Andy Grove, the former Intel Corp. chief executive and chairman, is frustrated. He’s been pushing for changes to the U.S. health care system — an interest due in no small part to his experiences with prostate cancer and Parkinson’s disease. But even though he meets regularly with some of the most powerful people in Washington and on Wall Street, Grove isn’t sure his message is hitting home.
“Do I get an audience with just about anyone I so desire?” he said in an interview this week. “Yes.” But does he get what he wants? “Mostly no. My name gets me an audience, but that’s all.” That’s a sad commentary on the state of health care reform in the United States. Many advocates of change believe that for meaningful reform to take hold, it will have to be pushed by business leaders. In other words, risk-averse policymakers will listen only when there’s serious money involved.
So if a corporate figure of Grove’s stature and background can’t make much headway, what does that say about the chances of lawmakers doing anything significant to address the shameful problem of nearly 47 million Americans being uninsured or of health care costs spiraling out of control?
Grove, 70, doesn’t know. In fact, when asked how optimistic he is about his own relatively modest proposals being enacted — and I’ll get to them in a moment — he says his optimism registers maybe a 3 or 4 on a scale of 1 to 10 (with 1 being gloomily pessimistic and 10 deliriously upbeat). “Why the hell should I be optimistic about solving this problem?” he asked, his voice rising in volume. “To solve a problem this big, you would need a war or a depression or some other cataclysm.”
Barring such a catastrophe, Grove is focusing his reform efforts on what he calls “Shift Left.” That’s not to say this stalwart Republican is embracing a more liberal-leaning ideology (although a freewheeling conversation with him suggests this could indeed be the case). Rather, Grove is thinking of the bottom axis of a graph in which the daily cost of care increases significantly as an individual moves from independent living and home care to hospitalization.
Shifting left, in other words, means placing greater emphasis on the side of the chart that keeps as many people as possible out of hospitals and out of increasingly overwhelmed emergency rooms. To do this, Grove advocates a vast network of walk-in clinics that would allow people to receive relatively minor treatment from a nurse practitioner. Such clinics would be privately run — Grove bristled when I termed them “McClinics” — and would be located in large retail stores, say, or in various neighborhoods.
Funding is tricky. Grove says the cost of treatment at walk-in clinics would be much cheaper than in hospitals because of their different business structures, but patients would be expected to foot the bill for whatever care they receive. He doesn’t yet have a good answer for why a low-income, uninsured person would choose to pay $40 at a clinic rather than being treated at taxpayers’ expense at an emergency room. “I’m not proposing to fix the entire system,” Grove said. “I’m proposing to fix parts of it that are pragmatically addressable.”
Along those lines, he’s advocating a wholesale change in how people’s medical records are stored. As it stands, you visit a doctor or a hospital, your data are recorded on a clipboard, and that information, in turn, is often filed away in a paper folder. Efforts are under way to store patient information electronically, but most such proposals include state-of-the-art technology that would keep data safe yet accessible to health care workers. “All of a sudden there is an exponential increase of cost and complexity, and no one is doing anything,” Grove observed.
His alternative would be to create plain-vanilla Web pages for all patients that could be accessed by any nurse or doctor. You stroll into one of Grove’s walk-in clinics, explain your situation and your full medical file would be instantly available to whoever is seeing you.
This is indeed a pragmatic idea, but it has a fundamental drawback: personal medical records being clandestinely accessed by hackers. Grove acknowledges the problem. “There are going to be breaches,” he said. “You will either learn to live with those breaches or you will retreat behind a wall of paper records. A perfect system, electronic or otherwise, would cost an infinite amount of money.”
Clearly, Grove’s remedies aren’t perfect. But at least he’s thinking about the problem and attempting, like the engineer he’s always been, to come up with workable solutions.
So far, he’s been reluctant to weigh in on broader aspects of the problem, such as whether a government-run program similar to what’s available in all other industrialized democracies would work here. When pressed, Grove said, “If I could wave a magic wand, I would probably move in that direction.”
However, he doesn’t have a magic wand, nor does he have much confidence that policymakers will ever manage to insure the ever-increasing number of Americans without health coverage.
“This country is running a horrendous deficit and I cannot conceive of where that money will come from,” Grove said.
He’s frustrated. But that doesn’t stop him from trying.
Courtesy: David Lazarus