Excerpted from Mission-Driven Leadership: My Journey as a Radical Capitalist, by Mark Bertolini, 2019, Currency, an imprint of the Crown Publishing Group, a division of Penguin Random House.
Editor’s Note: In 2014, after CVS CEO Larry Merlo announced the decision to stop selling cigarettes at its 7,700 retail pharmacies, Mark Bertolini, then CEO of healthcare giant Aetna, called to congratulate him. They agreed to meet to discuss business strategies and the future of the healthcare industry. In the conversation that ensued, Merlo referenced the estimated $2 billion revenue hit the decision would cost. “You make money on a fee-for-service basis,” Bertolini recounts responding. “I make money by keeping people healthy. You need a different revenue model, and if you continue doing the things that you’re doing, our revenue model is the right one.”
The discussion that ensued laid the groundwork for possible partnerships, including the idea of combining the two companies. Bertolini, who was in the throes of Aetna’s attempt to acquire Humana at the time, left the meeting with a mission: wrap the Humana deal, buy CVS—and change the healthcare industry.
“That a health insurer would buy a pharmacy chain is certainly unconventional—such a merger, as far as I knew, had never been contemplated—but it fit precisely with what I was envisioning for the future of healthcare,” he writes in his new memoir, Mission-Driven Leadership (Currency Books, April 2019).
That plan went south when the Department of Justice blocked the Humana acquisition, claiming it ran afoul of antitrust laws. But Bertolini, who had a harrowing firsthand experience with healthcare when his son, Eric, was fighting a rare form of cancer, didn’t give up on the vision. In this excerpt from the book, he lays out the healthcare system’s flaws—flaws that are not only spiraling costs, but resulting in our dying younger and killing ourselves more often. And he tells us how to fix it.
Aetna’s mission is to “build a healthier world,” and it starts at home. I view our healthcare system through a unique prism. I’ve been a worker, a manager or an executive in the industry for more than four decades. I saw it up close, in its glory and its failings, with Eric. And I continue to experience it firsthand, intensely, gratefully and inadequately, with my own injuries.
Consider how our health system works. You buy insurance and you get a card. You pull out that card when you get sick or sustain an injury, and you go to a clinic or a hospital, and then the system throws you back into your life. That’s how we take care of people—no sustained engagement in you as an individual, no effort to understand what your needs might be. Our system is mainly reactive: it responds to illness or injury but is otherwise detached from the daily lives of most Americans. That approach may have been adequate at one time, but our country’s social and economic ruptures have exposed its unsuitability to our current needs.
In 2015, researchers Anne Case and Angus Deaton published a paper documenting the dramatic rise in deaths among middle-aged white Americans, driven not by conventional disease but by suicide, drugs, alcohol and loneliness. The report stunned many commentators, as these “deaths of despair,” as they were called, seemed beyond the reach of our $3.3 trillion medical-industrial complex.
Opioid abuse rightfully drew much of the attention. Eighty percent of all opioids produced in the world are consumed by Americans, or enough to keep every American stoned for six weeks. The scourge is only getting worse. According to the National Center for Health Statistics, opioids were blamed for 34,572 deaths in 2016, a 52 percent increase from 2015. Drug fatalities overall in 2016 reached a staggering 72,000. That number does not reflect the millions of Americans who have been compromised, incapacitated or removed from the workforce due to drugs. According to a study by the American Action Forum, nearly 1 million people were not working in 2015 due to opioid addiction.
The cumulative toll, from opioids and other threats, is grim. According to the National Center for Health Statistics, death rates are ballooning across virtually all major diseases and rising or staying the same for every demographic. This defies everything we thought was true about our healthcare system, in which extraordinary advances in medical technology, diagnostics and individual therapies were lifting us to ever higher plateaus of wellness. Instead, we are dying younger, and we are killing ourselves more often. In 2018, the CDC reported that suicide rates rose steadily in nearly every state from 1999 to 2016; the CDC attributed this increase to social isolation, lack of mental health treatment, drug and alcohol abuse and gun ownership.
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If you’re in pain, if you’re not clearheaded, if you’re addicted to drugs, if you’re sluggish or depressed or lonely, you don’t care about anything else. You won’t have a steady job. You won’t have an intact family. You won’t be economically, socially or physically mobile, and the American Dream will be something that you read about in a middle school history book.
That’s why I believe if we’re going to solve the big economic and social problems in our country, we have to start with healthcare. Toward that end, we need to rethink what our healthcare system should do and even redefine what health is.
Redefining What “Health” Means
I’m partial to the World Health Organization’s definition of health, from 1948, as “a state of complete physical, mental and social well-being and not merely the absence of disease” (my emphasis). That definition grasps the deeper and more holistic nature of health, yet very few people describe it in that fashion. Maybe the WHO’s language does not speak directly enough to outcomes. We need something that is more affirmative and reflects the broader good of wellness, so I like to say that “a healthy person is productive; a productive person is socially, spiritually and economically viable, and a viable person is happy.”
How we get there begins by changing our understanding of healthcare from something provided by your employer or the government to a journey that you are in charge of. Consider how you buy a car. You don’t go to GM’s headquarters and order one, and you don’t go to GMAC or to some other lender. You go to a dealership, and you tell the dealer what you want: the size, the color, the interior, the sound system, the trunk space, the seat covers, all the bells and whistles. You get the car that meets your needs, and then you develop a plan for how to pay for it.
Our healthcare system does the exact opposite. In most cases, we tell you about your health plan, and then you figure out whether it meets your needs. We need to flip that. What if we had a system in which your health insurer asked first about your health status and your life goals? Those goals may be to watch your grandchild graduate from college, to climb Mount Kilimanjaro or to see your 50th wedding anniversary. We could then say, “Based on your current health and your long-term goals, let’s design a set of benefits and a way to pay for them that would take care of you for life.” That would be a much better experience than for you to buy a health insurance policy and wait until your knee is broken or your lungs don’t work.