I left that talk yesterday more pessimistic than ever about healthcare.
To think that there I was listening to decorated, allegedly innovative healthcare thinkers and all I heard were hackneyed ideas that were long ago disproven; I expect this from casual entrants in the healthcare discussion, not people running the benefits for 1.2 million people.
The natural place to start is the Enron-level accounting that miraculously hails increased spending as saving. Just think how laughable it would be in any other context to go from spending $8 in year 1 to $10 in year 2 to $11 in year three and hail this as savings because the rate of increase was lower.


Thank you for having the integrity, unlike xxxxxxxxx, to say what we all knew: you have no idea how to save money in healthcare.
Sure, you didn’t say it directly, and in fact presented yourself as some sage on the topic, but your own numbers don’t lie – the numbers that show you presiding over a positive healthcare spending trend every single year. Only in the backward world of healthcare would anyone dare to present such obvious increases in spending as savings.


Do I Offend?

I would not give this gift to just any baby. I wouldn’t because you happen to be born into a world where people have turned “taking offense” into a sport.

If playing this perverse game, you could score points by being appalled that anyone would gift a book containing ideas some people find loathsome. Depending on your competitive spirit, you’d push back on my consideration that a girl (you) might have a higher affinity for a book written by a fellow girl (Ayn Rand). Or one could take the other side and complain that Ayn Rand isn’t girly enough. To which a third person would shriek that there’s no such thing as “girly.”

Final score: we all lose.


Smiling Through Pain


“I’ll race you and win by throwing sweet potatoes on the side of the track.”

I’ve returned back to that joke several times since learning of your departure. To think that in your last moments at Brighton you were still able to laugh. To then think that basically everyone is going through something, and that only the best among us can keep smiling in spite the pain.

Yes, I saw you as the “best among us.” Never has my ambition been lower than the moment I first comprehended the insanity of your schedule. Up early. Up late. Meeting to meeting with no time to prepare, yet audiences always expecting that you would be “on.”


I still think, for the most part, our meetings (the deal call in particular) are pretty wasteful.

Don’t get me wrong, I love talking with the team, but I think it would be better for everyone if the discussion was operating at a higher level.

Currently, the majority of meeting time is “chit-chat” about deals on the table. Problem-solving and/or strategic thinking is almost totally absent.

Now, there is value in “network updates” (a.k.a. chit-chat), but I contend that bringing everyone together for 30min+ is not the best way to disseminate that information.

I personally think written updates would be preferable. Why?


Realizing Reality

You may not have signed up for this, but it’s the reality. Don’t accept this reality? Fine. Know this: denial of this reality means xxxxxxxxx will die.

And, if you ask me, it’s a pretty incredible reality.

Because it means you have the opportunity to fix arguably the largest problem in our country: overpriced, opaque, excessive and uncompetitive healthcare. (I will buy you the book. Tell me your address. Seriously. Don’t like reading? Fine. Watch this interview. )

That is what you get to work toward every day.

Good news: unlike those punk kids one-year out of college, you can leverage the insights of an actual money-making business to inform your startup.

Bad news: this leverage can turn into a crutch and halt innovation – xxxxxxxxx becomes merely another version of xxxxxxxxx. (more…)

Oooh. I like that.

My general answer is to deliver tremendous value.

What is value?

One form is making the company money by doing things that aren’t being done today. The xxxxxxxxx program is a perfect example of this.

Or by fixing things that lose us money in both the short and long-term.

Measuring the long-term, more indirect effects of your actions is a bit challenging. But through creativity and logic, it can be done.

Value is also visible when you innovate. (more…)

LGA in Gecko

Seek First to Understand

Mr. xxxxxxxxx,

Not since Marilyn Manson have I heard one of life’s keys so beautifully explained as you did in your recent conversation with xxxxxxxxx xxxxxxxxx.


Medicare for All

subject: You are a smart, deep thinker about healthcare,

which is what made your interview with Pramila Jayapal so disappointing.