A CALL TO ACTION –Taking Back Healthcare for Future Generations, by Hank McKinnell, McGraw-Hill, New York, Chicago, San Francisco © 2005, ISBN: 0-07-144808-X, 218 pp, $27.95.
Reviewed by Del Meyer, MD
Hank McKinnel, Chairman & CEO,
Pfizer, opens the preface with the question, “Is our healthcare system really in
crisis?” He finds the question difficulty to answer because it makes a presumption
he doesn’t accept. The phrase with which he has trouble is “healthcare system.”
He agrees there’s a crisis, but it isn’t in “healthcare”- it’s in
He quotes Mohandas Gandhi who had
similar difficulty in 1932. He had led a campaign of non-violent disobedience to help
colonial India win independence from Britain. After being named Time
magazine’s “Man of the Year,” Gandhi visited London for the first time. The
entire world was curious, the press swarmed wherever he went, when one reporter’s
hastily called-out question became a defining moment, both for him and for the
nation, he was trying to set free.
“What do you think of Western
civilization?” yelled the reporter.
“I think it would be a good
idea,” replied Gandhi.
That’s what McKinnell thinks
about our healthcare system: It would be a good idea.
He maintains we’ve never had a
healthcare system in America. As far as he can tell, neither has any other nation.
What we’ve had—and continue to have—is a system focused on sickness and its
diagnosis, treatment, and management. It’s a system that is good at delivering
procedures and interventions. It’s also a system focused on containing costs,
avoiding costs, and, failing all else, shifting costs to someone, anyone else. In
fact, discussions about better health now take a back seat to arguments about costs.
In the United States, a nation already spending nearly $2,000,000,000,000 a year on
sick care, tens of millions of people do not have adequate access to the system. In
other developed nations, rationing and price controls undermine the patient-physician
relationship, degrade the quality of care, and add to the anxiety of individuals
struggling with health issues. An aging population around the world clamors for
relief from chronic diseases and the cumulative effects of heredity and lifestyle
behaviors. Some of these we cannot as yet prevent. Others, such as smoking, we can.
Today, in healthcare, we have it
entirely backwards. We’re like a community that builds the best fire-fighting
capability in the world but stops inspecting buildings or teaching kids abut fire
prevention. Fighting fires is sometimes necessary, and we must be prepared to do that
with the most modern technology available. But firefighters around the world will
tell you that they’d rather prevent fires than fight them.
To put it simply, McKinnell feels
that our fixation on the costs of healthcare—instead of the costs of disease—has
been a catastrophe for both the health and wealth of nations. By defining the problem
strictly as the cost of healthcare, we limit the palette of solutions to those old
stand-bys—rationing and cost controls. What if we reframe the debate and consider
healthcare not as a cost, but rather an investment at the very heart of a process
focused on health? Then other solutions suddenly appear out of the fog.
That’s why this book was titled A
Call to Action. It represents McKinnell’s conviction that the debate on the
world’s healthcare systems is on the wrong track. Unless we correct our course, we
will not be able to make the same promises to our children and grandchildren that our
parents and grandparents delivered to us: that you will receive from us a better
world than we received from our forebears. He feels that the basic bio-medical
research conducted by his company is doing just that. But he’s concerned that his
and other research-based pharmaceutical companies might lose the capacity to advance
the science that can change the lives of our children and grandchildren for the
better, just as polio vaccines and cardiovascular medicines and other therapies
changed out lives.
McKinnell doesn’t believe in
surprise endings. Although he loves a good mystery, this book was not meant to be
one. The first phase of his book sets up its basic theme—that when our most
cherished support systems are at risk, we are called to rethink our most
well-accepted assumptions. Everywhere in the developed world, people are dissatisfied
with the healthcare their families are receiving. The near universal experience is
that healthcare is increasingly unaffordable, fragmented, and impersonal. Thus, the
first third of the book details the proposition that the current system is profoundly
misfocused in three ways. It is preoccupied with the cost of healthcare, it defines
the provider as the center of the system, and it regards acute interventions as its
primary reason for existence.
In chapter one, he gives his
“Personal Take, a Personal Stake” which outlines his qualifications to write the
book. In chapter two, he addresses the almost trivial question of “What is
Health?” which he finds very resistive to answers. In chapter three, on
“Reluctant Healthcare Providers,” he considers how employers are instrumental in
the healthcare of their employees.
After establishing these basic
theses, the second third of the book speaks of the pharmaceutical industry that
McKinnell helps lead. It is a source of considerable pain to him that this
life-saving industry that he represents is viewed with suspicion, cynicism and anger.
In this section, McKinnell answers some of the most pointed questions that patients
In chapter four, “Why Are
Prescription Medicines so Expensive?,” he deals directly with questions and
objections that customers and patients send him. In chapter 5, he discusses a common
question “Why Does the Industry Do So Much Marketing?,” which they feel should lower pharmaceutical costs. In chapter
six, he answers the question, “Why Do Americans Pay More Than Canadians for
Drugs?” The answers are interesting.
In chapter seven, he “Welcomes
Competition in Healthcare” which currently is between the wrong players and over
the wrong objectives. He favors value added competition that focuses on increasing
healthcare value instead of dividing it. In chapter eight, he describes his
conviction that investments in health pay off in great wealth: “Health Creates
Wealth: No One Left Behind.” Uninsured people in poor health cannot be said to have
equal opportunities in a market economy. In chapter nine, he discusses
“Consumer-Driven Healthcare: Balancing Choice, Responsibility, and
Accountability,” a model based on the notion that the demand for healthcare service
is limitless, especially when someone else is seen as paying the bill. Giving the
correct financial incentives to patients will reduce use of services of marginal
value. It will also give patients an incentive to seek out lower-cost providers of
In chapter ten, “The Research
Imperative: The Search for Cures,” he feels that the real task of innovation is to
make the new discovers and ideas into widespread use. In chapter eleven,
“Information Intensive: Reaping the Benefits of Technology,” he addresses the
difficult problem of incorporating patient-friendly information technology into a
healthcare system that resists accountability demanded by information systems.
Information technology is not the problem, and it’s not a solution. But we cannot
get a handle on costs, reduce medical errors, and put individuals in control of their
healthcare without embedding information systems deeply into healthcare at every
In the last part of the book,
McKinnell delivers on the implicit promise made by the title of the book and sets
forth a number of calls to action that seem to him most critical if the healthcare
system is to be transformed. If taken seriously, he believes these actions can save
millions of lives and billions of dollars over the next generation.
In chapter twelve, “Change is
Possible: Infectious Disease and the Struggle for Hope,” he describes social
investments and projects. . In chapter thirteen, "Next Steps: A Call to
Action Starts Here," he connects the dots with his prescriptions for change that
include action items at the individual, corporate, regional or national level.
Chapter 14 “The Deadline for Complaints Was Yesterday,” describes his hopes that
transformation is not only possible, but it is inevitable. Our children are depending
on us. He is confident we will not let them down.
A Call to Action distills more than
three decades of experience—both joyous and painful—that has brought McKinnell to
this special vantage point. He offered these thoughts, plans, and calls to action to
give our descendents all the benefits of healthcare that we have enjoyed. But we
cannot do so under the liabilities and constraints that today weighs down the
world’s healthcare systems. These systems promise healthcare but actually swindle
people out of both their health and wealth. He concludes that you and I, our
children—indeed, our entire human family—most certainly deserve better.
The three decades of thought and experience shows throughout the entire treatise. There is little to disagree with. Every physician, nurse, administrator and healthcare executive should read this volume and keep it as a handy and useful reference—someplace within reach, preferably on your desk. This refocus is crucial to our understanding and to healthcare reform.