When I was around my son’s age, it barely registered that Jimmy Carter and Ronald Reagan had been elected. However, even a middle-schooler can’t miss what’s going with this year’s election. I attempted to put the oddities around the election into perspective for him. For example, economic distress can create a strong response — often misdirected. I mentioned how even a NPR reporter would ignore an economic expert on how healthcare is a root cause of the Trump/Sanders phenomena.

You can always count on Americans to do the right thing – after they’ve tried everything else. – Winston Churchill

I shared how often the best things come out of the darkest times and that this can cause normal political divisions to be washed away and Americans to pull together. For example, both World War II and the Soviets getting to space first united the country. Sometimes there are dramatic events whereas other times the movements start at the grassroots level, growing much more gradually until the politicians eventually jump to the front of the “parade” that is well underway. We’ve seen the latter in civil rights, climate change and food-related issues.

How on earth can we solve the fact that the American Dream has been stolen for much of the country?

As the ground-breaking Rand study pointed out, the U.S. middle class has gone backwards (financially) in the last 20 years. This is the core reason we have one of the most unique presidential elections in the last 40 years. I told my son about the quest I’ve been on the last several years to find the reason why the American Dream has been stolen and how to restore it. I’m regularly asked to speak about how to thwart the heist at customer events for benefits consultants, business coalitions, nonprofit associations and public-sector organizations. The overriding sentiment is that organization executives and benefits leaders have reached their breaking point and are no longer going to accept that every year they’re obligated to get less and pay more when it comes to health benefits.  Outlined below are some examples of how they’ve put that frustration into action.

Of the thousands of tweets I’ve posted, the one I have pinned states the following:

I like to invest in startups that want to disrupt healthcare from place of love, not contempt. We should expect so much more than what we’re getting.

The three most trusted professions are nurses, doctors and pharmacists. When I think back to being in school, the smartest, kindest and most gratification-delaying individuals I knew most frequently became clinicians of some kind. It’s not limited to clinicians. A key reason I love working in the healthcare industry is the great people I’ve gotten to know. Beyond inspiring clinicians, I have endless examples of non-clinicians who are amazing individuals. To name a few, you won’t find nicer, more passionate individuals than Shannon Brownlee, Aneesh Chopra, Dave deBronkart (aka “ePatientDave”), Alexandra (Alex) Drane, Esther Dyson, Lucien Engelen, Regina Holliday, Jan Oldenburg, Susannah Fox, Leonard Kish, Jim Millaway, Todd Park, Sherry Reynolds, Lygeia Ricciardi, Jane Sarasohn-Kahn, Claudia Williams and many others. For every Martin Shkreli, there are 100,000 great people in the healthcare industry across every sector imaginable. That includes people in the sectors that are sometimes subject to criticism such as health plans and pharmaceuticals. I’ve met just as many in those sectors that are as passionate and well-meaning as anyone else in the industry. However, great people inside of a flawed design will always under-perform those in a great system design.

Companies are spending far more on employees than 20 years ago – the problem is it all got eaten by healthcare and contributed to American companies becoming noncompetitive. This resulted in jobs getting shipped overseas. But there’s great news: I’ve seen the future of healthcare and I like what I see.

First, I’ll outline the extent of the collateral damage from healthcare’s hyperinflation that has had de minimis impact on health outcomes, in aggregate, but a catastrophic impact on the middle class. Second, I’ll highlight a grassroots movement driven by forward-looking employers and unions around a concept called the “Health Rosetta” – it’s a Do-it-yourself health reform determined to restore the American dream by slaying the healthcare cost beast. If it was a reality show, it would be called “Extreme Makeover: Healthcare Edition” — the results are breathtaking when can-do spirit is combined with the smarts and passion of clinicians who are determined to see the healthcare system realize its full potential. Fortunately, unlike WW II or the moonshot, all of the solutions to the dysfunction have already been invented, proven and modestly scaled — it’s now time to liberate America from the shackles of an under-performing healthcare system.

[Disclosure: As I've disclosed many times, the Health Rosetta is an open-source project that provides a reference model for how purchasers of healthcare should procure health services. In my role as managing partner of Healthfundr, a seed-stage venture fund, the Health Rosetta is the foundation of our investment thesis.]

While it will take clinicians of all stripes to lead on the professional side of the movement, doctors have a unique role to play. In fact, it’s doctors who are leading the revolution (click for a sampling of doctor-leaders driving the revolution). The administrative burden typical doctors face is the leading driver of burnout that has snuck up on them over a few decades. Having lived under the oppressive regime of bureaucracy, their victory is even sweeter as the revolutionaries are at the top of the class as the Quadruple Aim over-achievers. For these healthcare revolutionaries, it’s what a famous president called Morning in America.

We’ve gone to war for less than what healthcare is doing to the country

[To be clear, this isn't meant to be a political diatribe. Let's just say it's been a team effort that has led us into this predicament. Many of my international friends have emphasized that their countries have similar issues -- perhaps not as acute but still major issues. The primary over-arching initiative I'm supporting to address these problems is the Health Rosetta which isn't country-specific -- in fact, I regularly speak in Europe on this open source project. In part, because solutions to healthcare's predicament come from all over the world.]

Imagine if a foreign country was doing the things outlined below to America. We’d go to war in a second. Healthcare’s under-performance has been a “sneak attack” of a different kind but arguably far more damaging. The list below captures some of the collateral damage from healthcare:

Household income has been devastated by healthcare costs. Despite significant employee cost increases over the last 20 years for organizations, essentially all of it has gone to fund healthcare’s hyperinflation rather into worker’s pockets. Washington Post, NY Times, WSJ, Time and others have reported, healthcare cost increases have been borne by both the employers and employees, not to mention shareholders. Despite employers spending huge sums to keep up with healthcare’s hyperinflation, the reality is the status quo health benefits are horrible. If economists looked just at the middle class, they’d classify their economic state as equivalent to the Great Depression.
State level data demonstrates how healthcare is choking other budgets such as education as well as other social determinants of health. Bill Gates pointed out in a TED Talk, out-of-control healthcare costs are directly devastating education budgets. In other words, we’re stealing our kids’ future. Frequently, what used to be paid for by taxes has been cut or parents have to raise money to ensure their kids get these core programs.
Each year preventable hospital deaths are more than the equivalent of all of the soldiers buried in Arlington National Cemetery. The National Library of Medicine, Pro Publica and others have published that the number of preventable patient deaths associated with hospital care every year is 440,000. That is also more than total U.S. deaths from World War II. In addition, there are approximately 4 million preventable major complications per year. Major complications (10,000 per day) are also more than four times the total number of U.S. casualties from the entirety of WW II (one million). As with most cases of “friendly fire”, it’s leadership and design that are at fault — not the individuals who are horrified when their mistake has caused great harm.
Nest eggs have been crushed by $1M due to healthcare costs. 68% of working age people aren’t participating in an employer retirement plan. As a consequence, the majority of Americans have next to no retirement savings. Even with Medicare, it’s estimated that there are $300,000 of costs not covered by Medicare not to mention other living needs. Retirement accounts would be far bigger if healthcare wasn’t stealing from retirement savings.
There are unprecedented levels of dissatisfaction and burnout by doctors. A major reason is we’re layering more bureaucracy on top of a design failure. Sadly, doctors have the highest rate of suicide of any profession.
As US News & World Report found, due to healthcare costs, cities are unable to perform basic services such as maintaining roads. It’s as though our cities have gone through The Blitz but can’t repair the damage. More dramatically, there are 100’s of millions of unfunded pension commitments due to healthcare costs.
At the state and federal level, trains are literally going off the tracks and bridges are falling into rivers as healthcare costs have starved budgets of infrastructure investment. Both the NY Times and the nonpartisan Center on Budget and Policy Priorities have reported on the tragic consequences of the spending on healthcare waste and over-treatment while roads, airports, bridges and rails fall apart.
As Atul Gawande pointed out in his book and in the recent PBS Frontline special, we are doing a horrendous job dealing with end-of-life issues leading to a tortuous experience for those at the end of their life and it needlessly squanders money in the process. Knowing the limits of medicine and what impacts quality of life, the fact is doctors die differently from the rest of us using much less intervention (not to mention cost). As the author of that article, Dr. Ken Murray, stated about what we’re doing to people at the end of life, “What it buys is misery we would not inflict on a terrorist.”
Medical expenses are the number one driver of bankruptcy (even for those with health insurance). Some say it may also be the top cause of homelessness. The majority of healthcare-driven bankruptcies (72%) are people who had insurance.
As a former Chair of the Council of Economic Advisors once said, “We don’t have a debt problem. We have a healthcare problem.“ Every financial challenge the U.S. has would be solved if we get healthcare costs under control. The items that could be funded just with the waste in healthcare are almost unimaginable.
My family has gotten in the spirit of how important it is for the country that we fix healthcare. When I was drawing the analogy with my son about how every now and then the country pulls together such as during WWII, I shared how Rosie the Riveter was symbolic of the country pulling together in WWII. It’s time for a new symbol. Who else but a mom would unquestionably sacrifice herself and jump in front of a speeding train to save their child? Moms are like super heroes and form the foundation of health in this country. I’ve seen a range of moms who are in the industry that have had their “Mama Bear” instinct triggered. All I can say is “watch out” when you threaten their kids’ future! This is where the name Rosie came. Since our Rosie is ensuring the Health Rosetta is put into place to restore the American Dream, that’s why we call her Rosie…Roise the Restorer. My son took this idea and ran with it. The drawing below is a draft of a mashup of a superhero, mom and Rosie the Riveter.

Not a Right Solution. Not a Left Solution. An American Solution

The oft-quoted “The future is here, it’s just unevenly distributed” by William Gibson is apropos. I’ve written extensively about various Health Rosetta successes but I’ll highlight a few that were tackled by individual citizens simply doing the right thing:

I recently started a series on America’s Most Innovative Benefits Leaders who play a pivotal role. Oftentimes, it’s benefits consultants like David Contorno, Jim Millaway and Keith Robertson who put the nuts and bolts together to make it happen.
A small manufacturer in Oklahoma who was able to tackle healthcare’s most vexing problem — pricing failure. This meant that an employee avoided joining the ranks of the bankrupted and her kids’ having no Christmas if they’d been in a typical, flawed health plan.
School and union leaders in the Pittsburgh area realizing they should be on the same side of the table. They are spending nearly 50% less than their Philadelphia peers on health benefits leaving more money to invest in education rather than needlessly squandering it on healthcare. This has been accomplished despite childish squabbles between the large health system and plan that is damaging their community.
A city realizing that the best way to slash healthcare costs was to improve health and retirement benefits. When I spoke with that city’s HR leader, he spoke about how what they implemented was a blend of what those on the right and left tout.
By spending 50% less per capita on health benefits compared to similar organizations, a hotelier used money otherwise squandered on healthcare to fund fantastic employee benefits (e.g., paying for employees’ and their children’s college education after a few years of service). He didn’t stop there. He also adopted a nearby crime-ridden community and invested in daycare, pre-K, after-school programs and college educations. The result: Crime down 67%. High school graduation rates spiked from 45% to nearly 100%.
While the “preservatives” squabble in DC, individual citizens aren’t waiting around. They see the threat for what it is and are creating an example for all of us to follow. There is a budding partnership between clinicians dissatisfied with the status quo, citizens who realize they have more power than they’d imagined and employers no longer passively being accomplices to the American dream being stolen. This is the only way to overcome the 3 trillion reasons ($$) to protect the horrible status quo despite the harm it is doing. Healthcare’s “inconvenient truth” is that its “super sized” gluttony has become the single greatest immediate threat to America — a documentary is in the works to outline the scope of the damage and the inspiring stories reversing the damage. As MacArthur Genius Grant Winner, Dr. Jeffrey Brenner put it, “There comes a point in a democracy when the public’s had enough and they stand up.” For many across all segments of healthcare and all political persuasions, that time is now. They won’t take it sitting down anymore.

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