Hey, Healthcare: Just Do the Right Thing

How about that: it appears that big corporations have a social conscience after all. 

The Business Roundtable (BRT), which primarily represents large corporations, issued a statement earlier this week that steers away from its previous stance that a corporation exists to serve the interests of shareholders.  Now, 181 member CEOs agree, corporations must seek to serve all stakeholders.  Corporations must, they say, help promote "An Economy That Serves All Americans."

As soon as I saw this I started thinking about healthcare.

Credit: Getty Images

Jamie Damon, Chairman & CEO of JP Morgan Chase and the current BRT chairman, said:

The American dream is alive, but fraying.  Major employers are investing in their workers and communities because they know it is the only way to be successful over the long term.

The key commitments outlined in the BRT statement are as follows:

1. Delivering value to our customers
2. Investing in our employees
3. Dealing fairly and ethically with our suppliers
4. Supporting the communities in which we work
5. Generating long-term value for shareholders

The Washington Post described the reaction by corporate critics as "cautiously optimistic."  Robert Hockett, a Cornell Law School professor who also advises the Presidential campaigns of Bernie Sanders and Elizabeth Warren (no lovers of corporations!), told The Post: 

It’s almost astonishing.  They’re in effect coming right out and saying, ‘We’ve been wrong for the last 20 years"...some folks in the BRT are recognizing there’s something unsustainable about an economy that’s all about shareholder primacy.

Steven Pearlstein, a professor at James Madison University, told The Post:  "Rather than thinking of them of as bad people with bad motives, it’s probably more correct to think of them as reasonably good people in a bad system."

Credit: Sophia Foster-Dimino

"Reasonably good people in a bad system" may well describe people working in corporations, but it definitely applies to our healthcare system.  Our healthcare system is filled with good people, most of them trying to do the "right thing," but beset by a Kafkaesque system filled with perverse incentives.

It is worth noting that CEOs of for-profit health companies Abbott, Anthem, Baxter, Bayer USA, Bristol-Myers Squibb, Cigna, CVS Health, Johnson & Johnson, McKesson, Medtronic, Pfizer, Stryker, and Walgreens all signed the statement.  It is also worth noting that Kaiser Permanente Chairman and CEO Bernard Tyson was one of only 7 BRT CEOs who did not sign the statement; a spokesperson indicated Kaiser agreed with the principles, but as a non-profit did not have shareholders.

Healthcare is filled with "non-profits," some of whom manage to generate a lot of surplus nonetheless and to pay their executives quite a lot of money, or are small corporations (or LLCs).  It's time for healthcare -- from the smallest solo physician practice to non-profit health systems to the largest for-profit corporations -- to step back and consider a new set of commitments as well.  

Here are my suggestions:

1. It's the patient, stupid: In theory, of course, healthcare has always been about the patient, but that's getting harder and harder to believe.  No one who sits in a waiting room for hours, gets shocked by a large (and usually incomprehensible) bill, has difficulty getting enough time and attention from their healthcare professional, or has to pay more in cases of medical errors or bad outcomes can believe that. 

Healthcare organizations and professionals have to stop being about what they do to patients and focus on what they do for them. 

2. Fair pricing, always.  Drug companies up the prices of longstanding drugs (insulin, anyone), or reformulate them to maximize pricing.  Hospitals maintain chargemasters that have prices that would embarrass defense contractors.  Physicians send out "surprise" bills to patients who had no opportunity to even choose who treated them.  Commercial prices are multiples of Medicare prices, and prices for those without insurance are even higher.

Healthcare organizations and professionals should charge a fair price, one that allows them to make a reasonable return but which does not depend on the kind of insurance one happens to have (or not have) or how skillful they are at upcoding.

3. Share and share alike: Repeat after me -- patient data is theirs.  It is not the property of those treating the patients.  It shouldn't be resold without their explicit consent, and it should be easily accessible to them and to any others they choose to share it with, even if that includes competing healthcare organizations.    

Healthcare organizations and professionals should stop treating patient data as a siloed asset, and look to the business opportunities of interoperability.

4. Health does not happen in a vacuum: Yes, people can be prescribed a pill or given a procedure, but most of what influences their health happens outside healthcare settings.  It matters where they live, how well they eat, what kind of social support they have, how much they exercise.  Sending patients off with instructions they can't understand/can't follow/can't afford, or to settings where they are not safe, just invites bad outcomes and more care.   

Healthcare organizations and professionals need to deal with patients in the world in which they actually live, not in the cloistered healthcare world.

5.  Unhealthy communities mean unhealthy people.  Physicians were once always community leaders, just as hospitals used to exist as community institutions.  Not so much anymore.  Healthcare remains a leading employer in many, if not most, communities, but that is not enough.  Public health matters.  The overall economic health of the community matters.  Taking leadership roles in civic issues matters.  Communities that do not thrive usually have fewer people who thrive.  

Healthcare organizations and professionals must be community leaders with a broad view of the health of that community.

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It's great that the BRT is at least paying lip service to a broader purpose. I'll be more impressed when they do something about executive compensation, tax loopholes, and pollution, or take proactive positions on controversial issues like climate change or gun violence.  Most will not change overnight and some will not change at all.  

But we should expect more from healthcare organizations and professionals.  Lip service to the Hippocratic Oath is not enough, especially when it only is applied to physicians.  We need to stop pretending that too many in healthcare aren't driven primarily by their own economic interests or personal preferences.  We need to start acting with a higher set of principles.

The above five commitments is my proposed set.  What are yours?