A CALL TO ACTION

Reviewed by Del Meyer, MD

Hank McKinnel, Chairman & CEO, Pfizer, opens the preface with the question, “Is our healthcare system really in crisis?” He finds the question difficulty to answer because it makes a presumption he doesn’t accept. The phrase with which he has trouble is “healthcare system.” He agrees there’s a crisis, but it isn’t in “healthcare”- it’s in “sick-care.”

He quotes Mohandas Gandhi who had similar difficulty in 1932. He had led a campaign of non-violent disobedience to help colonial India win independence from Britain. After being named Time magazine’s “Man of the Year,” Gandhi visited London for the first time. The entire world was curious, the press swarmed wherever he went, when one reporter’s hastily called-out question became a defining moment, both for him and for the nation, he was trying to set free.

“What do you think of Western civilization?” yelled the reporter.

“I think it would be a good idea,” replied Gandhi.

That’s what McKinnell thinks about our healthcare system: It would be a good idea.

He maintains we’ve never had a healthcare system in America. As far as he can tell, neither has any other nation. What we’ve had—and continue to have—is a system focused on sickness and its diagnosis, treatment, and management. It’s a system that is good at delivering procedures and interventions. It’s also a system focused on containing costs, avoiding costs, and, failing all else, shifting costs to someone, anyone else. In fact, discussions about better health now take a back seat to arguments about costs. In the United States, a nation already spending nearly $2,000,000,000,000 a year on sick care, tens of millions of people do not have adequate access to the system. In other developed nations, rationing and price controls undermine the patient-physician relationship, degrade the quality of care, and add to the anxiety of individuals struggling with health issues. An aging population around the world clamors for relief from chronic diseases and the cumulative effects of heredity and lifestyle behaviors. Some of these we cannot as yet prevent. Others, such as smoking, we can.

Today, in healthcare, we have it entirely backwards. We’re like a community that builds the best fire-fighting capability in the world but stops inspecting buildings or teaching kids abut fire prevention. Fighting fires is sometimes necessary, and we must be prepared to do that with the most modern technology available. But firefighters around the world will tell you that they’d rather prevent fires than fight them.

To put it simply, McKinnell feels that our fixation on the costs of healthcare—instead of the costs of disease—has been a catastrophe for both the health and wealth of nations. By defining the problem strictly as the cost of healthcare, we limit the palette of solutions to those old stand-bys—rationing and cost controls. What if we reframe the debate and consider healthcare not as a cost, but rather an investment at the very heart of a process focused on health? Then other solutions suddenly appear out of the fog.

That’s why this book was titled A Call to Action. It represents McKinnell’s conviction that the debate on the world’s healthcare systems is on the wrong track. Unless we correct our course, we will not be able to make the same promises to our children and grandchildren that our parents and grandparents delivered to us: that you will receive from us a better world than we received from our forebears. He feels that the basic bio-medical research conducted by his company is doing just that. But he’s concerned that his and other research-based pharmaceutical companies might lose the capacity to advance the science that can change the lives of our children and grandchildren for the better, just as polio vaccines and cardiovascular medicines and other therapies changed out lives.

McKinnell doesn’t believe in surprise endings. Although he loves a good mystery, this book was not meant to be one. The first phase of his book sets up its basic theme—that when our most cherished support systems are at risk, we are called to rethink our most well-accepted assumptions. Everywhere in the developed world, people are dissatisfied with the healthcare their families are receiving. The near universal experience is that healthcare is increasingly unaffordable, fragmented, and impersonal. Thus, the first third of the book details the proposition that the current system is profoundly misfocused in three ways. It is preoccupied with the cost of healthcare, it defines the provider as the center of the system, and it regards acute interventions as its primary reason for existence.

In chapter one, he gives his “Personal Take, a Personal Stake” which outlines his qualifications to write the book. In chapter two, he addresses the almost trivial question of “What is Health?” which he finds very resistive to answers. In chapter three, on “Reluctant Healthcare Providers,” he considers how employers are instrumental in the healthcare of their employees.

After establishing these basic theses, the second third of the book speaks of the pharmaceutical industry that McKinnell helps lead. It is a source of considerable pain to him that this life-saving industry that he represents is viewed with suspicion, cynicism and anger. In this section, McKinnell answers some of the most pointed questions that patients are asking.

In chapter four, “Why Are Prescription Medicines so Expensive?,” he deals directly with questions and objections that customers and patients send him. In chapter 5, he discusses a common question “Why Does the Industry Do So Much Marketing?,” which they feel should lower pharmaceutical costs. In chapter six, he answers the question, “Why Do Americans Pay More Than Canadians for Drugs?” The answers are interesting.

In chapter seven, he “Welcomes Competition in Healthcare” which currently is between the wrong players and over the wrong objectives. He favors value added competition that focuses on increasing healthcare value instead of dividing it. In chapter eight, he describes his conviction that investments in health pay off in great wealth: “Health Creates Wealth: No One Left Behind.” Uninsured people in poor health cannot be said to have equal opportunities in a market economy. In chapter nine, he discusses “Consumer-Driven Healthcare: Balancing Choice, Responsibility, and Accountability,” a model based on the notion that the demand for healthcare service is limitless, especially when someone else is seen as paying the bill. Giving the correct financial incentives to patients will reduce use of services of marginal value. It will also give patients an incentive to seek out lower-cost providers of care.

In chapter ten, “The Research Imperative: The Search for Cures,” he feels that the real task of innovation is to make the new discovers and ideas into widespread use. In chapter eleven, “Information Intensive: Reaping the Benefits of Technology,” he addresses the difficult problem of incorporating patient-friendly information technology into a healthcare system that resists accountability demanded by information systems. Information technology is not the problem, and it’s not a solution. But we cannot get a handle on costs, reduce medical errors, and put individuals in control of their healthcare without embedding information systems deeply into healthcare at every level.

In the last part of the book, McKinnell delivers on the implicit promise made by the title of the book and sets forth a number of calls to action that seem to him most critical if the healthcare system is to be transformed. If taken seriously, he believes these actions can save millions of lives and billions of dollars over the next generation.

In chapter twelve, “Change is Possible: Infectious Disease and the Struggle for Hope,” he describes social investments and projects. . In chapter thirteen, "Next Steps: A Call to Action Starts Here," he connects the dots with his prescriptions for change that include action items at the individual, corporate, regional or national level. Chapter 14 “The Deadline for Complaints Was Yesterday,” describes his hopes that transformation is not only possible, but it is inevitable. Our children are depending on us. He is confident we will not let them down.

A Call to Action distills more than three decades of experience—both joyous and painful—that has brought McKinnell to this special vantage point. He offered these thoughts, plans, and calls to action to give our descendents all the benefits of healthcare that we have enjoyed. But we cannot do so under the liabilities and constraints that today weighs down the world’s healthcare systems. These systems promise healthcare but actually swindle people out of both their health and wealth. He concludes that you and I, our children—indeed, our entire human family—most certainly deserve better.

The three decades of thought and experience shows throughout the entire treatise. There is little to disagree with. Every physician, nurse, administrator and healthcare executive should read this volume and keep it as a handy and useful reference—someplace within reach, preferably on your desk. This refocus is crucial to our understanding and to healthcare reform.