Extractive Era of Healthcare: The Effects of Medical, Workplace & Financial Toxicity on Nurses, Doctors & Patients

How do we re-mediate and restore the health ecosystem?

The following is a paraphrased recap of an interview after I keynoted a social impact event following the publication of the "CEO's Guide to Restoring the American Dream: How to Deliver World Class Health Care to Your Employees at Half the Cost" (free download of the book below). Many of these investors have made impact investments designed to restore the environment so I used an analogy from the environment. The theme of the talk was "The U.S. Healthcare System is a Giant Superfund Site - Remediation and Restoration."

Question: You’ve called the U.S. healthcare system a giant Superfund site. That’s a very provocative statement. What do you mean by that?

Answer: That’s true. In fact, the first chapter of my book is entitled American Has Gone to War for Less where I outlined major areas of damage from the U.S. healthcare system. Healthcare has been an extractive industry stealing resources from middle class income and education for our kids. Like a Superfund site, there are major toxicities that are causing tremendous damage. Even if healthcare isn’t “your issue” the downstream effects on all of us are tremendous.

Q: Can you expand on what you mean by that in terms of the effect on health outcomes?

A: Yes, we have severe medical toxicity. Health outcomes are so bad that preventable medical mistakes are the 3rd leading cause (due to shockingly high rates of overtreatment and misdiagnosis). Further, the largest public health crisis since the 1918 flu pandemic (and bigger than polio, gun violence or HIV/AIDS) is the escalating opioid crisis. This is a crisis nearly entirely created by first and second order effects of the severely under-performing healthcare system. [Note: Those downloading the book will get early access to the chapter being added to v 1.1 of the book on the driving role employers have unwittingly played in fueling the opioid crisis.]

Q: Is there an effect on healthcare professionals? I talk to my doctor friends and they are quite unhappy.

A: Yes, there is tremendous workplace toxicity. Doctors have the highest rate of suicide and burnout of any profession and it has gotten significantly worse in the last 10 years. Nurses and other healthcare professionals also suffer from high rates of burnout and experience workplace violence five times worse than the average worker.

Q: We hear about the costs of healthcare. What is the effect of that?

A: There are multiple types of financial toxicity starting at the personal/family level with medical bills being, by far, the largest driver of bankruptcy and the overwhelming driver of 20 years of wage stagnation and decline among the middle class. If that wasn’t bad enough, it’s worse for millennials with the most conservative estimate being that half of all lifetime earnings for millennials will go to healthcare. At the government level, exploding healthcare costs are choking off funding for education and other social determinants of health. It probably goes without saying that the primary cause of government budget crises and massive deficits is healthcare spending. Businesses are just now waking up to the reality that the health benefits industry (the source of their second biggest area of spending) is rife with conflicts-of-interest, undisclosed broker compensation and misaligned incentives. My business partner was a securities attorney involved in defending Enron executives and says what’s he’s learned in healthcare is far more pervasive than what he saw in working on securities fraud cases.

Q: It sounds pretty grim. Is the government capable of solving this crisis?

A: In a word, no. Naturally, they have a role but like virtually all great societal challenges whether it’s civil rights, climate change, or better food, bottom up change is how transformation happens. Since I’m using an environmental metaphor, remember that it was citizens who conceived of and popularized Fair Trade, organic foods, and LEED for sustainable building. The government can help after a track record of success has been established. For example, many states and municipalities now mandate public sector buildings achieve LEED certification and that has been a great market accelerator. We sometimes forget that the government is one of the largest employers in the country. Unfortunately, public sector workers' benefits under-perform just as badly as private sector health benefits. Fortunately, from states like New Jersey to towns like Kirkland, Washington to larger cities such as Milwaukee and Pittsburgh are realizing that the best way to slash healthcare costs is to improve benefits.

Q: If the government isn’t going to drive this change, what is the equivalent of Fair Trade, LEED or organic food to drive change?

A: As a skeptical empiricist, I spent the last seven years first understanding the root causes of the dysfunction and then scouring the country to find who had truly solved the problems I’ve touched on. It turns out that the root cause of nearly every dysfunction in the U.S. healthcare system (and many other countries) is the way we purchase healthcare is extremely ineffective. The great news is that forward-looking people have solved all of the structural fixes we need to address the problem in rural and urban settings, in large and small employers in the public and private sector in virtually every corner of the country. When you look at how the best organizations are dramatically reducing the rates of misdiagnosis and overtreatment for areas ranging from oncology to musculoskeletal procedures, the human impact is greater than any blockbuster drug I can think of. I co-founded the nonprofit Health Rosetta Institute to rapidly disseminate the learnings and successes. The institute is creating a Fair Trade like organization to create a new health ecosystem.

Q: Is there a need for financial capital and what does that look like?

A: Yes, transformation requires new thinking rather than minor tweaks on outdated healthcare approaches that may have produced a financial return but created tremendous collateral damage from the toxicity of our system. Just as there have been countless investment opportunities around a more sustainable economy, there are many opportunities in healthcare. However, it’s notable that traditional venture capital and private equity typically aren’t sufficient to create a health ecosystem that we all want. Many of the traditional models are extractive to communities even though local healthcare professionals are delivering services to local people, organizations outside their community are the ones who profit. We believe a regenerative investment model facilitates a "shop local" dynamic brought to healthcare. There’s an emergent category of investing we call community building capital that is a better fit for driving systemic, positive change. We couldn’t be more excited about what that can achieve.

Follow the link to the book below for a free download of the book that expands on the themes in this interview.

 __________

Dave Chase is the co-founder of the Health Rosetta Institute (a LEED-like organization for healthcare), Managing Director of the Quad Aim Fund, Executive Producer of The Big Heist, and author of the book, “CEO's Guide to Restoring the American Dream - How to deliver world class healthcare to your employees at half the cost.” Chase's TEDx talk was entitled "Healthcare stole the American Dream -- here's how we take it back." The Health Rosetta Institute is transitioning from two years of self-funding/bootstrapping and recently achieved 501-c3 status. See the Health Rosetta Institute website for how to get involved, resources and how to join others to support its mission.

Subscribe to The Future Health Ecosystem Today to stay ahead of healthcare changes. Follow Dave on Twitter

Click for information on speaking engagements