August 21, 2017
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How to reduce the absurd amount of money Americans spend on health care? One community at a time

By Wendell Potter, Center for Public Integrity

If you’d like to meet someone who is truly “part of the solution,” someone who understands the problems of American health care in a way that few politicians do—and someone who is putting her money where her mouth is to get us healthier—meet Esther Dyson.

Dyson is a former journalist and angel investor whom Forbes magazine named one of the most powerful women in American business. Thirty-five years ago, Dyson founded EDventure Holdings, a pioneering information technology and new media company. In 1998, she became the first chair of the Internet Corporation for Assigned Names and Numbers (ICANN), a nonprofit that was created to manage the global domain-name system.

She has a keen sense of what stands a good chance of being the next big thing, having been an early investor in a Who’s Who of Internet-based companies. Her investment portfolio includes names like Facebook, LinkedIn and Evernote.

Now Dyson has set her sights on health care, and believes she’s found a way to reduce the absurd amount of money Americans spend, not with more legislation but by improving our health, one community at a time.

Dyson’s newest venture is HICCup, a nonprofit with the ambitious goal of encouraging  a “rethinking of how we produce health.” HICCup’s biggest project is “The Way to Wellville,” a five-year effort to do just that—“produce health”—in five small cities across the United States.

Dyson admits to a mix of reasons for her efforts.  Yes, she does care that so many of us are one cheese steak away from a heart attack, but she told me recently that her main motivation is something that drives her nuts.

“The reason I’m doing this is not really because I’m such a nice person. Yes, I do want to help the people in those (five) communities, but honestly, it was born of a hatred of stupidity and waste,” she said. “It’s crazy that people lose their health and then have to pay so much in agony and pain and disrupted lives, not to mention money, to recover it—if they ever do.”

She went on: “I was a tech person and I love technology and business models and economics and making things more efficient. At one point not long ago I discovered health care and I was like, ‘Wow, this is so messed up. Nothing makes sense. The economics aren’t aligned. Everything we know that we should do, we’re not doing. What’s wrong with us?’ ”

After doing the requisite due diligence she concluded that much of the money, time and attention devoted to improving our health care system is not really addressing why things have gotten so messed up. Her “aha” moment was in realizing that the answers lie not just in changing the “system” but in improving our health and well-being.

Dyson is convinced something can be done to address what ails us in a way that can make everybody happy, including mayors, taxpayers, even investors. And in a way that steers clear of partisan politics.

“I don’t know how to change the world on a broad scale, and Washington doesn’t either, nobody does,” she said,  “but what we’re trying to do at HICCup is to change the world in five small places to show what it looks like.” Those places, selected from 42 applicants in 26 states, are Clatsop County, Ore.; Muskegon, Mich. Lake County, Calif.; Niagara Falls, N.Y; and Spartanburg, S.C.

“One of the things we’re setting out to do is produce an outcome, to have a measurable impact. We’re not going to change longevity in five years in any significant way, but we can change the rate of transitions to diabetes. And we want to show what it looks like so others can be inspired. If the folks in Clatsop County can do this, the folks in Louisville and El Paso and Newark can, too.”

While all the initiatives in the five communities have yet to be determined, Dyson hinted at what some of them might be. She said it’s known, for example, that numerous measures of health can be improved simply by properly preparing young women for giving birth. Health can also be ‘produced’ by providing effective early childhood education and making healthy, affordable food more available and by addressing people's mental health and substance abuse issues. And even solving transportation problems.

To improve the odds that HICCup’s mission itself has longevity, Dyson is helping to design a new financial instrument that will enable people to invest in, say, Muskegon’s diabetes prevention portfolio. The return on investment would be determined at least in part by the amount of money Muskegon avoided spending by having fewer diabetic employees a few years from now. The investor would get a percentage of the savings.

Dyson acknowledges this is a novel concept. “We couldn’t do it before because we didn’t have good enough data or tracking or anything like that, but it is now possible, and there are investment bankers working on it.”

What they’re working to do is create a new asset class for investment opportunities. “You can buy stocks and bonds, you can invest in income-producing assets like a mortgage or a mine or a company, why can’t you buy a portfolio of people’s health?”

Thanks to the brilliant mind of a woman who can’t abide stupidity and waste, you’ll soon be able to do just that.

Wendell Potter is the author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans and Obamacare: What’s in It for Me? What Everyone Needs to Know About the Affordable Care Act.