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So we went into hospice.
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I went down to the chapel, took the scapular off around my neck, the rosary from around my neck, put it on the altar, and said, "Me for him."
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And at that moment, I made the bargain.
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I said, "Let me have his disease. Let me have his pain. Let him live.
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I've lived a great life."
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He comes home on February 18th, 2003.
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February 18, 2004, I hit a tree, break my neck.
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I was in level 7 to 10 pain, sleeping 1 hour a night for 18 years. >> How's that possible?
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>> It I didn't >> sleeping 1 hour a night.
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The right side of my brain literally shut down.
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So my level of empathy was pretty low.
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Left side of my brain was a machine.
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It was like a supercomput.
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>> So you were just like a business terminator effectively. >> Yeah.
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>> During this time 18 years. >> 18 years.
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>> What got you out of it?
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[Music] I would love to begin with the story of this beautiful, incredible ring that you're wearing. Yes.
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>> You were just telling me about it and then we rushed over here to get rolling so that we don't lose the story.
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Can you tell us the story of that ring?
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skiing one day and um had gone into the woods um and um caught an edge looking over my shoulder and hit a tree, broke my neck and slid 60 ft head first down into a river in a coma.
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Um I broke five of my vertebrae.
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Um masserated my brace brachoplexus, disconnected my nerve root from my left arm from my spinal cord.
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Um, and they it took them 2 hours to extract me from this ravine I was in.
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And they medevaced me to a hospital, gave me last rights on the way.
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I was in a coma for 5 days.
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And a friend of mine sent me this momento mori ring.
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He said, "Remember you will die."
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And when you look in Renaissance paintings, there's always see a skull.
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That's the concept of momentto mori. Remember you will die.
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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, run.
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C >> can you mention what the Daly Lama told you in the same vein? >> Yeah.
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So, I I asked the question >> first Daly Lama reference on the podcast was what do what do how do you react to people who frighten you?
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people who frighten you? because you know there's this thing called loving kindness meditation where you should find a way to to to to meditate about those that you fear and and he said well Mark he said in your heart you need to
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find compassion for the journey they're on because everyone has their own journey in life but physically run and he laughed it's an incredible beautiful idea 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, right? Can you talk about Can you talk about this?
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Just expand on this insane story.
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>> 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.
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>> And um as they extracted me, there was a lot of ice and I had my backpack on.
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They couldn't get it off of me.
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I had all this ice and snow in there.
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And it was that ice and that cold water that prevented my spinal cord from rupturing >> cuz I have a quadriplegic injury.
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In cases like that, there's often this event where the spinal column starts the spinal cord starts swelling and and there is damage created to the spinal cord.
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And it didn't happen for me.
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Um when I woke up 5 days later, then I was getting a sponge bath with a nurse and I said, "What are you doing?"
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And he went running from the room and said, "Oh my god, he's alive."
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Um and they had didn't expect me to to make it.
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They were very concerned as to whether or not I would make it.
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Um, and then from there it was this, you know, journey to this day of trying to figure out who I was and how to live with the kind of disabilities I had as a result.
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>> I want to talk a lot about that period of of struggle and exploration, but I would actually love to begin by setting the stage with sort of like a a one minute life story up until that point.
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You can set the context of what your life was like from when you were little up through then.
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>> Grew up on the east side of Detroit.
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Um uh my dad was an auto worker.
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He was a pattern maker in the pattern making business and my mom was a nurse part-time. I'm the oldest of six.
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Um there are six of us in seven years.
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So um the youngest is seven years younger than I am.
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So I'm 69 and Philip is 62, but there are six of us in there.
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And we grew up in a thousand foot house with a bath, one bathroom.
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Um, and I slept in a breezeway um, between um, you could see the garage and, you know, and in and the back of the house.
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And so it was one of those rough and tumble sort of, you know, you had to compete for households. >> Yep.
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You know, and it was um, 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.
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And so I always tell people this story of, you know, privilege.
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And I I say, you know, when we walked down the street, we could pick up 24 25 kids to go play baseball at the sand lot down the end of the street.
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And we stood on the third baseline.
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We picked two captains and they picked you. They picked the teams.
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And if you didn't get picked, that meant you weren't good.
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There were no participation trophies. Nobody had to play.
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And the only way you got to play was by practicing and improving your own game.
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I had this little cockapoo named Toby who used to shag flyballs for me when I would hit them and play, you know, trying to just learn how to hit better.
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And when you got better, you got picked.
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>> Wow, what a concept, you know, meritocracy.
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And so I grew up in that kind of neighborhood.
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We, you know, we were loose all the time.
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We had to make arrangements in the neighborhood to to be safe and we had fights and we had friends and um and in that process I learned that, you know, there is no good bully and the only way to beat a bully is to challenge them.
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And so I was the one who always defended my brothers from bullies.
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Um, and so take that into my career.
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I was an auto worker in the assembly line of Ford Motor Company when I flunked out of college.
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I did rear axle differential housing on the Mercury Bobcat.
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Um, and um, got in a fight with my union steward.
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Um, because I changed my work rules.
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I moved my stuff around and he didn't like that.
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I said, "That's got to go to the union."
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I said, "How do I get your job?"
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He says, "You need a degree, kid."
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So, I looked at my course books, said, "Here are the classes I could keep if I actually I passed them.
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Here are the ones I could pass if I actually went to them.
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Um, and then these are the other ones I should never take, like organic chemistry."
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My mother wanted me to be a doctor.
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Ultimately realized after working on the streets of Detroit as a paramedic, that I shouldn't be a doctor.
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Um, that it wasn't the thing I wanted to do.
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And 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.
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>> Buddy of mine was studying for the GMATs. I helped him.
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I have a photographic memory.
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He said, "You should take the exam."
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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?"
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And so I went around and I went to Cornell.
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Um, and they had these great gorges and water running through the, you know, these gorgees through the campus. It was beautiful. It was in the country.
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Was very laidback socially, not very laid-back economic. I said, "Wow."
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And you can drink beer and smoke pot down in the gorgeous. This is a cool place.
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I want to go to school here. So that's how I went.
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So I was married at the time.
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My wife and I went and we moved to Ithaca.
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She worked as a public health nurse in the hills outside of Ithaca, which are some of the poorest Appalachian neighborhoods um in in America.
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Um there's a great book um rural poverty in America's written about that area.
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And she was their angel in the hills um that took care of them when they were when they needed when they needed healthcare coverage.
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And when I graduated, I was talking to Wall Street about doing invest, you know, investment banking or um I was talking to Mike Milin at Drexel about junk bond trading because I was top of my class in finance.
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And a friend of mine called me, said, "You want to start an HMO?"
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And I said, "What the hell's an HMO?"
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And he sent me this note, though, was a US healthcare public offering.
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Um, and I looked at it and I went, "Wow, that looks pretty cool."
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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.
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>> Describe what it's like to have a photographic memory. >> Scary. It makes you lazy.
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So when in in high school when I took my exams, I went to a public high school.
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Um all I had to do is remember what was on the blackboard and I could just repeat it >> and I would just write it down.
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So when I got to college, I went to the Monteth program at Wayne State.
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That's where I flunked out.
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was self-study and that was an absolute disaster for me. There were no blacks.
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I remember I had to recalibrate my learning.
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Um, and then in business when people hand me spreadsheets, I remember them.
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And when the cell changes and 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.
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>> So it actually glows on the page for me.
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or when I'm looking at a printed page and there's something misprinted, I can see that word before without reading it. >> And it's persisted.
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It's not It hasn't changed at all.
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>> No, it gets a little crowded up here at times at my age now. I'm just turned 69.
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So, you know, every once in a while you have to get rid of stuff in order to put new stuff in, but >> spring cleaning. >> Yeah.
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>> Um maybe you could describe the key chapters now, starting with the HMO up through what you're doing now.
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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 >> so first company ran out of money in 3 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
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>> um and that's where I developed the concept of platonists versus arisatilians >> right plist plonists are people who think the great idea communicate it and consider their job done >> and then the arisatilians actually have to translate it into real work >> and I found that being an arisatilian far more powerful than being a platonist. >> There are a lot of people with great
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>> There are a lot of people with great ideas.
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Not too many people can actually make them happen.
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>> So that was that chapter.
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We fixed the business, turned it around.
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Ultimately, it got sold off.
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I was sitting at home thinking about what to do next.
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And New York Life called me.
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Um, 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 Etna.
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Etna hired me after they start ran into trouble um to um help them fix the company.
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They were losing a million dollars a day when I showed up in 2022.
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Um and we had to fix that and that took a took us on a whole journey.
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whole journey. and and and so my career has had one job search which was my first job search out of out of graduate school and the rest have been phone calls of people who I know who have said hey I got an idea or a problem and if I if it fit my profile which is to fix
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broken things and build new things not to make the trains run on time um 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 >> so when you go into a new situation let's I want to talk of both fix and build. Um what is the strategy that
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Um what is the strategy that you've developed for fixing something broken?
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Like the I'm interested in the deep details of the steps you go through when you encounter one.
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You're in one of these new situations.
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You're orienting yourself up through it being fixed.
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>> You have to get down in the mud and crawl on your belly below the pillbox slot >> so you don't get shot.
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And it's just literally the work of doing deep deep thinking.
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And in the beginning, I can tell you because I was a group, you know, 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.
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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.
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But it's just the issue of making a decision and moving forward.
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And if you have a good management process around it, it will get better as you go along.
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it will change because you have to navigate um the changes in the business model, the changes in the marketplace. It's a lot like sailing.
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You don't sail from one point to the next.
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You actually have to vector because you have the waves and the wind and the sun um and and you and and and the topography and you have to manage that.
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So just it's just like any idea.
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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 would be a better thing.
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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, right?
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That those green and orange and yellow boxes, you probably don't even remember them.
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the first PCs aren't what they've sold and made them successful today.
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So, it's about this sort of navigation.
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And so, to do it today and when I went to Oscar, the first 10 weeks, all I did was do deep dives with everybody in the met everybody, sat in the room, asked questions, kept a list, set priorities, and over that time, what I thought was lowhanging fruit in the organization were actually watermelons rolling around on the floor, and all we had to do is pick them up and manage them.
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and and Josh I remember called Josh Kushner called me and said I hear you're like in meetings asking questions when when are things going to happen.
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I said Josh I have screwed up everything this company has screwed up at least twice myself.
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I've broken it all and I know what I I could walk in here and say do this, do this, do this, do this, do this and we'll be just fine.
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And people will look at me and go who are you?
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Cuz you know I doubled the age average age of the employee population when I walk in the building right? Who are you?
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What what is an old man in here telling us how to innovate and create new things? >> Yeah.
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>> And 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.
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I want to bring them to a place where they can succeed.
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And so and and I said my leadership philosophy is we are here to help ordinary people do extraordinary things.
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And if we can help them by showing them then or talk asking questions and bringing them along, we can we can fix things.
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And that's been part of the story at Oscar.
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>> In your experience, do you think that's that's actually possible at scale that ordinary people can do extraordinary things? >> Yes. >> How?
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>> All they need to do is believe they can do it.
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>> How do you get them to do that?
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>> Tell a story about why it matters.
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So, one of the first things I said at Oscar is we are a pirate ship filled with cannons among Spanish gallions filled with gold.
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All we have to do is take their business.
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>> They don't think we can succeed. We're too small.
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We have none of the ballots that they carry around with them about how they run their business.
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They won't go where we will go.
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>> And that's how we win.
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>> But how do you derive the the why that's inspiring enough?
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Like I I'm struck by how infrequently even a great, smart, charismatic founder can really articulate the point of the thing they're doing. >> Right.
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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.
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>> So it starts with just doing the basics right?
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It's a lot like um trading in the markets.
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It all starts with a tea account, right?
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Someone's asset is another person's liability.
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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.
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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.
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So you don't spend a lot of time looking at little things and and and dealing with them.
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They're now they now know the intent of the commander, the march, and the mission.
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Then you start adding on the layers of all the cool things we can do as a result of that.
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>> Can you teach us about like a cliffnotes version of the history of US health insurance?
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It was started 80 years ago um as a result of soldiers and and and and personnel coming back from war and in that they were worried about wage inflation.
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And so they said we can't have any increases in wages competing for talent but you can create benefits.
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There will be operating expenses that you can then expense into your business and it won't be taxable to the individuals.
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Health insurance was the first one.
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People were worried about a baby boom.
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They were worried about all the support that'll be needed.
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And so seven years after that, they started the Hill Burton Act in 1952 where we built hospitals in every community in America.
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So that when the when everybody started having babies, we would have places for these babies to be seen and everybody would have health insurance.
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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.
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And that's what's happened in large part.
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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 their of the of that benefit without really looking at the individual requirements underneath and what people need.
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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.
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One of the things that you hear all the time is this system is so octopus-like. Yes.
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And so complicated and so entrenched that it's just sort of feels hopeless >> that it's bad. Nobody really likes it.
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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.
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And so the result is like everyone kind of throws their arms up. Why? Why could that be wrong?
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and what could we maybe do about fixing this problem that everyone seems resigned?
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>> 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.
18:04
Um now we need to help them understand how to do that more effectively.
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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?
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And it's all based on your age and your risk profile and what you need to retire in the future.
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How do we hit that target?
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And they use financial advisors.
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Our best opportunity is to have brokers help people understand what they can pick.
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The second part is is that when employers buy insurance, they buy large networks because they have all these employees in multiple places.
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and they give a range of benefits but only a few which is sort of fits the average of the employee.
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The economics of large networks are that they are inversely cost effective.
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The larger the network you have the less stability you have to negotiate better rates.
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In the benefits when you give an average benefit for employees the employees have to decide which is the best for them.
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and they settle for whatever it is they get and they have to pay 15% out of pocket.
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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.
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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.
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five years running, small group employers have been paying double-digit rate increases.
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They're now just dropping coverage and saying to their employees, "Go find your own coverage. Go to the ACA."
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Let's make that a more thoughtful transition.
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Let's help employers go to define contribution.
19:50
In in the ACA, 75% of all providers are in the networks of some plan.
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All the plans develop narrow networks.
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So, from our perspective, it's not about Oscar membership.
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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.
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There's narrow networks in every market.
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It's designed by market and the benefit plan designs range from bronze to gold where I can pick my journey.
20:20
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.
20:31
Last year, two out of five Americans borrowed $74.
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9 billion to pay their out-of- pocket cost for healthcare >> from banks. >> Crazy, >> isn't that?
20:43
>> 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.
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Are you going to have a kid this year?
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Are you thinking about building your family?
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Are you going to have any surgeries that you need?
20:59
You build your plan designed to support that. You buy it.
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You have money left over most often.
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I can use that to pay those out-of- pocket costs instead of going to the bank.
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Or I can buy dental and vision, life insurance, or disability.
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All of a sudden, it's my plan. It's my choice.
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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.
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They can make their own choices.
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So, that's what we should do.
21:24
if I could draft in like the smartest skeptics or or the ones that least wanted to have that outcome other than obviously incumbency that you know where businesses benefit from this or something.
21:34
Um but are there smart critics that would disagree with you and if so how?
21:38
>> There's a concern that sick people won't be well taken care of in that system.
21:43
It's exactly the opposite.
21:43
Consumers when educated can make a good po choice because it's about them, right?
21:47
It's not it's just like medical care.
21:50
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.
22:02
>> I was at one point, but only for a fleeting moment and then it was gone.
22:06
And so this whole idea of having having the tools to allow people to be educated and make this choice will and that they can keep it because it's in their community and as their circumstances chance they 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.
22:28
>> Maybe you can describe like the state of the union of Oscar today.
22:30
So just like describe for those that aren't familiar with the business, I think people know like the very broad broad strokes, but give us just like a a highle summary of what the business is and looks like and then we'll talk about, you know, directions that we will go.
22:43
>> We currently cover about 2 million lives.
22:44
Um, and they're all ACA members, Affordable Care Act.
22:47
They're all people who in some way, shape, or form need to have subsidized healthcare that they otherwise could not afford.
22:53
We're expanding to more markets as we speak.
22:57
And the idea is to continue to um bring to them tools that they can use.
23:01
So we have a chatbot we're about to launch that helps people understand their condition in a deep way.
23:07
They can talk to it and get information and go back and forth with it.
23:11
Um we have implemented over 20 almost almost two dozen um um large language models on the back end of the business that have reduced our operating costs.
23:22
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 um bigger costs.
23:30
Um so it's a digital forward cloudnative platform.
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First new platform for health insurance that has been built since 1972.
23:42
So everybody uses the old health edge platform.
23:43
I've modified Health Edge three times in my career and was built in 72. Everybody has it.
23:47
Um pretty much we have our own platform.
23:53
Secondly, we have one version of the truth in data.
23:54
So we can use large language models and AI at scale which has huge advantage for us in the marketplace.
24:01
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.
24:14
So one of our great products is for diabetes.
24:17
We actually have a program where we encourage diabet diabetics to join us.
24:21
Counterintuitive in the insurance industry, asking sick people who cost $1,600 to $1,700 a month to join your plan.
24:29
But we know if we give them the tools and the capability and the understanding, they're going to get better.
24:35
We're going to get the risk adjustment for it in the system and we'll be able to take care of them and and and not have to rate them up as a result of what they've been going.
24:46
>> Maybe that's a great example.
24:46
maybe use like the diabetic plan as an example of like the flow of funds and how it all works.
24:52
Like if I think about the economics of that product specifically, it's a great example to like explain a complicated system around one patient.
24:59
>> An uncontrolled diabetic costs about $1,600 a month.
25:01
A controlled diabetic can get down to $900 a month. $700 opportunity.
25:07
>> Y >> you can invest $699 and get a return out of it >> per month in that patient to make them better.
25:13
So, we put together a set of tools and capabilities that they can learn, including wearable glucose sensors that help them manage that that care.
25:21
And because we're digitally forward and people can make their they can learn and go at their own course um and work with their doctor, we attract a population that's interested in being better.
25:33
>> Three, four times a year now, we submit to um the government all of our claims.
25:40
Y >> and those all have risk adjustments on them, the diagnosis codes and treatments that were given.
25:46
And then that's all compared to each each health plan.
25:48
And the health plans that have more risk as a result of that analysis get paid by the plans who have less risk.
25:57
>> We set aside money for risk adjustment clearance and we do that throughout the year.
26:03
We send out money to the government who then reallocates it to people who didn't get paid as much as they should have.
26:08
And so if you think about the um 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?
26:20
>> So we think we can serve 125 million people.
26:23
So um the last group of insured business on a group basis is middle market and small group employers.
26:29
So small group employers are under 100, large group employers or a middle market up to a thousand.
26:36
And those people all buy insured products.
26:39
They pay a premium to the insurance company and they get coverage back.
26:44
That is a less effective system because those populations that they underwrite for those groups are anywhere from 10 employees to a thousand employees.
26:55
And when you compare it to the um um individual market where we have 24.
27:00
2 million people, the ability to manage risk over larger populations isn't there for them.
27:04
So they are subject to higher rate increases.
27:09
There's 79 million of those people.
27:12
So we believe that if we offered a defi an IRA product, individual consumer health reimbursement account to those employers, we can reduce their costs and keep them sustainable over time.
27:20
We have an example right in front of us that works.
27:24
So 79 million people there.
27:24
There are 20 to 30 million gig workers who can't buy insurance through a group.
27:30
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.
27:43
And then there are large employers who are looking at this as well um that want to take their first their part-time workers, but then ultimately over time more of their workers and put them into the system.
27:54
That's another 80 to 100 million lives.
27:57
So it's a massive market.
28:00
If we get everybody to move that way where every American gets the choice to pick my network, my benefit plan.
28:05
>> Is it fair to summarize it as uh the journey to a reformed healthcare system?
28:11
Sub subinflation, you know, cost growth uh which I'm sure everyone would would want to sign up for is will be the result of personalization and efficiency and that's 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 >> spreading the risk. Yeah.
28:29
>> of the of the sicker people in the population across a larger set of numbers makes it more effective from a riskmanagement standpoint.
28:37
>> A pregnancy can't blow up your rate next year, >> right?
28:41
Because that gets spread across all the whole population.
28:43
The idea is better risk management um equalizing the risk across the population.
28:51
Um and then secondly having freedom of choice on what I get and what I buy.
28:56
Now there will be limits.
28:56
It doesn't mean people can take their their their defined contribution, put it in account, and spend it on beer.
29:02
Um, they actually have to buy health insurance or health care in some way, shape, or form.
29:09
So, we don't want people taking unnecessary risks by saying, "Oh, here's a great pot of gold from my my employer.
29:14
I'm going to spend it in a different way.
29:15
They have to use it to provide that benefit."
29:17
If you do like a like a a premortem on this attempt to make this 2 million into 120 million and I say you just have to assume that it doesn't work.
29:27
What do you think the most likely reasons are that it won't work at Oscar specifically?
29:32
>> There's going to be resistance at the large end employers.
29:34
They have benefit staffs of hundreds of people.
29:35
This person buys pharmacy.
29:37
This person buy dental and they just manage the whole process.
29:41
You don't need all those people when you give the money to the employees and say, "Hey, go buy your own health insurance."
29:46
Um, that's going to be one resistance.
29:48
There are consultants that advise large employers and get paid a fee every year. That goes away.
29:51
Um, brokers who think they're disadvantaged by it can help us with the employees picking the right plan.
29:59
So, we can help preserve that model for them.
30:01
And then there's just going to be the regulation required to make the changes.
30:04
So, in Indiana, we've already made the changes to allow to occur from the standpoint of that state.
30:11
We need it on a national basis.
30:13
It was in the original bill that came out of the house.
30:15
It was called choice, which I think is a better name than IRA because Icarus doesn't sound >> sounds like Icarus. >> Yeah. Right. Right. It does. Or icky.
30:26
So, but we it's called choice, but that got pulled out by the Senate because of the tax effect of HSAs for all those benefits.
30:34
But those benefits are being tax advantage for employers now anyway.
30:40
So, it really shouldn't be scored that way.
30:42
Um but that's the way they scored it.
30:44
So it saved 30 billion so they pulled it out.
30:46
>> I like this concept of um the battlegrounds or competitive frontiers within a given industry.
30:52
>> Oscar is fighting other people that are offering other things.
30:54
Incumbent solutions, all this kind of stuff.
30:55
What are the competitive frontiers?
30:58
What are like the places that you win and lose versus others today? >> Size has an impact. >> Yeah.
31:06
>> We only have two million people. >> Yeah.
31:07
You know at we took care of 54 million people around the world and so you know that's a different issue but size has an advantage as well.
31:14
We have the a team on this product for these people every day.
31:21
>> That's a subsidiary and most of the other companies who didn't take the time to understand it.
31:25
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.
31:35
So size has it's a double-edged sword.
31:38
We think about this every day.
31:38
We innovate against it every day.
31:40
We know it could be bigger.
31:42
We're larger employer, larger competitors have a lot of other businesses to pay attention to like Medicare Advantage. So that's one set.
31:49
The other is the regulatory framework.
31:51
We have 51 regulators, 50 states and the federal government and we have to try and react with them all.
31:56
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.
32:07
Like the abortion issue, you get penalized as a national employ as a national carrier.
32:16
If Missouri absolutely forbids abortions and it's an employee who works for an employer in another state that offers them, you get penalized.
32:24
there's a fine for every case.
32:27
And so you have all of these things that you need to navigate in from a regulatory standpoint.
32:30
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.
32:38
Um, and we'll be able to make this work across the country.
32:41
So we have all of these, you know, interian warfare going on between the states and the federal government over how you spread the cost of this. So that's an issue.
32:51
I think the the the third one is just there are a whole bunch of actors in the system.
32:56
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 their accounting model.
33:04
The hospital systems and the facilities that provide healthcare around the country work on a revenue basis.
33:11
As long as I have enough revenue coming in, I can win.
33:15
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.
33:23
And so you have 760,000 physicians cash basis.
33:28
You have 6,900 hospitals and add probably another 6,900 facilities as well.
33:35
So almost 13,000 that work on a revenue basis.
33:38
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.
33:46
It's a wonder people get care at all.
33:49
And so when you look at that discontinuity, it really should be the other way around where the individual buys.
33:58
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 healthare costs because they've got so few people.
34:06
It should be the individuals saying here's what I want out of the health care system.
34:10
And then ultimately the health care system will have to align, but those actors are all going to fight against one another.
34:18
And there's a a quote I have have had under my bladder every day of my working career that I I'm I'm a fascinated with um with Renaissance Italy.
34:27
um with Renaissance Italy. And it was Nicolo Makavelli when he wrote you know to the pr and the prince there's nothing more dangerous to affect than to initiate a new order of things because those who are advantaged by the current current order have the laws behind them
34:42
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 run great danger >> but you like to live >> and that's where I've lived I've lived right in that place my whole career. I I am an iconoclast.
35:01
>> What does that mean to you?
35:01
What does it mean to you to be an iconoclast?
35:04
>> Yeah, you just challenge everything.
35:06
Nothing should be remain the same unless it can stand on its own >> in that space in that dangerous space that Mackie describes, how much of a grenade does AI feel like to you?
35:17
Because if I think about if I try to boil this down to its basics, it's like >> um when I'm normal and healthy kind of nothing happens.
35:23
So typically like you get older, stuff starts happening or you know you're young, something happens, something happens.
35:28
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.
35:35
And that's kind of like the value chain or something >> increasingly like I've heard stories about people uh solving very hard diagnosis problems by themselves with chat GPT that 15 doctors couldn't solve and and disintermediating that part of it.
35:50
Um obviously there's tremendous innovation I want to ask you about later on like the biomedical side and the biotech side and um self-s served solutions and screenings and all this crazy stuff.
35:58
How much does like AI plus other technologies uh represent a grenade?
36:04
>> So for a long long time we sort of deferred to our clinicians and said you know whatever you think I ought to do doctor I want to do.
36:10
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.
36:20
They know all the latest science.
36:21
If they were to read two journal articles every night for a year, by the time the year passed, they would be 5 years behind on the latest literature in healthcare. So how do they keep up?
36:31
Particularly for an internist.
36:33
I mean, it's almost impossible.
36:33
And so this idea of using AI as a way of gathering information and giving you insights, I 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.
36:47
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.
37:01
and and and and so I I look for two things in executives, curiosity and courage.
37:05
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.
37:12
And that's where I think that could help better informed consumers about how healthcare works and what their options are is a far better world than just deferring.
37:22
And there 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 out in the waiting room and they walk in and go, "What can we do next?"
37:35
Doctor, the doctor never really wants to say, "Well, I think it's time to let this person go, grandma go."
37:42
They want to say, "Okay, well, we could try this or we could do that."
37:45
We often get those prior authorization requests when the patient is at end of life.
37:51
And the reason is is because they're stuck in the medical industrial complex.
37:55
I had to put my son in hospice July 15th, 2002.
37:57
And it was a horrible decision to make. I had to give up hope.
38:02
I had to say he's no longer curable and that we just need to wait for him to die.
38:05
And he went into his hospice room and then I found a drug for him.
38:08
They came to me and said, you know, your son has to come out of hospice if you apply this drug.
38:12
I said, let's see, dead maybe living.
38:16
I think I'll take the maybe living route.
38:18
He can go back to his room and we'll work there.
38:19
and and and and so what what we found was is that in hospice end of life where 60% of your lifetime costs are spent.
38:31
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.
38:38
I have to give up hope. I have to say I'm going to die in a certain period of time and you go at Etna we tried this and I remember when I brought it into the into the office and they all looked at me and said you're going to break you're going to break the back company 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
38:57
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
39:18
So changing the rules about how we do these things AI can help us in these places.
39:28
You know, there there are just certain things that are just not going to end well.
39:33
And as my eastern belief system says, we just change our form and go to a different place as a result of death.
39:41
It's not the end of your energy and existence in the universe.
39:45
>> How did you arrive at your eastern belief system?
39:48
>> When my son was in in um in the hospital and needed a bone marrow transplant, >> what what was happening with your son?
39:54
>> My son had T- cell gamma delta lymphoma.
39:56
only 34 people, all men, had ever been diagnosed with it.
39:59
He was the youngest at 16.
40:00
And it had a six-month end date.
40:04
He was I was told he's only live 6 months.
40:07
And um I said, "Well, not me."
40:12
So I quit my job and I took him around with my wife.
40:16
We went around to meet all of these physicians.
40:18
And there was this physician, Ava Gynan, at Boston Children's Hospital. Said, "Dadly disease.
40:24
Nobody ever survives this. I've never seen one. They're so rare. But I got an idea.
40:29
If we create graph versus host disease, which is a bad bone marrow transplant, it will attack the tea cells, which are cancerous in your son's body.
40:38
If we can kill all the tea cells, we can kill the cancer.
40:40
But then he's going to survive graph versus host disease where the body goes to war with the the bone marrow that we put in that isn't his bone marrow.
40:49
So finding the right mismatch happened to be my my my my brother Peter who's the third in in the line.
40:58
John's 11 months behind me.
41:00
Peter's 10 months behind John.
41:00
So you know we're the Irish triplets 21 months apart.
41:04
And Peter was the perfect mismatch.
41:08
So Peter graciously gave up his bone marrow for Eric.
41:10
We put Eric into radiation.
41:13
We zapped him where he had no ability to live after his final radiation period unless he got my brother's bone marrow.
41:20
Put the bone marrow in, killed the cancer.
41:21
We're getting ready to go home.
41:24
Graph versus host disease hits him.
41:25
And we're in the hospital for a year fighting a horrible scenario.
41:30
Graph versus host disease.
41:30
The skin starts to come off. Your gut sloughs off. You can't eat.
41:34
It's just terrible stuff.
41:36
And so I'm in the hospital with I'm living in his room with him.
41:40
I'm sleeping in his room. made him bring a bed in.
41:42
I am meeting with the medical team for an hour every morning going through my Harrison's immer internal medicine text and sticky notes.
41:50
I've got a PubMed and we're talking to NAH doctors on the website about his disease and what to do next.
41:58
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.
42:06
He went from 140 lbs to 80 lbs. He was starving. It It was horrible. His hair fell out. It was just a mess.
42:13
And he was bleeding out his total body volume of blood every day through his bowels.
42:18
He had gra he had gastric dysplasia.
42:20
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.
42:26
But he was getting almost his whole body for weeks and weeks and weeks.
42:30
So they came into my room one into the room one day. We need to talk to you.
42:33
He's not going to make it.
42:34
We need to put him in hospice.
42:34
So I went in and sat down with him and said, "Eric, game over."
42:38
He said to me when when we I said do you want to try this crazy thing?
42:43
He goes if you do it with me. Okay, I'm in.
42:44
And I went into his room and I said, "Game over."
42:47
And we we did the sorrowful mysteries of the rosary together.
42:51
And he went into hospice and I was meeting with the medical team that morning.
42:56
I didn't have my Harrison's mortal text internal medicine text or my laptop.
42:58
And they said, "Where's your stuff?"
43:00
And I said, "None of that works.
43:02
We're in space that nobody knows. He's starving.
43:04
He's allergic to soy, so he can't give him intraipids to help him come back.
43:12
There's got to be an intraipid somewhere in the world that's not omega-3 fatty acid, not soy.
43:16
And so, one of the residents runs off and calls her nutritional professor at at John Hopkins.
43:22
He says, "Oh, yeah, there's a thing called omega then.
43:24
It's omega-3 fatty acid in Austria."
43:26
And she comes back, "I found it.
43:28
I found one, but it's not FDA approved. So, go see the FDA.
43:34
How can I get my son this drug?
43:38
They said, "Well, there's these three pages you fill out.
43:40
It's called a compassionate a single patient compassionate use exception.
43:43
Have the doctors fill it out.
43:45
Call us and we'll approve it." They approved it. It was made by Fzenius.
43:52
The Fzenius CEO was in Austria.
43:52
He brought it back with him to Boston.
43:58
We gave it to my son and four weeks later his hair started growing back and his starvation album went from 02 to four.
44:06
and he came home and this was in August.
44:09
He came home in um on February 18th of 2003.
44:15
Holy His kidneys were damaged.
44:15
So he got my left kidney two years later cuz I had the best match for a kidney.
44:23
And they did it laparoscopically by then.
44:25
They didn't have to cut you in half like they used to.
44:26
They put two holes up here in a slot down here and 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.
44:33
You know, after that, you know, he he was he and I used to ride motorcycles together.
44:38
We went down to Rolling Thunder and, you know, doing all sorts of cool stuff and we're riding around on the bikes one day and we're sitting at the bar and he looks at me, he goes, "Dad, why are we both here?"
44:45
He came home on February 18th, 2003.
44:47
I broke my neck on February 18th, 2004.
44:49
So, we went into hospice.
44:49
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."
45:00
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.
45:10
And at that moment, I made the bargain.
45:13
I said, "Let me have his disease. Let me have his pain. Let him live.
45:16
I've lived a great life."
45:18
He comes home on February 18th, 2003.
45:20
February 18, 2004, I hit a tree, break my neck.
45:23
And there was a a friend of mine who was praying for Eric at the Whailing Wall in Jerusalem.
45:28
Took his picture every day, put it in the Wailing Wall and prayed for him while I was sick.
45:34
And he called me and he said, "How's it going?"
45:35
I said, "Well, Eric's doing well. I broke my neck."
45:37
And I tell him the story and he goes, "You made a deal, didn't you? Send me a picture."
45:46
And so he started praying for me.
45:46
He says, "You're going to be fine."
45:48
And so this this whole So we're talking.
45:50
He goes, I he goes, you know, Dan, why are we both still here? Why does this matter?
45:57
And I told him the Neil Degrasse Tyson thing.
46:00
I was, you know, out of a trillion different genetic combinations, there's only 100 billion people on this earth.
46:04
We won the lottery, so let's make good use of it.
46:06
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.
46:12
And by the way, you can't have the other kidney until I'm gone.
46:17
When I gave him the left kidney, I said to him, "You have to drink bud longnucks because that's what it was raised on.
46:23
Don't start changing the grease that runs the machine."
46:28
>> This notion of a father saying that his purpose to be is to be spare parts for his son. >> Yeah.
46:33
>> Um you told me that when we first talked and that that like that line got burned into my brain.
46:39
>> We were sitting in this other restaurant one day.
46:41
um it was a Gold Rock Diner in Hartford and we're sitting there and I we got our helmets on the table and we're talking and he's a theoretical physicist.
46:49
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, right?
46:56
Everything that's ever happened is happening now.
46:58
Um we just too limited in our intelligence to understand it. We don't see it. We can't see it.
47:04
and and we're talking back and forth on these different concepts and he goes, "Yeah, but mine's science base."
47:09
I said, "Mine mine's too science base."
47:13
And there's this father sitting with his 5-year-old at the table next to us and I get up to leave and he's 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?"
47:22
And I said, "Only if you're lucky."
47:25
So Eric's in the hospital.
47:27
He has his bone marrow transfer. He's he he's radiation.
47:28
It was the most frightening thing I ever I had it.
47:32
I panicked the first time I went in room with, you know, 12-in walls and, you know, they're just 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 on his body. Killed it all.
47:53
And so he can't survive without it.
47:53
And so one day I walk in and he's got this woman doing raiki therapy on him.
47:58
and and she's doing Reiki and and I'm and he's she's not touching him, right?
48:06
They're hovering this energy thing and um and and he goes, "Dad, this feels great."
48:11
And I and I'm sitting on the bed next to him.
48:14
I'm going, "I she's not touching you."
48:16
He goes, "Dad, it feels great."
48:17
So I lay on the bed and she's she goes, "Would you like to try?"
48:20
And so she starts it with me and after about five minutes, this is too much.
48:23
So when I get injured, I'm on seven different narcotics every day.
48:28
Everything sounded like Charlie Brown's mother in the cartoons when she would talk was always, "Whoa, whoa, whoa, whoa, whoa." That's all I heard.
48:37
My whole rule world was that I was so high, but I was still incredible pain.
48:41
The drugs didn't touch the pain.
48:43
They just let me not care about it was the way it it worked.
48:45
And so I'm like, I I can't do this.
48:47
Um, I'm sitting on the side of the freeway in Hartford in my 740 ILIL getting ready to run into a bridge abutman police officers in the middle of the night because I used to get up in the middle of night and just drive around like a madman and I'm trying to get police to stop me and they never did.
49:03
But when I'm sitting on this on the shoulder, they stop me.
49:06
They come over and go, "What's going on?"
49:08
So, I'm thinking about running my car to that bridge.
49:09
And they're looking I got a brace on my neck.
49:11
I got my arms in a thing and and they go, "What's going on with you?"
49:14
I told them the story and they said, "Get in the car." like they drive me home. They take the keys. They take my license.
49:22
And your spouse can pick this up tomorrow, but you're not to drive again. It's too dangerous.
49:29
Just let alone whether or not you're going to hurt yourself, you're going to hurt somebody else.
49:34
So, I was like at wit's end.
49:34
And so, this friend of mine says, "You should try cranial sacral therapy."
49:37
And I'm going, "What is that?"
49:39
And I read about it and it's, you know, the subtle manipulation of your bones and your head and your sacrum to reestablish a rhythm in your cerebral spinal fluid.
49:48
And I had ripped my my dural sheath and all this sort of stuff with the accident.
49:52
So everything was torquing inside of me.
49:56
And so I go in, I get on the table and this woman puts her hands on my head and on my sac.
50:01
All of a sudden I she goes, "Give me just four visits."
50:04
After four visits, I started coming off all my drugs.
50:08
She got the rhythm because the cerebral spinal fluid is like a heartbeat inside of you.
50:11
It moves up and down around your spinal cord and your brain all day long.
50:16
And if you can establish that rhythm again, which might have been distorted by the accident, um you can be better.
50:22
And so I'm feeling better doing that.
50:24
I start reading, you know, about the the procedure.
50:27
And then this therapist says to me, "You should try yoga."
50:32
Because I couldn't run anymore because I was too unstable.
50:34
I said, "Yoga's for for girls." She goes, "Oh, no."
50:39
And she said, "Just give me again, give me four visits. I'll show you."
50:44
And she was a yoga teacher.
50:44
And like after the first one, I could barely move the next day after my first, you know, set of asas.
50:50
And I started doing it more.
50:52
And I was doing it on my own.
50:54
And I said, you know, there's more to this than just the practice, the physical practice.
50:58
And so I started reading about the American Viney Yoga Institute.
51:02
And there was this great book by Leonard Pearl Malter called the heart and science of yoga and it relates it to western medicine and I'm going this really makes sense.
51:13
So I started reading the Bhagavad Gita and the opanads and the pratabayam and all these other sorts of things and started to realize this is just rich and that yoga is not in the United States is this physical practice but it's actually
51:27
understanding the teachings yamas and nyamas 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 as you would treat yourself written 50,000 years ago not 2,000 years ago. Um and
51:42
Um and and you know codified the the ten commandments um written 50,000 years ago.
51:49
And then there's um the physical practice asa the movements initiated by breath called pranayyama.
51:57
And all of that is to still the body and the mind in a way where you can sit in um an extended period of time meditating.
52:06
And there are four limbs of yoga of meditation.
52:09
So there's eight total limbs.
52:11
the the ultimate being sad.
52:14
You're one with everything.
52:14
You move back to the one. You find the creator.
52:19
And it's built on a model of that in the beginning the the creator existed and only it existed.
52:24
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.
52:36
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.
52:45
And so my mantra which is across the back of my neck is so hum in Sanskrit it means I am that and everything is me. It's all just one.
52:55
Um and if you can keep that in mind um when you're when you're with others you and I are are one.
53:00
And so it's this model of thinking differently about your place in the world and what you do.
53:08
So then I go to work one day. I say, "You know what?
53:11
I think we ought to do yoga for our employees."
53:12
And I'm the president of the company and everybody sitting the room goes, "Oh, sure, boss. That's a great idea."
53:21
The chief medical officer follows me to my office and he goes, "You know, this is voodoo medicine."
53:25
I said, "Lonnie, no, it's not.
53:27
It's not voodoo medicine.
53:30
What do I need to do to prove it to you?"
53:31
He said we need to do a double blind study.
53:34
So we do a bic coastal double blind study.
53:36
We have employees sign up.
53:38
We had 795 employees sign up by coastally.
53:41
We did cortisol levels and heart rate of variability of all those employees.
53:45
Um and it was interesting.
53:48
The west coast people were actually more >> more revved up >> more revved up than the east coast.
53:51
And I don't know if the if the the avocado prices were up or whatever, but somehow they're you know they were like more wigged out than the than the east coast.
54:01
And we did 12 weeks of mindfulness and yoga classes and Mari my my then partner but was my wife for a while.
54:13
Mari was the teacher and she worked with Gary Crassau at Mini Yoga and they taught these classes and after 12 weeks we had and 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.
54:31
So we put everybody through these programs.
54:32
We had them journal and after 12 weeks heart rate, veritability, cortisol levels dropped 50%.
54:39
In this population, they started going home and having their families do it with them.
54:42
I mean all sorts of amazing things.
54:45
Our health care costs went down, not trend.
54:48
The actual dollar cost went down 7 and a half% the next year.
54:51
So I said, "We got to let every employee do this.
54:54
We open it to employees during work.
54:56
They got the time off to do it.
54:58
You know, go to the classes."
54:58
And one day Mari walks in the house and she hands me the journals. And she goes, "Okay, Mr.
55:06
Big Shot CEO, you ought to read that journals." I said, "Why?"
55:08
She goes, "Because the problem with their stress is you."
55:15
They're working two jobs.
55:15
They got their kids on Medicaid because they can't afford the company's dependent coverage.
55:22
They got people on food stamps.
55:22
They're calling bill collectors while they're in break.
55:26
You're not paying them enough.
55:28
So, I read these things and I'm I'm going, "Wow, they're, you know, I'm the jerk here." Um, so and I'm now CEO.
55:33
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.
55:41
I want to know what their life's like, how much they make, and it was about 12 bucks an hour, and they were 81% were women.
55:50
20% of the kids were on um food families were on food stamps.
55:54
25% of the kids were in on Medicaid because they couldn't afford dependent coverage. So, this is crazy.
56:01
Here we are, a company that's come out of being almost out of business to being profitable.
56:05
We've got to do something about it.
56:07
So, I said to her, I want to know what we can do for these employees.
56:09
I want to raise their minimum wage.
56:13
So, we started in 150 50 cents in improvements.
56:15
I said, this is just not enough. Let's go to 16 bucks.
56:20
And the CFO goes, "Oh my god, this could kill us." We put the 16 bucks in.
56:21
And then one of my um other executives came to me and said, "You know, when you raise their wages, they're going to their dependent cost.
56:30
their their coverage b 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 um where the frontline employees who were at $12 were paying like 20%.
56:46
So um we what we did is we said okay let's take all these there's 7100 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 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. Um, it was $75 million.
57:17
Um, the first year I was at the JP Morgan conference on January 1st, 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."
57:29
I didn't ask the board because he said, "Well, how did your board let you do?"
57:32
I said, "Well, this is one of those things where you ask for forgiveness and not for permission."
57:35
And I just went ahead and did it. I got applause.
57:37
Our employees all of a sudden realized that we could help one another and we started doing other thing and I never had to do another suggestion.
57:46
We had we doubled our tuition assistance.
57:48
We paid back student loans up to $10,000 a year.
57:49
We did dog pet therapy in all of our offices.
57:55
And the only time I ever said no was when we went beyond dogs, cats, gerbles, and rabbits.
58:00
Somebody wanted to bring in mini ponies.
58:02
I said, "We're not bringing mini ponies into the building.
58:07
that's just not going to happen. Cool idea, but no.
58:08
Um, and and then, you know, it just took off and all of a sudden we're spending like $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.
58:24
And my last five years at Etna were joyful because I didn't have to tell people to get to Sandy Hook to help families with critical incident streies briefing. it all just happened.
58:35
We were like a company on a mission.
58:37
Um and um and that's how the Eastern Practices just changed my company.
58:43
So if 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 of it's 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.
58:58
Um what would you teach them?
59:00
What are the components of doing that?
59:01
Well, >> so we so we created a website for them >> because the spreadsheet would never work if you put the numbers in. >> Yeah, it's bad.
59:10
Not going to be CFO friendly.
59:13
>> Well, the spreadsheet the spreadsheet is the worst invention ever created for business, right?
59:16
Um if if you read the book, the the terrorism of Excel or something like that I put in their book.
59:22
Um but you know, we've created a tool that allows us to manipulate numbers on the page to get the answer we want.
59:27
And then we man, we actually managed to it.
59:31
We actually create a belief system that's not real and then we manage to it.
59:36
Instead of saying what are the five risks on this page and this is what we did on the on the wage thing.
59:39
Okay, here's all the hard benefits.
59:41
Let's take all the soft benefits.
59:43
Presenteeism, better attitude at work, empathy for our members.
59:49
Let's put all those on a page and let's discount them by 90%.
59:51
And so when we did that, the the group that we discounted by 90% added up to the exact same amount of savings as we had in the hard savings, which we didn't discount.
1:00:03
And actually what it meant was is that we were just not seeing far enough.
1:00:04
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.
1:00:17
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 and so we put together a
1:00:34
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 a family-owned string of memory centers and they had employed that were making $12 an hour and they wanted to raise their wage. They said,
1:00:48
They said, "But you know, we're in the business of getting reimbursement for people with Parkinson's and Alzheimer's and it's hard."
1:00:54
And I said, "Well, what's your biggest cost?" False. Hospitalizations. How's that caused? Anger, combiveness.
1:01:04
Does it matter how much your employees know those patients? Well, what do you mean?
1:01:09
Because I worked in an Alzheimer's ward um with my my mother, one of my mother.
1:01:13
My mother ran a string of nursing homes.
1:01:14
And what I found in working with them is if you spent the time to understand how they behaved and you got them interested to talking about something they were interested in, you could find a way into them that would make them much calmer.
1:01:25
You knew how to talk to them to do it.
1:01:27
But I was there for 3 years in that unit.
1:01:29
So I said, if you kept employees for 3 years and they were able to help your patients be much better and reduce falls and anger and combiveness, would that be worth your money?
1:01:42
And they did it and it worked.
1:01:44
It's not about what's the data tell us.
1:01:46
It's what's what can how can we understand the data in a way that allows us to do this effectively >> and not break the bank.
1:01:54
>> How long were you in pain after your injury?
1:01:57
>> 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. How's that possible?
1:02:14
It >> I did it >> sleeping one hour a night. >> Yeah.
1:02:19
My right side of my I would literally walk around in my room.
1:02:21
The right side of my brain literally shut down.
1:02:24
So my level of empathy was pretty low.
1:02:26
And the left side of my brain was a machine.
1:02:31
It just like it was like a supercomput.
1:02:34
So I could look at things and say, "Okay, we got let's get the group together. Let's do this."
1:02:37
Every morning I would get the run of the billions of reserves at Etna um at 6:30.
1:02:44
We would run the reserves every night and I would get that report at 6:30.
1:02:48
I'd look at it and if I found a problem, everybody was in my office at 8:00 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.
1:03:01
So that was my my key metric.
1:03:01
And so that's my brain was like that.
1:03:04
So you were just like a business terminator effectively. >> Yeah.
1:03:08
>> During this time, >> 18 years. >> 18 years.
1:03:12
>> What got you out of it?
1:03:13
>> So I was getting ready to go to Switzerland to end my life at at Dignitas.
1:03:17
It's an assisted suicide organization, but I had to prove I had intractable pain.
1:03:21
Um, and pain that can't be cured.
1:03:25
And so I was sent to a doctor and the doctor evaluated me and the doctor said I was going to do it on February 15th, 2023 was going to be my death day.
1:03:35
Um and um I um I wanted to do the 18th, but it was a Sunday.
1:03:40
Um it was the day I had the accident.
1:03:42
Um but and so I 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.
1:03:50
You have neuroplastic pain and we can fix it."
1:03:55
I go, "Here we go again."
1:03:55
I mean, I did seven days in the Hanaman Hospital ICU, 50 milligrams of ketamine an hour IV um to try and reboot my my system. I had a great time.
1:04:09
Um but and it felt better for the first month afterwards, but then came back in a rush. >> Yeah.
1:04:16
>> And so I said, "Yeah, here we go again."
1:04:18
And uh you know, and I had worked with Mari to help get her through how that was going to work.
1:04:23
and what the plans were and all that sort of stuff.
1:04:26
I go, "Okay, well, let's start."
1:04:28
So, part of it was cognitive behavioral therapy and I had to go back to my childhood and my con I was not well treated as a child and um and so I was constantly under threat assessment um 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.
1:04:50
And they said, "And also your 42 pain centers in your brain have wired together um from all this chronic pain over the years.
1:04:58
So any touch feels like pain."
1:04:58
So in essence, I was addicted to pain.
1:05:00
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.
1:05:10
That's why they see the ball in slow motion.
1:05:12
That's why they see how it's moving.
1:05:14
That's how they hit so well.
1:05:16
You have a baseball hitter's brain on pain.
1:05:20
you there's cognitive there's no latency in your system something touches your arm you're in pain.
1:05:25
So they help me understand the system then they put me in transranial magnetic stimulation and they zap my brain for 30 minutes to disconnect those pain centers and they put me in a virtual reality lab with a helmet and they repattern my brain >> and it worked. >> And it worked. I'm now out of pain.
1:05:44
>> How long did that take?
1:05:46
>> It took about six months. Yeah.
1:05:49
And my first reaction was extreme anger. >> Why?
1:05:53
>> I was so pissed >> because you had endured it for so long.
1:05:55
And >> and my it was my brain.
1:05:56
It was all pains in the brain anyway, as you probably well know that it it it all happens in here.
1:06:04
And um that my brain betrayed me. I thought I was smart.
1:06:10
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.
1:06:18
Because when I was in pain, it was like, I gotta get this done.
1:06:19
I don't have a whole lot of time here to argue with you.
1:06:22
So, let's talk about how we get it done.
1:06:24
I was patient, but I was not tolerant.
1:06:26
And it should be the other way around.
1:06:28
It's okay to be impatient, but you have to be incredibly tolerant to get things done effectively.
1:06:31
And so, I was in this like it was like going through the the 12 steps of um Alcoholic Anonymous.
1:06:40
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."
1:06:47
And then I had to start controlling my emotions because all of a sudden I had them again.
1:06:52
Um, as my amygdala amygdala dump dumped out.
1:06:54
You know, your amygdala stores all trauma and it doesn't date stamp it.
1:07:01
So it sits there until you work it out.
1:07:03
And and so once I started doing that, I'm I'm watching dog commercials. I'm crying.
1:07:10
and go, "What the hell's going on here?"
1:07:11
I had to go through all of these emotional and physical changes >> as part of it.
1:07:16
>> During that 18-year period, y >> you made a ton of money. >> I did.
1:07:20
>> Talk a little bit about that process. Your story is so crazy.
1:07:23
I mean, one of these stories is crazy.
1:07:25
them together is is is remarkable.
1:07:27
But then the fact that you also had this like fairly epic run of business success during this time is like um it's hard to wrap one's mind around.
1:07:39
Uh 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 1 hour sleep at night, you were also somehow like one of the more successful business people in the country and you personally made tons of money. How did that happen?
1:07:54
reflect on that for us a little bit.
1:07:56
>> So, I never worried about the money.
1:07:58
When I was 14 years old, I was working with my father in his plan.
1:08:01
He he was a foreman in a pattern making plant and I was painting walls, cleaning bathrooms, and cutting the lawn and doing all this sort of stuff.
1:08:08
And I was making a dollar and a quarter an hour.
1:08:10
I went to high school where we had the 7 a. m. to the 12 noon shift. And I was in that shift.
1:08:15
I would catch the bus at 1:30, take it down to his his operation about 4 miles away, and I'd go to work and I'd ride home with him in the evening.
1:08:23
And there was this other guy that worked with me, Jerry. He was 24.
1:08:26
And Jerry was not, you know, the brightest bulb in the pack.
1:08:30
And and he would work with me, but he I I was always working circles around him.
1:08:33
I was always So one day, Jerry and I are having a cigarette out behind the the shop at lunch.
1:08:37
And Jerry lets me know he's getting $4. 25 an hour.
1:08:39
So I go into my dad and I go, "Dad, I mean, I work circles around this guy. I want a raise."
1:08:47
He goes, "Well, what happens if I don't give you one?"
1:08:48
I said, "I'm gonna quit."
1:08:49
He goes, "Do you have another job?" I said, "No." He goes, "Good. You're fired. go home.
1:08:55
So, I go home and we had one of these tables, the be trussle tables, and you we have the meal.
1:08:59
There's eight of us around the table and and and and you know, the meal ends and I go to get up and my dad goes, "Sit down." Okay.
1:09:04
He goes looks at me, he goes, "Let me tell you about Jerry. Jerry's got a family.
1:09:11
He's got a daughter and he's got a wife and he's got a house to pay for."
1:09:12
And so, I'm helping Jerry make his payments because he has a family to raise.
1:09:17
has responsibilities and he's doing a job as good as he can and probably not much better than he's going to be ever be able to.
1:09:25
So, I have an obligation to Jerry. You You're 14 years old.
1:09:27
I know we take some of your money to help the family, but you have spending money in your pocket. I said, I understand.
1:09:33
He goes, so do you get why I'm helping Jerry and why there's a difference? Yeah.
1:09:38
Were you happy before when you were making money? I was. Okay.
1:09:39
Do you want your job back? I said, yes. Okay.
1:09:45
You start tomorrow at a dollar an hour. He cut my pay.
1:09:50
And he said, "This is a very important lesson for you.
1:09:51
Never count anyone else's money.
1:09:57
Never compare yourself to anyone else on how much money you have.
1:09:59
When you have it, make sure you share it for people that need it when you have enough.
1:10:05
Never threaten to quit a job unless you got another one to go to.
1:10:09
It's stupid and you're going to have a family one day and that won't work really well for your family."
1:10:16
The money for me was always something that I got as a result of doing good work versus having to have it up front.
1:10:22
As a matter of fact, when I became CEO of Etna, they didn't change my compensation.
1:10:25
They said, "We don't know you.
1:10:27
We're going to give you a shot for three years."
1:10:29
And I said, "Okay, well, at the end of three years, I want some I want you to recognize what I've done."
1:10:34
And I did a lot of good things in that time.
1:10:36
And so I always and I this is my guidance to most everybody that works with me.
1:10:41
Your salary pays for the bills.
1:10:44
Your bonus pays for the balls and your stock is never to be touched.
1:10:46
It's part of generational wealth.
1:10:48
It's for the future and to help others.
1:10:49
So when I left at I had three million shares of stock. I never touched them.
1:10:54
And I didn't expect it to ever be at $28 a share because I took over.
1:10:58
It was $9 a share, but it ended up being a lot of money.
1:11:04
And the vast majority of it went into a foundation called Anahhata, which is the heart chakra and yoga, where I joyfully help food banks.
1:11:12
I do I do environment, education, and community sustainability and I give away close to 12 to 15 million a year doing that.
1:11:20
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 than versus them having distributed through the tax system.
1:11:29
And so every year I do that same thing.
1:11:32
Whatever I make, I I take a portion of it, I throw it into the foundation, and it'll be generational. my son to daughter.
1:11:39
I told them they both they have a great responsibility to manage something that'll be generational.
1:11:43
Um but it's not I don't have yachts and I don't have all those other sorts of things.
1:11:47
As George David told me when I became first became CEO George David came over and spent days with me and he sat down.
1:11:53
He said Mark I'm here to help you. He said okay.
1:11:55
He goes you you got two Sakorski 76s here at you know how they work.
1:12:00
And he described everything and the redundancy and everything.
1:12:04
He goes you know how I know that I walk the floor and I'm with the workers every day. They know me.
1:12:09
Anybody who goes on um Undercover Boss should be fired by their board of directors. They know me.
1:12:13
And when George left, he was banged out.
1:12:16
And in a factory, in a in a manufacturing plant, when you get banged out, that's the workers banging on their machine.
1:12:21
They never do it for a CEO, but he got banged out because of what he did for that company.
1:12:26
and he made three times the total shareholder return that um the guy at uh General Electric made without having a book and crowing on TV every other week.
1:12:37
And and so my view of the 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 it.
1:12:48
But they have >> money comes naturally as a result of service. >> It is. Yeah.
1:12:51
The important thing was is that every day I woke up and I reminded myself that I had 50,000 families at Etna that relied on me to be a good leader and to make sure that what we did created opportunity for the future and and in my first company when I started my first company sister Joyce Deno was on my board.
1:13:14
Sister Joyce Dashiano ran the Providence Hospital in Detroit.
1:13:16
And Sister Joyce was the ultimate chairwoman of the Ascension Health System.
1:13:21
She created the um Ascension Health System, Daughters of Charity, and Sisters of St. Joseph.
1:13:28
And so I went to see her because we were having a for-profit board and you know, a third was owned by management, a third by doctors, third by hospitals.
1:13:34
And I sat down, I said, "I want to just make you comfortable with for-profit governance."
1:13:37
She goes, "Mark, we don't need to do this."
1:13:38
I said, "Why, Sister Joyce?"
1:13:41
And she goes, "At the Daughters of Charity, we have one very important mission. No margin, no mission. We don't make money.
1:13:50
We can't continue to serve our people and extend our services to more people."
1:13:54
So, so the only difference between a for-profit and a not for-profit that are well-run is the forprofit pays taxes. >> I don't.
1:14:04
>> 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 mar no margin no mission is on the back of her t-shirt we believe this >> and so what I tell people at Oscar because I said we going to grow or are
1:14:21
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 whether or not that company knows what they're doing. And at
1:14:35
And at Etna when I had 652% total shareholder return over eight years and we when we looked at the underlying only a third of it related to earnings and twothirds 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.
1:14:59
twothirds of that gain was largely around the PE um 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.
1:15:09
We created 2,000 new millionaires when we sold the company at CBS >> employees.
1:15:15
It's about creating something that's valued.
1:15:18
I've always finished everything I've started and I made it valuable and and and how it gets valued and and the and how people perceive it is up to them.
1:15:28
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.
1:15:35
Um and and so this idea of creating great companies is by building great teams.
1:15:45
60% of my time spent on people doing great things, solving big problems.
1:15:51
>> Before I ask the question of like why then go to do what you're doing now at Oscar. Yeah.
1:15:56
>> I'd love you to talk about the Bridgewater chapter. Yes.
1:15:57
This is a this is a a topic that this audience in particular will find fascinating.
1:16:01
So you went to run Bridgewwater uh and helped Dalio sort of like try to transition out of Bridgewwater.
1:16:10
>> Describe this story for us.
1:16:11
>> So I get a phone call from a guy that I know Rusty O Kelly um at Russell Reynolds and he says, you know, I'm on this assignment and Bridgewwater.
1:16:17
Ray Dalio wants to talk to you. Would you go see him? I said, wow.
1:16:21
But who would not >> sure >> want to have a conversation with Ray Dalio, right?
1:16:25
and he's such an iconic guy.
1:16:27
So I go to meet him and we're having coffee downtown somewhere here and he says to me, "I got to get out of here.
1:16:35
I'm I'm approaching, you know, mid70s and I got to I got to I'm trying to create a deal where I can go.
1:16:41
Um but I really worry that the company will go to hell in a hand basket when I'm gone because I've been at the table every day and it's been largely me running the show.
1:16:55
So, I'd like to get the deal structured.
1:16:57
I'd like to create a governance model that includes more independent directors.
1:17:00
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.
1:17:09
He's got the typical entrepreneur founder kind of thing.
1:17:13
If I'm not here, the place is going to just go to hell in a hand basket. So, I said, "Sure. >> Sounds fun."
1:17:20
>> It was It was like literally a week after I I retired. >> What year is this? fall of 18.
1:17:23
So I join in February and I'm provisional as a board member and I start helping build the committee structure and you know charters and looking at the bylaws and working the deal and um and it was you know it was it was it was chaotic um to say the least.
1:17:44
Um I mean here's a firm that by computer trades all this money every day in 200 liquid markets around the world.
1:17:51
I mean, it's fascinating, right?
1:17:53
As I'm doing that, Ray one day calls me and says, "You know, I'd really like you to become chairman of the board.
1:17:56
I can't make this transition as chairman."
1:17:58
So, I became chairman of the company and we started doing more and more.
1:18:02
And we'd have these marathon negotiating sessions over his, you know, the exit deal and all that sort of stuff.
1:18:08
And, you know, there was no detail that was too small to consider, right?
1:18:11
We finalized the deal at on July 15th at 4:15 a. m.
1:18:20
We got all these people at 4:15 a. m.
1:18:22
It's like, can we just And I'm on Zoom.
1:18:25
I've got a B a bottle of Papy Van Winkle batch B >> waiting for me to have a toast.
1:18:31
We do we did we toasted at 4:15 a. m.
1:18:34
We got the deal done and then I'm hanging out in California.
1:18:41
I spent time in the winter in California in Lagouna Beach and I get this phone call and Dave McCormack had decided to run for Senate in Pennsylvania for reasons I'll never understand but he wanted to do it.
1:18:51
We had created a co-chair role and so um for the two of us to go with a co-CEO job role and he calls me and he goes um Ray wants to talk to you about being the CEO of of Ridgewater.
1:19:04
And I'm going I I you know what a I don't want to put in that kind of time um to because I got to learn the business.
1:19:11
I don't know the business like other people do.
1:19:13
But there's a young guy near Barda um former um IDF uh commando and he was um he was working there as the underling to Dave McCormack.
1:19:25
I said tell you what I'll ride shotgun with Near until he's ready.
1:19:30
So, we did an 18-month deal and I did that and the the the culture is so institutionalized in that organization that causing any changes at the management process level about how we work was really difficult.
1:19:44
People wanted to operate the way they always operated.
1:19:48
That was a bit of a struggle.
1:19:48
Near wanted to make the changes as well, but it was just really the the investors who run the business and make all the money, they call the shots and that's how it works in those places.
1:19:57
Um, and you know, Rey was kind of getting nervous getting out and he wanted to do other things, but he didn't want to be too far.
1:20:02
And it was all of those sorts of minations. Near was ready.
1:20:07
I went back to the board.
1:20:09
And then I had been working with Josh and Mario for three or four years um the last year, an hour a week, and they said, "You're not you're not CEO co-CEO at Bridgewater." I go, "No, I'm not."
1:20:22
And they go, "Well, um, could you come and run Oscar?"
1:20:26
>> And why did you decide to do it?
1:20:26
When I left Hartford, I I'm digging through these boxes and I find this um small flat box of acetates.
1:20:33
You know what acetates are?
1:20:35
>> The projection sheets. >> Yeah. >> Yeah. >> Yeah.
1:20:37
You know, 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.
1:20:42
And I would do presentations of health reform and what the future could look like.
1:20:46
And I had these assetates interspersed with Gary Larson cartoons to prove points like you know one person playing chess and the other person playing checkers at the same table or the one I always liked was a bunch of nights staying on the field half of them with the top of their armor going off.
1:21:00
Why do we have to be skins today?
1:21:01
So it was like so typical of how things get done in the healthare system in negotiations.
1:21:06
And so I looking through them I'm going oh the human genome project I talked about it back in 1991.
1:21:12
Oh virtual healthcare I talked about that 1991.
1:21:14
Oh my god, individual market.
1:21:17
I'm looking at all these sides going, "Oh my god, we haven't accomplished anything >> in 32 years.
1:21:22
We're like not making any progress here and the system's still broken and now it's 20%.
1:21:26
Back then it was 14% or 15%.
1:21:31
This isn't going to end well."
1:21:31
And the CVS deal was meant to do with that.
1:21:33
Um, 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?"
1:21:46
Because I did work with IDO with George Blankenship who built the Tesla dealerships and the uh first Apple stores.
1:21:52
And when we talked to people, they didn't describe themselves as a disease state.
1:21:55
Like I never say, I'm a spinal cord injury survivor.
1:21:57
Um, you know, I've got certain deficit.
1:21:59
My handicap went from 12. 7 to 21.
1:22:01
Um, you know, I had to have my motorcycles modified so I could still ride them.
1:22:06
Um, my I can't play the piano like I used to.
1:22:10
I was classically trained.
1:22:10
My fish my fly fishing just I can't tie flies anymore.
1:22:14
I mean, that's my problem with my health. >> Yeah.
1:22:17
>> That's what bothers me.
1:22:17
And that's what we found is most people described it as a barrier to something they wanted to do.
1:22:23
>> And so, if you could 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?"
1:22:32
They say, "I can't go to the senior center anymore and play cards, or I can't walk to the senior center anymore and play cards, or I can't take my grandchildren for a walk in the park and sit on the bench without my feet hurting."
1:22:44
Well, what if we got your diabetes under control, and you could do that again?
1:22:48
Now, you 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. Um, and so they give up.
1:23:01
And 41% of the American public actually has this attitude of my mother died of sugar.
1:23:06
I'm eventually going to get it.
1:23:09
As long as I can live my life comfortably.
1:23:11
When that time comes, I'll deal with it. They just give up.
1:23:13
So, how can we get people engaged in improving their life and living the life they want by helping them be better?
1:23:23
>> And that's what you get to do at Oscar now.
1:23:25
>> That's what I get to do at Oscar now.
1:23:27
and Oscar's smaller and it's more nimble and we're like this little pirate ship floating around among all these Spanish gallions filled with gold and they just look at us and go look at that little company.
1:23:36
How will they ever make it?
1:23:36
And most of our most of our class of um companies that came out when we came out are all gone and didn't make it and here we are.
1:23:48
>> How do you know what to do?
1:23:48
I like this idea that the job of the CEO is to know what to do.
1:23:53
>> How do you know what to do?
1:23:54
>> It starts with the mental heroist stick in your head. We all have a model.
1:23:57
And I remember sitting next to Bill Taylor who was chairman of Sigma at the time and he's talking about all these people he knows.
1:24:04
I'm going, I will never know this stuff. How do I get this?
1:24:07
I said to him, Bill, how do you know?
1:24:09
He goes, Mark, you have to have a network.
1:24:10
You have to constantly cultivate that network and you have to add to your mental heristic in your brain.
1:24:16
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."
1:24:22
And that's how it happens for me.
1:24:22
I constantly educate myself.
1:24:25
constantly educate myself. I remember Sir Michael Marmmont was coming to Columbia University and Linda Freed who's the dean of the public school the school of public health calls me up and goes I'd like you to do grand rounds with sir Michael Marman on social determinance of health going holy I don't a noble laureate I'm going to walk
1:24:42
around with him talking about social determinance of health I had nine months I crashcoursed 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 you're zip zip code is far more important than your genetic code. Where
1:24:57
Where you live matters more than what you are.
1:25:02
And and that makes a difference.
1:25:02
And so we started building programs around in the home.
1:25:08
We had a 72-y old lady in Camden, New Jersey, $2.
1:25:10
7 million worth of health care costs in one year.
1:25:13
$45 ER visits in the same year, more than one a day.
1:25:18
So we finally go to her house, thermostat set at 62 cuz she can't afford her heating bill.
1:25:23
She's got blankets and and and and sweaters all over the house to keep herself warm that are made of her favorite material, angora.
1:25:32
She's allergic to angora. Crazy.
1:25:37
Buy her new sweaters, buy her new blankets.
1:25:39
The next year, one year visit. >> Huh?
1:25:41
>> So, it was just learnings as we learn more.
1:25:43
I said, "We got to do more in the home.
1:25:44
We got to get connected to the home.
1:25:46
We got to be closer to the customer.
1:25:47
We got to make things more convenient for them."
1:25:51
And we are now able, thank God, for the pandemic in one way.
1:25:53
It taught us how we could do this all virtually a lot better than we thought we ever could.
1:25:57
I worked with Andrew Wild 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.
1:26:07
It's going to take him 6 months to make the money in order to do it.
1:26:11
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.
1:26:18
And so he he stayed there.
1:26:20
So I was working with him and he said, "We don't do virtual healthcare.
1:26:24
We have to put our hands on people."
1:26:27
That changed with the pandemic. Wait a minute.
1:26:28
We can do something different here.
1:26:30
And so I think the pandemic taught us a lot of things about how we could virtualize healthcare.
1:26:33
Oscar is really a virtual company.
1:26:36
Um we do virtual home assessments and all sorts of other things.
1:26:40
So can we deploy that at scale and make it better for everybody?
1:26:44
>> A big part of the answer to the question is constant curiosity. >> Constant curiosity.
1:26:47
>> The courage was the other part of this. Can you define courage?
1:26:49
Like what does courage feel like in your experience?
1:26:52
>> Moving forward without perfect information.
1:26:54
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.
1:27:02
And often people search for perfect information before they make it and then it's too late.
1:27:05
It's a non-decision which is as bad as anything.
1:27:07
So let's make a decision based on a hypothesis.
1:27:13
So another medical story.
1:27:13
I am at a public health department dinner in Connecticut. I get food poisoning.
1:27:22
I wake up in the middle of the night and I am like by myself and I am sick for three days. I mean really sick.
1:27:26
I finally crawl out of the bathtub where I just ran the water all day long to keep me clean.
1:27:33
And I went I went and I went to work and as I'm and I'm and I realize I got heart palpitations, electrolyte imbalance.
1:27:39
So I I buy smart smart water.
1:27:44
And so I'm drinking Smart Water.
1:27:44
And after about a week, it's getting worse.
1:27:48
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."
1:27:54
And she comes up and she goes, "We're going to get an ambulance and take you over to the medical center."
1:27:57
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.
1:28:04
I can see the stock price tomorrow.
1:28:06
Get my driver and take me to my doctor."
1:28:09
And I have this doctor, Dan Chilton. Love the man.
1:28:13
Um, family practitioner, general medicine.
1:28:15
And he's, "Doctor, don't do that."
1:28:18
And I call, he call him that because I used to say, "Well, you know, when I roll my shoulder back this way, it hurts."
1:28:22
He goes, "Don't do that."
1:28:26
And so I go see him and I walk in, I tell him the story, he looks at me, listens to my heart.
1:28:31
Um, he looks at the bottle of water. He walks out.
1:28:33
He goes, "Wait a minute."
1:28:35
He comes back with a 16 bottle of Diet Coke. I he says, "Drink it."
1:28:39
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.
1:28:44
And I drink the whole thing.
1:28:46
And And after about 15 minutes, he goes, "How do you feel?" I said, "I feel great." "What happened?"
1:28:51
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?"
1:28:58
He goes, "Well, Mark, my last two years of medical school," my father was the dean of the medical school at University of Virginia, and his buddy was at NIH in in London, and he had a son who wanted to come to the United States for his last two years of medical school, and he offered a swap for you to go um and sit for me to go and sit in in the UK.
1:29:16
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.
1:29:25
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.
1:29:34
Said, so you've got one kidney, your electrolyte balance takes longer to reset, especially after you have food poisoning. So that's number one.
1:29:42
It would have been better to get a ringer lactose to IV um early on had you known that it would have fixed it a lot quicker.
1:29:51
Two, Smart Water is for sweating.
1:29:55
You have a bicarbonate problem.
1:29:55
You had a bad gut thing going on. That's a bicarbonate.
1:29:59
There's no bicarbonate in this.
1:30:01
So, you actually making your electrolyte imbalance worse by drinking the smart water.
1:30:05
There are two sources, great sources of bicarbonate. There's Perry.
1:30:09
I can't afford it because you don't pay me enough.
1:30:10
And and and Coke and I brought you a Diet Coke because you're 20 pounds overweight. You need to stop. You need to lose weight.
1:30:19
You owe me a buck and a half. Go home.
1:30:21
I was a dollar for the Coke and I went home.
1:30:26
But he says, "We're taught to understand our patients deeply, know the science, do a great history and physical, and come up with a with a hypothesis and test it." And that's how I work.
1:30:34
I figure out there's obviously something wrong.
1:30:39
What are the possible possible ways of moving forward, testing a number of hypotheses to find out what's truly wrong and then fixing them?
1:30:47
>> We talked a lot about the worldview you've adopted through all these experiences.
1:30:51
If I if I rewind all all the way back to prior to going through what you went through with your son, >> like 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?
1:31:06
Like if if you could sit down and have lunch with the 2000 version of you, how are you most different?
1:31:13
Like what is it like to experience the world after having been through all this craziness?
1:31:16
I always thought when I graduated from the MBA program at Cornell, that I knew everything I needed to know about running a business.
1:31:23
And I didn't know anything about running a business.
1:31:26
Um, I used to go to RUFoffs, which is a bar in college town, and they have the largest brain collection at Cornell, and and the largest brain they had was for Ruof, who was an axe murderer in the late 1800s, and um, he killed seven people and got electrocuted.
1:31:44
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.
1:31:52
And so they have this underneath the computer lab at Cornell, they have this massive brain collection of all these brains.
1:31:58
And somehow Ruoff's brain got above the cash register in this bar.
1:32:01
And so Thursday nights I would go to Ruofs and we'd drink beer and party.
1:32:07
And Friday morning was my first was was my class on um corporate governance and and and running or and building organization structures which I slept through most of the time and you know just wrote a piece of a paper on it and sent it in and just got the grade I needed to get out.
1:32:22
So I never learned all I never spent my time learning all the subtle sciences of social management of organizations and had to learn the hard way.
1:32:32
And over time, I used to have this every night, I get all my material before I go home for the next day.
1:32:38
I review it all and I come up to a point of view on all of it.
1:32:40
So that when I walk into the meeting, I'm ready to discuss where we go versus having somebody read me PowerPoints.
1:32:45
And I tell people, do not read me PowerPoints. I will stop you. Um, I have read them. So, let's get going.
1:32:52
So, I always just say, I have the right I would have the right those were all the right answers.
1:32:57
And how long will it take the people in the room tomorrow to get to the same conclusion I know is the right one?
1:33:03
And then I'd start asking questions to try and steer them to the right, right? Leading the witness.
1:33:07
And one day, Ron Williams is sitting there and this is in 2003 before the accident.
1:33:15
He goes, "You know, it's really interesting the way you operate."
1:33:16
He goes, "It's very transparent to somebody like me.
1:33:20
And I would offer you a suggestion. Just try it.
1:33:22
Those questions you put together for everybody.
1:33:25
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?
1:33:32
you'll be amazed at how much smarter you are.
1:33:34
And now I know 35% of the time I'm right and the rest of the time I got to learn by asking questions.
1:33:40
So it changed my style completely.
1:33:43
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.
1:34:03
What's your unfinished business, if any?
1:34:06
>> I'm going through this debate internally about, you know, why do I continue to work? What am I looking for?
1:34:10
What am I trying to find?
1:34:11
And I don't know what it is.
1:34:13
I know I'm not afraid of being alone. I love being alone.
1:34:15
I'm an introvert by nature.
1:34:17
Um, you probably wouldn't recognize it, but I'm very introverted. Um, I hate large groups.
1:34:23
When I get up in front of large audiences, I'm sick to my stomach.
1:34:24
Um, it really is trouble for me.
1:34:27
And and and it's not because I'm not confident in myself.
1:34:32
It's just that I'm I'm I don't I don't feel I need to convince others that I'm a good person. I know who I am.
1:34:40
My unfinished business is understanding how I can be much more effective with what I have than trying to accumulate more, I guess, would be the And what is that?
1:34:48
I mean, it's my foundation.
1:34:48
We're rebuilding the libraries and the elementary schools in Harlem.
1:34:52
We have created a reforestation plan for our f five burrows of New York.
1:34:56
Um, and we're planting trees now.
1:34:58
And we're doing all these amazing things.
1:35:00
Harlem Grown was one little farm and it's now 25 farm across all from 25 elementary schools in Harlem helping families eat and learn.
1:35:10
We have students that go to the farms and work with the children after school until their parent comes to pick them up.
1:35:15
They get food, go across to the school, build a meal together, and review homework instead of watching TV with fast food.
1:35:20
I mean, all really cool stuff.
1:35:22
And I'm really proud of all that work, but it's I'm like unsatisfied and I don't know why.
1:35:30
>> What have you learned about enduring impossibly hard things?
1:35:32
Lots of people have to do this to varying degrees.
1:35:35
Yours is extra extreme and extraordinary. >> Yeah.
1:35:38
>> What can you say reflecting on the totality of it about the endurance of difficult things?
1:35:45
>> Never waste a good crisis.
1:35:45
There's opportunity in everything that confronts you.
1:35:49
And I would say, and um it was actually Kino Reeves that said this, um the challenges that come your way, um the things that could break you are really gifts because they make you a better person.
1:36:06
And I, you know, people that have known me my whole life, including my 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.
1:36:19
could I. I mean, my role was gonna be work in the plant, get home by three, head up to Northern Michigan, um, to a little place I have up there and hang out and, um, and and just be a good dad and, you know, make it and here I am and I have all these other things and and a
1:36:37
lot of wrinkles along the way that have been very disappointing and things that I've done that I not very proud of that I did and and in the end in 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
1:36:48
and the person that's coming out of the other side.
1:36:49
What I've learned is every crisis you face, you can't go back. You can only go forward.
1:36:57
And you just have to pick up the pieces and start rebuilding.
1:37:00
>> I've been excited to ask you my final traditional closing question because your insane story.
1:37:05
>> What is the kindest thing that anyone's ever done for you?
1:37:13
>> I've had so many people be so kind to me.
1:37:15
It's really hard to dist distinguish one thing.
1:37:18
When I was in the hospital with Eric, I mean, it was like a I still have my They gave me an ID badge um so I didn't have to go through security every time and get a a pass to the room.
1:37:28
And um there was this doctor, Dr.
1:37:35
Gynan, who came up with this treatment.
1:37:36
And um and every time a dark turn would happen, I get a phone call from her and I didn't know why.
1:37:45
I mean, she was not on the floor.
1:37:48
She was the head of the program.
1:37:50
But I get this call from her and she said, "I am really I am really hungry.
1:37:56
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.
1:38:02
And I used to go over there to work out um every day.
1:38:04
The only time I left Eric was from 10:00 to 11:00 every day.
1:38:08
I went to the gym to work out and they would do a sponge bath and all that other sort of stuff for him.
1:38:11
And and she would sit down with me and say, "You're an amazing human being.
1:38:19
Here's what I would do next.
1:38:22
Don't let them convince you that he's dead.
1:38:23
Here's what I would do next."
1:38:23
It cost her her job as a head of that program.
1:38:29
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.
1:38:38
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 in sitting with your son talking about emancipating him as a minor so he can make his own decisions."
1:38:55
I flipped around one of the turnarounds on the the turnpike and I headed back to Boston at like a 100 miles an hour hoping to catch a cop and say, you know, my son needs me. Not one cop.
1:39:08
>> What is it these cops in you?
1:39:12
>> Nobody pulled me over.
1:39:12
It was like I would have appreciated the escort is what I was going to be able to get.
1:39:18
>> I walk in the room, I grab the attorney and said, "This stops right now. I am the I'm the adult.
1:39:22
he can't apply for it without my permission.
1:39:27
And I threw them out of the room.
1:39:29
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.
1:39:42
And they tried to get me to do DNRs.
1:39:44
They tried me to put him into hospice and they just tried everything.
1:39:46
I had a doctor in the cafeteria one day saying to me, "Hey, Mr.
1:39:50
Berlin, have you thought any more about that DNR?"
1:39:51
I grabbed him, threw him on the floor, and next thing I have security all over me.
1:39:56
I go, "How dare you ask me that question in the middle of a cafeteria? What's wrong with you?"
1:39:59
Ava put herself on the line for him.
1:40:01
And she didn't know him or me for anything.
1:40:03
And she's still an amazing friend.
1:40:06
And if there's any one accomplishment I could point to is his he's alive because of my engagement and my in my advocacy for him and in in her partnership in it.
1:40:18
That's the kindest thing that anybody's ever done for me.
1:40:22
>> Mark, your story is crazy, incredible.
1:40:25
I'm so thankful that you chose to tell it with me uh and for all that you're building and doing.
1:40:30
I'm really appreciative for your time. Thank you. >> Thank you so much.