Tuesday, August 11, 2009

Health Innovators Series - Bill Bradley on the Ethics of Connectnedness

Bill Bradley shares his ideas on the power of the people and how the philosophical divide between Democrats and Republicans can be bridged through the "Ethics of Connectedness"

Senator William W. Bradley is another Healthcare X PRIZE Advisor who needs no introduction. He began his public life as an All-American, Olympic gold medalist, NBA Champion, and ultimately Hall of Fame basketball player. In addition to his athletic prowess, he received his BA degree in American History from Princeton University and an MA degree from Oxford University where he was a Rhodes Scholar. He later served from 1979 – 1997 representing the state of New Jersey. In 2000, he was a candidate for the Democratic nomination for President of the United States. Since his retirement, he has served as a Senior Advisor and Vice Chairman of the International Council of JP Morgan, chief outside advisor to McKinsey an Company, and currently serves as a Managing Director of Allen and Company

Thanks for joining us today.

I am very pleased to be a part of the Healthcare X PRIZE competition that Wellpoint is sponsoring. I believe it is one of those special moments where we can get people together from different elements of the healthcare system, get them collaborating with each other, and try to devise a system that will produce the highest quality healthcare for the greatest number of people at the lowest possible cost. The key to its success will be tapping the creativity of the American people and getting them involved. Anybody who has got a great idea should have the opportunity to put it forward.

What challenges are faced by the healthcare industry as a whole?

Well, I think that the healthcare problem in America is one of coverage. Forty-seven million people don’t have any health insurance in America. It’s also one of costs. It is much more expensive on a per capita basis than any other country by a factor of 10. And to round out the issues we need to be concerned about the quality of care we are receiving for how much we are paying for care. We have too many people in our hospitals for example who die of medical errors that could be prevented if we had the right kind of systems and the right kind of incentives.

What challenges in particular are faced by the federal government in terms of healthcare?

Well, the thing about the federal government is it already spends over half of all healthcare dollars. Between Medicare, Medicaid, civil service retirement, and the gigantic tax subsidy that exists for private sector coverage offered by corporations. As a result, the federal government clearly has a decisive role and it has the same issues related to healthcare that the industry as a whole has - how do you assure quality, how do you assure lowest cost, and how do you assure access to the system. From my perspective, the government currently and will continue to have a major role in any type of reform efforts.

What challenges have you faced in terms of developing broad based healthcare solutions?

Well, the problem is that the healthcare industry reminds me of the Balkans. It is a lot of small groups arguing with each other and fighting with each other, and you’ve never been able to get everybody on the page. This is one of the reasons I find the X PRIZE concept so interesting; perhaps this model will allow everyone and anyone to contribute within an organized framework to actually accomplish something that no one has otherwise. I also think it can be the beginning of a national dialogue on a true national health care system. At the federal level there’s always been the "Balkanization" problem, with the special interest groups at war with each other and everyone.

The problem with the federal level is when you put it in political context, it is so easy to distort the best efforts of people. You can always pick out one small aspect of a healthcare program and attack it politically, and it’s as if that’s the only part of the healthcare program. So what you have to see is the interconnectedness of payment with delivery, of cost and quality, and of best practice and best outcomes, then it becomes much harder to attack.

If you look at the healthcare system we currently have in America today, and you look at what we need, I think it’s the best example of what I call the ethic of connectedness. In other words we’re all connected, and we need both what I call the ethic of caring - which typically means this shared responsibility toward collective action which is most often associated with democrats. But we also need the ethic of individual responsbility, which is often associated with individual action and the republic perspective. This is ground zero for the philosophical ward we have been fighting for centuries which is perhaps best illustrated by our current healthcare debate.

Sure, everybody needs to be covered, but you need to take care of yourself too. That’s the individual responsibility part, and we need to have a payment system that is rational in this regard. Did you realize that doctors spend 30 to 50 billion dollars a year trying to get paid, and insurance companies spend 30 to 50 billion dollars a year trying sort out incomplete billing records and related information? This is just wasteful nonsense that needs to be eliminated.

How would you compare US healthcare versus that of other developed nations?

Most developed nations have a system of health that is funded by the government in some form. Some are single payers, some are variations on the theme, some are hybrids organized by government but privately run. We have Canadian, German, Swiss, and related models of care that are unique to the cultural and environmental conditions of those countries. What we universally see is that they typically deliver much better public health for significantly less than what we are getting in America. The difference in cost per capita is dramatic, actually astounding, and I think we need to seriously look at that. Having a single system can really drive down some of the wasteful costs that I mentioned earlier.

What do you believe are the differences in quality between private versus public versions of health care?

Well, I think that on primary care, most other countries probably have a better primary care system than we do. When it comes to specialties, we have clearly have the most advanced, most sophicasted, and most expensive specialists in the world. There is really no doubt or question about that. It is an interesting perspective, however, because as a result of our technology, innovation, and breakthroughs our people are living longer lives which introduces a whole new set of questions and concerns. Back to your point, I think you can see in the example that a more public focused health system results in better quality primary care but in a private based system attempting to maximize profits the dollars flow to the highest paying activities which results in increased specialization.

How do you think the recent economic and environmental should shape the way we approach healthcare?

I think it’s still a little too early to know exactly how the finanical crisis will play out. In terms fo the federal budget, we are seeing that it is going to cost alot, which means that funding for other areas will be affected. The hope is obviously that we can recoup some of our healthcare investment fairly quickly by reallocating funding and financing in a much more rational way. My hope is that the looming recession, which will result in large deficits at the federal level, will not dampen the enthusiasm and willpower to complete meaningful reform this year.

This is actually one of the reasons that I think the Healthcare X PRIZE is so important. I think it can be a catalyst in charging and energizing the debate by involving the American people. I really see the American people actively competing in this effort as competition and awards and championships are part of the amerian way. We are all familiar with winnign the NBA Champtionship and getting a championship ring. I can see that same mentality and effort and competition being applied to the Healthcare X PRIZE.

Do you think using incentives like prize competitions will encourage more innovation to address these challenges?

I think it’s very important that people take responsibility for their own actions and their own health. I think that part of that is being attuned to the costs and not just attuned to one’s needs and desires in healthcare - which quickly leads us to something that I call value based healthcare. This requires a completely transparent health system - much like the Healthcare X PRIZE commitment to transparency - in order to work. You should be able to go online and find at the Cleveland Clinic what a hip operation costs as well as the results of the various physicians who perform that procedure and the patients who underwent the procedure. The information should be detailed - how many people, what was the experience, how much pain, when were they able to return to normal, what were the side effects, etc. Virtually every procedure, heart operations, kidney transplants, hip replacements or whatever should have transparent information available about outcomes. Armed with this information, consumers can now begin to make rational choices regarding where and how and when they spend their health resources. Also, think about what happens when large health groups begin to compete on who can deliver the best healthcare outcomes? This would be powerful.

What outcomes do you hope to see as a result of this process?

My hope is that as a result of the Healthcare X PRIZE that millions of people across the country will feel a part of the effort to totally rethink our health care problem in America. I realize that this is a highly complex problem but I also think there are quite a few very smart people in America who could contribute to this effort. I truly believe that we can develop a model in which we can provide coverage for everyone at the lowest possible cost at the highest quality.

I always found in politics, the best thing to do was ask somebody what they thought, and that’s exactly what the Healthcare X PRIZE is intended to do - it is national conversation with the American people saying, "what do you think?". It is unlikely, perhaps inprobably, that a small business owner in Duluth, Georgia is going to conceptualize an entirely new health system but you never know. I think this potential, the vast possibilities, are what make X PRIZE's so fascinating.

Any additional comments?

I think that the key thing is getting information to people, and the more information the people have, the easier it’s going to be for them to influence decisions that will help shape our health care system. As I said before, the ethic of caring is to cover everybody; the ethic of responsibility is for everyone to take care of your own body; and the more information you have to help guide your decisions in both areas help you realize and participate in what I previously mentioned as the Ethic of Connectedness.
blog comments powered by Disqus