A Second Opinion with Jeff Goldsmith – A Second Opinion Podcast

A Second Opinion with Jeff Goldsmith

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In today’s episode, we’re joined by health care futurist, Jeff Goldsmith. Jeff Goldsmith is president of Health Futures, Inc., and national advisor to Navigant Healthcare. For over a decade, Jeff was a lecturer in the Graduate School of Business at the University of Chicago on health services management and policy. He is one of the nation’s foremost health industry analysts specializing in corporate strategy, trend analysis, health policy and emerging technology. Wait until you hear his predictions for the future of health and health care.

Sen. Bill Frist:               Welcome to A Second Opinion podcast where we are rethinking American health. I’m your host, Senator Bill Frist. To make sense of all the dynamic perspectives in health care, you need a trusted source engaging at the intersection of policy and medicine and innovation. You need A Second Opinion, a podcast where it all comes together.

Sen. Bill Frist:               In today’s episode, we’re joined by health care futurist, Jeff Goldsmith. But before we get started I want to thank our sponsors. A Second Opinion is powered by MEDHOST, a trusted EHR for healthcare facilities and by Tivity Health, lifestyle brands that transform healthy living for adults through nutrition, fitness and social connections.

Sen. Bill Frist:               Now, let’s turn to the episode. Jeff Goldsmith is president of Health Futures, Inc., and national advisor to Navigant Healthcare. For over a decade, Jeff was a lecturer in the Graduate School of Business at the University of Chicago on health services management and policy. He is one of the nation’s foremost health industry analysts specializing in corporate strategy, trend analysis, health policy and emerging technology. Wait until you hear his predictions for the future of health and health care.

Sen. Bill Frist:               And now, please join me and our guest for A Second Opinion.

Sen. Bill Frist:               Jeff, welcome. Over the next 30 minutes or so, there are a whole range of issues that I want to touch upon, but I really do want to thank you for spending time with me and our audience today talking about all sorts of issues. I would like to come back to the big thematics of health, health system, demographics and innovation today. But let me open with something just totally different, and it’s something you and I have talked about and that is living the rural life. You live on a 300 acre farm right outside Charlottesville. How does it affect you in your overall thinking as you look at health care and larger issues in life?

Jeff Goldsmith:             I grew up in the suburbs of Portland, Oregon, and then moved to the South Side of Chicago to go to graduate school, and I spent the next 26 years of my life in metropolitan Chicago. It was an exciting place, it was a great place, both to learn and to start a career, but it took a toll. It was stressful. You didn’t notice the stress.

Jeff Goldsmith:             I was married at the time to a woman that rode horses, and it was breeding horses. She wanted to breed Olympic event horses, and we wanted to find a place that we could do that, that wasn’t going to eat us out of house and home and we ended up on a horse farm in Charlottesville. We separated in 2003, she took the horses, and I kept the farm, and it’s been a marvelous… it’s just a calming, peaceful place. I love having neighbors that have lived on my street for 70 years. I can take a walk in the woods, and it’s transformative. It’s quite unlike anything I’ve experienced.

Sen. Bill Frist:               You know, it’s interesting in life today, and I open with that a little bit because our young people today and with urbanization, really don’t have that opportunity as much. We have to more actively seek it. But in some shape or form, I wonder if that sort of calming, that sort of physiologic response of nature isn’t something we could look to as we look at what’s happening in the world today, but in America today with the things like stress and anxiety and Type A personalities, all of which have an impact on health.

Sen. Bill Frist:               Let me ask, you’re a futurist and literally one of the busiest in America in terms of people accessing you and your thought processes and your experience over time. But take me back to 1986. In 1986, you were asked to write a paper. Tell me about that.

Jeff Goldsmith:             In 1986 the editor of Hospitals Magazine asked me to write a paper about the US health care system in 50 years, in 2036. I was like, “Who knows?” I mean, literally anything could happen and then I realized that not only was I going to be dead in the year 2036, so I could be completely wrong and no one would know, but no one would remember the article so even the people that read it wouldn’t know, and it was just a marvelous free shot.

Jeff Goldsmith:             But I talked in that piece about the idea that health care was going to reshape itself around information technology and how an intelligent, clinical record, a sentient clinical record was going to be the core of the health system and that we were going to be connected to the health system by webs of telemetry, similar to cellular communication as of 1986. There were a couple-

Sen. Bill Frist:               It was before the internet, before webpages.

Jeff Goldsmith:             Yeah, exactly, before cell phones.

Sen. Bill Frist:               Yeah.

Jeff Goldsmith:             There were a couple of things in there that I’m fairly proud of but I also said in there that I thought individuals would be the single largest source of health spending.

Sen. Bill Frist:               What do you mean by that?

Jeff Goldsmith:             Not governments, not corporations. It’s that we would have ended up pushing enough economic responsibility off on to individuals through IRA-type health plans that… I really thought that the Health Reimbursement Accounts, health savings accounts would become the dominant form of health care financing, even for publicly funded people. The result of that would be the consumers would actually have more economic leverage than governments or employers did. That was also a forecast in the 2036 thing which I think is not going to come to fruition.

Sen. Bill Frist:               [crosstalk] your expectations, going back to ’86, but also in the last 10 years, the move towards the consumer being the driver, the levering force, has it moved faster or slower than you thought?

Jeff Goldsmith:             This idea of consumer directed health plans kind of surfaced in the late 1990s and then kind of sputtered during the boom that we had in the first seven or eight years of the 21st century. Then it really got kicked into high gear by the recession.

Jeff Goldsmith:             I think a lot of employers faced a choice between eliminating the benefit altogether or significantly shifting economic risk to their workforce, and they did the latter instead of the former. We had almost a quintupling of the number of people who had deductible plans from 2003-2012. It just exploded and then it’s leveled off again. What I think is likely is that when we do have an economic downturn, there’s going to be a further wave of benefit buy-down and shifting of cost onto consumers.

Jeff Goldsmith:             Unfortunately, I think a lot of that shifting has taken place without looking at whether the people that the risk is being shifted to actually have any savings, actually have the resources to be consumers.

Sen. Bill Frist:               Right.

Jeff Goldsmith:             I think one of the sources of political instability in the health system right now is that a huge percentage of the 60 million people that have $3,000, $5,000, $7,000 deductibles don’t have the $3,000, $5,000, or $7,000.

Sen. Bill Frist:               They’re not really getting power. They don’t have the resources to force as a force function their decision.

Jeff Goldsmith:             Right. Well, the rhetoric is empowerment, but are you empowering somebody that has no money when you give them a huge economic risk? No, you’re not. You’re building a 12 foot fence around the health system and then putting a layer of barbed wire on top of that. If people aren’t filling prescriptions because they don’t have the money, if they’re not following up on a referral from their primary care doctor for a problem that’s controllable or manageable because they don’t have the money, that’s not helping our country. That’s not moving us forward.

Sen. Bill Frist:               Let’s go back and talk about this consumerism when we really look to the future. I’d like to hear some of your predictions and bold predictions on the future.

Sen. Bill Frist:               Before doing that, about five years ago, I was in the audience and you talked about the demographics. Not that you predicted, but you talked a lot about it and other people were beginning to talk about it, but take us back about four or five years and let’s use survival or length of life, how long people lived as sort of a basic measure. But what has happened, how surprising, what are the drivers of the demographic changes?

Sen. Bill Frist:               You and I grew up with the American dream that we were going to live better lives than our parents and that was the goal of our parents, and our grandparents and every generation, to live longer, happier, more fulfilling, more productive lives and that’s been blown up. Take us back four or five years.

Jeff Goldsmith:             If you go back more than that, if you look back to the 1970’s, we’ve had this long string of improvements in life chances for Americans and continuous reductions in mortality rates from things like heart disease and strokes and cancer, that are the scary things that people worry about that may take them out. Really, in 2013, ’14, ’15, you saw those curves of decline begin to flatten out and turn around.

Jeff Goldsmith:             In 2015, US life expectancy declined for the first time in 24 years and then declined again in 2017 which is the first time we’ve had two years that close together in 53 years. It’s really an anomaly. When you look at the underlying demographics of it, the health status of minority populations, of blacks and Hispanics, have continued improving. The turnaround has been in white folks in mid-life.

Jeff Goldsmith:             There was a brilliant article in the proceedings of the National Academy of Sciences by a couple of Princeton economists, Angus Deaton, who’s a Nobel Laureate, that spotted this trend in almost a 15% increase in the mortality rate for white Americans in mid-life since 1997.

Sen. Bill Frist:               So, it’s a mid-life crisis.

Jeff Goldsmith:             It’s in mid-life, people in their 40’s and 50’s. A lot of that spike came from what Deaton and Case called diseases of despair, so drug overdoses, suicides, cirrhosis, things that people were doing to themselves. It’s really an anomaly because you think about a country where that continuous economic growth and tremendous prosperity and vitality in the economy that isn’t reaching everybody.

Jeff Goldsmith:             The talk I gave a few years ago that you referenced about what was happening to the Baby Boom generation. People think of the Baby Boomers as a monolith. They’re not. There’s a sub-set of Baby Boomers that are incredibly fortunate and wealthy that was, I think at the time I thought about a third of the generation. There was maybe a third of the generation that was in trouble in mid-life, that were having problems with their weight, problems with their emotional status, economic problems and all the rest of it.

Jeff Goldsmith:             And then there were a group of people that I characterized as anxious and hurting. This was about a third of the generation, about 25 million people, that were already in serious enough trouble that they really needed to be on Medicare. They really needed access to social and human services but weren’t getting it because they didn’t have the resources and their employers weren’t providing it.

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Sen. Bill Frist:               As you look ahead, there are obviously levers that a policy maker can use. One would be tax policy, stimulation, to invest in rural communities for example. There is education, which clearly our country, not at the higher education level, because we’ve done well there, but K-12. We’re miserable compared to the rest of the world.

Jeff Goldsmith:             Let alone pre-K.

Sen. Bill Frist:               Yeah, and then go down to pre-K, but just based on your experience as you look ahead and looking at this tight, intertwining, this relationship between health and poverty. The policy maker, what advice would you give? Is it education? Is it economic development? Is it tax incentives? Where would you put the emphasis?

Jeff Goldsmith:             I think one of the illusions that our most recent Congress had about taxes is that you cut corporate taxes and money will automatically flow into people’s paychecks and into investment creating new jobs. It didn’t happen. The money flowed into stock buybacks and that sort of thing. It generated a short-term burst of cash flow, but it didn’t really create the infrastructure that created jobs. I think this stuff is really hard and really subtle. It’s sort of beyond my pay grade to kind of suggest the types of things that bring sustainable growth into an area.

Jeff Goldsmith:             I talked to the West Virginia Hospital Association back last fall. I said to them, “You guys have as much of an investment in a successful economic development strategy for your state as anybody else in this state. What are you doing about it? Are you using the power that you have?” I said, “I’ve run rivers in West Virginia. I’ve fished and hunted in West Virginia. It’s one of the most beautiful states in the union. It’s a great place to retire. Why isn’t it being marketed as a place for people to come and bring their wealth and spread it around a little bit? Why aren’t these places creating a more sustainable base of wealth by bringing people into the area?” It may not be business development in the very first instance where the leverage is, but bring in the money and the business development will follow. [crosstalk 00:24:12]-

Sen. Bill Frist:               Big tourism is where we started. Where we started, where you live is a beautiful area and Appalachia is gorgeous, yeah.

Jeff Goldsmith:             Absolutely. If people don’t feel like it’s a friendly place to visit, they’re not going to come.

Sen. Bill Frist:               Let me switch because I know there’s so many things that we could cover. Let’s look to the future a little bit. We haven’t talked very much about health systems, per se, so far, which is really interesting to me. We’ve got health, we’ve got survival, we’ve got infant mortality, we’ve got really discouraging statistics today because of these social reasons that we all need to work on.

Sen. Bill Frist:               What is the role of the health system of the hospitals, and the doctors and the insurance industry? It’s amazing we haven’t even been talking about that because a lot of people would jump and say that we need to have universal health care. It’s all in our insurance system and that’s going to cure it all. Obviously, it’s not. But what is the role of the health system of the future in addressing these issues?

Jeff Goldsmith:             It’s interesting that for most of my career I’ve been doing strategy work for health systems. A lot of my energy in that work went into thinking about the very first layer of patient contact, that is, of primary care physicians and community health workers and all the rest of it.

Jeff Goldsmith:             In a lot of these communities that are having trouble, that first layer of contact with the health system has withered away and all there is, is the emergency room and this big complicated building.

Jeff Goldsmith:             That’s not a flexible enough enterprise to be able to address a lot of these issues early which is when you need to get on them. You’re not going to solve problems of undiagnosed and unmedicated hypertension with an emergency room. You’re going to need community health workers. You’re going to need primary care physicians that are capable of communicating with people, “Here’s some of the reasons why you’re not feeling so hot. And here are some things that are pretty affordable that can help you fix it.”

Jeff Goldsmith:             That level of investment has withered away in a lot of places. In a lot of rural areas and small towns, primary care physicians can’t afford to practice anymore. They’ve been absorbed into hospitals and hospitals have not done a very effective job of managing those practices. As long as we’re continuing to pay those folks peanuts, we’re not going to renew the primary care base. We’re not going to renew the nurses and community health workers that can really make a difference.

Sen. Bill Frist:               That, I think, is a really great point. The entry-level system, which is a radical change from 40 years ago, probably only 1 out of 2 people today have a primary care doctor, per se. Very different than 50 years ago, my dad making house calls and internal medicine and family practice and the like. Urgent care centers are springing up and that gives better access, but again it really is not the primary care where you diagnose the hypertension and you treat the chronic disease coming in.

Sen. Bill Frist:               You mention primary care, with 50,000 primary care physicians short over the next 10 years, so that’s one element. What else from a system, as we look to the future, how do you see the systems adapting to address these issues, whether it’s survival, or quality of life or better treatment?

Jeff Goldsmith:             We do, as a society, spend a ton of money on health care. It’s $3.6 trillion. Guess how much we spend on public health?

Sen. Bill Frist:               What is it?

Jeff Goldsmith:             $85 billion.

Sen. Bill Frist:               Yeah.

Jeff Goldsmith:             That’s it. That sounds like a lot of money, but in a country of 330 million people, it’s not enough. A big chunk of that public health spending is actually very successful. It’s the community health centers that take care of 25 million people, largely poor people, in both urban and rural poverty situations.

Jeff Goldsmith:             It would cost us pennies as a society to double that capacity. We could double the number of people that had access to those with about the same amount of money it would take to build Mr. Trump’s border wall.

Sen. Bill Frist:               That’s right.

Jeff Goldsmith:             $5 or $6 billion is all it would take. It would have an enormous impact.

Sen. Bill Frist:               Do you see the private sector, on community health centers, where they can put prevention in product disease management, clearly cut out the number of admissions to a hospital and huge cost savings, spending savings coming in. Is that the role, just of government itself where it lies today? When I was in the Senate, we doubled the spending on community health centers, the work initially with President Clinton, then with President Bush.

Sen. Bill Frist:               Or is it also a business model potential? The need is out there, there’s a lot of money in health care, it has demonstrated savings. Can you build a business model for community health center type of delivery in Appalachia, in parts of America where we know health care is not being delivered at the level we’d like?

Jeff Goldsmith:             I’m an individual that’s biased towards private sector solutions, but I think the answer on the community health centers is probably it’s a lot easier and more efficient to just expand the public system that we have.

Sen. Bill Frist:               Which we know are working.

Jeff Goldsmith:             Which we know are working. I know from a business model standpoint, CVS Aetna combination, they really want to see their Minute Clinics turn into chronic care management and care management enterprises. I’m not sure that’s going to happen. I just don’t think the bandwidth that you get from a pharmacist and a nurse practitioner expands sufficiently to do that kind of thing but they’re thinking about it and it’s one of the-

Sen. Bill Frist:               And 80% of the population lives within 3 miles of a Walgreens or a CVS, so conceptually the geographic barrier is overcome. I guess, and I’ve heard you talk, the potential for telemedicine, of technology today, if appropriately applied can really extend beyond a retail sort of nurse presence if you need it.

Jeff Goldsmith:             Right, but I guess that I just don’t think of the retail experience as something that penetrates deeply enough into people’s motivations or has a sufficient degree of credibility with the patient.

Jeff Goldsmith:             People use them because they’re easy, cheap, convenient. Easy, cheap, convenient, is not necessarily what’s going to penetrate down into actually changing people’s lives.

Sen. Bill Frist:               I think the best example is hypertension which is a silent killer.

Jeff Goldsmith:             Yeah, that’s a great example.

Sen. Bill Frist:               Probably the number one killer in America today is hypertension but it’s asymptomatic. There’s no reason for somebody to go to your local retail clinic or urgent clinic until you have your stroke.

Jeff Goldsmith:             Right.

Sen. Bill Frist:               We’ve got primary care accessing the systems, the systems change where people have the lowest barrier to make sort of the healthy choice, the easiest choice in terms of it. What else in the health system, we’ve got hospitals, we’ve got doctors, we’ve got the best hospitals, the best doctors, the best ambulatory surgical clinics in the world.

Jeff Goldsmith:             Right.

Sen. Bill Frist:               Yet, we’re not doing it. How else will the health system over the next five years have to evolve to address the sort of issues that we’re talking about today which are reversing the increase in survival we’ve seen for the last 100 years.

Jeff Goldsmith:             I think part of it goes back to the fact that we’re buying the wrong stuff. We’re buying visits. We’re buying tests. We’re buying surgeries. We’re buying hospitalizations. That’s what we pay for and we’re getting them.

Jeff Goldsmith:             What we really need to be buying are relationships and complete clinical solutions to the episodic problems that are addressed. We need to pay for them in a sort of a unified, simplified way that doesn’t take half the clinicians time to be typing in the details that enable that to get paid for. I think we need to fund a relationship with a primary care physician, not visits with them. I think they need to get…

Jeff Goldsmith:             I have a primary care doctor. I think it would be more efficient for him and for me if my Medicare paid him per month to sustain the relationship and that relationship had all the stuff that you talked about a minute ago built-in to it. It had my text connection to him, my ability to send him or her pictures, my ability to have them monitor conditions that are unstable enough that they could put me in the emergency room and all that gets paid for inside that monthly fee where he doesn’t have to have 5 people in the back room billing for it all and typing away to make sure it’s all adequately documented.

Jeff Goldsmith:             Now, I had both of my hips replaced a couple of years ago. The way we paid for it made no sense at all. What ought to happen is there ought to be a single severity adjusted payment for not only the surgical procedure but all of the rehabilitation and monitoring necessary to get me back out there working.

Jeff Goldsmith:             We ought to pay for that in a bundle, severity adjusted where it isn’t each separate encounter or each separate test or procedure or home health visit, each of which has to be elaborately documented but a single payment for a complete clinical solution.

Jeff Goldsmith:             I think if we just did those two things well, paid for relationships, like the relationships that people had with your dad, and paid for my surgery as a complete clinical solution, we could leave the rest of it go. Solving those two problems would make an enormous difference in both health outcomes and in costs.

Sen. Bill Frist:               I love that. The whole idea of a bundled payment, and yet, when you use these words, they all become buzzwords, but the idea of having a group of resources, giving them to a team of people and letting them micro-allocate according to what they think is best, built around outcomes, makes so much sense instead of what we did when I was in Washington and had just a fee-for-service system and basically pay on the more that somebody does with no coordination whatsoever.

Jeff Goldsmith:             Right.

Sen. Bill Frist:               The real question we have, I think, is who does the forcing function? Who does the engineering? I think the bundled payment is, as you suggested, one very, very good way to allow that appropriate allocation of resources.

Jeff Goldsmith:             The sad thing is, I think we’ve tried a bunch of different models. Some of them worked, some didn’t, but the core flaw was that they were overlaid on top of all of that fussy fee-for-service stuff and multiplied the amount of data and the amount of worrying about it all that the clinical teams had to do without saving a dime.

Jeff Goldsmith:             If you’re going to get rid of fee-for-service for things like that, you get rid of it. You don’t overlay on top of that and that’s what the Obama folks did that I think generated a lot of the backlash. It ought to be simpler to practice medicine. We need to take a lot of the typing away.

Jeff Goldsmith:             I have friends at the University of Virginia the Department of Medicine that had a retreat about this and they were talking in the retreat about pajama time. Pajama time. Do you know what pajama time is, Bill?

Sen. Bill Frist:               Tell me.

Jeff Goldsmith:             It’s like the time that their primary care docs have to spend after they put the kids to bed. They go back in their pajamas to finish typing into their medical record all the stuff that happened during the day so that the Department can get paid for their services. That’s pajama time. That’s crazy.

Sen. Bill Frist:               We need to free up… and that’s not why people go to medical school or nursing school.

Jeff Goldsmith:             They’re spending half their time typing. I had an article a couple of years ago that I’m glad didn’t go viral. It was in the spirit of Jonathan Swift’s A Modest Proposal. You remember where he suggested the solution to the Irish Famine was just to eat the babies.

Sen. Bill Frist:               Yeah.

Jeff Goldsmith:             Well, my idea was to have something called a charting day where Friday, no patient care is rendered on Friday because it’s an entire day devoted to charting to documenting clinical encounters. No patient care at all is rendered. The people in the hospital, you just send them home. They get to come back on Monday. If they don’t come back, well, you know, that’s too bad. You put the folks in the ICU in a medical coma and they can spend their entire day catching up on their documentation.

Jeff Goldsmith:             Well, it’s not a joke because it’s more than a day a week that people are spending typing into their medical records. We have given ourselves a societal hotfoot and we’ve created a shortage of primary care physicians, of surgeons, of nurses, just by what we’ve asked them to do because we don’t trust them. We don’t trust the system to do the right thing.

Sen. Bill Frist:               Let me ask you, in a series of points, I’m going to give you just a couple of words and just respond in 30 seconds. Young people and their role in the future of health care. You talked about your 37 year old surgeon and the miraculous things she did, but very quickly, the role of youth in health in the future.

Jeff Goldsmith:             We’ve already seen the generational transition on the front lines of medicine. Of the five surgeries that I had from ’15-’17, only three of the people that touched me were over the age of 40. But then you go into the c-suites of their institutions and there’s almost nobody under 60 other than the clerical support staff. That’s not okay. You go into their board rooms and as people, Bill, our age and older, that are sitting in those board rooms, there’s a handful of people under the age of 50.

Jeff Goldsmith:             The generational transition that’s already happened on the front lines of medicine which is inspiring. When you interact with those young people, they’re just on fire and they’re looking to do stuff differently. You’re not seeing that same vitality in the executive suites and in the board rooms and I think that is a fundamental management failure. It’s a governance failure. We haven’t permitted enough of the Gen X and Gen Y folks into the places where decisions get made and where resources get allocated and I think it’s really hurting a lot of institutions because of it.

Sen. Bill Frist:               All right. Risk taking, risk adjustment in health systems today, when people say risk, what does that imply to you and what direction should we be moving in?

Jeff Goldsmith:             There has been an assumption that we’re moving from volume to value and that we’re going to be paying people in a much more comprehensive way for services and that isn’t happening. The data just doesn’t support it.

Jeff Goldsmith:             I think we have grossly overestimated the role of financial risk in changing how people render medical care services. I think we’ve been in a sort of a technocratic cycle where we assume that if we find the perfect payment scheme, all the other changes that we want to see take place in health care are just going to happen the day after tomorrow and I think it’s really been a lot of wasted motion and wasted energy.

Jeff Goldsmith:             And I take the bundling example out of that. I think we tried bundling. I think we did it wrong. I think the idea of simplifying how we pay for care is a very powerful idea that we need to take a lot more seriously.

Sen. Bill Frist:               Big data, information, the information age, will it be useful to a better health and better health care or detrimental in the future?

Jeff Goldsmith:             If I’m a patient, I want decisions made based on good information, but to me the heart of the matter is the relationships that are at the heart of medicine. I think that’s the part that’s broken and it is more broken than the lack of information.

Sen. Bill Frist:               Transparency in pricing, a huge issue today. It’s hard for consumers to shop with these high deductibles today. They need to know what they’re buying, and they need to know what the prices are. Is transparency in pricing, are we making progress and will it be useful once we make further progress in the future?

Jeff Goldsmith:             If I have a $7000 deductible and I don’t have the $7000, how much does it matter what the prices are?

Sen. Bill Frist:               Okay, is the listing of prices important. I understand that somebody doesn’t have the resources, but should there be a move to know what things cost and pricing from the consumer’s standpoint?

Jeff Goldsmith:             I actually tried to do this with my hip replacements. I tried to ask the five places that I interviewed what it was going to cost and none of them knew. To say to me, “Well, that implant is going to cost $3800 and the OR time is going to cost $1200.” That doesn’t help me at all. I want to know what the procedure is going to cost all in, all the way from my diagnosis to the point where I’m back working. I think pricing out the individual components of that procedure don’t help me one little bit.

Sen. Bill Frist:               Every talk you basically end, and we’ll bring this to a close and let you reflect on it a bit, on being optimistic. You always say you’re optimistic about the future, yet much of what we’ve talked about today are the failures in our health, and failures in our health care system. Are you optimistic about the future as we look ahead for the next 5-10 years?

Jeff Goldsmith:             Well, you can get discouraged looking at the macro indicators in a society as complicated as our health system, or a health system as complicated as the Vanderbilt Medical Center.

Jeff Goldsmith:             My optimism came from actually using the medical care system and seeing all these brilliant young people that really put themselves out there to help me. That part, you lose sight of it when you’re going to meetings and you’re reading journals. You don’t see any of that stuff. You don’t feel it. That part, the personal part, the interaction with the people that are trying to help me solve a major problem in my life, that’s the part that I found just stirring.

Jeff Goldsmith:             I think the real richness in our health system is on the front line. Those people have been buried under layers of complexity and five, six, eight layers of management above them. If you’re in the c-suite, you don’t see it every day.

Jeff Goldsmith:             When I entered this field, there was a routine in health administration called administrative rounds where you got out of the office and went into the ICU, went into the operating room, went into the ER. That stuff isn’t happening anymore, and it’s really too bad because if you’re in contact with those 20 and 30-somethings that are on fire because they’re helping people, making a difference in people’s lives, it really changes the way you look at the health care system.

Sen. Bill Frist:               Jeff, thank you so much. It’s always a pleasure. I learn so much each time that we’re together and I love your inspiration both for all of us in the health policy, but the health providers for the consumers themselves, for the young people, who again, you come back to as sort of where the real hope is in the future.

Sen. Bill Frist:               Thank you very much and it’s time for you to go back to your farm and me to get back on my farm and go convene a little bit more with nature and bring those stresses down, bring that tension down and hopefully improve the health of people around the country.

Jeff Goldsmith:             Works for me, good to see you, Bill.

Sen. Bill Frist:               Thanks so much, appreciate it.

Jeff Goldsmith:             All right, bye-bye.

Sen. Bill Frist:               This episode of A Second Opinion was produced by Todd Schlosser, the Motus Creative Group team and Snapshot Interactive. You can subscribe to A Second Opinion on Apple Podcast or wherever you are listening right now and be sure to rate and review A Second Opinion so we can continue to bring you great content.

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