Universal health insurance: The COVID-19 dole outs to businesses gave the lie to the government’s case that the U.S. cannot afford universal health care. We cannot afford NOT to pay for it. People who do not have health insurance, or have high-deductible plans, avoid primary care services only to end up in the ER — where many cannot pay for the services. Hospitals lose billions each year to this system, and those who do have insurance have to bear the additional cost. The result is higher-cost care with a higher burden on the healthcare industry.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Dan Cook.
Dan Cook is a longtime journalist, with stops along his circuitous route at BusinessWeek, Knight Ridder, Newhouse Publications, American Lawyer Media, Reuters, Time, and various other journalistic weigh stations. For the past six years he has been a regular contributor to BenefitsPro.com, an online news service dedicated to the healthcare and insurance industries. He has written more than 2,000 articles for BenefitsPro and has an insanely detailed understanding of health insurance and healthcare reform. A Cleveland native and diehard Indians fan, he lives in Portland, OR.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
It was pure coincidence. I had a pal who bounced around in various editing roles, and he always brought me along. He landed at BenefitsPro and started sending assignments my way. Prior to that I had absolutely no interest in or understanding of the complexities of health insurance and our healthcare system.
Can you share your most interesting story since you began leading your company?
I tend to put teams together to manage large journalism projects. I was assigned to do profiles of 50 top business women in Colorado Springs about 10 years ago, and I divvied up the articles between three people. On my list was Dr. Nancy Saltzman, a Milken Family Foundation Award winning elementary school educator. When I called to interview her, I asked her what made her exceptional. Nancy said, “Well, my husband and two boys died in a plane crash a few years ago. Ever since, I’ve been speaking out about how to recover from intense trauma.” “OMG! Please send me a copy of your book,” I said, assuming she had written one. Instead, Saltzman replied, “I don’t have a book. Can you help me write one?” And I did. It was an amazing journey into the soul of a survivor. The book, Radical Survivor, is one of the most memorable projects of my writing career.
Can you share a story about the funniest mistake you made when you were first starting out? Can you tell us what lesson you learned from that?
My biggest faux pas occurred when I joined BusinessWeek. Just a couple of weeks after I was hired, the magazine had its annual retreat outside Philly. I was completely overwhelmed by the caliber of journalists I was meeting and was doing my best to act like I belonged. At one of the sessions, I sat down next to a young guy with long hair and an engaging smile. “I’m Dan, what’s your name?” “Steve Jobs.” I asked, “Why are you here Steve? What do you do for a living?” He started to laugh, as did everyone else nearby. He was the keynote speaker at the conference. I had honestly never heard of him before. But I knew this would be a long week!
What do you think makes your company stand out? Can you share a story?
We dig very deep into healthcare coverage to understand the nuances of health insurance, the benefits, and drawbacks of different types of coverage, and the inconsistencies that run rampant through healthcare provider billing systems. But we also look at the human side of the business. I have written several in-depth articles on the barriers women and African Americans face, particularly within the insurance industry. My articles have raised thorny and uncomfortable truths about prejudice within the industry that have helped redress some of the inequities in health insurance.
What advice would you give to other healthcare leaders to help their teams thrive?
Be open minded! Think about the benefits of your products or services to the customer, not about the short-term payoff for you. Healthcare and insurance are both undergoing rapid change. Ugly truths are being revealed. Those who truly focus on the long-term health of their clients will prosper — and sleep better at night.
Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the U.S. Healthcare System is ranked as the worst among high-income nations. This seems shocking. Can you share with us 3–5 reasons why you think the U.S. is ranked so poorly?
You bet. The Top 5 are:
- The outdated clinical treatment model. It burns out physicians and does not contribute to the overall health of the patient. This is the key area for healthcare reform. It needs to be replaced with other models like centers of excellence care, in-home care for the homebound, health visits with no time limits, and methods for compensating physicians that do not participate in the exhausting turnstile format of the clinic. Physicians want to do great work but cannot when faced with a 15–20-minute time limit on patient exams.
- Physicians with hidden financial interests in certain technologies and specialty treatment facilities. This leads to overprescribing, needless tests and procedures, and massive waste — and all of it is unethical, because the financial interest overrides the physician’s professional judgment. .
- The health insurance industry in this country is currently designed to discourage millions who have insurance from receiving proper care. Through high-deductible plans, salted with heavy copays, the insured are faced with paying 5,000-10,000 dollars out of their own pockets before their insurance kicks in. So, they forego the upstream, preventative care that would keep them healthy, and instead resort to the ER when they get really sick. This wastes billions in expensive treatments that could have been prevented, in lost hours at works, and in the overall health of Americans. Patients are being treated when they are sicker rather than spending less on prevention.
- Opioid overprescribing has become a national shame, and yet it continues because of the financial structure of Big Pharma. Prescribing opioids represents the physician’s shortcut to patient pain treatment while providing big bucks to drug makers. Physicians also receive financial incentives to prescribe these insidious painkillers. Until much stricter regulations are enacted to hold this trend in check, Americans will continue to dull treatable pain with drugs. And sadly, as we have seen, many will overdose.
- Physician shortages are becoming more acute by the year. Given the decreasing income for most newly minted MDs, fewer are seeking medical degrees. Rural communities often don’t have a local MD (not to mention a psychiatrist). The caseloads of existing MDs are increasing, causing a further degradation of the healthcare being delivered in this country.
As a “healthcare insider,” what 5 changes would you make to improve the overall U.S. healthcare system if you had the power? Please share a story or example for each.
I could certainly list more than that, but I would say my top 5 are:
- Universal health insurance: The COVID-19 dole outs to businesses gave the lie to the government’s case that the U.S. cannot afford universal health care. We cannot afford NOT to pay for it. People who do not have health insurance, or have high-deductible plans, avoid primary care services only to end up in the ER — where many cannot pay for the services. Hospitals lose billions each year to this system, and those who do have insurance have to bear the additional cost. The result is higher-cost care with a higher burden on the healthcare industry.
- End the brick-and-mortar clinic system of primary care service delivery. It is inefficient, burns out clinicians, and does not give caregivers a full health perspective on patients. It also leaves millions of shut-ins without any primary care services because they cannot get to a physical building. A Portland, Oregon nonprofit, Housecall Providers (now part of CareOregon) provides in-home medical care for those who cannot get to a clinic. A federal project demonstrated that the Housecall Providers’ model could save billions in healthcare dollars spent on homebound patients who only get treatment in the ER.
- Expand Telemedicine. I met a Portland psychiatrist who flies to Pendleton once a week to see patients because Pendleton has no local psychiatrist. But he has gradually shifted many of his therapy sessions to his laptop, which allows him to manage more rural patients and respond more quickly to emergencies.
- Establish centers of surgical excellence throughout the country. I interviewed a major employer whose insurance pays all employee surgical costs if they have the surgery done at centers of excellence (COE) hospitals and dedicated facilities. If they elect to go elsewhere, they must pay part of the cost. COEs are designated due to high- quality based on their outcomes.
- Allow Nurse Practitioners to manage MD caseloads and patient care throughout the U.S. A shortage of MDs in many regions is being offset by revising regulations that formerly restricted NPs from certain types of caregiving. In Oregon, where those regulations have been relaxed, Housecall Providers was able to become fully staffed by hiring NPs rather than MDs. (An MD must still be on staff to ‘supervise’ the NPs.) This allowed the organization to expand its home healthcare services throughout the Portland metro region, bringing quality healthcare to thousands of homebound patients.
Ok, suggesting changes is great, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities, and d) leaders do to help?
Oddly enough, for most of these reforms, corporations can be the leaders of change. They have the greatest financial stake in employee health, both from a prevention standpoint so people lose less work time to illness, and from an overall reduction in their costs as peoples’ overall health improves. Major self-insured employers are the changemakers in healthcare. And you have another great example in Amazon, which has committed billions to overhauling the U.S. healthcare system.
Individuals can help the most by becoming literate about their health: insurance, physicians, and healthcare companies. Health literacy leads to better healthcare choices and outcomes.
Communities, sadly, have the least power in this matrix today. They can pass a tax to build a hospital, but do they have the knowledge to staff it, equip it, maintain it, and manage it? Likely, no. They could contribute to health literacy by insisting on including it in educational curricula from kindergarten through college.
Leaders? Sorry, only a scant few are immune to the Big Pharma/Big Insurer campaign dollars. Our politicians, apart from a handful of Democrats, have only obstructed healthcare reform. Religious leaders are AWOL in the fight for decent health coverage. There are a handful of healthcare professionals and insurance brokers who are pursuing progressive alternatives to the current system. Dave Chase of The Health Rosetta has been a leading figure in the battle to reform health insurance. But most of the effective leaders are those who run corporations.
I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
Sadly, mental health ‘issues’ are still stigmatized in the U.S. The acceptable solution to anxiety, depression, and related conditions is prescription medication, which only treats symptoms of mental and emotional imbalances. As a result, mental health in general is poorly funded compared to physical health.
What can be done? How do you overcome a) Big Pharma’s pill-pushing might and b) Americans’ stigmatization of mental health conditions?
There are no quick solutions to either. Education can address the stigma piece. But to address Big Pharma requires a national will to break its grip on politicians, physicians, and, through its massive ad campaigns, on consumers. I don’t see either of these options happening with our educational system crumbling and our national will at an all-time low.
How would you define an “excellent healthcare provider”?
Individual: One who is patient-centric, always learning new skills, listens, and seeks to treat the whole patient.
Institution: One that emphasizes primary care, makes primary care accessible and affordable, and includes telemedicine and home medical visits in its care model. The ideal institution is not a brick-and-mortar fortress anymore, but an organization that is dispersed throughout the community it serves.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
Soar with your strengths, from the book of the same name. I was introduced to it at an editor’s conference in 1999. It changed not only the way I managed people, but the way I led my life. No longer did I struggle with employees whose flaws could not be corrected — but whose strengths I was ignoring by trying to ‘fix’ their shortcomings. I stopped asking employees, friends, relatives, and volunteers to do everything, and instead asked them to do what they did best. Then I worked to support them, so their best became even better. And I stopped trying to fix my own chronic shortcomings, instead focusing on what I did best. When we focus on our strengths, we celebrate our talents, skills, and finest attributes. It’s not that we ignore shortcomings — in fact, I was more aware of mine than ever before. But I began to expend most of my energy on good-better-best.
Are you working on any exciting new projects now? How do you think that will help people?
One aspect of good health is good food. As a volunteer, I work with two community gardens to raise healthy, pesticide- and fertilizer-free food, and share it for free with others. One large garden project explores the ‘no-dig’ food production method, where seeds or starts are sewn directly into rich compost. As part of that project, I have become the lead on managing our huge compost stash. I love the dirt. By participating in these community gardens, I learn from fellow volunteers, and I teach others what I have learned.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
The Health Rosetta is a terrific resource for information on emerging types of health insurance. I read endless academic papers through the Journal of the American Medical Association. A professional organization, The Association of Health Care Journalists, provides endless resources for reporting on medical topics. My connections with professionals at Providence Health System in the Pacific Northwest have been invaluable sources of medical information. And simply reading publications like The New York Times keeps me up to date. For podcasts, I enjoy Lisa K. Fitzpatrick of Grapevine Health. Resources are truly endless for this kind of information.
You are a person of great influence. If you could inspire a movement that would bring the most good to the greatest number of people, what would that be? You never know what your idea can trigger. 🙂
Sorry, mine is not original. Universal health coverage. It is the one ‘revolution’ that would, with one stroke, improve more lives in America than any other reform effort.
How can our readers follow you online?
Dan: LinkedIn is where I hang out. You can browse through my 2,000-plus articles for BenefitPro.com as well.
Thank you so much for these insights! This was so inspiring!