Mindfulness and Medicine | Mark Bertolini, Jon Kabat-Zinn, Tim Ryan | Wisdom 2.0 2016

I wish we could have recorded the backstage conversation we just had, so we're going to try to tap into that a little bit. Obviously, most of you know Mark, most of you know John. One of the biggest issues facing the country right now, from the issue of long-term budgets, investments for the private sector, burden for the private sector in the public sector, we spend about 30 to 35 percent of our federal budget on healthcare in the form of Medicare for our seniors, Medicaid for the poorest citizens in our country, and the growth of those programs is really driving long-term budget issues. So I think we can have a great conversation here from both the private side and the public side. So I think we start with Mark, who's doing some amazing things at Aetna. Mark, if you could just give us a minute or two or three on the innovative programming you're doing at Aetna.

The great thing about being on stage with Tim is that in the polls of how people think about people, healthcare insurance executives are pretty low, but we have the very firm shoulders of Congress. Yeah, all right. I'm here to help, you know, whatever I can do. So John, you've been doing this for a long time, but not just the mindfulness piece. I think why so many people respect you and your opinion is because you've always... this is part of a broader engagement with the healthcare system exactly. And so I would be interested in your vision of what does an ideal healthcare system look like when you are moving it from a place of mindfulness and stress reduction and attention, awareness, focus.

I don't think anybody really knows, but at least we can sort of paint a little bit of an impression of what it might be, and by investigating it and enacting it, we continually learn so much. So the whole idea of mindfulness-based stress reduction back in 1979 was to use the environment of a hospital to catch people falling through the cracks of what we would call the healthcare system. Many, many people turn out fall through the cracks of the healthcare system, and to challenge them to do something for themselves in a kind of form of participatory medicine that would tap into their deep interior resources, which everybody has by virtue of being born and being human, for learning, for growing out of the learning, for healing, and for transformation. Not as a kind of the opposite of healthcare, but as a complement to whatever medical treatments and so forth people can have. The basic idea was to have hospitals actually teach people how to stay out of the hospital and to use the hospital much more wisely and to use the medical system much more wisely. In fact, what we have so far is much more a disease care system than a healthcare system. I'm not knocking that we have a good disease care system, although it's very, very expensive. But what if we could rotate that in consciousness so that we're teaching people, so to speak, how to be healthy across the lifespan through diet, through exercise, through yoga, through meditation, through a sense of deep interconnectedness with others and purpose, and then let that kind of be the sort of default mode, so to speak, of how we live our lives. And then, of course, untoward things always happen, and sooner or later we're going to die. But the question... People often ask me, well, do you... Oprah once asked me this thing: 'Well, John, just out of the blue, what do you think about life after death?' And I'm saying, 'Oprah, I'm not that interested in that question. I'm much more interested in is there life before death.' And so you see where that's going. It's like, how can we actually live the moments that are ours to live? That's what yoga is all about. And then let the awareness be a kind of full-spectrum awareness that doesn't stop at the skin but that goes deep down into the bones, into the genome, into the telomeres, into the connectivity and plasticity of the brain, and also out into the social networks and into government and into society and globally. So that would be a kind of redefinition of what we truly mean by health. And I think that your work at Aetna is just a kind of object lesson for all of us to kind of wake up and realize that whether it's how much we're paying our workers or how the systems that we develop, as long as we come in with an old mindset that's really like more like auto mechanics than anything else—you drive your car until it breaks down, then you go in, get a new liver or a new carbon or whatever. But instead, and that's not to say that at times people don't need that kind of high-tech medicine, but why not develop a truly participatory, mindful, heartful medicine where people live their lives in community and let the community actually nurture that? And you told me backstage a phenomenal idea about the phrase you used: it was 'Uber nurses.' So I'd like to just really hear what your vision is for how to actually bring that into the society in a way that would globalize, generalize way beyond hospitals.

This is the important message that you don't hear from too many people, and I think it really bears underscoring that if we see through the wrong lenses, we're going to get the entirely distorted picture of what would be required to actually heal and transform the society the way it takes care of its people. So the OECD nations, there's a study: if you look at all the OECD nations and you look at the percent of GDP they spend on healthcare and the percent of GDP on social programs, and you add them together, the United States is 9:9. All the nations are within 5% of one another except for Mexico and Korea. All of them spent less than 50% of that amount on healthcare and the rest on social determinants: safety, shelter, food, water, social engagement. And so I would make the argument that if we start at the home and we make our investments in social determinants, you could make the argument that we are under-invested or invested poorly in social determinants of health because we've lost community and we turned it to the government. And because of that under-investment, the way we approach it, we now have a healthcare system that costs too much. That's the end of the conversation. Goodnight everybody. Drop the microphone. Plato would stop there, but no, Aristotle actually got to go do it.

This is just really interesting in the context of because we all live in the context of the world we're living in and the presidential election. And I feel the same way when you're talking about community. So in the Medicaid program, for example, communities like Detroit that you grew up in, or Youngstown in Cleveland, Ohio where I am, you have 80 or 90 percent, sometimes a hundred percent of the kids that are in a school will be Medicaid, and we sit there and wait until those kids get diabetes or hypertension or any issue, and then they'll come into the system and we'll take care of them, and that's driving the cost up. And what's important with what you're saying is from the governmental side, we need to do the same thing. Why are we waiting until you get sick and then we'll take care of you? How do we use some of that money to play offense, not just in the home but in the school where you know these kids are going to be? And to me, that's how you bend the cost curve in the long run. So what you're saying is that we have plenty of resources in the society, we just don't know what we're doing. And I think that's an important point because the debate in Washington, as you know, is we need to spend more, we need to spend less, cut government, increase government, when the reality of it is it's about innovating in a way that realigns the investments that we're making now. There's something that really has been implicit, but I think it's worth making it explicit. You and me sitting on the stage, and virtually everybody in the audience understands that one of, if not the key element to any kind of profound transformation, is having a practice of some kind. This has been brought out by many people on the stage and in our conversations together over the past few years. So I would love to hear you speak about how you bring your own life and practice and life experience into the unfolding of your largest view about how to transform healthcare into this society so that one, it's caring, and two, it works in a profound way.

It reminds me, there's a panel later with Michael Gervais and Pete Carroll, and I watched clips of Michael, who's the sports psychologist for the Seattle Seahawks, and he talks about as an athlete being vulnerable. You can't be great, and Michael here you could articulate this much better than me, but you can't be great unless you're vulnerable. You really can't lead unless you're vulnerable too. And I think that's part of the rub now with the presidential... I keep bringing it up, but it is on TV all the time, infiltrating us as we speak. But there's very little vulnerability, very little 'I'm going to say this, and I know that at the end of the day it may hurt me, but I need to say it because I think it's the best direction for us to go.' And it was like watching Trump the other day about he beat up George Bush about going into Iraq, and then in a town hall meeting someone asked him about it, he's like, 'Well, I didn't really say that.' I was like, wait a minute, you were just on TV for like an hour saying it all the time, and then you just... so what his instincts maybe were, he had that pull back from because there was a level of vulnerability there. So I think from the public side, I think for me, and this is a reminder to myself, you've got to go out there with these ideas. And I think a lot of people would like to hear the fact that if someone says we don't need to spend more, we don't need to spend less, we need to spend the same but we got to rearrange it in a lot of different ways, I think that would get somebody's attention who would be tired of the one side or the other argument, because neither of those are working quite right. And if I may, I'd like to point out and really also ask you about how this figures in your work: that now there is an ever-growing science of mindfulness and science of yoga that really brings a deeper understanding of what it means to be human in the sense of the plasticity of our biological systems. So not just neuroplasticity, but meditation and exercise and all sorts of different things, including how you eat and how you are in relationship, actually transforms not just activity in the brain but the real estate of the brain in ways that develop profound connectivity between regions that before may not have had it. There's just something that came out in the New York Times this very week by David Cresswell at Carnegie Mellon, a beautiful study of mindfulness versus relaxation that shows brain changes when you pay attention to the body, no brain changes when you don't, and also inflammatory markers that go down in the mindfulness case. So we're learning that in terms of longevity, in terms of gene expression of inflammatory genes and so forth, that these kinds of practices actually... they're not just 'six out of the, um, kumbaya, we're all one,' but actually there's transformation going on. The more you get out of your own way, the more it happens. And the more you try to get the transformation—'I have to lower my blood pressure' or all that stuff—you're going to learn that it's a practice of non-doing rather than adding one more thing in or forcing anything to happen. So this is kind of a new principle, so to speak. It's very, very ancient, but we're bringing it now into the modern world through the science and through the medicine of mindfulness and so forth. And it really has the potential, in concert with what you're saying, to transform our very understanding of what it means to be an institution or corporation or a corpus, a human being in relationship in your own home, and how to take the 24 hours that each one of us gets—it's like nobody gets a little extra and nobody gets a little less—and to actually make use of those moments, those days, those breaths, so that we actually live the life that's ours to live in its fullness while we have the chance, which is only now. And to me, that would be health, right here, right now, starting with whatever your basic diagnoses are or medical conditions or anything else. So when we see that unfold in the hospitals, it's just staggeringly beautiful that you can be healthy with cancer, you can be healthy with back pain, you can be healthy with what some people call disabilities that enable you in other ways. So it's like, really, we need to in some sense wake up to the limitations of our definitions of what it means to be human in my own body and what it means to be human in community. And I think that this meeting, actually, this conversation and all the other conversations on this stage, are actually diagnostic of that already happening in profound ways. And we all need to in some sense contribute to it, whether you work for Aetna or you work someplace else or you're just in the home, whatever it is that you're doing, that's the most important thing on the planet at this particular moment for you to be doing. And if you're doing it consciously, then in some sense maybe we will get healthier. But in another way, we're never going to be any healthier than we are right in this moment.

So Mark, one of the things that drives the healthcare system is incentives, reimbursements. Not to get too technical, but can you talk a little bit about how we would, whether it's from Washington or within insurance companies, how do we shift the incentives, the reimbursements, so that people who teach MBSR, for example, can get reimbursed to do that, people who teach dietitians and nutritionists? How do we create that system?

Wow, I'm just amazed at how progressive you are, how your company is. And I just think if we had 20 other CEOs like Mark, where this country would be right now. And I wonder... People ask me all the time, you know, meditation, yoga, and the stuff that I do, what are your colleagues think about it? So I'd like to ask you, who know the CEOs that you interact with, what's their opinion of this?

Part of the charge I think for this crowd, I've been trying to say for the last few years, is how do we mobilize politically? And I'm not getting into the Democrat-Republican, but when the system needs to change and there aren't enough people influencing that through the electoral process, it's up to us to be a part of that system. And you could go down the line and say, is this liberal or is this conservative? It's way deeper than that. It's sane. You know, like Jim Wallis used to say, 'We don't need to go further left, we don't need to go further right, we all need to go deeper.' And if you go deeper, you start to see just from what Mark was saying, arguments that would appeal to both people who are into mindfulness, yoga, health, nutrition, urban gardens, and all the rest, and then you would also appeal to people who are interested in long-term budget deficits and the government not working and it's dysfunctional and it's a waste of money and all the rest. So there's a message here that I hope we can take to the next step, maybe with the CEOs who are into this, with government officials who are into this, with healthcare people that are into this, and really broaden this as a campaign. Because at the end of the day, if this doesn't get down to the kids in Youngstown, Ohio, I don't care about it. If it doesn't get down to the kids in Detroit, where we can make the argument that we're not spending money properly on these things, we're wasting money, and instead we want to spend that money on clean water, safety in our neighborhoods, good schools, healthcare, healthy food, I think most people would buy that. I think most people would want to be a part of that. And so I think as we kind of wrap up here, I think that would be the charge. John, do you have any closing nuggets of wisdom?

No, I'm too happy to say anything. Old people, thank you very much.