Healthcare Needs Its Mary Barra

With all that has been going on, I’ve been remiss in reflecting on General Motor’s big announcement a couple weeks ago: it is going to have an all electric, zero emissions fleet of “light duty” vehicles (cars, SUVs, pickups) by 2035, and be carbon neutral by 2040.  One of the largest manufacturers of internal combustion vehicles for over a hundred years is recognizing that its past is not its future.

Of course, I immediately wondered what the equivalent move in healthcare would be, and from whom. 

GM's Mary Barra Credit: GM

 In the announcement, GM Chairman and CEO Mary Barra declared:

General Motors is joining governments and companies around the globe working to establish a safer, greener and better world.  We encourage others to follow suit and make a significant impact on our industry and on the economy as a whole.

You can just imagine Henry Ford fuming in his grave.

GM has had electric vehicles for some time, but they remain a small percentage of its business, as they do among the auto industry generally (Tesla’s market cap notwithstanding).  GM had supported the Trump Administration’s policies efforts to rescind emission standards, which benefited internal combustion engines, but quickly changed course in light of Biden Administration priorities on climate change.

GM now plans to spend some $27b on electric and autonomous vehicles over the next few years.  “We’re committed to fighting for EV market share until we are No. 1 in North America, Ms. Barra said at an investor’s conference.   “EVs are core to creating GM shareholder value.”

None of the major auto manufacturers immediately matched GM’s move, although all have introduced electric vehicles and Ford, in particular, vowed to invest $29b in electric/autonomous vehicles through 2025. A Ford spokesperson said the company was “committed to leading the electric vehicle revolution in the areas where we are strong.” 

Although there are, not surprisingly, skeptics, most observers praised GM’s announcement.  Paul Bledsoe, a climate expert at the Progressive Policy Institute, told The Washington Post: “When America’s most iconic manufacturer commits to carbon neutrality, that’s a huge signal to the rest of the economy.” Erik Gordon, a business professor at the University of Michigan, told The New York Times:

This is a guardedly bold move.  It’s not that risky. Fifteen or 20 years from now, who knows where we might be? Mary Barra won’t even be C.E.O. But right now it’s hugely symbolic. This is very forward-looking.

To be sure, the 2035 emissions deadline is a goal, not a commitment.  Mike Ramsey, a vice president at Gartner told Sierra: “I think GM is serious in the sense that it is an aspirational goal. If the market doesn’t move that way fast enough, they aren’t going to stop making engines and gas tanks just because they said they would.”

“The central point is that we made a firm commitment to carbon neutrality by 2040,” Jessica James, assistant manager of sustainability communications at GM, explained. “That is happening. But some things need to come together to meet the 2035 deadline—it’s out of our direct control.” 

I don’t know if GM will live up to its announcement, or even if GM will still be around in 2035, but I love bold promises from otherwise stodgy companies.  If Microsoft can become a leader in open source software, who’s to say that GM can’t reinvent itself?  More power to them.

So what are some equivalent things healthcare organizations might do, changing core parts of how they’ve operated to better serve society?  Here are a few suggestions:

• Epic could promise that data in its EHRs will be fully interoperable with other EHRs, with a consolidated patient record across health systems.  “Patient data belongs to patients.  Our job is to use that data to help patients and all of their health care professionals make better health decisions.”
• Sutter Health could announce it is getting rid of its chargemaster.  “Medicare payments shall be our base payment level, and no payor will have rates more than 120% of that."
• UVA Health could vow to stop suing its patients.  “We’re here to help patients, not go after them during vulnerable times in their lives.  Any billing/collection disputes will be worked out through third party arbitration.”
• UPMC could agree to pay local property taxes.  “We are committed to helping improve the health of our community, and we recognize that paying our fair share of local taxes is an important part of that goal.”
• TeamHealth and Envision Healthcare, both owned by private equity firms, could put an end to their surprise billing practices.  “We commit that all of our professionals will be in-network for all major health insurers, or will accept the payment level from the largest health insurer in the given market as our charge.” 
• Pfizer and Eli Lilly could put an end to pricing practices that make their drugs much more expensive in the U.S. than in other countries, especially for such necessary products as Epipen and insulin (respectively).  “We can no longer drive our profits from U.S. customers.  Our U.S. prices will be consistent with prices charged in G20 countries.”
• The AMA and the medical specialty societies could agree to give up control of the Relative Value Scale Update Committee (RUC), which determines changes to RBRVS weights.  “We recognize that, in this era of transparency, our involvement in helping set payment levels that our members may benefit from is no longer appropriate.” 
• The Association of America Medical Colleges and The American Association of Colleges of Osteopathic Medicine could agree to merge.  “Over 110 years after the Flexner report, we believe it is long past time that the historical differences between M.D.s and D.O.s be eliminated, in favor of a single system of education, training, licensing and oversight of physicians that will best serve patients in the 21^st century.”

One difference between these promises and GM’s: we shouldn’t have to wait until 2035.  These are things that can and should be done within a few years.

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 Almost seventy years ago, GM President Charles Wilson made his famous (mis)quote: “what’s good for GM is good for America” (although his actual quote was “I thought what was good for our country was good for General Motors, and vice versa.”)  Healthcare is a much bigger portion of our economy than auto manufacturing is or ever was, and anything that is good for healthcare but bad for the people using it cannot really be good for either healthcare or the country.

Healthcare has a chance to re-stake its future.  It should make, and keep, some bold promises.  If doing so is good for GM, it should be good for healthcare as well.  Where are its Mary Barras?