WTF Health: Accolade Navigates Itself into New Territory: CEO on Personalized Healthcare & Tech Infrastructure

By JESSICA DaMASSA, WTF HEALTH

Healthcare navigator Accolade (NASDAQ:ACCD) is on the move. Not only are they now cruising in care delivery territory with two new primary care/mental healthcare offerings that let them personally guide their 9M members further into the healthcare system, BUT they’re also starting to talk more and more about their tech infrastructure and the “operating system” they’ve built to power that healthcare GPS with shared data and access.

CEO Rajeev Singh stops by to walk us through the strategy behind both sides of this (especially interesting when you consider his tech startup background in the context of those “operating system” statements) and why Accolade launched its own new category (personalized healthcare) as a framework for talking about the new course they’re charting.

We get into the September debut of Accolade Care, which bundles primary care and mental health in a per-employee-per-month model, and Accolade One, which wraps the full Accolade ecosystem around the Care product in a value-based model. At-risk models seem to be rising in popularity these days, and I get Rajeev’s perspective on why Accolade chose to go-to-market with one of those…and one that falls into the usual PEPM structure.

More interesting to me, however, is this whole “operating system” thing and how it’s playing out behind-the-scenes to strengthen integration across the businesses Accolade has acquired (Health Reveal being the most recent) and point solutions its partnering with like Virta, Headspace Health, Sword Health, RxSavings Solutions, and Carrot Fertility. The “purpose-built” architecture Rajeev describes sounds like it’s not only giving Accolade what it needs to better manage population health outcomes within its own offerings but that it, in and of itself, could be a new offering for partners who don’t want to build a tech platform themselves.

New directions explored…next moves discussed…AND Raj’s six-year CEO Anniversary celebrated! Watch now.

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Health in 2 Point 00, Episode 242|Owlet, EasyHealth, Luma Health, Calal Health, and more

Today on Health in 2 Point 00, Jess and I talk about the FDA informing Owlet, whose CEO Jess interviewed about their products and business model, that they can no longer sell their socks. EasyHealth, a medicare advantage broker, gets 35 million plus 100 million credit. Luma Health gets 130 million, bringing their total up to 170 million. Calal Health gets 77 million dollars, led by Ascension Ventures. Evercore buys Dr. Chrono. -Matthew Holt

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Where’s Our National Health Tech Academy

By KIM BELLARD

It has been said that if your company has a Chief Innovation Officer or an Innovation Department, it’s probably not a very innovative company. To be successful, innovation has to be part of a company’s culture, embraced widely, and practiced constantly.  

Similarly, if your company has a Chief Digital Officer, chances are “digital” is still seen as a novelty, an adjunct to the “real” work of the company. E.g., “digital health” isn’t going to have much effect on the healthcare system, or on the health of those using it, until it’s a seamless part of that system and their lives.

What got me thinking about this, oddly enough, was a report from the U.S. Government Accountability Office (GAO) as to the advisability of a Federal Academy – “similar to the military academies” – to develop digital expertise for government agencies.  As the GAO noted: “A talented and diverse cadre of digital-ready, tech-savvy federal employees is critical to a modern, efficient government.”

Boy, howdy; you could say that about employees in a “modern, efficient” healthcare system too. 

The GAO convened a panel of technology experts from across the government, academia, and non-profit organizations to help evaluate the problem(s) and potential solutions. The panel identified a variety of short and long-term needs for digital expertise, including updating legacy systems, applying advanced technologies (e.g. AI), managing cybersecurity risks, and reimagining service delivery.

Again, any of those that do not apply to any healthcare organization? 

Even if the government could attract the appropriate digital talent it needs, the GAO warned, it would still be subject to significant limitations, including FTE count restrictions, existing technology infrastructure, long-term career pathways, ability to offer competitive compensation, and existing laws and regulation. Unless it’s a hot new digital health start-up, and perhaps even then, these apply to most healthcare organizations too. 

Despite the “military academy” analogy, the GAO panel saw the digital service academy as perhaps better suited to a graduate-level institution, “because agencies need staff with advanced skills in leading projects and programs, data curation, and digitalization.”  I.e., the National War College might be a better example than West Point (and, in fact, if its graduates were as accomplished and wide-ranging as the War College’s, the Digital Academy would be doing well).  

Even with such a digital academy, the GAO recommended other actions were needed to further support the digital talent, such as ongoing training programs, relationships with academic institutions, and support networks, the latter in part because “the work of digital service staff may introduce changes that could be met with resistance from existing employees.”  

Been there, encountered that. 

As much as our members of Congress universally proclaim their love for and admiration of the military academies, in today’s hyper-polarized political climate the odds that we’ll actually see the creation of such a Digital Service Academy seem dim, alas for us.   

Healthcare needs a better pipeline of digital, and more broadly technology, talent too. There are plenty of the usual suspects that could be candidates to train such expertise, starting with the nation’s medical schools (allopathic and osteopathic). We’ve got a lot of them, they attract very smart, motivated people and physicians are certainly on the front-line of much of what happens in healthcare. 

The problem is, though, that they’re focused on teaching medicine, a task that has always been hard and which grows ever harder as the knowledge base expands exponentially. Yes, some physicians are tech-savvy and many are innovative, but one suspects that this is as much despite their medical school experience as because of it. 

Perhaps, then, schools of public health could be loci of digital/tech expertise. The pandemic should have taught us the great potential for digital solutions to public health problems – as well as the barriers to actually making them work.  The problem here is that, again, the pandemic has revealed to us how broken and fragmented our public health systems are, and how isolated they often are from the rest of the healthcare system. There shouldn’t be such separation, but there is.

If we’re looking for tech expertise and innovation bias, we need look no further than our business schools, especially those which offer specialization in healthcare. The problem with them is that graduates tend to come out of them with, you might say, business orientations. Healthcare is certainly a business and a huge one at that, but if all we’re looking at are the business aspects of healthcare, we’re likely to be not happy with the healthcare system we get.

There is another candidate that might make sense. We do have a National Academy of Medicine after all, whose mission is: “To improve health for all by advancing science, accelerating health equity, and providing independent, authoritative, and trusted advice nationally and globally.”  Despite the “medicine” in the name and the preponderance of physicians among its members, it sees itself as “collaborative and interdisciplinary… across disciplines and domains to advance science, medicine, technology, and health.”  

So it might make sense that the NAM take on the challenge of helping train healthcare leaders in the new technologies that the 21^st has brought/will bring, and how they could be used to improve our healthcare system and our health. 

A little over twenty years ago the NAM (in its former existence as the IOM) issued its landmark To Err Is Human report, with its startling estimate of 98,000 deaths due to medical errors and its assertion that “the problem is not bad people in health care–it is that good people are working in bad systems that need to be made safer.”  It’d be hard to argue that 2021 finds the healthcare system much safer, while it certainly has gotten much more complex. 

What we need are not more reports but new generations of leaders, conversant with a broad range of 21st-century technologies and with a predilection towards action and innovation. It may not be the NAM that will train them, and it could be a Federal Academy, but what we are doing now is not going to suffice.

We badly need government employees who are tech-savvy and who can help modernize the outdated systems at every level of government. But, when it comes to that, the healthcare system should be looking at itself first.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

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Matthew’s health care tidbits: Drug prices

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

For my health care tidbits this week, I am going to talk drug pricing. Anyone who gets basically any health policy newsletter has seen some of the cash PhRMA has splashed trying to make it seem as though the American public is terrified of drug price controls. But as Michael Millenson on a recent THCB Gang pointed out, when Kaiser Health News asked the question in a rational way, those PhRMA supported numbers don’t hold. 85% of Americans want the government to intervene to reduce drug prices.

Big pharma whines about innovation and how they need high prices to justify R&D spending but health care insiders know two things. First, for ever Big Pharma has spent about twice as much on sales and marketing as it’s spent on R&D. This was true when I first started in health care thirty years ago and it’s still true today. Second, the “R” done by big pharma is resulting in fewer breakthrough drugs per $$ spent now compared to past decades. Which means that they should be increasing that share spent on R&D and need to improve the “R” process. But that’s not happening.

Finally, pharma is very good at increasing prices of branded products and extending their patent protection. Lots of dirty games go on here. Look into it and you can expect a lot of discussion about insulin pricing or discover how Humira is still raking in $16bn a year in the US, despite the fact its original patent expired in 2018. With 85% of the American public in favor, you’d think then that a Democratic Congress would leap at the change to pass a bill that might save the taxpayer $50bn a year in drug costs. But of course that’s not going to happen. There is about $30bn a year in savings in the House version of Build Back Better that passed last week, but there’s little chance of much of that being in the Senate version given Joe Manchin’s daughter’s role running a drug company, and Krysten Sinema being a recent recipient of PhRMA’s largesse. And that’s assuming any version of #BBB gets through the Senate.

Instead hope something small happens to help desperate patients, and wonder how we ended up in a political system that apparently disregards what 85% of the public wants.

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Health in 2 Point 00, Episode 241| Papa, Sword, Trevueta, Trusted Health, Ieso, and Talkspace

Today on Health in 2 Point 00, Jess and I talk about fundraising efforts this past week, as well as leadership issues within Talkspace. Papa raises 150 million dollars, bringing their total to 240 million. Sword raises 189 million dollars, with a secondary of 26 million dollars, bringing their total to 320 million dollars. Trevueta raises 105 million, and Trusted Health raises 149 million dollars. Ieso raises 57 million dollars. Talkspace had no growth in their third quarter, and their founding team left the company while their COO resigns after a review of conduct at a company offsite event. -Matthew Holt

Subscribe to WTF Health’s YouTube Channel: https://www.youtube.com/channel/healt… Follow Jess DaMassa on Twitter: https://twitter.com/jessdamassa Follow Matthew Holt on Twitter: https://twitter.com/boltyboy Subscribe to our channel and tweet us your questions using the hashtag #healthin2point00

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THCB Spotlights: Maya Said, CEO, Outcomes4Me

Today on THCB Spotlights, Matthew Holt talks with Maya Said, the CEO of Outcomes4Me, which works in the cancer patient empowerment space. Outcomes4Me is a patient empowerment platform that helps patients diagnosed or in active treatment for breast cancer understand their situation and treatment options, as well as connect better with providers to enable meaningful shared decision making. Maya tells us about the goals of Outcomes4Me, the current needs for enabling value-based care, and what the future directions are for Outcomes4Me, which recently received $16 million from North Point.

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The Kids Aren’t Alright

By KIM BELLARD

America, like most cultures, claims to love and value children, but, gosh, the reality sure seems very different. Three recent reports help illustrate this: The Pew Research Center’s report on the expectation of having children, Claire Suddath’s searing look at the childcare industry on Bloomberg, and a UNICEF survey about how young people, and their elders, view the future.   

It’s hard to say which is more depressing.

———

Pew found that the percentage of non-parents under 50 who expect to have children jumped from 37% in 2018 to 44% in 2021. Current parents who don’t expect to have more children edged up slightly (71% to 74%). The main reason given by childless adults for not wanting children was simply not wanting children, cited by 56% of those not wanting children. Among those who gave a reason, medical and financial reasons were cited most often. Current parents were even more likely – 63% – to simply say they just didn’t want more.

This shouldn’t come as a huge surprise. Earlier this year the Census Bureau reported that the birthrate in America dropped for the sixth consecutive year, the largest percentage one year drop since 1965 and the lowest absolute number of babies since 1979. It’d be easy to blame this on the pandemic, but, as sociologist Phillip N. Cohen told The Washington Post: “It’s a shock but not a change in direction.” 

In many ways, having children seems like ignoring everything that’s going on. We have a climate change/global warming crisis that threatens to wreak havoc on human societies, we’re still in the middle of a global pandemic, and our political/cultural climate seems even more volatile than the actual climate. One Gen Xer told The New York Times: “As I think of it, having a child is like rolling dice with the child’s life in an increasingly uncertain world.”

Yikes.

——–

The mess that is America’s child care industry (nurseries, daycare, preschool) may help explain why people are reluctant to have kids/more kids.  If you’ve had a child or known people who have, you’ve heard the complaints about child care. It’s hard to find good ones, harder to get into them, and harder still to pay for them. The people who work in them are, for the most part, wonders, but there are too few of them and they’re woefully underpaid…despite how expensive the child care is.

Ms. Suddath writes: “Child care in the U.S. is the rare example of an almost entirely private market in which the service offered is too expensive for both consumers and the businesses that provide it.” She quotes Treasury Secretary Janet Yellen: “The free market works well in many different sectors, but child care is not one of them.”

At least in healthcare, some people are making money.

The workers are paid less than they’d make at Amazon or Walmart, but, between staffing ratios and other regulatory requirements, the costs can approach college tuition levels. It keeps many women out of the workforce, hampering both their careers and our overall economic development. Even worse, lack of preschool has lifelong impacts on children’s development. She quotes Catherine Wolfram at the U.S. Treasury: “There’s very robust, strong economic literature that documents the positive effects of early childhood education. Educating kids has all these benefits for the rest of society.”

The Build Back Better Act is supposed to address some of the child care issues, such as limits on how much parents have to spend on it and improving wages for the workers, but Ms. Suddath warns, not so fast.  The bill is, she suggests, more aspirational than prescriptive:  

States can decide to take money for preschool but reject additional funds to subsidize other forms of child care. Or a state could call all this communism and do nothing.

Beyond that, there’s not a lot of detail in the bill. States have no guidance on how to help child-care businesses pay higher wages, for example.

Think all those Red states that have defied masks/vaccine mandates/Medicaid expansion are going to rush into fixing the child care problems?  

———-

The UNICEF survey, which included respondents from 21 countries, found that, overall, young people (15-24) thought children in their country would be better off than their parents – but, in the U.S., only 43% thought so, with 56% disagreeing. It could have been worse; the “worse off” percentages were worse in many other developed countries. The older respondents were even more pessimistic (64%). 

Laurence Chandy, the UNICEF official who oversaw the survey, said: “In a lot of the developing world, there is a bit more optimism that yes, with each generation our living standards are improving.  But there’s a recognition in the West that’s stopped happening.”  In point of fact, U.S. children born in 1980 or later are no longer likely to earn more than their parents, a startling reversal of the trends from 1940 to 1980.  

Young Americans still cite “hard work” as the key to success, but just narrowly edging out “Family wealth or connections,” which is in contrast to their elders, who are much more likely to still believe in hard work.  Education is a distant third. 

We’re supposed to be the country where success is about getting a good education and working hard, not about who your family and friends are. We’re not that country anymore.

No wonder our young people are pessimistic about their futures. 

——-

When it comes to children’s health, of course, the U.S. should hang its head. We have too many children in poverty, too many children going hungry, too many children without health insurance. Our infant (and maternal) mortality rates are positively third world. Compared to other developed countries, our kids are too overweight, too likely to have diabetes, too likely to get pregnant, too likely to use illegal drugs. 

We have some of the best children’s hospitals in the world, but we pay pediatricians lower than any other physician specialty, and, as a result, have a shortage. It’s similar to those child care workers or elementary school teachers: we say we want the best for our children, but we don’t seem to be willing to pay for the best. And it shows.

——–

I wish I had some good news. I wish I had some solutions. When I look at the young people in my life I admire their spirit, but I fear for their futures. Why politicians fight things like universal preschool, affordable childcare, or paid family leave – each of which is undeniably good for children – I’m at a loss. 

We can do better for our children. We must.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

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THCB Spotlights: Lindsay Jurist-Rosnar, Wellthy

Today on THCB Spotlight, Matthew sits down with Wellthy’s CEO Lindsay Jurist-Rosnar to talk about the healthcare system’s need to support caregivers. Wellthy works in the caregiving space, and Lindsay tells us about the company’s mission to provide a software and platform experience that offers organization and structure to support those who are caring for a loved one. Lindsay also talks to us about her personal inspiration for starting Wellthy and how their business model operates. Wellthy has raised $50 million in total and has closed up $35 million this summer.

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988: A New Lifeline for Mental Health Emergencies

By BEN WHEATLEY

Miles Hall, a 23-year-old Black man experiencing a psychotic episode, was shot and killed by police after 911 received calls of a disturbance in his Walnut Creek, California neighborhood. His mother Taun Hall had taken steps to warn the local police that her son had been diagnosed with schizoaffective disorder and that he might be prone to mental health crises. She believed she had done enough to ensure that, in the event of a crisis, her son would be treated with care. But when the crisis came, authorities viewed Miles’ behavior through the lens of public safety, not through the lens of mental health, and it cost him his life. 

On June 2^nd, 2019, the day of the shooting, Miles believed he was Jesus. He believed that a large iron gardening tool resembling a crowbar had been gifted to him by God. But according to police reports, Miles had used the crowbar to break a sliding glass door at his parent’s residence. 911 received calls from his grandmother, who said that Miles had threatened her, and from his mother, who said that he was acting violently. In the calls, they both reiterated that Miles had mental health issues.

In addition to the calls from his family, nearby residents also placed calls to 911. One resident said he could hear “an argument, and possibly a gunshot.” The other said that a man with a red bandanna over his head and face and a “giant crowbar in his hand” had been pounding on his front door. 

In response to the 911 calls, police arrived on the scene. The police report stated that “officers gave multiple commands to Mr. Hall to drop the pry bar. [However,] Mr. Hall ignored those commands and ran towards the officers with the pry bar in his hand.” They fired upon him first with bean bags, but when he didn’t stop, they shot him fatally with their handguns. 

The events of June 2^nd, 2019 constituted both a mental health emergency for Miles Hall and a public safety emergency for those around him. However, the sequence of events involving 911 calls and police dispatch dictated that his case would be treated exclusively as a public safety issue. The deadly force employed by the police was seen as an appropriate countermeasure to the threat he posed. 

A lawyer for the Hall family said that an officer who had experience working with the mentally ill and who “knew Mr. Hall well” had been on her way to the scene. “But instead of waiting for her to arrive so she could help calm him down, officers approached him aggressively, weapons drawn.” 

The police chief said after the shooting, “My heart goes out to the family of Miles Hall as this was an outcome nobody wanted to have happen.” In September 2020, the city of Walnut Creek agreed to pay the Hall family a $4 million settlement as recompense for the loss of their son. None of the officers involved in the shooting were charged with crimes. 

The family has established the Miles Hall Foundation and is working to ensure that other families do not face similar situations in the future. “We really want to see a non-police response to mentally ill calls,” Taun Hall has said. For its part, the police have expanded its crisis intervention team, with the goal being to have someone available around the clock to respond to mental health emergencies. 

988 for Mental Health Emergencies

In October 2020, the federal government enacted legislation establishing 988 as the national number dedicated to mental health crises. The law instructs that calls to 988 will be patched through to the national suicide prevention hotline (800-273-TALK). Like 911, the new number will be implemented at the state and local levels. The federal government has said that each jurisdiction around the country will need to have its 988 lines open by July of 2022. 

The federal law allows states to raise funds by levying a surcharge on monthly bills for mobile and landline phone services. This money can be applied in several ways, including supporting the dedicated call centers, paying for trained mobile response teams, and providing more involved stabilization services for people in crisis. Telecommunications companies have argued that their portion of the funding should only support the call centers, not the other components of the response. 

California’s Department of Health Care Services has already announced that it will invest $20 million to support the launch of the new 988 hotlines in the state. Assemblymember Rebecca Bauer-Kahan, who sponsored supporting legislation, said “The Miles Hall Lifeline and Suicide Prevention Act will develop and designate a new three-digit phone number, 988, as the universal number to request an appropriate response to urgent mental health crises. With 988, callers will be connected to around-the-clock intervention, including mobile crisis teams staffed by qualified mental health professionals and trained peers instead of a traditional law enforcement response.” She said, “Mental illness is a health condition, not a crime, and health practitioners should respond to crisis calls, not law enforcement.”

A well-known and highly respected model for this type of response is known as CAHOOTS (Crisis Assistance Helping Out On The Streets), based in Eugene, Oregon. The program includes mobile crisis teams that work closely with the local police to assist in non-violent cases such as those involving homeless residents in need of help and people who are overdosing or intoxicated. These are cases that police are not well trained for and, in many cases, would prefer not to be involved in. But CAHOOTS does not immediately address violent situations or cases where there are potential weapons involved. In those instances, 911 dispatchers send police to the scene first, and police issue an “all-clear” before CAHOOTS members approach. 

The impetus for a non-police response gained momentum after the May 2020 murder of George Floyd and the “defund the police” movement that occurred nationwide. There are grave concerns that 25% of all officer-involved shootings involve people showing signs of mental illness. However, public safety obviously remains a central concern and most see the need for a continued police presence.

Making 988 Work

In order to work, 988 will need to address (and ultimately reconcile) two very different kinds of situations. In one scenario, a person in distress calls a phone line seeking help for themselves (the suicide helpline model). In another, people who are fearful about someone else’s erratic behavior call the police for help (the 911 model). 

The existence of 988 will not in itself mitigate public safety concerns. 911 operators and the police saw Miles Hall as a potentially violent person wielding a 5-foot-long weapon with a sharp edge, not as a suicide risk. And Miles wasn’t placing calls on his own behalf. Neighbors (and family members themselves) wanted some type of force to be utilized to restore calm to a chaotic situation. But the family expected that force would be wielded with compassion, with an emphasis on de-escalation. To quote the National Alliance on Mental Illness (NAMI), there are some cases that require “help, not handcuffs.” 

In responding to a mental health emergency, personal safety is the central concern. This applies to everyone involved, including family members, neighbors, strangers, the person in crisis, and the police themselves. Members of CAHOOTS have come to recognize that, when they arrive at a scene, their first step is to make sure the situation is as physically safe as possible. The Eugene police chief has said that CAHOOTS “has a tendency to almost immediately deescalate a situation,” and that is its “secret sauce.”

Addressing the needs of people in mental health crises involves both care and containment. This is illustrated by the close working relationship established over time by CAHOOTS and the Eugene police department. According to David Zeiss, CAHOOTS’ co-founder, “Partnership with police has always been essential to our model. A CAHOOTS-like program without a close relationship with the police would be very different from anything we’ve done. I don’t have a coherent vision of a society that has no police force.”

But we are left with the question: what should we do about situations called in to 911 involving potential weapons or violence? Miles Hall was not the first psychotic person to wield a potentially lethal weapon and he won’t be the last. To ensure that steps toward de-escalation are taken, 988 must be integrated with the 911 response. The calls placed to 988 will serve as a reminder to responders that the person posing the threat is someone in the middle of a mental health emergency, and that it is still possible to avoid a tragic mistake.

Ben Wheatley has 25 years of experience working in health policy with organizations including AcademyHealth, the Institute of Medicine, and Kaiser Permanente.

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What is the “Right” to Health Care Worth? It Depends

By MIKE MAGEE

In my course this Fall at the University of Hartford, titled “The Right to Health Care and the U.S. Constitution”, we have concentrated on the power of words, of precedents, and the range of interests with which health has been encumbered over several hundred years.

The topic has been an eye-opener on many levels. On the most basic level, it is already clear that the value of this “right” depends heavily on your definition of “health.”

We’ve highlighted three definitions worth sharing here. 

The first is attributed to Eleanor Roosevelt. In 1948, as lead for the United Nations Declaration of Human Rights, she defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” She also made clear at the time that each of us, as responsible citizens, bore a level of personal responsibility for our own health. By virtue of the choices we make, and the behaviors we exhibit, we raise or lower the chances of being “healthy.”

The second voice highlighted was also a woman. She is a physician from Norway, born on April 20, 1939, in Oslo, the daughter of a physician and politician. She received her Medical Degree from the University of Oslo and went on to earn a Master’s in Public Health at Harvard. She served three separate terms as Norway’s Prime Minister, never having fewer than 8 women in her 18-member cabinet. Her name is Gro Brundtland. In 1998, she was confirmed as director-general of the World Health Organization (WHO).

In one of her first WHO directives in 1998, she took on the definition of health which she described as “Part Goodness and Part Fairness.” She went on to explain, “Goodness in the sense that our professionals are well trained and qualified; our institutions well outfitted and safe; our processes engineered to perfection; our teamwork a reflection of training and excellent communication.” 

“Fairness in the sense that these skills and capabilities are fairly and equitably distributed to the broadest population possible.”

The third featured definer of health was a Catholic Cardinal from Chicago during those early Brundtland years. His name was Joseph Bernardin. He had terminal cancer in 1996 and was ultra-focused on health delivery when he addressed the Annual Meeting of the American Medical Association. He said, “There are four words in the English language that have common English roots. They are heal, health, whole, and holy. To heal in the modern world, you must provide health. But to provide health, you must keep the individual, the family, the community, and society whole. And if you can do all that, that is a holy thing.”

As the Earth and its inhabitants entered the new millennium, it was clear that the delivery of health care – whether local, national, or global – was a complex human endeavor. Even if you declared it a “universal right” as the UN and the WHO did, you would still need responsive programs, trained professionals, equal access, continuity of care, funding, compassion, understanding, and partnership. And even these would not be enough without forward-planning, anticipation, scientific discovery, and reliable funding.

When the Covid-19 pandemic hit, it rapidly revealed the cost of lack of U.S. planning, investment, and capacity. Specifically, the complex supply chain, including materials, human capital, and science failed. More alarming than these however was the damage and confusion that flowed directly from flawed leadership at the top. What Trump revealed was that trust, truth, and integrity were critical elements when it came to health delivery.

Weaknesses in this regard have been with us since the birth of this nation. But they have never quite been called out with such penetrating clarity as they were by Rev. Martin Luther King Jr., when he addressed the crowd at the Poor People’s Campaign on March 25, 1966, and said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

As I said to my students, we could learn a great deal by pondering whether Dr. King was right, and if so, why? At the time, President Lyndon Baines Johnson was struggling to make real his “Great Society.” The three-prong “Martyr’s Cause (as he labeled his efforts to honor JFK’s death), included the implementation of The Civil Rights Act, The War on Poverty, and Medicare. All three, integrated and interdependent, were necessary if justice was to prevail as suggested by the U.S. Constitution. 

Mike Magee, MD is a Medical Historian and Health Economist, and author of “CodeBlue: Inside the Medical Industrial Complex.“

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