Mark Bertolini, president of Aetna (No. 30 on The DiversityInc Top 50 Companies for DiversityÂ® list), sat down with DiversityInc CEO Luke Visconti in our Newark, N.J.,studio to discuss healthcare reform and ways to reduce costs through personal responsibility. Here are outtakes of their conversation.
Visconti: How do you control the costs of healthcare?
Bertolini: We need to change the incentives around how we pay hospitals, physicians and other providers of healthcare services. We also need to change the incentives around people.
We’ve been trying to figure out why people didn’t believe that having a body-mass index (BMI) of greater than 30, which is over 35 percent of our population now, or being overweight (62 percent of our population) is not a perfectly appropriate thing to do. Do they understand the long-run ramifications? The economic impact? The single biggest threat to the financial security of everybody in America is going to be the health status. The single biggest threat to everyone’s health status is the weight. We have a pandemic in this country around obesity. We spend all this money on H1N1 vaccines, which is great, but I think we’ve stemmed the tide on it. If we put the same level of effort on obesity, we could have a huge impact on healthcare costs. That personal responsibilityâ€”Jungian-behavioral economicsâ€”doesn’t necessarily work for long-run behavior change and the impact of that behavior change on your health and financial status. So a lot of employers are turning to Pavlovian behavior economics: If you don’t do this, it’s going to cost you more.Â Â
Visconti: Aren’t you fighting a food and beverage industry that has incentivized people to eat wrong?
Bertolini: I think it’s a socioeconomic problem because the dollar menu at McDonald’s is enticing. In grocery stores, the cheaper it is, the worse it is for you. Cheaper food is probably not the best nutritionally. However, I would acknowledge that it’s not impossible to eat a clean diet. I eat a lot of vegetables and fruit, which doesn’t cost me a lot of money. I spend about $84 a week at the grocery storeâ€”pretty responsible.
Visconti: You could buy a bag of lentils for 89 cents and a handful of carrots and celery and have three perfectly good dinners from that. But you have to know that.
Bertolini: Our education around nutrition isn’t sufficient. We ought to be teaching people how to eat properly and what the right foods are. There’s a huge impetus from the sugar and junk-food industry; they actually tell people that they are making it better and making healthier food. But it still doesn’t excuse personal behavior around making sure you have the right stuff. Personal responsibility is important. More important is what we’re incentivizing the system to deliverâ€”and that leads to quality. It’s access, affordability and quality.
Visconti: I’ve been subsidizing my employee’s premiums. I know what the cost of healthcare is and it’s astronomical.
Bertolini: [Healthcare] is the single biggest cost in some way, shape or form through reduced wagesâ€”out of their own pocket. The impact on price results in the economy is the single biggest line item. If people did their own P&L, they’d be startled. Compensation is a zero-sum game. And those costs [that] go into someone else’s P&Lâ€”the companyâ€”get borne into the prices of products and services that they sell, which you pay out to the economy when you buy stuff. And with the coming change, it’s going to be more startling to folks.
This is back to Pavlovian behavioral economics versus Jungian. If it’s going to impact my pocketbook, am I now going to pay attention? … The number of pre-diabetic people running around this world that don’t know yet that they’re going to have diabetesâ€”and all the things that come with it, like personal lifestyle issues, out-of-pocket costs and injections or pills every dayâ€”don’t know what the true economic cost will be for them.
I have a primary-care doctor who is trained in the U.K. where they are taught that healthcare resources are scarce, and uses the understanding of the sciences and actually touching the patients. Can you recall how many times a doctor has actually touched you? In the U.K., they do your complete history and physical and then come up with a hypothesis as to what the diagnosis is and then validate it through tests, versus here [in the United States] where they run you through tests, the doctor gets the results and tells you what’s wrong. We have this consumption of resources and very little physical touch â€¦ When it comes to a conversation about [being] pre-diabetic and what it is that I can do based on me, my current lifestyle and where I need to go, that conversation isn’t reimbursed and is beyond the interests (and a lot of times the education) of some physicians. They can’t have that conversation of “how about putting the cookie down.” Doctors who are willing to and actually challenge people about what the consequences are of their behaviorâ€”and not feel threatened and not have the patient threaten by itâ€”our system is not ready for that. I am greatly concerned about all the work being done (or not being done) around medical homes, the advancement of primary care and primary-care extenders and practitioners who can help us get to that point.