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Invest Like the Best with Patrick O'Shaughnessy
Mark Bertolini - Performance During Pain - [Invest Like the Best, EP.438]
01:37:54
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- [00:00]
A
The best operators have a relentless focus on leverage, finding ways to multiply their impact rather than just working harder. But here's what I see happening in finance teams everywhere. Brilliant people getting buried in expense management. Busy work. If you think about it, you become a finance leader because you love strategic work. Modeling scenarios, optimizing capital allocation, finding the insights that actually move the business forward. But instead you're chasing receipts and categorizing transactions. It's the opposite of leverage. This is exactly why I'm so bullish on what the team at Ramp has built. Karim and Eric understood that every minute spent on manual expense management is a minute stolen from high leverage work. So they automated all of it. Automatic categorization, receipt matching, spending controls that actually work. I love the network effect that this creates. When finance teams at companies like Shopify and Stripe automate the mundane stuff, they free up cycles to think bigger, to ask bigger questions, spot patterns others miss, and make the kind of strategic bets that separate great companies from good ones. The math is simple. Get your time back, focus on what matters. Check out ramp.com invest and see what happens when you eliminate the busy work in asset management. Growth often depends on customization. It's the nature of the beast in our industry. And I know, having experienced the problem firsthand as an active manager, it's a competitive differentiator to tailor products and services to clients preferences. And we want to say yes. When we say yes, it means delivering a tailored portfolio of a tailored report or a tailored expectation for service. Saying yes leads to growth and it also creates customization and a trade off. The more you grow, the more complexity you absorb. The more you say yes, the harder it is to scale efficiently and consistently. That's where Ridgeline comes in. Ridgeline automates customization. It gives asset managers the ability to deliver personalized experiences at scale without adding headcount, manual work or operational risk. Having been an early design partner myself, I saw firsthand the power of taking an entirely clean sheet of paper to building the system we've all been waiting for. It's how leading firms stop choosing between growth and efficiency and start saying yes to both. I believe the best firms will be built on Ridgeline as their operating system. I also believe they will be a leading case study in the combined power of systems of record and AI. If you haven't spent time with them yet, I urge you to see what Ridgeline might unlock for your business as an investor. Gaining an edge means having the right tools and one platform leading the way is AlphaSense, trusted by 75% of the world's top hedge funds. AlphaSense is the market intelligence platform that gives institutional investors access to over 500 million premium sources, from company filings and broker research to news, trade journals and more. And with its recent acquisition of Teagus, it also includes the world's largest library of expert interview transcripts, over 200,000 calls covering more than 24,000 public and private companies all in one platform so investment teams can move faster, go deeper and make high conviction decisions with confidence. Now AlphaSense is transforming the research process with the launch of its Deep Research tool, part of the next generation of its AI powered platform. Unlike other deep research tools, AlphaSense's version is purpose built for investment research. It runs multi step iterative analysis using AlphaSense's proprietary content, including those 200,000 expert transcripts and in minutes services, insights that would take multiple interviews and days of digging to uncover. It's like adding 10 analysts to your team, helping you accelerate analysis, deepen understanding and make sharper decisions. See it in action@alpha sense.com invest hello and welcome everyone. I'm Patrick O' Shaughnessy and this is Invest like the Best, this show is an open ended exploration of markets, ideas, stories and strategies that will help you better invest both your time and your money. If you enjoy these conversations and want to go deeper, check out Colossus Review, our quarterly publication with in depth profiles of the people shaping business and investing. You can find Colossus Review along with all of our podcasts@joincolasis.com Patrick O' Shaughnessy.
- [03:51]
B
Is the CEO of Positive Sum. All opinions expressed by Patrick and podcast guests are solely their own opinions and do not reflect the opinion of Positive Sum. This podcast is for informational purposes only and should not be relied upon as a basis for investment decisions. Clients of Positive Sum may maintain positions in the securities discussed in this podcast. To learn more, visit Psum VC.
- [04:19]
A
My guest today is Mark Bertolini. Mark is the former CEO of Aetna and the current CEO of Oscar Health. He shares one of the most extraordinary leadership stories I've ever encountered, surviving a catastrophic ski accident that left him in chronic pain for 18 years while simultaneously leading one of healthcare's most successful corporate turnarounds. His personal experience navigating his son's life threatening cancer battle and his own medical challenges fundamentally changed his approach to health care, leading to innovations in employee welfare that Wall street initially questioned but ultimately celebrated. During his tenure at Aetna, mark generated a 652% total shareholder return by implementing Revolutionary employee policies and is now applying these same lessons at Oscar Health to disrupt the $4 trillion healthcare industry with a technology first approach. We discussed the power of servant leadership, employer sponsored insurance versus individual choice based plans, and the horizons of health care. Please enjoy this wild conversation with Mark Bertolini. I would love to begin with the story of this beautiful, incredible ring that you're wearing.
- [05:19]
B
Yes.
- [05:19]
A
You were just telling me about it, and then we rushed over here to get rolling so that we don't lose the story. Can you tell us the story of that ring?
- [05:25]
B
So I was skiing one day and had gone into the woods and caught an edge looking over my shoulder and hit a tree, broke my neck and slid 60ft headfirst down into a river in a coma. I broke five of my vertebrae, macerated my brachial plexus, disconnected my nerve root from my left arm from my spinal cord. It took them two hours to extract me from this ravine I was in. And they medevaced me to a hospital, gave me last rites on the way. I was in a coma for five days. And a friend of mine sent me this ring, this memento mori ring. And he said, remember, you will die. And when you look in Renaissance paintings, there's always a skull. That's the concept of memento mori. Remember, you will die. And he said, so with that in mind, every day when you wear this ring, look at it and ask yourself, am I spending my time with the right people doing right things? And if you're not running. So it's always been a thing, Am I in the right place doing right things?
- [06:28]
A
Can you mention what the Dalai Lama told you in the same vein?
- [06:30]
B
Yeah. So I asked the question.
- [06:32]
A
His first Dalai Lama reference on the.
- [06:34]
B
Podcast was, how do you react to people who frighten you? Because there's this thing called loving kindness meditation where you should find a way to meditate about those that you fear. And he said, well, Mark, in your heart, you need to find compassion for the journey they're on, because everyone has their own journey in life, but physically run. And he laughed.
- [06:59]
A
It's an incredible, beautiful idea. It is going back to the accident. I think there was a crazy detail where the fact that you were in this frozen river was a positive. Can you expand on this insane story?
- [07:10]
B
So I laid in the water and it took them two hours to get me out of there, but the water was just running across the back of my neck as they extracted me. There was a lot of ice and I had my backpack on. They couldn't get it off. Of me. I had all this ice and snow in there. And it was that ice and that cold water that prevented my spinal cord from rupturing because I have a quadriplegic injury. And in cases like that, there's often this event where the spinal column starts swelling and there is damage created in the spinal cord. And it didn't happen for me. When I woke up five days later, I was getting a sponge bath with a nurse and I said, what are you doing? And he went running from the room and said, oh my God, he's alive. And they didn't expect me to make it. They were very concerned as to whether or not I would make it. And then from there it was this journey to this day of trying to figure out who I was and how to live with the disabilities I had as a result.
- [08:04]
A
I want to talk a lot about that period of struggle and exploration. I would actually love to begin by setting the stage with a one minute life story up until that point so you can set the context of what your life was like from when you were little up through then.
- [08:18]
B
Grew up on the east side of Detroit. My dad was an autoworker. He was a pattern maker in the pattern making business. And my mom was a nurse part time. I'm the oldest of six. There are six of us in seven years. So the youngest seven years younger than I am. So I'm 69 and Philip is 62, but there are six of us in there. We grew up in a thousand square foot house with one bathroom and I slept in a breezeway. You could see the garage in the back of the house. And so it was one of those rough and tumble sort of, you had to compete for Americana households. Yeah. With days when there wasn't any real organized sports for kids. So we were sent out of the house and told to come back when the street lights came on. And so I always tell people this story of privilege and I see. And when we walk down the street, we could pick up 24, 25 kids to go play baseball at the sandlot down the end of the street. And we stood on the third baseline, we picked two captains and they picked the teams. And if you didn't get picked, that meant you weren't good. There were no participation trophies, nobody had to play. And the only way you got to play was by practicing and improving your own game. I had this little cockapoo named Toby who used to shag fly balls for me when I would hit them and try to just learn how to hit better. And when you Got better. You got picked. Wow, what a concept. Meritocracy. And so I grew up in that kind of neighborhood. We were loose all the time. We had to make arrangements in the neighborhood to be safe. And we had fights and we had friends. And in that process, I learned that there is no good bully. And the only way to beat a bully is to challenge them. And so I was the one who always defended my brothers from bullies. Take that into my career. I was an auto worker in the assembly line of Ford Motor Company. When I flunked out of college, I did rear axle differential housing on the Mercury Bobcat. Got in a fight with my union steward because I changed my work rules. I moved my stuff around, and he didn't like that. He said, that's got to go to the union. I said, how do I get your job? He says, you need a degree, kid. So I looked at my course books, said, here are the classes I could keep if I actually passed them. Here are the ones I could pass if I actually went to them. Then these are the other ones I should never take, like organic chemistry. My mother wanted me to be a doctor. And I ultimately realized after working on the streets of Detroit as a paramedic that I shouldn't be a doctor, that it wasn't the thing I wanted to do. So I decided to get an accounting degree because that was the quickest way to get a degree so I could become a union steward. Buddy of mine was studying for the GMATs. I helped him. I have a photographic memory. He said, you should take the exam. I placed high on the exams, and I got all these graduate schools of business to say, hey, why don't you come and talk to us? And so I went around and I went to Cornell. And they had these great gorges and water running through these gorges, through the campus. It was beautiful. It was in the country. It was very laid back socially, not very laid back academically. I said, wow. And you can drink beer and smoke pot down in the Gorgeous. This is a cool place. I want to go to school here. So I went. I was married at the time. My wife and I went and we moved to Ithaca. She worked as a public health nurse in the hills outside of Ithaca, which are some of the poorest Appalachian neighborhoods in America. There's a great book, Rural Poverty in America is written about that area. And she was their angel in the hills that took care of them when they needed health care coverage. And when I graduated, I was talking to Wall street about doing investment banking or I was Talking to Mike Milken at Drexel about junk bond trading because I was top of my class in finance. And a friend of mine called me, said, you want to start at hmo? And I said, what the hell's an hmo? And he sent me this note. Although it was a US Healthcare public offering, I looked at it and I went, wow, that looks pretty cool. And we went to Detroit for about a third of the pay I could have got anywhere else and went to work in Detroit to start an hmo.
- [12:05]
A
Describe what it's like to have a photographic memory.
- [12:08]
B
Scary. It makes you lazy. So in high school, when I took my exams, I went to a public high school. All I had to do was remember what was on the blackboard, and I couldn't just repeat it and I would just write it down. So when I got to college, I went to the Monteith program at Wayne State. That's where I flunked out. It was self study, and that was an absolute disaster for me. There were no blacks or acetates, the things that you put on top of a projector.
- [12:34]
A
Yeah, yeah.
- [12:35]
B
An overhead projector. So I had to recalibrate my learning. And then in business, when people hand me spreadsheets, I remember them. And when the cell changes, I view myself as a forensic scientist looking at spreadsheets to see which cells were changed in order to make the numbers work. Yeah. And I can see it. So it actually glows on the page for me when I'm looking at a printed page and there's something misprinted. I can see that word before without reading it.
- [13:01]
A
And it's persistent. This hasn't changed at all.
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B
No. It gets a little crowded up here at times. At my age now, I've just turned 69. So every once in a while you have to get rid of stuff in order to put new stuff in spring cleaning. Yeah, yeah.
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A
Maybe you could describe the key chapters now, starting with the HMO up through what you're doing now. Just. We'll go into each in more detail, but just maybe give us the chapter headings as you think about them looking back.
- [13:25]
B
So first company ran out of money. In three years, we're almost out of business. Had to learn that you actually need to implement what you think about, not just think about it. And that's where I developed the concept of Platonists versus Aristotelians. Platonists are people who think the great idea, communicate it and consider their job done. And the Aristotelians actually have to translate it into real work. And I Found that being an Aristotelian was far more powerful than being a Platonist. There are a lot of people with great ideas. Not too many people can actually make them happen. So that was that chapter. We fixed the business, turned it around. Ultimately, it got sold off. I was sitting at home thinking about what to do next, and New York Life called me. And that was my next chapter. Going to work in a larger organization to see if I could do what I did with my first turnaround, which was the first company I had, I went to work there. That got sold to Aetna. Aetna hired me after they start ran into trouble to help them fix the company. They were losing a million dollars a day when I showed up in 2022, and we had to fix that. And that took us on a whole journey. And so my career has had one job search, which was my first job search out of graduate school. And the rest have been phone calls from people who I know who have said, hey, I got an idea or a problem. And if it fit my profile, which is to fix broken things and build new things, not to make the trains run on time, then I said, hey, you know, I can help you. And so all of my jobs after that were people who reached out to me to ask for help.
- [14:52]
A
So when you go into a new situation, I want to talk about both fix and build. What is the strategy that you've developed for fixing something broken? I'm interested in the deep details of the steps you go through when you encounter in one of these new situations. You're orienting yourself up through it being fixed.
- [15:07]
B
You have to get down in the mud and crawl on your belly below the pillbox slot so you don't get shot. And it's just literally the work of doing deep, deep thinking. And in the beginning, I can tell you, because I was an MBA out of Cornell, and I had all these brilliant ideas that I knew all the answers and didn't need a lot of help. But ultimately, over my time, I found in my career that while I thought I was right 100% of the time, I'm really only right about 35% of the time. But it's just the issue of making a decision and moving forward. And if you have a good management process around it, it will get better as you go along. It will change because you have to navigate the changes in the business model, the changes in the marketplace. It's a lot like sailing. You don't sail from one point to the next. You actually have to vector because you have the waves and the wind and the sun and the topography. And you have to manage that. So that's just like any idea. So instead of waiting for all the perfect information to move forward, what you do is you develop a hypothesis, build a process around managing that hypothesis, take in the data as you move along, and then ultimately it would be a better thing. And if you look at all the great innovations in our society, those things didn't start as the thing that entrepreneur started with Apple. Those green and orange and yellow boxes, you probably don't even remember them. I remember the first PCs aren't what they've sold and made them successful today. So it's about this navigation and so to do it today. When I went to OSCAR the first 10 weeks, all I did was do deep dives with everybody in the arts, met everybody, sat in the room, asked questions, kept a list, set priorities, and over that time, what I thought was low hanging fruit in the organization were actually watermelons rolling around on the floor. And all we had to do was pick them up and manage them. And Josh Kushner called me and said, I hear you're in meetings asking questions. When are things going to happen? I said, josh, I have screwed up everything. This company has screwed up at least twice myself. I've broken it all. And I know I could walk in here and say, do this, do this, do this, do this, do this, and we'll be just fine. And people will look at me and go, who are you? Because you know, I doubled the average age of the employee population when I work in the building. Who? Kouri? What is an old man in here telling us how to innovate and create new things? And I said, but what I want to do is find out where people are and how they think about it so that I can figure out how to bring them to a place. Because I can't fire everybody. I want to bring them to a place where they can succeed. And so my leadership philosophy is we are here to help ordinary people do extraordinary things. And if we can help them by showing them or asking questions and bringing them along, we can fix things. And that's been part of the story at Oscar.
- [17:54]
A
In your experience, do you think that's actually possible at scale, that ordinary people can do extraordinary things?
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B
Yes. How? All they need to do is believe they can do it.
- [18:02]
A
How do you get them to do that?
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B
You have to paint for them. You have to tell a story about why it matters. So one of the first things I said at Oscar is we are a pirate ship. Filled with cannons among Spanish galleons, filled with gold. All we have to do is take their business. They don't think we can succeed. We're too small. But we have none of the ballast that they carry around with them about how they run their business. They won't go where we will go, and that's how we win.
- [18:26]
A
But how do you derive the why? That's inspiring enough. I'm struck by how infrequently even a great, smart, charismatic founder can really articulate the point of the thing they're doing. So how do you get one of those that is not just good, but so good it can galvanize ordinary people to do extraordinary things.
- [18:44]
B
So it starts with just doing the basics right. It's a lot like trading in the markets. It all starts with a T account. Someone's asset is another person's liability. That's it. And so you have to show people the connections and the line of sight instead of looking at each thing and saying, here, fix this, fix this, fix this. And when they start to see how it all fits together, then you've recruited everybody into a mental model about how the world works that we can share. So you don't spend a lot of time looking at little things and dealing with them. They now know the intent of the commander, the march, and the mission. And then you start adding on the layers of all the cool things we can do as a result of that.
- [19:25]
A
Can you teach us about the Cliff Notes version of the history of US health insurance?
- [19:30]
B
It was started 80 years ago as a result of soldiers and personnel coming back from war. And in that, they were worried about wage inflation. So they said, we can't have any increases in wages competing for talent, but you can create benefits. There will be operating expenses that you can then expense into your business, and it won't be taxable to the individuals. Health insurance was the first one. People were worried about a baby boom. They were worried about all the support that'll be needed. And so seven years after that, they started the Hill Burton act in 1952, which we built hospitals in every community in America. So when everybody started having babies, we'd have places for these babies to be seen, and everybody would have health insurance. Well, if you create enormous capacity and you give people no sensitivity to price by giving them coverage, you have created a great inflationary monster. And that's what's happened in large part. So we now have employers who buy insurance for a large group of people providing a limited range of benefits that, on average control the price of that benefit without really looking at the individual requirements underneath and what people need. And so people are stuck with more or less holding their nose and picking a plan that works for them, even though it's not something they would otherwise buy if they had the opportunity to pick it on their own.
- [20:52]
A
One of the things that you hear all the time is this system is so octopus like and so complicated and so entrenched that it just feels hopeless that it's bad, nobody really likes it. And the ambition to try to change it is impossible because of the path dependence that you just described going back to post World War II. And so the result is everyone kind of throws their arms up. Why could that be wrong? And what could we maybe do about fixing this problem that everyone seems resigned?
- [21:24]
B
We need to eliminate employer sponsored insurance and we need to say we're going to let individuals buy their own, but we need a marketplace to do that. And that's what the ACA has created, is a marketplace where people can buy my network, my benefit plan for me and my family. Now we need to help them understand how to do that more effectively. It's a lot like when we went from defined benefit to defined contribution in pensions. What should I invest in? How do I invest? And it's all based on your age and your risk profile and what you need to retire in the future. How do we hit that target and then use financial advisors? Our best opportunity is to have brokers help people understand what they can pick. The second part is that when employers buy insurance, they buy large networks because they have all these employees in multiple places and they give a range of benefits, but only a few which fits the average of the employee. The economics of large networks are that they are inversely cost effective. The larger the network you have, the less stability you have to negotiate better rates in the benefits. When you give an average benefit for employees, the employees have to decide which is the best for them. They settle for whatever it is they get and they have to pay 15% out of pocket. So in a small group employer, that small group employer with one pregnancy in a year will have a double digit rate increase every year because of an a blessed event. So what happens is a lot of those employees in that employer who didn't spend that kind of money pay 15% of a higher sum every year and don't have any control over their benefits and they get dissatisfied. Five years running, small group employers have been paying double digit rate increases. They're now just dropping coverage and saying to their employees, go find your own coverage. Go to the aca. Let's make that a more thoughtful transition. Let's help employers go to defined contribution. In the ACA, 75% of all providers are in the networks of some plan. All the plans develop narrow networks. So from our perspective, it's not about Oscar membership, it's about membership being able to pick their doctor and their hospital in a more price effective way. Because it's not an employer buying a large network, it's a narrow network. There's narrow networks in every market. It's designed by market. And the benefit plan designs range from bronze to gold. Where I can pick my journey. And so if I can pick the right plan with my doctor in my hospital and I can keep it, then I'm going to be willing to pay for it. Last year, two out of five Americans borrowed $74.9 billion to pay their out of pocket costs for health care from banks. Crazy, isn't that? What if I get to find contribution from my employer what they're paying for me today and I buy a plan that suits me at a better cost for the network and a plan design that works for my family using a plan selection tool. Are you going to have a kid this year? Are you thinking about building your family? Are you going to have any surgeries that you need? You build your plan design to support that, you buy it, you have money left over. Most often I can use that to pay those out of pocket costs instead of going to the bank. Or I can buy dental and vision, life insurance or disability. All of a sudden it's my plan, it's my choice, it's what I want, which Americans have in every other part of our economy. They buy what they want, they can see it online, they can make their own choices. So that's what we should do.
- [24:53]
A
If I could draft in the smartest skeptics or the ones that least wanted to have that outcome, other than obviously incumbency, where businesses benefit from this or something. Are there smart critics that would disagree with you? And if so, how?
- [25:06]
B
There's a concern that sick people won't be well taken care of in that system. It's exactly the opposite. Consumers, when educated, can make a good choice because it's about them. It's just like medical care. I want my doctor to take care of me and what I want to accomplish in my medical care, not what the person on the front of Men's Fitness magazine looks like, because I'm never going to be there. I was at one point, but only for a fleeting moment and then it was gone. And so this whole idea of having the tools to allow people to be educated, to make this choice will end that. They can keep it because it's in their community. And as their circumstances change, they can fund that plan from another employer they go to or from the government. They can keep that network and that plan. All of a sudden it's what I want and it's mine.
- [25:54]
A
Maybe you can describe the state of the union of Oscar today for those that aren't familiar with the business. I think people know like the very broad, broad strokes, but give us just a high level summary of what the business is and look, and then we'll talk about directions that we'll go.
- [26:07]
B
So we currently cover about 2 million lives and they're all ACA members, Affordable Care Act. They're all people who in some way, shape or form need to have subsidized healthcare that they otherwise could not afford. We're expanding to more markets as we speak and the idea is to continue to bring to them tools that they can use. So we have a chatbot we're about to launch that helps people understand their condition in a deep way. They can talk to it and get information and go back and forth with it. We have implemented almost two dozen large language models on the back end of the business that have reduced our operating costs. So we've been able to reduce costs and hold our prices at a lower place other than what we would have had we had these bigger costs. So it's a Digital Forward cloud native platform. First new platform for health insurance that has been built since 1972. So everybody uses the old Health Edge platform. I've modified health edge three times in my career and was built in 72. Everybody has it pretty much. We have our own platform. Secondly, we have one version of the Truth in Data so we can use large language models and AI at scale, which has huge advantage for us in the marketplace. So Digital Forward, working virtually AI capabilities on a new platform that is lower cost than almost anybody else's, allows us to put a very unique product in the marketplace. So one of our great products is for diabetes. We actually have a program where we encourage diabetics to join us. Counterintuitive in the insurance industry, asking sick people who cost $1,600 to $1,700 a month to join your plan. But we know if we give them the tools and the capability and the understanding, we they're going to get better, we're going to get the risk adjustment for it in the system and we'll be able to take care of them and not have to rate them up as a result of what they've been going through.
- [28:02]
A
That's a great example. Maybe use the diabetic plan as an example of the flow of funds and how it all works. If I think about the economics of that product specifically, it's a great example to explain a complicated system around one patient.
- [28:15]
B
An uncontrolled diabetic costs about $1,600 a month. A controlled diabetic can get down to $900 a month, $700 opportunity, so you can invest $699 and get a return out of it per month in that patient to make them better. So we put together a set of tools and capabilities that they can learn, including wearable glucose sensors that help them manage the care. And because we're digitally forward and people can learn and go at their own course and work with their doctor, we attract a population that's interested in being better. The people that join our plans want to get better. Every so often, four times a year now, we submit to the government all of our claims, and those all have risk adjustments on them, diagnosis codes and treatments that were given, and then that's all compared to each health plan. And the health plans that have more risk as a result of that analysis get paid by the plans who have less risk. We set aside money for risk adjustment clearance, and we do that throughout the year. We send out money to the government, who then reallocates to people who didn't get paid as much as they should have.
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A
And so if you think about the idealized version of this business, not serving 2 million, but 20 million customers or more, what does it look like in the ways that are the most different from how it looks today?
- [29:36]
B
So we think we can serve 125 million people. The last group of insured business on a group basis is middle market and small group employers. So small group employers are under 100. Large group employers are middle market up to 1,000. And those people all buy insured products, they pay a premium to the insurance company and they get coverage back. That is a less effective system because those populations that they underwrite for those groups are anywhere from 10 employees to 1,000 employees. And when you compare it to the individual market, where we have 24.2 million people, the ability to manage risk over larger populations isn't there for them. So they are subject to higher rate increases. There's 79 million of those people. So we believe that if we offered an Ichra product, an Individual consumer health reimbursement account to those employers. We can reduce their costs and keep them sustainable over time. But we have an example right in front of us that works. So 79 million people there, there are 20 to 30 million gig workers who can't buy insurance through a group. But if we create hour banking, the ability to set aside hourly rates that you then can aggregate at the month and buy your policy, that allows them access to the individual market. And then there are large employers who are looking at this as well that want to take first their part time workers, but then ultimately over time more of their workers and put them into the system, that's another 80 to 100 million lives. So it's a massive market. If we get everybody to move that way, where every American gets the choice to pick my network, my benefit plan.
- [31:18]
A
Is it fair to summarize it as the journey to a reformed healthcare system? Sub inflation cost growth, which I'm sure everyone would want to sign up for, will be the result of personalization and efficiency. And that's the style of plan and personalization and AI and other tools on the efficiency side that those are the two major levers.
- [31:37]
B
Spreading the risk of the sicker people in the population across the larger set of numbers makes it more effective from a risk management standpoint. A pregnancy can't blow up your rate next year because that gets spread across the whole population. So the idea is better risk management, equalizing the risk across the population and then secondly having freedom of choice on what I get and what I buy. Now there'll be limits. It doesn't mean people can take their defined contribution, put it in an account and spend it on beer. They actually have to buy health insurance or health care in some way, shape or form. So we don't want people taking unnecessary risks but saying, oh here's a great pot of gold from my employer, I'm going to spend it in a different way. They have to use it to provide that benefit.
- [32:23]
A
If you do a pre mortem on this attempt to make this 2 million into 120 million, and I say you just have to assume that it doesn't work, what do you think the most likely reasons are? That it won't work at Oscars specifically.
- [32:36]
B
There'S going to be resistance at the large end employers, they have benefit staffs of hundreds of people. This person buys pharmacy, this person buys dental and they just manage the whole process. You don't need all those people. When you give the money to the employees and say, hey, go buy your own health insurance and that's going to be one resistance. There are consultants that advise large employers and get paid a fee every year that goes away. Brokers who think they're disadvantaged by it can help us with the employees picking the right plan so we can help preserve that model for them. And then there's just going to be the regulation required to make the changes. So in Indiana we've already made the changes to allow Ichra to occur. From the standpoint of that state, we need it on a national basis. It was in the original bill that came out of the House was called Choice, which I think is a better name than Ichra because Ichras doesn't sound.
- [33:25]
A
Sounds like Icarus.
- [33:26]
B
Yeah, right, right, it does. Or Icky. But it's called Choice. But that got pulled out by the Senate because of the tax effect of HSAs for all those benefits. But those benefits are being tax advantaged for employers now anyway. So it really shouldn't be scored that way. But that's the way they scored it. So it saved $30 billion. So they pulled it up.
- [33:48]
A
I like this concept of the battlegrounds or competitive frontiers within a given industry. Oscar is fighting other people that are offering other things, incumbent solutions, all this kind of stuff. What are the competitive frontiers? What are the places that you win and lose versus others?
- [34:04]
B
Today size has an impact. We only have 2 million people and we took care of 54 million people around the world. And so that's a different issue. But size has an advantage as well. We have the A team on this product for these people every day. That's a subsidiary of most of the other companies who didn't take the time to understand it. Some companies are pulling out of the market because they use their commercial networks instead of narrow networks, because they didn't really pay attention to it because they had their C team on it instead of the A team. So size has. It's a double edged sword. We think about this every day. We innovate against it every day. We know it could be bigger where larger employer, larger competitors have a lot of other businesses to pay attention to like Medicare Advantage. So that's one set. The other is the regulatory framework. We have 51 regulators, 50 states and the federal government and we have to try and react with them all. And as you see with changing regulation now by state, it's almost impossible in some cases to deal with the way these regulators behave because they're contradicting one another. Like the abortion issue, you get penalized as a national carrier if Missouri absolutely forbids abortions and it's an employee who works for an employer in another state that offers them. You get penalized. There's a fine for every case. And so you have all of these things that you need to navigate from a regulatory standpoint. It would be far better if we just said to the states, you run your own exchange and your own markets for your people in that market, and we'll be able to make this work across the country. So we have all of these internecine warfare going on between the states and the federal government over how you spread the costs of this. So that's an issue. The third one is just there are a whole bunch of actors in the system. So if you look at the way the economic models are, physicians, 760,000 or so, all work on a cash basis. That's their accounting model. The hospital systems and the facilities that provide healthcare around the country work on a revenue basis. And as long as I have enough revenue coming in, I can win. And then you have insurance companies and pharmaceutical companies and biomedical research companies and DME and all these other companies that work on a margin basis. And so you have 760,000 physicians, cash basis. You have 6,900 hospitals and add probably another 6,900 facilities as well. So almost 13,000 that work on a revenue basis. And then you've got Act 1300 insurance companies, and add up all the others that are on a margin basis, and you put those economic models together, it's a wonder people get care at all. And so when you look at that discontinuity, it really should be the other way around, where the individual buys, it's my money, not some employer who's trying to manage a whole group of people or a small employer who can't manage their own healthcare costs because they got so few people. It should be the individual saying, here's what I want out of the healthcare system. And then ultimately, the healthcare system will have to align. But those actors are all going to fight against one another. And there's a quote I have had under my blotter every day of my working career. I'm fascinated with Renaissance Italy. And it was Niccolo Machiavelli when he wrote to the Prince, there's nothing more dangerous to effect than to initiate a new order of things, because those who are advantaged by the current order have the laws behind them and experience to continue to support the way it is. And for those who would be advantaged by the new order of things really won't embrace it until they experience it. And between the two, you are in great danger. But you like to live in that place. And that's where I've lived. I've lived right in that place my whole career. I am an iconoclast. I never fit in with the CEO club. I'm an iconoclast.
- [37:53]
A
What does that mean to you? What does it mean to you to be an iconoclast?
- [37:56]
B
Yeah, you just challenge everything.
- [37:58]
A
A pirate.
- [37:59]
B
Nothing should remain the same unless it can stand on its own in that.
- [38:03]
A
Dangerous space that Machiavelli describes. How much of a grenade does AI feel like to you? Because if I think about, if I try to boil this down to its basics, it's when I'm normal and healthy, nothing happens. So typically you get older, stuff starts happening, or you're young, something happens, something happens. I have to figure out what it is with experts, with one of the 760,000 doctors or whatever, and then I need to do something about it. And that's a value chain. Increasingly I've heard stories about people solving very hard problems, diagnosis problems by themselves, with chatgpt that 15 doctors couldn't solve and disintermediating that part of it. Obviously there's tremendous innovation I want to ask you about later on the biomedical side and the biotech side and self serve solutions and screenings and all this crazy stuff. How much does AI plus other technologies represent a grenade in this system that's positive.
- [38:53]
B
So for a long, long time we deferred to our clinicians and said, whatever you think I ought to do, doctor, I want to do. And really what we should understand is that the best prepared clinicians in the world today are people who just got out of their residency. They know all the latest science. If they were to read two journal articles every night for a year, by the time the year passed, they would be five years behind on the latest literature in healthcare. So how do they keep up? Particularly for an internist, I mean, it's almost impossible. And so this idea of using AI as a way of gathering information and giving you insights, I always say to people, the mental model that exists inside your head about how the world works is the most critical tool you have. And if you don't constantly add new information to it and are not a continual learner, you can't possibly know what you need to know to make good decisions. And so I look for two things in executives, curiosity and courage. The curiosity to continue to ask questions and learn more every day, and the courage to act on it when you have a hypothesis that might be powerful and that's where I think that could help. I think better informed consumers about how healthcare works and what their options are is a far better world than just deferring. There are a lot of times we have cases, and I've been in these situations where a patient is dying and the family looks at the doctor in the waiting room when they walk in and go, what can we do next, Doctor? The doctor never really wants to say, well, I think it's time to let this person go. They want to say, okay, well, we could try this or we could do that. We often get those prior authorization requests when the patient is at end of life. And the reason is because they're stuck in the medical industrial complex. I had to put my son in hospice July 15, 2002, and it was a horrible decision to make. I had to give up hope. I had to say, he's no longer curable and that we just need to wait for him to die. And he went into his hospice room and then I found a drug for him. And he came to me and said, you know, your son has to come out of hospice if you apply this drug. I said, let's see, dad maybe living. I think I'll take the maybe living route. He can go back to his room and we'll work there. And so what we found was, is that in hospice end of life, where 60% of your lifetime costs are spent, Medicare rules and most rules in most insurance companies require you to say, I can no longer seek curative services and I have to give up hope. I have to say, I'm going to die in a certain period of time. And you go, what we found is at Aetna, we tried this. And I remember when I brought it into the office and they all looked at me and said, you're going to break the company's back. I said, let's not require them to give up hope for curative services. Let's allow them not to have to say they are going to die in a short period of time. And let's just let them go into hospice early. It was amazing. It went from 18% of people being in hospice before to 75% of people going into hospice. The letters we got from people about how amazing the final days were and how much better it was when they weren't hanging out in a waiting room waiting for a doctor to tell them what's next. And the costs were 75% lower in end of life. So changing the rules about how we do these things, AI can help us in these places. There are just Certain things that are just not going to end well. And as my Eastern belief system says, we just change our form and go to a different place as a result of death. It's not the end of your energy and existence in the universe.
- [42:29]
A
How did you arrive at your eastern belief system?
- [42:32]
B
When my son was in the hospital and needed a bone marrow transplant.
- [42:36]
A
What was happening with your son?
- [42:37]
B
My son had T cell gamma Delta lymphoma. Only 34 people, all men, had ever been diagnosed with it. He was the youngest at 16, and it had a six month end date. I was told he was only lived six months and I said, well, not me. So I quit my job and I took him around with my wife and we went around to meet all of these physicians. And there was this physician, Eva Guinan at Boston Children's Hospital, who said, deadly disease. Nobody ever survives this. I've never seen one. They're so rare. But I got an idea. If we create graft versus host disease, which is a bad bone marrow transplant, it will attack the T cells, which are cancerous, in your son's body. If we can kill all the T cells, we can kill the cancer, but then he's going to survive. Graft versus host disease, where the body goes to war with the bone marrow that we put in that isn't his bone marrow. So finding the right mismatch happened to be my brother Peter, who's the third in the line. John's 11 months behind me. Peter's 10 months behind John. So we're the Irish triplets, 21 months apart from. And Peter was the perfect mismatch. So Peter graciously gave up his bone marrow for Eric. We put Eric into radiation. We zapped him where he had no ability to live after his final radiation period unless he got my brother's bone marrow, put the bone marrow in, killed the cancer, we're getting ready to go home. Graft versus host disease hits him, and we're in the hospital for a year fighting a horrible scenario. Graft versus host disease. Skin starts to come off, your gut sloughs off, you can't eat. Just terrible stuff. And so I'm in the hospital. I'm living in his room with him. I'm sleeping in his room, made him bring a bed in. I am meeting with the medical team for an hour every morning, going through my Harrison's internal medicine text and sticky notes. I've got a PubMed and we're talking to NIH doctors on the website about his disease and what to do next. And they tried over and over and over again to get me to do a do not resuscitate, because they said, your son's just not going to make it. He was not able to eat. He went from £140 to £80. He was starving. It was horrible. His hair fell out. It was just a mess. And he was bleeding out his total body volume of blood every day through his bowels. He had gastric dysplasia. And there were times when I gave my own blood because we're the same blood type, to help him get the blood he needed. But he was getting almost his whole body volume for weeks and weeks and weeks. So they came into the room one day. We need to talk to you. He's not going to make it. We need to put him in hospice. So I went in and sat down with him and said, eric, game over. We did the sorrowful mysteries of the rosary together, and he went into hospice. And I was meeting with the medical team that morning. I didn't have my Harrison's, Myrtle's internal medicine text, or my laptop. And they said, where's your stuff? And I said, none of that works. We're in space that nobody knows. He's starving. He's allergic to soy, so we can't give him intralipids to help him come back. There's gotta be an intralipid somewhere in the world that's not omega 3 fatty acid. And so one of the residents runs off and calls her nutritional professor at John Hopkins. He says, oh, yeah, there's a thing called omegaven. It's omega 3 fatty acid in Austria. And she comes back, I found one, but it's not FDA approved. So go see the fda. How can I get my son this drug? They say, oh, there's these three pages you fill out. It's called a single patient compassionate use exception. Have the doctors fill it out, call us, and we'll approve it. They approved it. It was made by Fresenius. The Fresenius CEO was in Austria. He brought it back with him to Boston. We gave it to my son, and four weeks later, his hair started growing back and his albumin went from 0.2 to 4. And this was in August. He came home February 18th of 2003. Holy shit. His kidneys were damaged. So he got my left kidney two years later because I had the best match for a kidney. And they did it laparoscopically. Then they didn't have to cut you in half like they used to. They put two holes up here in a slot down here, and they Went in, they cut it off, and it fell into the slot. And the doctor pulled out of the slot, and I was home the next day. It was an overnight stay.
- [46:46]
A
I've heard you say it before, but can you describe this line about your purpose?
- [46:50]
B
So Eric and I, after that, he and I used to ride motorcycles together. We went down to Rolling Thunder and doing all sorts of cool stuff. And we're riding around on the bikes one day, we're sitting at the bar, and he looks at me and he goes, dad, why are we both here? Because he came home on February 18, 2003. I broke my neck on February 18, 2004. So we went into hospice. I went down to the chapel, took the scapular off around my neck, the rosary from around my neck, the rosary out of my pocket, put it on the altar, and said, me for him. And having been trained by Jesuits in my career, we were always taught to be of right mind, to make good decisions, not to make bargains with God. And at that moment, I made the bargain. I said, let me have his disease. Let me have his pain. Let him live. I've lived a great life. He comes home on February 18, 2003. February 18, 2004, I hit a tree, break my neck. There was a friend of mine who was praying for Eric at the Wailing Wall in Jerusalem, Took his picture every day, put it in the Wailing Wall, and prayed for him while he was sick. And he called me and he said, how's it going? I said, well, Eric's doing well. I broke my neck. I tell him the story, and he goes, you made a deal, didn't you? Send me a picture. And so he started praying for me. He says, you're going to be fine. And so we're talking. He goes, dan, why are we both still here? Why does this matter? And I told him, the Grass Tyson thing. Out of a trillion different genetic combinations, there's only 100 billion people on this earth. We won the lottery, so let's make good use of it. I said, but I don't know what's in it for you, but you can't screw it up, because I'm just spare parts. And by the way, you can't have the other kidney until I'm gone. When I gave him the left kidney, I said to him, you have to drink Bud Long Nuts, because that's what it was raised on. Don't start changing the grease that runs the machine.
- [48:38]
A
This notion of a father saying that his purpose to be spare parts for his son. You told me that when we first talked, that line got burned into my brain.
- [48:47]
B
We were sitting in this other restaurant one day, it was the Gold Rock Diner in Hartford. And we're sitting there and we got our helmets on the table and we're talking. He's a theoretical physicist, he's talking about the absence of time and the concept of physics. And I'm talking about the absence of time in the Hindu belief system. Everything that's ever happened is happening now. We are just too limited in our intelligence to understand it. We don't see it, we can't see it. And we're talking back and forth on these different concepts. And he goes, yeah, but mine's science based. I said, mine's two. It's science based. There's this father sitting with his five year old at the table next to us. And I get up to leave, Eric's already headed out to the bikes, and he grabs my arm and he goes, is this something I have to look forward to? I said, only if you're lucky.
- [49:30]
A
The original question was, we also need to tell your story, which we'll come back to in a moment. But the original question was how you arrived at this eastern belief system.
- [49:38]
B
So Eric's in the hospital, he has this radiation. It was the most frightening thing. I panicked the first time he went in. Room with 12 inch walls and he's wearing these plates over his lungs to protect him. And they irradiate him with Hiroshima bomb kind of radiation. Five days straight to kill every piece of bone marrow in his body. Killed it all. So he can't survive without it. And so one day I walk in and he's got this woman doing Reiki therapy on him. And she's doing Reiki. She's not touching him. They're hovering. This energy thing. And he goes, dad, this feels great. And I'm sitting next to him, I'm going, she's not touching you. He goes, dad, it feels great. So I lay on the bed and she goes, would you like to try? And so she starts it with me. And after about five minutes I go, this is too much. When I get injured, I'm on seven different narcotics every day. Everything sounded like Charlie Brown's mother in the cartoons. When she would talk, it was always.
- [50:35]
A
Whoa, whoa, whoa, whoa, whoa.
- [50:36]
B
That's all I heard. What world was that? I was so high, but I was still in incredible pain. The drugs didn't touch the pain, they just let me not care about. It was the way it worked. And so I'm like, I can't do this. I'm sitting on the side of the freeway in HARTFORD in my 740IL, getting ready to run into a bridge abutment. Police officers, middle of the night. Cause I used to get up in the middle of night and just drive around like a madman and trying to get police to stop me, and they never did. But when I'm sitting on the shoulder, they stop me. They come over and go, what's going on? I said, I'm thinking about running my car into that bridge. And they're looking. I got a brace on my neck, my arms, and a thing. And they go, what's going on with you? I told them the story and I said, get in the car. Like, I go. They drive me home. They take the keys, they take my license. And your spouse can pick this up tomorrow. But you're not to drive again. It's too dangerous. Just let alone whether or not you're going to hurt yourself, you're going to hurt somebody else. So I was at wit's end, and so this friend of mine says, you should try cranial sacral therapy. And I'm going, what is that? And I read about it. And it's subtle manipulation of your bones and your head and your sacrum to reestablish a rhythm in your cerebral spinal fluid. And I had ripped my dural sheath and all this sort of stuff with the accident, so everything was torquing inside of me. So I said, how does this work? I go in, I get on the table, and this woman puts her hands on my head and on my sacrum. And all of a sudden she goes, give me just four visits. After four visits, I started coming off all my drugs. She got the rhythm. Because the cerebral spinal fluid is like a heartbeat inside of you. It moves up and down around your spinal cord and your brain all day long. And if you can establish that rhythm again, which might have been distorted by the accident, you can be better. I'm feeling better doing that. I start reading about the procedure. And then this therapist says to me, you should try yoga. Because I couldn't run anymore because I was too unstable. I said, yoga's for girls. She goes, oh, no. And she said, just give me again. Give me four visits. I'll show you. And she was a yoga teacher. And, like, after the first one, I could barely move. The next day, after my first set of asanas, and. And I started doing it more, and I was doing it on my own. And I said, you know, there's more to this than just the physical practice. And so I Started reading about the American Vinayoga Institute. And there was this great book by Leonard Perlmolter called the Heart and Science of Yoga. And it relates it to Western medicine. And I'm going, this really makes sense. So I started reading the Bhagavad Gita and the Upanishads and the Pratavija Nahar Dayam and all these other sorts of things, and started to realize this is just rich and that yoga is not in the United States. It's a physical practice, but it's actually understanding the teachings, yamas and niyamas, how you treat others and how you treat yourself. There's five of them each. They come into 10. And the first one is, treat others as you would treat yourself. Written 50,000 years ago, not 2,000 years ago, codified the Ten Commandments, written 50,000 years ago. And then there's the physical practice, asana, the movements initiated by breath called pranayama. And all of that is distilled, the body and the mind in a way where you can sit in an extended period of time meditating. And there are four limbs of yoga, of meditation, so there's eight total limbs. The ultimate being, samadhi. You're one with everything. You move Back to the 1. You find the Creator. And it's built on a model of that. In the beginning, the Creator existed, and only it existed. And upon realizing that there was no awareness of it unless there were others, it unfolded upon itself to create the world or the worlds how many there are so that those people, through a fog, could find their way back to the Creator and learn the lessons of being the One, that we're all just one thing, we're all the same. And so my mantra, which is across the back of my neck, is soham. In Sanskrit, it means, I am that and everything is me. It's all just one. And if you can keep that in mind, when you're with others, you and I are one. And so it's this model of thinking differently about your place in the world and what you do. So then I go to work one day. I say, you know what? I think we ought to do yoga for our employees. And I'm the president of the company. And everybody sitting in the room goes, oh, sure, boss. That's a great idea. The chief medical officer follows me to my office, and he goes, you know, this is voodoo medicine. I said, lonnie, no, it's not. It's not voodoo medicine. What do I need to do to prove it to you? He said, we need you to do a double blind study. So we do a bicoastal double blind study. We have employees sign up. We had 795 employees sign up bicoastally. We did cortisol levels and heart rate of variability of all those employees. And it was interesting. The west coast people were actually more revved up, more revved up than the east coast. And I don't know if the avocado prices were up or whatever, but somehow they were more wigged out than the east coast. We did 12 weeks of mindfulness and yoga classes. And Mari, my then partner, but was my wife for a while, Mari was the teacher and she worked with Gary Krassow at Vinyoga and they taught these classes. And after 12 weeks, what we found is that the people in the highest quintile of stress spent $2,500 more a year on healthcare than the average employee. So we put everybody through these programs. We had them journal, and after 12 weeks, heart rate variability, cortisol levels dropped 50% in this population. They started going home and having their families do it with them. All sorts of amazing things. Our healthcare costs went down, not trend. The actual dollar cost went down 7.5% the next year. So I said, we got to let every employee do this. So we opened it to employees during work. They got the time off to do it, go to the classes. And one day Mari walks in the house and she hands me the journals and she goes, okay, Mr. Big Shot CEO, you ought to read those journals. I said, why? She goes, because the problem with their stress is you. They're working two jobs. They got their kids on Medicaid because they can't afford the company's dependent coverage. They got people on food stamps. They're calling bill collectors while they're on break. You're not paying them enough. So I read these things. I'm going, wow, I'm the jerk here and I'm now CEO. So I bring in my head of human resources, who I ultimately had to let go, said, I want to know who these people are. I want to know what their life's like, how much they make. And it was about 12 bucks an hour. 81% were women. 20% of the families were on food stamps. 25% of the kids were in Medicaid because they couldn't afford dependent coverage. So this is crazy. Here we are a company that's come out of being almost out of business to being profitable. We've got to do something about it. So I said to her, I want to know what we can do for these employees. I want to raise their minimum wage. So we started in 50 cents in. So I said, this is just not enough. Let's go to 16 bucks. And the CFO goes, oh, my God, this could kill us. We put the 16 bucks in. And then one of my other executives came to me and said, you know, when you raise their wages, their coverage on their benefits is going to change because they're making more money because we graduated. I paid as CEO 65% of my medical costs, premiums and everything else where the frontline employees who were at $12 were paying like 20%. So what we did is we said, okay, there's 7,100 employees. Why don't we take these employees and say to them, if you are below 300% of the federal poverty level, we'll have an independent firm to adjudicate that and just say yes or no. I will eliminate all of your out of pocket healthcare costs if you join the wellness programs that are specific to your current needs. So I did this program. It was $75 million the first year. I was at the J.P. morgan conference on January 2nd of 2015, and I announced it in front of 240 of our 340 million shares and said, we're going to do this. I didn't ask the board because he said, well, how did your board let you do it? I said, well, this is one of those things where you ask for forgiveness and not for permission. And I just went ahead and did it. I got applause. Our employees all of a sudden realized that we could help one another. And we started doing other things. And I never had to do another suggestion. We doubled our tuition assistance. We paid back student loans up to $10,000 a year. We did pet therapy in all of our offices. And the only time I ever said no was when we went beyond dogs, cats, gerbils and rabbits. Somebody wanted to bring in mini ponies. I said, we're not bringing ponies into the building. That's just not going to happen. Cool idea, but no. And then it just took off. And all of a sudden we're spending 125, $130 million more a year and our stock price goes from $39 a share up to 80 because we then gave permission for our employees to care for our members like we were caring for each other. And in my last five years at Aetna, we're joyful because I didn't have to tell people to get to Sandy Hook to help families with critical incident structures. Briefing it all Just happened. We were like a company on a mission. And that's how the Eastern practices just changed my company.
- [60:07]
A
If we were to turn that amazing story into a directive to employers, CEOs, let's say, who want to treat their people the way that you just described because it's the right thing to do and because actually it's a selfish thing that you ultimately get a benefit out of it, what would you teach them? What are the components of doing that?
- [60:23]
B
Well, so we created a website for them because the spreadsheet would never work if you put the numbers in.
- [60:29]
A
Yeah, not going to be CFO friendly.
- [60:33]
B
The spreadsheet is the worst invention ever created from business. If you read the book, it was the terrorism of Excel or something like that I put in that book. But we've created a tool that allows us to manipulate numbers on the page to get the answer we want. And then we actually manage to it. We actually create a belief system that's not real and then we manage to it instead of saying, what are the five risks on this page? And this is what we did on the wage thing, okay, here's all the hard benefits. Let's take all the soft benefits, presenteeism, better attitude at work, empathy for our members, let's put all those on a page and let's discount them by 90%. And so when we did that, the group that we discounted by 90% added up to the exact same amount of savings as we had on the hard savings, which we didn't discount. And actually what it meant was, is that we were just not seeing far enough. And then what I said to the team is, let's not work by what the spreadsheet tells us, but let's ask ourselves, what are the top five risks of making this happen? Let's rank them by priority and let's stand back as a team and say, given this set of risks, do we believe as a leadership team that we can do this well and still make money? Said if we believe it, then it will happen. And so that's what we did. And so we put together a whole website for employers. And I would get phone calls from all these employers all over the country saying, help me walk through this, help me understand why. One of them was a family owned string of memory centers and they had employees that were making $12 an hour and they wanted to raise their wage. They said, but we're in the business of getting reimbursement for people with Parkinson's and Alzheimer's and it's hard. And I said, well, what's your biggest cost? False hospitalizations. How's that caused anger, combativeness? Does it matter how much your employees know those patients? Well, what do you mean? Because I worked in an Alzheimer's ward, my mother ran a string of nursing homes. And what I found in working with them is if you spent the time to understand how they behaved and you got them to talking about something they were interested in, you could find a way into them that would make them much calmer. You knew how to talk to them to do it. But I was there for three years in that unit. So I said, if you kept employees for three years and they were able to help your patients be much better and reduce falls and anger and combativeness, would that be worth your money? And they did it. And it worked. It's not about what's the data tell us, it's how can we understand the data in a way that allows us to do this effectively and not break the bank?
- [63:03]
A
How long were you in pain after your injury?
- [63:06]
B
I had no pain for a month. And then all of a sudden one night I woke up in the middle of the night, felt like somebody had set my hand on fire, and I went on a journey that until the end of 2022, I was in level 7 to 10 pain, sleeping one hour a night for 18 years.
- [63:23]
A
How's that possible?
- [63:25]
B
I did it.
- [63:26]
A
Sleeping one hour a night?
- [63:28]
B
Yeah. I would literally walk around in my room. The right side of my brain literally shut down. So my level of empathy was pretty low. And the left side of my brain was a machine. It was like a supercomputer. So I could look at things and say, okay, let's get the group together, let's do this. Every morning I would get the run of the billions of reserves at Aetna at 6:30. We would run the reserves every night and I would get that report at 6:30 and I'd look at it. And if I found a problem, everybody was in my office at 8 o' clock in the morning to review how we were going to fix it. Because every 50 basis points change in that trend was $980 million of margin. So that was my key metric. My brain was like that.
- [64:09]
A
So you were just like a business Terminator, effectively, during this time? 18 years.
- [64:14]
B
18 years.
- [64:16]
A
What got you out of it?
- [64:18]
B
So I was getting ready to go to Switzerland and my life at Dignitas, it's an assisted suicide organization. But I had to prove I had an attractable pain and pain that can't be cured. And so I was sent to a doctor, and the doctor evaluated me. And the doctor said I was gonna do it on February 15, 2023 was gonna be my death day. I wanted to do the 18th, but it was a Sunday. What was the day I had the accident? So I went, and this doctor sat down with me, and they did a few tests, and they looked at me and said, you don't have intractable pain. You have neuroplastic pain, and we can fix it. I go, here we go again. I mean, I did seven days in the Hahnemann Hospital ICU, 50 milligrams of ketamine, an hour IV to try and reboot my system. I had a great time, and it felt better for the first month afterwards, but then came back in a rush. And so I said, here we go again. And I had worked with Mari to help get her through how that was gonna work and what the plans were and all that sort of stuff. And so they go. I go, okay, well, let's start. So part of it was cognitive behavioral therapy, and I had to go back to my childhood and my constant. I was not well treated as a child, and so I was constantly under threat assessment. And threat assessment is the worst thing you can have when you have chronic pain, because you're always waiting for one cell to have pain, and then all of a sudden, it goes everywhere. And they said, and also your 42 pain centers in your brain have wired together from all this chronic pain over the years. So any touch feels like pain. So, in essence, I was addicted to pain. And they had done MRIs on baseball hitters, and they said, the best baseball hitters, their visual, cognitive, and motor cortices light up instantaneously. There's no latency. That's why they see the ball in slow motion. That's why they see how it's moving. That's how they hit so well. You have a baseball hitter's brain on pain. There's no latency in your system. Something touches your arm, you're in pain. So they helped me understand the system. Then they put me in transcranial magnetic stimulation, and they zapped my brain for 30 minutes to disconnect those pain centers. And they put me in a virtual reality lab with a helmet, and they re patterned my brain.
- [66:32]
A
And it worked.
- [66:33]
B
And it worked. I'm now out of pain.
- [66:35]
A
How long did that take?
- [66:37]
B
It took about six months. And my first reaction was extreme anger. Why? I was so pissed.
- [66:44]
A
Because you had endured it for so long.
- [66:46]
B
It was my brain. It was all pains in the brain. Anyway, as you probably well know, that it all happens in here, that my brain betrayed me. I thought I was smart. And then the second thing I had was incredible remorse for my lack of empathy for people and how I treated people and how callous I could be. Because when I was in pain, it was like, I got to get this done. I don't have a whole lot of time here to argue with you, so let's talk about how we got it done. I was patient, but I was not tolerant. And it should be the other way around. It's okay to be impatient, but you have to be incredibly tolerant to get things done effectively. It was like going through the 12 steps of alcoholic Anonymous. Then I felt like I needed to reach out to everybody and apologize to them and say, I'm so sorry if I ever treated you in a way that I didn't intend. And then I had to start controlling my emotions because all of a sudden I had them again as my amygdala dumped out. Your amygdala stores all trauma, and it doesn't date stamp it, so it sits there until you work it out. So once I started doing that, I'm watching dog commercials, I'm crying, I'm going, what the hell's going on here? I had to go through all of these emotional and physical changes as part of it.
- [67:55]
A
During that 18 year period, you made a ton of money. I did talk a little bit about that process. Your story is so crazy. I mean, one of these stories is crazy. Them together is remarkable. But then the fact that you also had this fairly epic run of business success during this time, it's hard to wrap one's mind around. I don't know how to formulate the question other than it's really interesting to me that during this period of insane pain and difficulty and one hour sleep a night, you were also somehow one of the more successful business people in the country. And you personally made tons of money. How did that happen? Reflect on that for us a little bit.
- [68:33]
B
So I never worried about the money. When I was 14 years old, I was working with my father and his plant. He was a foreman in a pattern making plant. And I was painting walls, cleaning bathrooms, cutting the lawn and doing all this sort of stuff. And I was making a dollar and a quarter an hour. I went to high school where we had the 7am to the 12 noon shift, and I was in that shift. I would catch the bus at 1:30, take it down to his operation about four miles away, and I'd go to work and I ride home with him in the evening. And there was this other guy that worked with me, Jerry. He was 24, and Jerry was not the brightest bulb in the pack. And he would work with me, but I was always working circles around him. So one day, Jerry and I are having a cigarette out behind the shop at lunch, and Jerry lets me know he's getting $4.25 an hour. So I go into my dad and I go, dad, I mean, I work circles around this guy. I want a race. He goes, well, what happens if I don't give you one? I said, I'm going to quit. He goes, you. Do you have another job? I said, no. He goes, good. You're fired. Go home. So I go home, and we had one of these tables, trussel tables, and we have the meal. There's eight of us around the table. And the meal ends. And I go to get up, and my dad goes, sit down. Okay? He goes, Looks at me and he goes, let me tell you about Jerry. Jerry's got a family. He's got a daughter, and he's got a wife, and he's got a house to pay for. And so I'm helping Jerry make his payments. Cause he has a family race. He has responsibilities, and. And he's doing a job as good as he can and probably not much better than he's gonna ever be able to. So I have an obligation to Jerry. You. You're 14 years old. I know we take some of your money to help the family, but you have spending money in your pocket. I said, I understand. He goes, so do you get why I'm helping Jerry and why there's a difference? Were you happy before when you were making your money? I was. Okay. Do you want your job back? I said, yes. Okay, you start tomorrow at a dollar an hour. He cut my pay. And he said, this is a very important lesson for you. Never count anyone else's money. Never compare yourself to anyone else on how much money you have when you have it. Make sure you share it for people that need it when you have enough. And never threaten to quit a job unless you got another one to go to. It's stupid. And you're going to have a family one day, and that won't work really well for your family. So the money for me was always something that I got as a result of doing good work versus having to have it up front. As a matter of fact, when I became CEO of Aetna, they didn't change my compensation. They said, we don't know you we're going to give you a shot for three years. And I said, okay, well, at the end of three years, I want you to recognize what I've done, and I did a lot of good things in that time. And this is my guidance to most everybody that works with me. Your salary pays for the bills, your bonus pays for the baubles, and your stock is never to be touched. It's part of generational wealth. It's for the future and to help others. So when I left Aetna, I had 3 million shares of stock. I never touched them. And I didn't expect it to ever be at $208 a share, because I took over. It was $9 a share, but it ended up being a lot of money. And the vast majority of it went into a foundation called Anahata, which is the heart, chakra and yoga, where I joyfully help food banks. I do environment, education, and community sustainability. And I give away close to 12 to 15 million dollars a year doing that. And it's a great way for the federal government not to get it and for me to use it in ways that I think are more useful versus them having distributed through the tax system. And so every year, I do that same thing. Whatever I make, I take a portion of it. I throw it into the foundation, and it'll be generational. My son to daughter, I told them they both have a great responsibility to manage something that'll be generational. I don't have yachts, and I don't have all those other sorts of things. As George David told me when I first became CEO, George David came over and spent days with me. And he sat down, he said, mark, I'm here to help you. I said, okay. He goes, you got two Sikorsky 76s here at Aetna, and you know how they work. And he described everything and the redundancy and everything. He goes, you know how I know that? I walk the floor and I'm with the workers every day. They know me. Anybody who goes on Undercover Boss should be fired by their board of directors. They know me. And when George left, he was banged out. And in a factory, in a manufacturing plant, when you get banged out, that's the workers banging on their machine. They never do it for a CEO. But he got banged out because of what he did for that company. And he made three times the total shareholder return that the guy at General Electric made without having a book and crowing on TV every other week. And so my view of the money part was, it will come Whatever it is, I have a responsibility, according to my dad, to share it with others and make sure I take care of those that don't have what they have.
- [73:12]
A
Money comes naturally as a result of service.
- [73:14]
B
It is, yeah, I have a servant leadership model. The important thing was, is that every day I woke up and I reminded myself that I had 50,000 families at Aetna that relied on me to be a good leader and to make sure that what we did created opportunity for the future. In my first company, when I started my first company, Sister Joyce Deschano was on my board. Sister Joyce deciano ran the Providence Hospital in Detroit. And Sister Joyce was the ultimate chairwoman of the Ascension Health System. She created the Ascension Health System, Daughters of Charity, and Sisters of St. Joseph. So I went to see her because we were having a for profit board, and Third was owned by management, third by doctors, third by hospitals. And I sat down, I said, I want to just make you comfortable with for profit governance. She goes, mark, we don't need to do this. I said, why, Sister Joyce? And she goes, at the Daughters of Charity, we have one very important mission. No margin, no mission. We don't make money. We can't continue to serve our people and extend our services to more people. So the only difference between a for profit and a not for profit that are well run is the for profit pays taxes. I don't. I said this at an investor conference one day, and I got a moan in the audience, and this young lady in the back stands up and she takes her sweater jacket off and she turns around, she goes, no margin, no mission is on the back of her T shirt. We believe this. And so what I tell people at Oscars, is we going to grow or are we going to make money? Well, you know, socialism works until you run out of other people's money. So we have to make money so we can continue our mission, grow to more markets. This other thing going on with the stock market is a bunch of people trading with each other, betting on whether or not that company knows what they're doing. And at Aetna, when I had 652% total shareholder return over eight years, when we looked at the underlying, only a third of it related to earnings and 2/3 of it related to the price earnings multiple or the Street's belief in whether or not the company generates a product that will consistently be valued by customers and it will continue to grow, that two thirds of that gain was largely around the PE and whether or not we were worth more, we were worth what we were saying we were going to do, and that was driven by our employees. We created 2,000 new millionaires when we sold the company to CBS employees. It's about creating something that's valued. I've always finished everything I've started and I made it valuable. How it gets valued and how people perceive it is up to that. One of my other sayings is what other people think of me is none of my business. It's their fault. They just don't know. So this idea of creating great companies is by building great teams. 60% of my time spent on people doing great things, solving big problems.
- [76:06]
A
Before I ask the question of why, then go to do what you're doing now at Oscar, I'd love you to talk about the Bridgewater chapter. This is a topic that this audience in particular will find fascinating. So he went to run Bridgewater and helped Dalio try to transition out of Bridgewater. Describe this story for us.
- [76:25]
B
So I get a phone call from a guy that I know, Rusty o', Kelly, Russell Reynolds, and he says, I'm on this assignment in Bridgewater. Ray Dalio wants to talk to you. Would you go see him? I said, oh, who would not want to have a conversation with Ray Dalio? He's such an iconic guy. So I go to meet him and we're having coffee downtown somewhere here. He's got a townhouse down here. And he says to me, I gotta get outta here. I'm approaching mid-70s and I'm trying to create a deal where I can go, but I really worry that the company will go to hell in a handbasket when I'm gone, because I've been at the table every day and it's been largely me running the show. So I'd like to get the deal structured. I'd like to create a governance model that includes more independent directors and I'd like to have a management process in the company that knows how to run the business while I'm gone without blowing the place up, because I think they'll just spend everything if they can, if I don't. He's got the typical entrepreneur, founder kind of thing. If I'm not here, the place is going to just go to hell in a handbasket. So I said, sure, sounds fun. It was literally a week after I retired.
- [77:36]
A
What year is this?
- [77:37]
B
2018. It was fall of 18. So I joined in February and I'm provisional as a board member and I start helping build the committee structure and charters and looking at the bylaws and working the deal. It was Chaotic, to say the least. I mean, here's a firm that by computer trades all this money every day in 200 liquid markets around the world. I mean, it's fascinating. As I'm doing that, Ray one day calls me and says, I'd really like you to become chairman of the board. I can't make this transition as chairman. So I became chairman of the company and we started doing more and more and we'd have these marathon negotiating sessions over the exit deal and all that sort of stuff. And there was no detail that was too small to consider. And we finalized the deal on July 15th at 4:15am we got lots of people at 4:15am and I'm on Zoom and I've got a bottle of Pappy Van Winkle batch feet waiting for me to have a toast. We did, we toasted at 4:15am we got the deal done. And then I'm hanging out in California. I spent time in the winter in California, in Laguna beach, and I get this phone call and Dave McCormick and had decided to run for Senate in Pennsylvania for reasons I'll never understand, but he wanted to do it. So we had created a co chair role for the two of us to go with the co CEO job role. And he calls me and he goes, ray wants to talk to you about being the CEO of Bridgewater. And I'm going, hey, I don't want to put in that kind of time because I got to learn the business. I don't know the business like other people do. But there was a young guy, Near Bardea, former IDF commando, and he was working there as the underling to Dave McCormick. I said, Tell you what, I'll ride shotgun with near until he's ready. So we did an 18 month deal and I did that. The culture is so institutionalized in that organization that causing any changes at the management process level about how we work was really difficult. People wanted to operate the way they always operated and that was a bit of a struggle. Near wanted to make the changes as well, but it was just really the investors who run the business and make all the money, they call the shots. And that's how it works in those places. Ray was getting nervous getting out and he wanted to do other things, but he didn't want to be too far. And it was all of those sorts of machinations. And so finally near was ready. I went back to the board and then I had been working with Josh and Mario for three or four years last year, an hour a week, and they said, you're not co CEO at Bridgewater. I go, no, I'm not. And they go, well, could you come and run, Oscar?
- [80:18]
A
And why did you decide to do it?
- [80:20]
B
When I left Hartford, I'm digging through these boxes and I find this small, flat box of acetates. You know what acetates are?
- [80:27]
A
The projection sheets?
- [80:28]
B
Yeah, yeah. They have the red cardboard rim, and then they have the clear sheet and you have words on it or cartoons. They were from 1991. And I would do presentations of health reform and what the future could look like. And I had these acetates, and they were interspersed with Gary Larson cartoons to prove points. One person playing chess and the other person playing checkers at the same table, or the one I always liked, was a bunch of knights standing on the field, half of them with the top of their armor going up. Why do we have to be skins today? So typical of how things get done in the healthcare system, in negotiations. And so I'm looking through them. I'm going, oh, Human Genome Project. I talked about it back in 1991. Oh, virtual healthcare. I talked about that in 1991. Oh, my God. Individual market. I'm looking at all these sites going, oh, my God. We haven't accomplished anything in 32 years. We're not making any progress here. And the system's still broken. And now it's 20%. Back then it was 14% or 15%. This isn't going to end well. And I thought maybe. And the CVS deal was meant to do with that. It was to create a presence in every local market and get people to come in and have a conversation in the stores that said, what is it about your health that gets in the way of the life you want to lead? Because I did work with ideo, with George Blankenship, who built the Tesla dealerships and the first Apple stores. And when we talk to people, they didn't describe themselves as a disease state. Like, I never say, I'm a spinal cord injury survivor. I've got certain deficit. My handicap went from 12.7 to 21. Had to have my motorcycles modified so I could still ride them. I can't play the piano like I used to. I was classically trained. My fly fishing just. I can't tie flies anymore. I mean, that's my problem with my health. Yeah, that's what bothers me. And that's what we found is most people described it as a barrier to something they wanted to do. And so if you can have a conversation with a diabetic who had pedal neuropathy and Say, what is it about your feet that get in the way of the life you want to lead? And they say, I can't go to the senior center anymore and play cards. Or I can't walk to the senior center anymore to play cards. Or I can't take my grandchildren for a walk in the park and sit on the bench without my feet hurting. Well, what if we got your diabetes under control and you could do that again? Now you have found a point of engagement with a patient or a member that's far different than saying, here's what a healthy person looks like. You want to be this. It ain't happening. So they give up. And 41% of the American public actually has this attitude of, my mother died of sugar. I'm eventually going to get it as long as I can live my life comfortably. When that time comes, I'll deal with it. They just give up. So how can we get people engaged in improving their life and living the life they want? By helping them be better. Was the whole.
- [83:09]
A
And that's what you get to do at Oscar now.
- [83:11]
B
That's what I get to do at Oscar now. And Oscar's smaller and it's more nimble. And we're like this little pirate ship floating around among all these Spanish galleons filled with gold, and they just look at us and go, oh, look at that little company. How will they ever make it? And most of our class of companies that came out when we came out are all gone and didn't make it. And here we are.
- [83:32]
A
How do you know what to do? I like this idea that the job of the CEO is to know what to do. How do you know what to do?
- [83:39]
B
It starts with the mental hero stick in your head. We all have a model. And I remember sitting next to Bill Taylor, who was chairman of CIGNA at the time, and he's talking about all these people he knows. And I'm going, I will never know this stuff. How do I get this? I said to him, bill, how do you know? He goes, bark, you have to have a network. You have to constantly cultivate that network. And you have to add to your mental heuristic in your brain. And all of a sudden new things will happen, and you'll say, oh, my God, I didn't see this, but now I see it. And that's how it happens for me. I constantly educate myself. I remember Sir Michael Marmot was coming to Columbia University, and Linda Fried, who's the dean of the School of Public Health, calls me and goes, I'd like you to do grand rounds with Sir Michael Marmot on social determinants of health. Holy shit. I don't a Nobel laureate. I'm going to walk around with him talking about social determinants of health. I had nine months, I crash coursed it, talked to all the experts and light bulbs went off in my head going, oh my God, we're doing this all wrong. And that's when I came up with the saying, which is now into the lexicon. Your zip code is far more important than your genetic code. Where you live matters more than what you are, and that makes a difference. And, and so we started building programs around in the home. We had a 72 year old lady in Camden, New Jersey, $2.7 million worth of healthcare costs in one year, 405er visits in the same year, more than one a day. So we finally go to her house, Thermostat's set at 62 because she can't afford her heating bill. She's got blankets and sweaters all over the house to keep herself warm that are made of her favorite material, angora. She's allergic to angora.
- [85:17]
A
Crazy.
- [85:19]
B
Buy her new sweaters, buy her new blankets, the next year, one year visit. So it was just learnings. As we learn more, I said, we got to do more in the home. We got to get connected to the home, we got to be closer to the customer, we got to make things more convenient for them. And we are now able to thank God for the pandemic. In one way, it taught us how we could do this all virtually a lot better than we thought we ever could. I worked with Andrew Weil down in Tucson, who on his way across the country after graduating from medical school, was going to San Diego to open a practice. His car breaks down. It's going to take him six months to make the money in order to do it. So he starts working with the Indian tribes and learns that, oh my God, medicine in this form as an integrative way is far better. And so he stayed there. So I was working with him and we don't do virtual healthcare. We have to put our hands on people. That changed with the pandemic. Wait a minute, we can do something different here. And so I think the pandemic taught us a lot of things about how we could virtualize healthcare. Oscar is really a virtual company. We do virtual home assessments and all sorts of other things. So can we deploy that at scale and make it better for everybody?
- [86:25]
A
So a big part of the answer to the question is constant curiosity, constant Curiosity, the courage was the other part of this. Can you define courage? What does courage feel like in your experience?
- [86:34]
B
Moving forward without perfect information or all the data? I always tell people 99 out of 100 people sitting around a table in a room are looking for somebody else to make a decision. And often people search for perfect information before they make it. And then it's too late. It's a non decision, which is as bad as anything. Let's make a decision based on a hypothesis. So another medical story. I am at a public health department dinner in Connecticut. I get food poisoning. I wake up in the middle of the night and I am by myself and I am sick for three days. I mean really sick. I finally crawl out of the bathtub where I just ran the water all day long to keep me clean. And I went to work and I realized I got heart palpitation, electrolyte imbalance. So I buy Smart Water. And so I'm drinking Smart Water. And after about a week, it's getting worse. So I said to Bev, my assistant, I said, bev, get the nurse from downstairs in the clinic and have her come up and look at me. And she comes up and she goes, we're going to get an ambulance and take you over to the medical center. I said, you are not backing an ambulance up to this building and putting the CEO in it and going off to the medical center. This will end badly. I can see the stock price tomorrow. So get my driver and take me to my doctor. And I have this Dr. Dan Chilton. Love the man, Family practitioner, general medicine. And he's, doctor, don't do that. And I call him that because I used to say when I roll my shoulder back this way, it hurts. He goes, don't do that. And so I go see him and I walk in, I tell him the story. He looks at me, listens to my heart. He looks at the bottle of water. He walks out, he goes, wait a minute. He comes back with a 16 ounce bottle of diet Coke. He says, drink it. And while I'm drinking, he's yelling at me about how screwed up insurance companies are and blah, blah, blah. Well, I've got you here. And I drink the whole thing. And after about 15 minutes, he goes, how do you feel? I said, I feel great. What happened? He goes, let me listen to your heart. It's gone. Let's do a quick ekg. It's great. Go home. He goes, stop. What just happened? It was. Well, Mark, my last two years in medical school, my father was the dean of the medical school at University of Virginia. And his buddy was at NIH in London, and he had a son who wanted to come to the United States for his last two years of medical school. And. And he offered a swap for me to go and sit in the uk. So I worked in family practice in the United Kingdom, where we don't have all these machines that go beep and all these blood tests that tell us all the answers. It's based on having a good hypothesis in your brain and knowing how to test it effectively to decide whether or not you're on the right track, because we don't have all this stuff. So you've got one kidney. Your electrolyte balance takes longer to reset, especially after you have food poisoning. So that's number one. It would have been better to get a Ringer's lactose IV early on had you known that it would have fixed it a lot quicker. Two, Smart Water is for sweating. You have a bicarbonate problem. You had a bad gut thing going on. That's a bicarbonate. There's no bicarbonate in this. So you were actually making your electrolyte imbalance worse by drinking the Smart Water. So there are two great sources of bicarbonate. There's Perrier. I can't afford it because you don't pay me enough. And Diet Coke. Coke. And I brought you a Diet Coke because you're 20 pounds overweight. You need to lose weight. You owe me a buck and a half. Go home. It was $1.50 for the Coke, and I went home. He says we're taught to understand our patients deeply, know the science, do a great history and physical and come up with a hypothesis and test it. And that's how I work. I figure out there's obviously something wrong. What are the possible ways of moving forward? Testing a number of hypotheses to find out what's truly wrong and then fixing them.
- [90:16]
A
We talked a lot about the worldview you've adopted through all these experiences. If I rewind all the way back to prior to going through what you went through with your son, this first crazy chapter, and then, of course, the subsequent chapter. How do you think your experience of the world today is most different than it was prior to that? If you could sit down and have lunch with 2000 version of you, how are you most different? What is it like to experience the world after having been through all this craziness?
- [90:44]
B
I always thought when I graduated from the MBA program at Cornell that I knew everything I needed to know about running A business. And I didn't know anything about running a business. I used to go to Ruloff's, which is a bar in College town. And they have the largest brain collection at Cornell. And the largest brain they had was for Ruloff, who was an axe murderer in the late 1800s. He killed seven people and got electrocuted. And they used to take these brains of criminal minds and try and see if there was any relationship between size and shape and bad behavior. Underneath the computer lab at Cornell, they have this massive brain collection of all these brains. And somehow Ruloff's brain got above the cash register in this bar. So Thursday nights, I would go to Ruloff's, and we'd drink beer and party. And Friday morning was my class on corporate governance and building organization structures, which I slept through most of the time and just wrote a paper on it and sent it in and just got the grade I needed to get out. And so I never spent my time learning all the subtle sciences of social management of organizations and had to learn the hard way. Every night I get all my material before I go home for the next day. I review it all, and I come up to the point of view on all of it. So when I walk into the meeting, I'm ready to discuss where we go versus having somebody read me PowerPoints. I tell people, do not read me PowerPoints. I will stop you. I have read them, so let's get going. So I always just say, those were all the right answers, and how long will it take the people in the room tomorrow to get to the same conclusion I know is the right one? And then I'd start asking questions to try and steer them to the right, leading the witness. And one day, Ron Williams is sitting there, and this is in 2003, before the accident. He goes, it's really interesting the way you operate. He goes, it's very transparent to somebody like me. And I would offer you a suggestion. Just try it. Those questions you put together for everybody, why don't you actually listen to the answers instead of preparing the next question and come up with two more questions as a result of the answer? You'll be amazed at how much smarter you are. And Now I know 35% of the time I'm right. And the rest of the time, I got to learn by asking questions. So it changed my style completely. So I would tell myself in 2000 or the late 1990s, a lot more humility and a lot more interest in what others think is a far better solution. And you'll get further along and you'll have support for it. Because when you tell people what to do and you stumble, the knives come out and you have no hope.
- [93:17]
A
What's your unfinished business, if any?
- [93:20]
B
I'm going through this debate internally about why do I continue to work, what am I looking for, what am I trying to find? And I don't know what it is. I know I'm not afraid of being alone. I love being alone. I'm an introvert by nature. You probably wouldn't recognize that, but I'm very introverted. I hate large groups. When I get up in front of large audiences, I'm sick to my stomach. It really is trouble for me. And it's not because I'm not confident in myself. It's just that I don't feel I need to convince others that I'm going to pursue. I know who I am. My unfinished business is understanding how I can be much more effective with what I have than trying to accumulate more, I guess. And what is that? I mean, it's my foundation rebuilding the libraries and the elementary schools in Harlem. We have created a reforestation plan for our five boroughs of New York. And we're planting trees now, and we're doing all these amazing things. Harlem Ground was one little farm, and it's now 25 farms across, all from 25 elementary schools in Harlem, helping families eat and learn. We have students that go to the farms and work with the children after school until their parent comes to pick them up. They get food, go across to the school, build a meal together and review homework instead of watching TV with fast food. All really cool stuff. And I'm really proud of all that work. But I'm unsatisfied and I don't know why.
- [94:34]
A
What have you learned about enduring impossibly hard things? Lots of people have to do this to varying degrees. Yours is extreme and extraordinary. What can you say, reflecting on the totality of it, about the endurance of difficult things?
- [94:48]
B
Never waste a good crisis. There's opportunity in everything that confronts you. It was actually Keno Reeves that said this. The challenges that come your way, the things that could break you, are really gifts because they make you a better person. People that have known me my whole life, including my five buddies that I went to kindergarten, grade school, high school and college with, I still see they just could never imagine I would be who I would be, nor could I. I mean, my role was going to be working the plant, get home by three, head up to northern Michigan to a little place I have up there and hang out and just be a good dad. And here I am. And I have all these other things and a lot of wrinkles along the way that have been very disappointing and things that I've done that I'm not very proud of that I did in the end analysis. Every one of them has been a learning opportunity that's made me a better person and the person that's come out of the other side. What I've learned is every crisis you face, you can't go back. You can only go forward. And you just have to pick up the pieces and start rebuilding.
- [95:51]
A
I've been excited to ask you my final traditional closing question, because your insane story. What is the kindest thing that anyone's ever done for you?
- [96:01]
B
I've had so many people be so kind to me. It's really hard to distinguish one thing. Wow. When I was in the hospital with Eric, they gave me an ID badge so I didn't have to go through security every time I get a pass to the room. And there was this doctor, Dr. Guinan, who came up with this treatment. And every time a dark turn would happen, I'd get a phone call from her. She was not on the floor. She was the head of the program. But I get this call from her, and she said, I am really hungry. Would like to share some fries with you over at the McDonald's at the Longwood Mall, which was right next to Children's Hospital. And I used to go over there to work out every day. The only time I left eric was from 10 to 11 every day. I went to the gym to work out, and they would do a sponge bath and all other sort of stuff for him. And she would sit down with me and say, you're an amazing human being. Here's what I would do next. Don't let them convince you that he's dead. Here's what I would do next. It cost her her job as the head of that program, and they put her into research because the hospital tried to take him away from me because they thought I was being unrealistically expectant of his potential. I was halfway to Hartford to go get my daughter, and the nurse called me and said, an attorney, the priest and the hospital administrator are, incidentally with your son, talking about emancipating him as a minor so he can make his own decisions. I flipped around one of the turnarounds on the turnpike, and I headed back to Boston at 100 miles an hour, hoping to catch a cop and say, you know, my son needs Me?
- [97:42]
A
What is it? These cops in you?
- [97:46]
B
Nobody pulled me over because I would have appreciated the escort is what I was going to be able to get. I walk in the room, I grab the attorney and say, this stops right now. I'm the adult. You. He can't apply for it without my permission. I threw them out of the room. Ava lost her role as the head of that bone marrow transplant program, largely because that cost that hospital a lot of money to have him in the hospital for a year and a half in an intensive unit. And they tried to get me to do DNRs. They tried to put him into hospice, and they just tried everything. I had a doctor in the cafeteria one day saying to me, hey, Mr. Brutalin, have you thought any more about that DNR? I grabbed him, threw him on the floor. Next thing, I have security all over him. I go, how dare you ask me that question in the middle of a cafeteria? What's wrong with you? Ava put herself on the line for him and she didn't know him or me for anything. And she's still an amazing friend. And if there's any one accomplishment I could point to is he's alive because of my engagement and my advocacy for him and her partnership in it. That's the kindest thing that anybody's ever done for me.
- [98:51]
A
Mark, your story is crazy, incredible. Just so amazing. I'm so thankful that you chose to tell it with me and for all that you're building and doing. I'm really appreciative for your time. Thank you.
- [99:04]
B
Thank you so much.
- [99:06]
A
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