What specifically worries you about the current trajectory of MA plans?

Well, can I go back to history a little bit? Because in order to understand the answer, we have to understand where Medicare Advantage came from.

And by the way, what its potential was, and I would say what its potential even could be.

So it came out of the HMO movement.

of the 1960s and even 50s, where we had organizations formed that combined the insurance and delivery aspects, Kaiser Permanente, the most famous of them.

And over the 1950s, 60s, 70s, the best of these places really did a good job.

I mean, they were more like the integrated care systems that I mentioned before.

And he used that as a good example of like, that's kind of what's wrong with health care.

What specifically worries you about the current trajectory of MA plans?

Well, can I go back to history a little bit? Because in order to understand the answer, we have to understand where Medicare Advantage came from.

And by the way, what its potential was, and I would say what its potential even could be.

So it came out of the HMO movement.

of the 1960s and even 50s, where we had organizations formed that combined the insurance and delivery aspects, Kaiser Permanente, the most famous of them.

And over the 1950s, 60s, 70s, the best of these places really did a good job.

I mean, they were more like the integrated care systems that I mentioned before.

And he used that as a good example of like, that's kind of what's wrong with health care.

What was the original insight that led to the triple aim and explain how you view its evolution now into the quadruple and then the quintuple aim?

Yeah, well, your words are extremely generous, Chris, and thank you for what you do.

I'm amazed by the work that I've gotten to study once having met you.

I'm actually not the author, though, of the AAA, and that came from two colleagues of mine named John Whittington.

who was on the faculty of IHI.

He's a physician in Peoria, Illinois, but teaching in IHI.

And probably my closest mentor, Tom Nolan, who sadly passed away a few years ago.

If you had the authority, and my God, it would be so cool if it was, if you can make three structural changes tomorrow to fix health care, where would you start?

What was the original insight that led to the triple aim and explain how you view its evolution now into the quadruple and then the quintuple aim?

Yeah, well, your words are extremely generous, Chris, and thank you for what you do.

I'm amazed by the work that I've gotten to study once having met you.

I'm actually not the author, though, of the AAA, and that came from two colleagues of mine named John Whittington.

who was on the faculty of IHI.

He's a physician in Peoria, Illinois, but teaching in IHI.

And probably my closest mentor, Tom Nolan, who sadly passed away a few years ago.

If you had the authority, and my God, it would be so cool if it was, if you can make three structural changes tomorrow to fix health care, where would you start?

people.

We have problems with chronic disease care, organizing care for flow.

We have problems with... proper protection of the well-being of kids in our country.

If the healthcare system could come together and say, wait a minute, we've got an agenda.

Even partial one this year, it'll be kids and substance misuse.

We could do a lot, but we don't have a way to come together with a consolidated payment system We could.

It doesn't solve it, but it makes it possible to solve it.

There's of course an overwhelming additional perception that will that lead to actual clinical care being yes, more equal, but actually worse for swaths of the population that might consider their care opportunities right now, yes, frustrating, but because they're commercially insured, they feel, hey, listen, we at least have a very high quality of care when we're able to get to a prestigious hospital, let's say, right? And not saying that's the right thing, but that is a big perception, is are we gonna go backwards with respect to clinical care, innovation, cutting edge therapies? What would you say to that? And how do you think about that in a budgeting process?

It

was written by Naomi Oreskes and a colleague in California.

Oreskes is a professor of history at Harvard.

The big myth is the myth that competition creates improvement.

The big myth is the myth that markets are essential to freedom and and thriving.

This myth in her book, she traces the source of it.

It goes back to the 1930s and 1920s and eventually the Chicago School of Economics.

So what, Don, right now, what keeps you, or if you are, I mean, are there things that make you optimistic right now?