"You can define health care into basically three buckets. There's those that receive, there's those that give and there's those that take. And if you look at those three buckets and you just put yourself in those that receive at the end of the day, that's the patient. And those that give are actually the providers, and in fact, the people that pay. And everything in between is those that take, i.e., the perverse incentives of fraud and abuse, the inefficiency of health care ... If you go to the essence of the question, what is it that you are trying to achieve, and we in the health care industry should be trying to achieve to keep the patient away from the hospital, not into the hospital. But there in no incentive to do that ... The whole issue is value-driven care, both for the patient as for the payer. So there's a combination of what we have to achieve. We need to achieve patient responsibility, patient knowledge and patient centric. The question at the end of the day is what value are we providing, why are we providing the value and who is it for? ... With this 2.3 trillion dollars (being spent on health care), we don't need more than what we are spending. It's not what we're spending that's creating the problem, it's how we are spending what we are spending." -- Patrick Soon-Shiong, M.D., speaking at RAND
Patrick Soon-Shiong is a knight on a crusade to heed an ailing and hurting humanity that beckons to him, but that is challenged and thwarted at every step by too many not-so-ailing or hurting humans and special interests furthering their own personal agendas.
He makes a case that there is currently no incentive to keep patients healthy. Even at UCLA, where he focuses many of his efforts, the wonderful mission is "healing humankind one patient at a time." Shouldn't we be promoting wellness one patient and one family at a time?
In his interview, Dr. Soon-Shiong raises the need for more integrated health care with the patient at the center and focus on the cost of not doing so vs. the current focus on what things cost. He is also a realist about the need to incentivize all parties toward promoting health. That includes the receivers, givers and takers. It has been my experience that people don't do what is important to them; they do what they care about (for example, healthy eating is important to me, but I don't care enough about it to do it that well).
If you read between the lines of Dr. Soon-Shiong's interview you get a sense that he is coming to the conclusion that most global change agents come to, which is: You can't solve a transformational imperative from a transactional paradigm. The challenge others face with transactional people (are you listening Washington?) is that most of them are not able to give up control sufficiently to embrace an as-yet-to-be-created paradigm that will be necessary to be the rising tide that lifts all boats. Until that happens, we are all sunk.
I have heard it said that the measure of a civilization is how it treats those who have hurt it. Soon-Shiong furthers the definition to "how it treats those who are hurting in it." Thank you Dr. Soon-Shiong, and Godspeed.
FOR READERS: In your comments, please suggest ways that might cause the receiver/patients, giver/provider-payers, taker/opportunists-inefficient health care providers and institutions to care enough to actually take action on the health and well-being that most of us already agree are important. I would also be interested in your suggestions that would cause siloed specialized interests to care enough to want to work together toward a shared future more than further their own agendas. I would appreciate your focusing on solutions as opposed to finger pointing.
Follow Mark Goulston, M.D. on Twitter: www.twitter.com/markgoulston