Klasko: People Have Way Too Much Respect for the Medical System

Stephen K. Klasko.

What will the country’s health care look like about 20 years from now? Will patients finally receive one-page medical bills and will telemedicine be the norm? In his new satirical and fictionalized book Bless This Mess: A Picture Story of the Healthcare in America Thomas Jefferson University and Jefferson Health president and CEO Stephen K. Klasko explores exactly where the country will be in 2035. And the book’s illustrations take readers on a humorous but disquieting journey to explain how the country began tackling a fundamentally fragmented, expensive and inequitable health care system.

Klasko tells Philadelphia magazine why the satirical approach was necessary and why we ought to stop respecting today’s medical system so much.

BizPhilly: Your book is nontraditional for its subject. There are colorful graphics everywhere and an in-your-face story. Why?
It hit me that we’re so serious about how difficult health care is. And the narrative is that Republicans are bad and Democrats are bad and so are the insurers. I’ve spent my career looking at the absurdity of why health care has never joined the consumer revolution.

What started this book is a talk I gave called, “The Hitchhiker’s Guide to the Galaxy.” The idea is that someone from another galaxy comes over and does a TripAdvisor on traveling to Earth, specifically to the United Kingdom and the United States. And I asked, if you came from another planet that actually has reasonable health care — at a reasonable cost and with believable, understandable bills — what would they think?

When I gave the talk, illustrator Chrissie O. Bonner was there drawing out everything I said. I looked at her piece and in the corner she had a picture of a kid reading a book called “Bless This Mess.” I told her we ought to write that book, and that’s what we did. We took a Dr. Seussian approach by putting difficult concepts in a form that isn’t threatening.

BizPhilly: Why is the book set in the future, with the galaxy and a total of ten planets as its setting?
It starts out by saying that in 2035 the U.S. finally made it to the intergalactic council of cool health care systems. And at that time we looked back and were amazed that in 2018 we were an absolute mess, but that’s the year when we started making changes to become one of the coolest most consumer-driven health care systems in the galaxy.

And in 2035 what they view as the Holy Grail was that we were able to send patients a one-page bill. The fact that today you get an 87-page bill or you get 12 bills highlights a lot of problems like fragmentation or the fact that there’s no alignment between insurers and providers. This all speaks to my overwhelming feeling that we spend way too much time waiting for the Democrats and Republicans to solve our health care problems. It’s up to us to transform.

BizPhilly: What are some of the things the other nine planets in the galaxy did to improve their health care systems?
One planet made every one of their CEOs spend a week eating the food at the hospitals that the patients get.

Another idea out of the book is that health care providers in this city, like Penn, Jefferson, Temple, should have 25 percent of everyone’s salaries connected to how health in the city is doing. It shouldn’t just be “Do I have a bigger MRI than my competitor?” Once one of the planets did this, the health care providers started to talk about things like the social determinance of health.

In Philly right now, we look and say if someone comes into my hospital or uses my insurance, I take good care of them. But there hasn’t been a disruptive event to say “No, my job is to make sure that the people in North Strawberry Mansion have the same kind of nutrition and social determinance as the people in Society Hill have.”

BizPhilly: What other implementations from the book do you see as doable right now?
With all this new technology, one of the planets says no one should be a surgeon unless they can prove every five or six years that they’re technically competent. I’m a pilot and every two years I have to get my technical competence assessed. I’m also a surgeon, and it’s been 32 years since anyone has objectively assessed my technical competence.

Another idea from one of the planets, and looking at the billboards and advertising on 76, is that providers get penalties if anything you say on your billboards isn’t true. Look at the health care marketing on Morning Joe or Fox News: Somebody’s got cancer. They’re feeling really down. They go into X cancer center. Then they walk out, and they’re frolicking in the weeds. That’s not what’s happening.

And lastly, one of the planets gets us away from looking at technology as one-offs. In the future I believe 45 to 50 percent of health care will happen at home. In the book America started to think about what that means. And we started asking how many hospitals do we actually need? And what even defines a hospital? In the book we pushed for “health care with no address.”

These are all things that could start today in 2018. Nothing we put in the book is superfluous.

BizPhilly: What can policymakers take away from the book?
I’ve said this to the Clinton campaign and people who represent President Trump. What we really need is a 9/11 Commission approach to health care. With 9/11, at some point we came together and said we really failed to keep the country safe. We got a bunch of smart people together to say let’s figure out what we can do. I think if you took this book, if Trump and Pelosi took this book and said why don’t we get people together, we’d find that these things are doable and we’re already partnering with folks to do some of these things.

BizPhilly: The cover of the book has a big warning sign that reads, “This is not a children’s story…it’s scary. Do not read at bedtime.” Yet the book seems geared toward younger generations. What’s their role in this?
I love that there are two young people on the cover looking to the sky. To the people who are young: Dammit, don’t accept this! You wouldn’t accept this in any other part of your life! I want millennials to say, if my doctor shows up 45 minutes late, I wouldn’t accept that in anything else. If my doctor is having an emergency, they can text me. But if it’s not an emergency, I need to go see someone else.

And why isn’t there enterprise internet scheduling where I can make an appointment like I can for anything else? I want to know exactly what it’s going to cost me before I see you. I want to be able to compare the quality of providers like I can for hotels on TripAdvisor. I want to be able to have virtual realms so if my mom is at the National Cancer Institute I’m not asking her, if I’m 100 miles away, what the doctor said. I want to be there virtually. I want you to demand all those things because the technology is there.

The people in my generation have way too much respect for the medical system. If a doctor is an hour late, it must be because he had an emergency not because he hung out at breakfast. If I get an 87-page bill, that’s because it must be very complicated.

I want hospitals to start hurting if they can’t provide this new kind of patient experience, quality and cost. I believe the only people who will do this are millennials.