And now, the highly-anticipated healthcare ‘initiative’ begins. This will be important because it may eventually impact all of us. But I’m getting ahead of myself…
This past Wednesday, after great fanfare and anticipation, the joint venture of Amazon, Berkshire Hathaway and JP Morgan anointed Dr. Atul Gawande as the inaugural CEO of the yet-to-be-named company that was announced in February. Although we don’t yet know the precise nature of this healthcare venture, as it is still shrouded in great speculation and mystery, we do know it will be based in Boston and become an “independent entity that is free from profit-making incentives and constraints.” The three organizations have stated they would initially focus on technology that would provide their employees and their families “Simplified, high-quality and transparent healthcare at a reasonable cost.” Gawande will begin his work on July 9.
The media is abuzz about the potential impact this new organization will have on a bloated and inefficient industry that comprises the size of Germany’s economy (GDP of $3.5 trillion in 2016 – the fourth largest nominal GDP in the world). Healthcare in the U.S., commonly acknowledged by those who are openly honest to admit this, has become a revenue-motivated business that creates an enormous jobs program, both of which make it difficult to politically challenge and reform. This powerful industry continues to prosper and wield its tight influence through lobbying and political pressure to those individuals we elect.
Here come three highly-regarded titans within their respective industries – CEOs Jeff Bezos (Amazon), Warren Buffett (Berkshire Hathaway), Jamie Dimon (JP Morgan) – and now another highly-respected healthcare ‘insider’ – Atul Gawande. Bezos, Buffett and Dimon are each fascinating in their own right, but Gawande is the wildcard that piques my attention. Here’s why…
Dr. Gawande’s accomplishments are both vast and deep. He is well known as a surgeon – he practices general and endocrine surgery at Boston-based Brigham and Women’s Hospital. He is also a professor at Harvard Medical School and Harvard T.H. Chan School of Public Health. Since 1998, he has been a highly popular staff writer at The New Yorker magazine. He has written critically-acclaimed books about healthcare, describing its’ problems and offering sensible solutions. Dr. Gawande is also the founder and executive director of Ariadne Labs, a research center looking for scalable health solutions to improve childbirth, surgery and other care.
What fascinates me the most about Gawande – primarily because of his professional medical background – is that he abhors inefficiencies and wasteful systems, both of which prevent our healthcare system from achieving much better medical outcomes and high-value care. The three sources of waste Gawande would like to eliminate are: 1) the layer of costs added by middlemen, 2) inflated pricing, and 3) misallocated care. While speaking in Aspen, CO, this past Saturday, Gawande mentioned this work will be a “tall fricken order.” He personifies the antithesis of a riddle that continues to dog the current approaches being used to ‘fix’ healthcare:
- Question: “What do you get when you put more people into an already high-cost, low-performing and inefficient system?”
- Answer: “A grossly higher-cost inefficient system that becomes even more untenable.”
Detractors of Gawande are somewhat skeptical for the following reasons:
- Too Complex to Fix – Even an accomplished healthcare expert (like Gawande) can only do so much within a dysfunctional mammoth industry that is unwilling to change – especially if revenue is threatened. The medical establishment may voluntarily publicly acknowledge that real change is needed to ‘fix’ healthcare, but behind closed doors, the devil will be in the ‘details.’ In healthcare, that devil usually centers around revenue – lost revenue.
- Lack of CEO Experience – Another perceived drawback for Gawande is his lack of CEO experience for a large, successful organization. How important this is, I’m not sure. Without knowing the specifics of the leadership hierachy and responsibilities in this new, unconventional role, Gawande will have three iconic business gurus solidly behind him to provide the necessary support, credibility and vision. Rest assured, this will not be a typical Ma and Pa startup.
- Must be Focused – Gawande apparently appears to be keeping his other commitments in play while assuming this new CEO role – physician, instructor and writer. Whether this will be humanly sustainable, only time will tell. I assume that Gawande will surround himself with talented and experienced lieutenants to provide the support system needed for this venture to be successful.
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Now we seem to be entering the savior complex time. Health care seems to be like education. We are always pursuing something, that one thing that will just make everything better. To get to a point where the RIGHT care is delivered at the RIGHT time at the RIGHT cost is a colossal, but not impossible endeavor.
To get to these 3 Rs I think we need to focus first on some outcomes or goals. It’s only after making some critical goals/choices that we will find the methods to get there.
For me, the initial goal would be a tax payer financed social insurance system to pay for health care with the caveat that the tax would be highly progressive. I sincerely believe that if we made that a goal in America, we could reach it.
I recognize that there is a multiplicity of well-founded and well intentioned opinions on what our initial goals should be. I would love to hear some of the goals ( and by this I mean TRANSFORMATIVE goals) that you and your readers Invision as a way to change our sick care system.
Looking at healthcareFrom the inside for the past 30 years myself, I have always found it interesting that so many people are rushed through the system, only to return within that magical 30 days that regulates the return to hospital rate. Studies have been done to show that up to 75% of return to hospitals could have been prevented. Health science has grown logarithmically the past 20 years. We have all the technology, science, research, machinery, and education to put miracles into affect. We can tell you everything about the human body, diseases, genetic and mutations, viruses, bacteria, and How the body responds. But in the end, we still have the same return hospital rates that we had in the early 1970s, According to Medicare statistics. If a CEO of any corporation was told that 22 to 25% of his product was defective, and he spent 15 years and trillions of dollars to fix what was wrong, and after all that money and all that time he still had the same percent of defects, One would have to ask why nothing improved. That is exactly what is happened to the healthcare system in the past 50 years. I spent the last 15 years building a system that will improve the returned hospital rates. My own work has results 1/3 of the national average. Buffet, Bezos, and Dimon, I have chosen Dr. Gawande. Because of his vision and philosophy. When it succeeds, it will be due to no corporate, political, or financial agreed. Then all the waste Will be exposed. There are many who will want this project to fail. But since they are not involved, it has a chance to succeed. Good luck Dr. Gawande.
Excellent comments, Paul! Sorry about my tardiness, as I just discovered your message today (Oct. 31, 2018)