Beyond the Blame Game: An Operator’s Perspective

Since stepping away from my CEO role, I've found myself spending a lot more time scrolling on LinkedIn than I should.  My feed is filled with people pointing fingers and provocative posts about why Healthcare in the U.S. is broken and why it’s this group of stakeholder’s fault.

One post says hospitals are the problem because prices are out of control. The next argues insurance “cartels” exist only to deny care. Then someone blames “ruthless” private equity for destroying clinician autonomy and “pillaging value” out of a vulnerable system. Another says physicians are overpaid or burnt out or too stuck-in-their-ways or not efficient enough. Scroll a little farther and government regulation, pharmaceutical companies, or even patients themselves are the real culprits.

The scrolling can go on-and-on and prominent thinkers like Mark Cuban, n8 Kaufman, and dozens of other executives, physicians, policy experts, etc. are amplified, shared and reshared where the comments section usually becomes an echo chamber of people who already agree or spectacle to watch what happens to the brave who dare to disagree.

After spending nearly two decades leading inside healthcare, including serving as CEO of a large academic medical center, I can tell you something that probably won't satisfy anyone:

Almost everyone is right and almost everyone is wrong.

As a leader, one of my most important skills is listening to understand. After thousands of conversations with patients, physicians, payers, managed care companies, tech organizations, clinicians, government representatives, consultants, and other stakeholders… I can count on one hand the number of times people showed sustained irrational behavior that defied logic. Sure, emotional people in the moment may temporarily behave irrationally. But in general, people have a good reason for their actions if you just care enough to listen and try to understand their full perspective.

Here's the truth.

People are responding rationally to the incentives they've been given.

The problem is that the system itself wasn't designed for those incentives to work together.

This creates a cycle that leaves everyone frustrated and pointing fingers.

Over the next several weeks, I'd like to explore that system and cycle, not to assign blame or get political, but to understand why our system keeps producing outcomes that no one is really satisfied with. I’ll use stories from my healthcare leadership experience and interactions over the years to illustrate key points and show why people are generally acting rationally in a broken system and how that impacts the struggles we feel across the U.S. healthcare system today. 

If we're serious about fixing healthcare, we first have to understand why it behaves exactly as it was designed to. (Paraphrased from W. E. Deming – shout out to my LSS folks!)

Here’s the outline I plan to follow with posts on Thursday’s starting next week. (Of course, subject to change as life happens.)

Intro - Beyond the Blame Game: An Operator’s Perspective

Post 1 - Beyond the Blame Game: The Patient’s Choices

Post 2 - Beyond the Blame Game: Why Employers Keep Paying More for Less

Post 3 - Beyond the Blame Game: The Insurance Company’s Paradox

Post 4 - Beyond the Blame Game: Hospitals aren’t the Problem… but They are a Problem

Post 5 - Beyond the Blame Game: Why Physicians Feel Trapped

Post 6 - Beyond the Blame Game: Regulation and Over-Regulation

Post 7 - Beyond the Blame Game: The Role of Private Equity in our Tangled System

Post 8 - Beyond the Blame Game: Don’t/Do Drugs

Post 9 - Beyond the Blame Game: A Fragile Workforce

Post 10 - Beyond the Blame Game: What Can We Do?

Hope you all find this enlightening, useful, and engaging. 

(AI disclaimer on the image – my artistic talents peaked somewhere around 8th grade and have gone steadily downhill since.)