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Billionaires sought health care reform but got pie in the sky

May 11, 2020

Topics: Quote of the Day

By Anna Wilde Mathews and David Benoit
Morningstar, May 8, 2020

Atul Gawande is in advanced discussions to step down as chief executive and take on a less operational role as chairman of Haven, the health-care venture backed by Amazon.com Inc., Berkshire Hathaway Inc. and JPMorgan Chase & Co., according to people with knowledge of the matter.

Dr. Gawande, a prominent surgeon and professor at Harvard University, wants to move away from day-to-day management of Haven and focus more on policy and advocacy work, particularly related to the current coronavirus pandemic, the people said.

Haven has launched a search for a new CEO, but has yet to settle on a candidate, the people said. There hasn’t been a final decision on the leadership structure, the people cautioned.

His transition suggests the health-care venture’s slow start since its splashy unveiling in January 2018. The venture has shown few public signs of impact, after its announcement by the three parent companies rattled health-care investors and pushed down the shares of major insurers.

The founding companies framed the venture as an altruistic effort to overhaul health care, reining in costs and improving outcomes, and said they would start with their own employees.

Despite the initial hype, the venture’s efforts so far have been of limited scope. It has launched pilot projects testing health-benefits approaches. This included a program for around 30,000 JPMorgan employees in Ohio and Arizona, who were given a menu of flat costs for health-care services, according to people with knowledge of the matter.

Haven has been spending much of its early time building data systems on employee health-care tendencies across the three companies, these people said.

An author known for his work on health-care quality, Dr. Gawande was a high-profile choice to lead the venture. His hiring was seen as a signal that the partners’ ambitions were set higher than conventional tweaks to health coverage.



pie in the sky

1. (idiomatic) A fanciful notion; an unrealistic or ludicrous concept; the illusory promise of a desired outcome that is unlikely to happen.


The phrase is originally from the song “The Preacher and the Slave” (1911) by Swedish-American labor activist and songwriter Joe Hill (1879–1915), which he wrote as a parody of the Salvation Army hymn “In the Sweet By-and-By” (published 1868). The song criticizes the Salvation Army for focusing on people’s salvation rather than on their material needs:

You will eat, bye and bye,
In that glorious land above the sky;
Work and pray, live on hay,
You’ll get pie in the sky when you die.



By Don McCanne, M.D.

Three billionaires with great financial success in the business world – Warren Buffett, Jeff Bezos and Jamie Dimon – decided that they could buy health care reform, and they chose popular physician-writer Atul Gawande to orchestrate that reform.

It was not as if they could invent a new wheel. While totally ignoring effective reform such as a single payer national health program, they delved into some of the current, hot trends. Big data was supposed to open doors, but apparently all they got was a collection of big data on their employees, stashed away in the cloud. Price transparency – the darling of the consumer-directed movement – brought menus of prices but not much else. Because much of their activity was behind closed doors, we don’t know what else they considered or attempted, but obviously the higher quality, lower cost, replacing-volume-with-value goal remained elusive for them as they now seem to be winding down, or at least likely recognizing that their ambitious processes and goals were pie in the sky.

All is not lost. Buffett, Bezos and Dimon are not stupid. They have the intelligence to understand the vast superiority of the single payer model of an improved Medicare for All, although they may have to look past ideological preferences as they acquire greater knowledge of the topic – a task that the PNHP leadership is quite willing to assist in.

At PNHP we do not serve pie in the sky, just the design of a financing infrastructure that really does provide affordable, high quality health care for everyone. Buffett, Bezos and Dimon need to check it out.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

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Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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