoor light into power-and doing it all without noise, moving parts, fuel, or pollution.”
Berke is breaking away from traditional silicon technology and using organic chemicals placed onto a thin film. His approach is already finding application in the market.
“Konarka recently landed multimillion-dollar contracts with the Pentagon to deliver, among other things, a tent made of material that generates electricity from the sun, and a thin piece of film that soldiers can carry on the field to recharge the batteries in their cellphones, night scopes, and GPS systems.”
This venture could be a breakthrough for both nanotechnology and energy production.

I have known a couple of folks who started businesses offering their services as professional organizers. This article at StartupJournal shows how much financial opportunity and satisfaction that there may be for this type of business.
“‘I keep doing it because I love it; it’s instant gratification,’ says Sally Allen, owner of A Place For Everything LLC in Golden, Colo. Maria Gracia, founder of Get Organized Now! in Watertown, Wis., says, ‘It’s a very rewarding field emotionally, and it can also be financially rewarding.’ And Barry Izsak, president of Arranging It All in Austin, Texas, concludes, ‘My life is so good. I never dreamed I’d be doing something that is so easy for me, and making so much money.'”
For many of these organizers, their businesses are growing much larger than they at first imagined. Many report that they are adding subcontractors and offering products to go along with their organizing (storage systems, books they have developed on how to keep organized, etc.).
As Barry Moltz likes to say, the best business opportunities are those that solve other people’s pain. I guess too much stuff is quite painful to a lot of people these days!