Esther Dyson & Nick Gillespie | Wellville: Investing in equitable wellbeing

Okay, so the great thing about Wellville is it started out as something different from what it became, and that's true of so many things. If you actually know what you're going to do right at the beginning, why bother to do it? Most of my investments I say are an education investment with a lottery ticket attached, and that included 23andMe, which fact check: I'm no longer on the board of, but I still wish it well. And back to Wellville. So this started with a bunch of origin stories. I'll just tell one short one. How many of you know the website RealAge? It asks you: do you live with a loved one? Do you eat right? It deals with some of the social determinants of health, not with racism or poverty, because mostly what they're really after is people who will buy vitamin supplements. Nonetheless, and racists are like, no supplements, right? Well, I live on rage, yes. So he sold this company to RealAge, to Hurst, and then they sold it to Sharecare. But what's really interesting is he had a company before that, you know, one of these serial entrepreneurs. And guess whom he sold his first company to? Nobody knows: Jiffy Lube. Maintenance, yes. Maintenance beats repair. And I thought, wow, that's interesting. I was getting really interested in healthcare. Long story short, 2013 I was at an event similar to this. I was going to say somebody should take that idea of Charlie Silvers and instead of the healthcare enterprise, they should do the health enterprise. And then I realized that's kind of a nice white lady says somebody else should do something. So I announced that I would do it. Then I had to figure out how. And so the original idea was five communities, five metrics, five years. And it turned into five communities, two of them switched out, metrics, but more important: changing the culture, focusing more on social fabric than philanthropic architectures, and trust, thinking long-term, and really keeping things healthy and resilient rather than, you know, I am Medicare, I care about old people, but honestly if you really want to make a long-term systemic change, you got to start with the kids and stop them from being damaged before they hit school. So we waded in, learned a lot, including that you need more than five years to earn trust. And I'll kind of explain our operating model. And then so we don't come in with fish, we don't even teach them how to fish. We say, what kind of fishing schools do you want to build? Can we help you do that more effectively? Can we help you collaborate? Can we introduce you to resources? We don't give them money, so they're not trying to win in our favor. We talk to the people who want our advice, we don't go around and try and get people to follow our programs and pay the money to do so. So just like raising kids, we're looking to help them realize their intrinsic motivations rather than do something that some grant maker wants them to do for two years, and then if it's successful they'll go do something more innovative, and if it's not successful they'll go do something somewhere else.

So when we started, I hired a CEO because I've seen enough of Silicon Valley that I think you always need a team, and you need somebody to talk truth to power. He came from Cigna, the health insurance company, and is very organized, and I'm less so. So we put out this call for applications, and he knew exactly where to publish it, and Robert Wood Johnson helped spread the word, and so did other people, and we got, to our amazement, 42 communities of under 100,000 people applying. Rick and I, the CEO, went and visited 10 of them that summer of 2014, which was the first education. It was amazing. We turned one down because they were too good. That was Columbus, Indiana, the company town of Cummins Engine. And they didn't, you know, like we didn't want to fix up something that was working. We wanted to help people build something where it was needed. So we looked not for the five best but the best group of five that would be different geographically, demographically, etc. And Muskegon was one of them. They ironically created something called Greater Muskegon because they were actually 180,000 people, which is above our limit. Greater Muskegon was actually lesser Muskegon, it was 88,000 people out of the 180,000. In the end we worked with the entire county, but the reality is the eastern part of the county, which was more rural and white, was there. There's so many disparities. We did not come in and fix everything. We focused on where the people we were talking to were looking for help. And a couple of... I would say most of what... So I ended up being the person for Muskegon. Each community had one of us as an adviser. The others: just raise your hand if you know them or from them, whatever. Spartanburg, South Carolina; the city of Hartford, the troubled part of Hartford is the polite way to say it; Clackamas County, Oregon, northwest of Portland; and Lake County, California, which I was very hopeful about because it's... if you're a tech, it used to be if you were a rich banker you'd go up to Lake County for the holidays with your family. Later on you could just fly to Hawaii in your jet or your yacht, and it kind of fell on hard times. But it's just north of Marin and Napa Valley and all these nice places, but it had some of the worst, and still does, some of the worst health conditions and metrics in the state of California. So I did Muskegon. And some of the things... I did not make any of this happen. We catalyzed some of it. I did a lot of introducing people in Muskegon to other people in Muskegon, as well as outside. One of the biggest problems is the well-meaning philanthropist, the charity people in the community know one another, the people who work for them often do not. And so it's nice to talk about collaboration, but what really needs to happen... One example was the YMCA. So they wanted to work with Mercy Health, the healthcare system, to foster their diabetes prevention program. And two nice stories there. One: I suggested, well, you need an API. And the person I was talking to said, oh, where would we hire one? But the joke was actually on me, because what they needed was an amazing personal interlocutor, and they ended up hiring somebody from Mercy Health, and then those connections started happening, and they got the referrals and so forth. That's one.

So a lot of what I'm going to come to in the end is none of this is going to happen without funding, and the funding can't come locally because it's not there. We need ultimately to collectively as a society fund this investment, and we need to change our terminology from spending on poor people to investing in the generations of the future, investing in your employees, investing in your customers, investing in the people you want to live among. And we're way too short-term focused in terms of looking for the ROI on how we do that spending. And also, I just read this article this morning that set me off about how Medicare is going to pay $35 billion extra for Ozempic, etc., and they'll save only... I think it was $1 billion a year, and it ended up being $10 billion versus $35 billion. But what's the payback to society if all these people become healthy and they get over the little addiction in their minds that makes them want to eat stuff, and it turns out maybe also smoke and drink and all these other distractions? They become better employees, they become better parents, they're happier. I mean, we are here to live happily as well as die having finished a nice long life. So it's the goal for these things to happen in the communities, but then I'm going to write a book and try and come back to Washington more, and also hang out with the people who vote and the people who set policy. The policy will come if you change the thinking, if you change what they count, if you change how they look at a return on whatever it is they do. It's not magic, but that's the basics. In Muskegon, then we'll open it up.