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Excerpted from Mission-Driven Leadership: My Adventure as a Radical Capitalist, by Mark Bertolini, 2019, Currency, an banner of the Crown Publishing Group, a analysis of Penguin Random House.



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Editor’s Note: In 2014, afterwards CVS CEO Larry Merlo appear the accommodation to stop affairs cigarettes at its 7,700 retail pharmacies, Mark Bertolini, again CEO of healthcare behemothic Aetna, alleged to congratulate him. They agreed to accommodated to altercate business strategies and the approaching of the healthcare industry. In the chat that ensued, Merlo referenced the estimated $2 billion acquirement hit the accommodation would cost. “You accomplish money on a fee-for-service basis,” Bertolini recounts responding. “I accomplish money by befitting bodies healthy. You allegation a altered acquirement model, and if you abide accomplishing the things that you’re doing, our acquirement archetypal is the appropriate one.”

The altercation that ensued laid the background for accessible partnerships, including the abstraction of accumulation the two companies. Bertolini, who was in the affliction of Aetna’s attack to access Humana at the time, larboard the affair with a mission: blanket the Humana deal, buy CVS—and change the healthcare industry.



“That a bloom insurer would buy a pharmacy alternation is absolutely unconventional—such a merger, as far as I knew, had never been contemplated—but it fit absolutely with what I was envisioning for the approaching of healthcare,” he writes in his new memoir, Mission-Driven Leadership (Currency Books, April 2019).



That plan went south aback the Department of Justice blocked the Humana acquisition, claiming it ran afield of antitrust laws. But Bertolini, who had a agonizing immediate acquaintance with healthcare aback his son, Eric, was angry a attenuate anatomy of cancer, didn’t accord up on the vision. In this extract from the book, he lays out the healthcare system’s flaws—flaws that are not alone ambagious costs, but consistent in our dying adolescent and killing ourselves added often. And he tells us how to fix it.

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Aetna’s mission is to “build a convalescent world,” and it starts at home. I appearance our healthcare arrangement through a different prism. I’ve been a worker, a administrator or an controlling in the industry for added than four decades. I saw it up close, in its celebrity and its failings, with Eric. And I abide to acquaintance it firsthand, intensely, acquiescently and inadequately, with my own injuries.

Consider how our bloom arrangement works. You buy allowance and you get a card. You cull out that agenda aback you get ailing or sustain an injury, and you go to a dispensary or a hospital, and again the arrangement throws you aback into your life. That’s how we booty affliction of people—no abiding assurance in you as an individual, no accomplishment to accept what your needs ability be. Our arrangement is mainly reactive: it responds to affliction or abrasion but is contrarily alone from the circadian lives of best Americans. That access may accept been able at one time, but our country’s amusing and bread-and-butter ruptures accept apparent its barbarism to our accepted needs.

In 2015, advisers Anne Case and Angus Deaton appear a cardboard documenting the affecting acceleration in deaths amid middle-aged white Americans, apprenticed not by accepted ache but by suicide, drugs, booze and loneliness. The address abashed abounding commentators, as these “deaths of despair,” as they were called, seemed above the ability of our $3.3 abundance medical-industrial complex.

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Opioid corruption appropriately drew abundant of the attention. Eighty percent of all opioids produced in the apple are captivated by Americans, or abundant to accumulate every American benumbed for six weeks. The affliction is alone accepting worse. According to the National Center for Bloom Statistics, opioids were abhorrent for 34,572 deaths in 2016, a 52 percent access from 2015. Biologic fatalities all-embracing in 2016 accomplished a amazing 72,000. That cardinal does not reflect the millions of Americans who accept been compromised, bedridden or removed from the workforce due to drugs. According to a abstraction by the American Action Forum, about 1 actor bodies were not alive in 2015 due to opioid addiction.

The accumulative toll, from opioids and added threats, is grim. According to the National Center for Bloom Statistics, afterlife ante are ballooning beyond around all above diseases and ascent or blockage the aforementioned for every demographic. This defies aggregate we anticipation was accurate about our healthcare system, in which amazing advances in medical technology, affection and alone therapies were appropriation us to anytime academy plateaus of wellness. Instead, we are dying younger, and we are killing ourselves added often. In 2018, the CDC appear that suicide ante rose steadily in about every accompaniment from 1999 to 2016; the CDC attributed this access to amusing isolation, abridgement of brainy bloom treatment, biologic and booze corruption and gun ownership.

If you’re in pain, if you’re not clearheaded, if you’re absorbed to drugs, if you’re apathetic or depressed or lonely, you don’t affliction about annihilation else. You won’t accept a abiding job. You won’t accept an complete family. You won’t be economically, socially or physically mobile, and the American Dream will be article that you apprehend about in a average academy history book.

That’s why I accept if we’re activity to break the big bread-and-butter and amusing problems in our country, we accept to alpha with healthcare. Toward that end, we allegation to amend what our healthcare arrangement should do and alike redefine what bloom is.

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I’m fractional to the Apple Bloom Organization’s analogue of health, from 1948, as “a accompaniment of complete physical, brainy and amusing abundance and not alone the absence of disease” (my emphasis). That analogue grasps the added and added holistic attributes of health, yet actual few bodies call it in that fashion. Maybe the WHO’s accent does not allege anon abundant to outcomes. We allegation article that is added acknowledging and reflects the broader acceptable of wellness, so I like to say that “a advantageous being is productive; a advantageous being is socially, spiritually and economically viable, and a applicable being is happy.”

How we get there begins by alteration our compassionate of healthcare from article provided by your employer or the government to a adventure that you are in allegation of. Consider how you buy a car. You don’t go to GM’s address and adjustment one, and you don’t go to GMAC or to some added lender. You go to a dealership, and you acquaint the banker what you want: the size, the color, the interior, the complete system, the block space, the bench covers, all the accretion and whistles. You get the car that meets your needs, and again you advance a plan for how to pay for it.

Our healthcare arrangement does the exact opposite. In best cases, we acquaint you about your bloom plan, and again you amount out whether it meets your needs. We allegation to cast that. What if we had a arrangement in which your bloom insurer asked aboriginal about your bloom cachet and your activity goals? Those goals may be to watch your grandchild alum from college, to ascend Mount Kilimanjaro or to see your 50th bells anniversary. We could again say, “Based on your accepted bloom and your abiding goals, let’s architecture a set of allowances and a way to pay for them that would booty affliction of you for life.” That would be a abundant bigger acquaintance than for you to buy a bloom allowance action and delay until your knee is burst or your lungs don’t work.

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