Former Aetna CEO Mark Bertolini on Fixing our Broken Healthcare System

So I'm really a Detroit Red Wings fan because I grew up in Detroit.

Okay, I was because some, you know, Michigan fans or Midwestern hockey fans, as I know a lot from business school friends, they won't have a secondary team. They'll just find the bar to watch the Red Wings or whatever. So it's very open-minded of you to embrace the Rangers as your second team.

Oh yes, there we go. Yeah, there, I knew there was something else to it.

The dawning realization was not so much during the episode or during the hospitalization. So when I was in the hospital with a broken neck and I had terrible neuropathic pain, I was just wondering if I was going to get out of the hospital. Same thing with my son when he was diagnosed with T-cell lymphoma. It was, is he going to survive? So it's sort of the immediate reptilian brain kicks in that says, am I going to make it out of this? But once you get out and you realize that what they fixed was the acute event and didn't really prepare you to somehow gather what remained of your life together and to move forward, I realized how disconnected the system was, how solely focused it was on acute issues, and that those acute issues once solved really didn't put you back in a place where you could live your life to the fullest extent. You had to figure that out yourself. And so I went on this search first for Eric and then for me around, okay, how do I find a place that eliminates the barriers that my present condition presents in the life I've wanted to lead? That was sort of the dawning moment, is that we as humans don't describe ourselves as 'I'm a spinal cord injury patient' or 'my son's a cancer survivor.' He never describes himself that way. He's got huge immunology issues because he's still on drugs for his cure. I have huge pain issues as a result of my injury, and I look at all the things that I used to do, like playing the piano—I was trained as a pianist—or riding my motorcycles, or riding my bike, or playing golf, or fly fishing, as things that are harder and in some cases impossible for me to do because of my injury. And I want to solve that problem, not my injury. I can't fix that; it is what it is. But I want to solve that problem, and nobody's around to help you figure that out but yourself.

No. And I can remember sitting in my son's room on the day that he got his infusion of bone marrow from my brother, one of my brothers. A person came in who did Reiki and she said, 'Would you like Reiki?' And he said, 'Sure, I'll try anything,' because he was obviously very stressed going through this. He'd been through total body radiation for the week before. And he had it and he said, 'Well, that was great.' And she said, 'Would you like to try?' I said, 'Sure,' because I was literally living in his room with him at the time. And she started doing Reiki on me and it drove me crazy because she wouldn't touch me. It was sort of like she was waving her hands over me and I found it annoying, quite frankly, and said, 'You know, you can stop now. It's not working for me.' Now, I had used TM, Transcendental Meditation, in college, but I largely did that because I was working full-time, going to school full-time, and partying full-time, and to fit all that in, you needed to find some restorative mechanism that allowed you to be alert, you know, 20 hours a day. So TM gave me that opportunity. But literally, Reiki was the first thing I tried since then, and I found it annoying. And I sort of put it on the back shelf until a year after my accident when I was on seven different narcotic medications to control my pain and not feeling any better. It was either kill myself or find a way out. And it was in that journey of finding my way out that I discovered complementary medicine in a more meaningful way.

Yeah. So there's a sheath, a bag if you will, that goes around your spinal cord and your brain. It's called the dural sheath, and the dural sheath contains cerebral spinal fluid. And that cerebral spinal fluid in healthy individuals flows back and forth in a very gentle way, like a heartbeat. And when I had my injury, I pulled my nerve root—one of the things beyond breaking my neck, I pulled the nerve root for my left arm, one of the big nerve roots, C7, C8, out of my spinal cord—and it ripped my dural sheath. And I lost most of the use of my left arm. You can see it's a little thinner. And it's now functional today because I've had a lot of surgery to reconnect it. But what was happening is my cerebral spinal fluid was torquing inside my dural sheath. And when I went for craniosacral therapy, the manipulation of the head bones and the sacral bones starts to reestablish that flow back and forth. That's how it works. And it's very gentle manipulation of the brain and sacrum to allow this flow to start to continue again. I remember somebody saying to me, 'Well, they hold onto your head really lightly and also your sacrum really lightly and it helps you.' And I'm thinking, you know, someone's going to hold onto my head and my sacrum and I'm going to feel better? You know, wacky, but maybe I'll try it. And after the fourth visit, I actually started coming off my meds. And a year later, I was off all my meds as a result. And it was just reestablishing this rhythm, because a lot of pain is around lack of sleep and anxiety, particularly your tolerance for pain. And a lack of sleep and anxiety arises from this noise inside your dural sheath about it not flowing gently, sort of like rocking you to sleep or keeping you calm. And so the reptile brain takes over and your pain spikes because you got the fight-or-flight response going, and it just cycles and gets worse. This is the very nature of PTSD.

Lucky for me, I'm not addicted to—I don't have an addictive physiology to opioids. I proved that because I was on fentanyl and Dilaudid and OxyContin and all these drugs, Neurontin and Klonopin, and all these drugs at the same time, Vicodin, and I didn't get addicted to them. So I was lucky, but very lucky.

Yeah. When I got off my drugs, I was a person that used to run four miles every morning and I worked out every day. And part of the survival of my accident was the fact that I was in very good shape. I was 184 pounds, 8% body fat. I mean, I was really strong. And so when I got off the drugs and I started feeling better, the next question was, well, how do I engage in activity? And my wife suggested, 'Well, why don't you try yoga?' And I said, 'Well, yoga is for girls.' And she said, 'Oh, really?' Mari trained with Desikachar and Krishnamacharya in India, in Madras, when she was in college. And so she took me on the journey to learn about Viniyoga. And I met the head of the American Viniyoga Institute, Gary Kraftsow, because Mari was training as a yoga teacher there. And we started on this discussion about what yoga really was. It's about connection. It's about physical poses and breathing connected in a way to allow you to prepare yourself to sit in meditation for an extended period of time. And in that meditation, to understand that we are all connected, we are all one, and that all this noise we have in our head are about attachments. And often people don't meditate because they say it's too noisy, I'm thinking of too many things. All those things you're thinking of are your attachments. And if you have a practice that allows you to recognize those thoughts, acknowledge that they're attachments, and let them go, when you do that every day over an extended period of time, they go away. You lose your attachments, and therefore you're more present, you're more available to others, and you find this whole pathway. So I'm going through this process with Mari and I'm reading the Upanishads and the Yoga Sutras and the Bhagavad Gita and I'm studying all this Sanskrit stuff. And I go to work one day and I'm meeting with my team. I said, 'You know, we should all have our employees do meditation and yoga.' And everybody sitting at the table dutifully said, 'Sure, boss, that's a great idea, good one.' And I get into my office and almost immediately the chief medical officer follows me in and says, 'That's crazy, that's voodoo.' And I said to Lonnie Reisman—his name, great doctor, great innovator, and he's an entrepreneur and we had bought his company and he came along with the company—I said, 'What does it take, Lonnie, for us to prove this?' So we need to do a double-blind study. So we did this double-blind study of yoga and meditation populations on East Coast, West Coast. And I found it interestingly, the West Coast people were more stressed than the East Coast people. And we looked at stress based on heart rate variability and cortisol levels pre- and post a 12-week program. Mari designed it, Mari taught the first classes. And like a month after the thing's done, Lonnie walks in my office, 'You won't believe this, like amazing.' And what we found was that people that were in the highest quintile of stress consumed $2,500 more a year in healthcare than the average employee population, which they were part of the average. And that those rates of stress dropped dramatically, more than half, the people in the program. And what it did is it reduced our healthcare—actually reduced the amount of our healthcare cost, the dollar amount, by seven and a half percent the next year because we got these people well again. But Mari brought home some of the journals for me to read, and I'm reading these journals and it's talking about people working two jobs, families that have to buy Medicaid instead of our own health plan because we charge our employees for dependents, people on food stamps. I'm going, 'Well, the reason these people are stressed is because of me.' And I always swore I was never going to work for the man, and now I'm the man. And Mari is going, 'Hey, big shot, what are you doing to help your employees? I'm teaching these classes, these people are burned out.' So I asked my head of HR at the time to look at who these people were, what did the frontline employees' experience of life look like, how much should we pay them. And sure enough, people on food stamps, people on Medicaid, people working two jobs, people returning bill collectors' calls at break, and they were making anywhere from $12 to $12.50 an hour. So I started working with the team and I gave them a copy of Thomas Piketty's book, 'Capital in the Twenty-First Century,' about redistribution of wealth as a solution to fixing income inequality and people at the lower end of the income spectrum. And I said, 'This is the solution, unless we as the captains of capitalism decide we want to make it different.' And through a lot of pushing and shoving and my forbidding spreadsheets, after a while we decided we would raise minimum wage from $12 to $16 an hour. And that for employees who needed health benefits and were under 300% of the federal poverty level, we would wipe out their healthcare costs if they engaged in wellness with our programs. And I remember flying to Jacksonville to make a big announcement. People thought I was going to sell the company or something, or I was retiring. And I walked into the room and told them we're going to do this for you. And it was the most amazing experience. It even gets me emotional today. It was 2015. I mean, free hugs, people in letters afterwards, 'I finally can send my kids to college,' 'I don't have to call bill collectors on break time,' you know, 'Thank you so much.' And what it did is it did two things: it helped all those employees, but more profoundly, among CEOs of change, they called me and said, 'What are you doing?' And I said, 'Well, if we're going to fix this problem, we can't wait for Washington to solve it because we know Washington can't work, it doesn't work. So instead of waiting as corporations to get permission from Washington, what we need to do as people, as leaders, is make the change and then turn to Washington and say, here's how you can help us make this better.' Now, I'm far more disappointed in what's happened since then, quite frankly. I think with this last tax cut, CEOs embarrassed all CEOs like me by taking the tax cuts and doing the largest share buyback in American history instead of enriching people's lives that needed it. So I'm not happy with that, and I even mentioned that in my book. But this idea gave my employees, my leadership team, permission to bring more ideas. And so a whole cascade: double tuition reimbursement, repay student loans, create PTO banks for people—paid time off banks for people. When I didn't use mine, I put it in the PTO bank; other people could use it if they had family hardships. Help our foundation, helping families that were in trouble, moving our people out of harm's way during hurricanes or major disasters and into hotels, including their family and their pets, so they would be safe. All that stuff just sort of happened. Pet therapy in all of our buildings—people would line up down the hall to go pet dogs and rabbits and cats and gerbils. I said no to mini ponies. That's the only time I said no, to mini ponies. But so all of a sudden was this huge cultural shift in the company that is impossible to measure from an economic standpoint.

We did. We actually offered it. We created a website called aetnasocialcompact.com to show CEOs about how we did the analysis, the decision-making, what kind of metrics we collected, so they could do it themselves. And I did a lot of phone calls with CEOs that said, 'Okay, tell me how you did that again and the kind of things you did.' The issue with yoga and meditation—it was the meditation was easy because we could do that with computer-based models for everybody. The yoga was harder because you need space to do it, and they needed really well-trained yoga teachers to do it, particularly the kind of yoga we were doing. We were doing direct-from-India kind of yoga stuff that goes on in these weekend classes. And so there are yoga teachers and then there are teachers, and getting the right number of yoga teachers, like from the American Viniyoga Institute, was hard. We didn't have enough around the country, so we were limited in that regard.

Yeah, I think the biggest problem we have is state-based licensing and regulation on providers. Because I use a naturopath, a naturopath in New York cannot bill as a—they can ask for cash, but they can't bill a claim, and they're not considered part of a medical provider, even though they're licensed in the state of New York. So you have different regulations depending on where you live. And as you know from living in the greater New York metroplex, borders are all over the place. You got Jersey, you got Connecticut, you got New York. And so solving that problem on a national basis and saying here's what a licensed provider can do and cannot do regardless of state lines is incredibly important. It's going to become more important when you get into super-specialized care, where you have providers, particularly with 5G coming along. When I sit on the Verizon board, with 5G coming along, remote medicine is going to be more, as we've learned in the pandemic. Right? You don't need the doctor anymore. I mean, for some things you do, but others you don't. That's one point. The second point is when you price all of that in, what are the premiums? But there's a point that most people don't understand, that they don't think of when they go to one of these providers. We all have HSA or HRA plans, most of us, or FSA plans. All those funds can be used to pay for those providers. And it's a wallet we don't know about. Often we don't even know what's in there because it's not readily available. And so those, you can easily do it, and you can easily do it on the spot with the cards they have now. But this has been my number one recommendation to people for as long as I've been doing this, is to max out their HSAs. And you can carry it on year after year, you can pass it on to a loved one when you die, you can invest that money. I just think it's fantastic. But it only comes with high-deductible health plans usually, which I realize have today, but it's the majority of what we have today, right?

Not actually. You can do that today.

On Amazon, in their payment section, you can actually add your HSA and FSA cards. And if you do anything on Amazon that would apply to that payment mechanism, they'll prompt you and say, 'Do you know you can pay with your HSA card?' I mean, they're opening up a whole wallet for Americans. So you can do that on Amazon today.