This Week Health

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November 3, 2020: Bill and Drex get political. There’s no doubt that COVID has played a major role in how voters will decide in this election. What will health IT look like if Trump is re-elected? What pathway lays ahead if Biden wins? Why is it more stressful to have political conversations with people you disagree with than in previous election years? Can we look past the political division and dig deeper into the human psyche? Security is also on the table today. Cybercriminals are targeting hospitals during the pandemic because of their vulnerability. And unfortunately smaller health systems don’t have enough resources to put together an adequate response plan. What other options do they have? Where can they go for help? 

Key Points:

  • You’ve got to have a risk conversation [00:11:55
  • Do you have the capabilities in your cybersecurity team to try to figure out how to help them? [00:16:45]
  • Let's talk about the election [00:18:05
  • What does Health IT look like with 4 more years of a Trump presidency? [00:21:45
  • HHS unveils new 2020-2025 Federal Health IT Strategic Plan [00:23:00
  • Get comfortable with your uncomfortableness. It makes you a better leader, a stronger thinker and a more agile problem solver [00:39:15

Stories:

Transcript

This transcription is provided by artificial intelligence. We believe in technology but understand that even the most intelligent robots can sometimes get speech recognition wrong.

 All right. Welcome to this week in Health it. It's Tuesday News Day where we look at the news which will impact health IT today, the election and its impact on health IT and Drex to Ford is in the house. My name is Bill Russell, former healthcare, C-I-O-C-I-O, coach, consultant, and creator of this week in health.

It. A set of podcasts, videos, and collaboration events dedicated to developing the next generation of health leaders. I wanna thank Sirius Healthcare for supporting the mission of the show. They continue to be a great supporter, sponsor of the show. Uh, their weekly support has allowed us to do so many things this year, and we're really appreciative.

Don't forget three X Drex, and if you, if you do forget it, Drex will remind you a little later, but three X extracts is a service of Drex. Ford Frequent contributor and on the show today, he will, he will send you three texts three times a week with three stories vetted by him to help you stay current. To receive the text, just text drex to 4 8 4 8 4 8.

drex, welcome to the show. Thank you so much. I'm always happy to be here. I was really excited too, to see last week I think that you've set up an A referral program, right? I did. I did and one of the prizes for being the biggest referer, and it's really easy to do when you go out there and sign up or when you send somebody to sign up for this week in health, it clip notes.

It's, it's to replace you a little spot. I know. And it's to replace me. I was like, that's a pretty good gig for somebody. I, I'm loving that. I, I, we were, we were hacking around. What would people like. For every, everybody who gets one referral gets put into a drawing and you can win a work from home kit.

And we get a bunch of this weekend health IT stuff. It's actually pretty cool. I Tess, uh, picked it out with, with Tess, who's our marketing person and I think it's, it's really cool. But we were like, is that really enough? And we're like. What if somebody gets like 10 referrals? And I'm like, all right. That has to be my black moleskin notebook.

And this could be one of the few times in my life where it is not ne Oh, it's out. It's out. Because I was I know. And I was just thinking the same thing. 'cause I was thinking about holding it up and I don't know, I, I, I have an idea where it is, but it's upstairs. I know, I know where Mine's right out by the couch.

'cause that's where I was this morning and I was journaling. But the Yeah, but the, the, the biggest one is, is the opportunity . I recognize that not everybody's gonna wanna do this, right? Not everybody's gonna wanna come on the show. Sure. They're gonna be nervous or that kinda stuff. You shouldn't be. I've had so many people on the show who are nervous the first time they come on, and almost everybody when they're done, they're like, I.

Oh, that was just like having a conversation. I'm like, yeah, that's what we do. We just, we just have conversations and, and some people have messed up from time to time, and we just edit it out. They'll say things like, Microsoft's predatory licensing practices, and we go, yeah, let's take that out. That's not gonna, that's gonna make your negotiation a little harder the next time you sit, sit across from them.

Yeah, so it's, it, it, it's pretty cool. But, you know, Drex, I noticed that no one has put your name in yet as the referred by. So here's, here's what we could do for today's show. If you're listening to today's show, if you want to help Drex to get a jumpstart on this, you can sign up for, could just go to, go to our website, hit, hit subscribe now, and, uh, put in Drex name as referred by.

So, Drex is referring you to this, to the clip notes, and. It's, yeah, to be honest with you, I, I wouldn't be doing this, but, so we've gotten so much great feedback from people of, Hey, I love just scanning that. I hit a couple of the, the highlights. It's been great. So yeah, Tracy, one of the folks on your staff and I were talking about it earlier, and the way that you write up the notes and the way that you do clip notes, it makes it really easy.

It's not a mining expedition to go through and find the thing that you . It's hot for you right now. It's a thing I wanna watch, but I don't have 20 minutes or 30 minutes. I just need to see the two minutes that they talk about this. So you guys do a really good job with that. Yeah. And today we're gonna talk about the election.

So people are gonna be like, ah, where did they talk about who's gonna win the election? 'cause we want to, we'll see. Alright, so the election's finally here, but before we get there, we, we really do have to talk a little bit of security because I don't think, uh, in my memory, I don't think we've had a week like we had last week with, uh, cybersecurity and healthcare.

I I really appreciate your, uh, feedback on this. So I, I did two posts last week on LinkedIn. The one sort of was a , oddly enough, was a precursor. It was the day before everything really broke open. And I said, well, actually, let me just pull it up, take two seconds, and. The, let's see. First post was this one.

Uh, I know your health system isn't targeted for ransomware attack, but humor me. Can I see your cyber response plan? And the reason I posted that is there's a lot of health systems that believe that anonymity is my, is my barrier. That we're such a small health system that they're not coming after us, but that's really been dispelled at this point as hast it.

Mm-Hmm. . Mm-Hmm. . It's, it's interesting. In July, we published at CI Security. We published the 2020 Healthcare Breach Report and we went through the HHS Wall of Shame and we did a whole bunch of analytics on that data. It was interesting, we took a two year period, we broke it down, down into six month segments, and oddly enough.

In the first half of 2020, the number of reports were down by 10%, and the number of individuals affected, meaning individuals affected, meaning the number of records breached, was down to 83% over the previous period. And it was a real head scratcher, right? Because why? So we went through a bunch of stuff like, well, maybe Cybersecurity's just gotten better and, but what we ultimately concluded was the first half of 2020 was super distracting.

And there were a whole bunch of things that health systems did to make exceptions to their cybersecurity rules and their operational rules because they brought new equipment and added . Folks who, who were travelers to come in and support them. And they changed roles for people in the EHR to be able to have more access because they were using people in different places and they stood up new points of service and the list goes on and on and on.

Telemedicine sent people to work from home, so it was, there was a lot of distraction at first half of 2020. So in that report, I predicted that the second half of 2020 was probably gonna be . Terrible. And part of the reason for that was that organizations were probably already breached in the first half of 2020 and just didn't know it yet.

And that really turned out to be the case with like UHS and Black Bot and other things that have revealed themselves so far. And then you have this happening on top of it. So your point about. Have you, have you done the stuff that you should do for cyber response, for incident response? Do you, I mean, if I was a healthcare executive and not the it, not the CIO, not somebody in that chain of command.

I was a chief operating officer. That's exactly the kind of thing I would be asking for. Let's sit down and talk about our incident response. How does that work? Do we have a plan? Have we exercised it? Who should be involved? You know, do we have the phone numbers for the FBI do. We have all those things that we need because.

It, you know, it really is now, uh, not if you're gonna be breached, but when you're gonna be breached. And so you really should be exercising and prepare, preparing for that event. So let's, let's be really pragmatic here. So how much does it cost to put that together? And if I don't have the resources internally, where do I go to put together a really good, because Cindy McDowell.

Posted. We're finding most health systems don't have an adequate response plan, not most, and the word adequate. Those two require some definition. What does most mean is what? What is an adequate response plan? Mm-Hmm. . Mm-Hmm. . But I've heard that statement. A fair amount. Like, you know, smaller health systems don't have the resources to put together an adequate response plan.

What does it cost to put it together and how hard is it to put together? I think a lot of it is just start with the, the intention of doing something right. Call your local FBI guys. If you don't know them, you should know them. They should be on speed dial. Ask them for help. Look around, I mean, . You know, call me, I can hook you up with some guys who do this, you know, as a profession.

I mean, use, use an outside organization who you know is that's, this is exactly what they do. They run incident response exercises. They help organizations build incident response plans. And it's not like you're gonna go from zero to a hundred overnight. You're gonna go from zero to 10 overnight, and that's gonna be better than where you were.

And then you're gonna have a pathway to make these programs better and better and better. Over time, but don't, don't just wring your hands because you don't have something That's perfect. A as with as we talk about in a lot of stuff, not just cybersecurity, just start, just start doing something. Get down the road.

Yeah, so I was two weeks into my interim CIO role in my first healthcare job, and we were breached, and we brought in a chief security officer. I, I took the CISO role, which, and by the way, this reports differently in a lot of health systems. But the CISO reported to me. We then decided, you know what? We're gonna split that out for accountability.

We had the chief security officer. Who oversaw not only cybersecurity, but also physical security, which was an interesting combination. We had a great guy do it. Mm-Hmm. But one of the first things he did is exactly what you said. He created a, he probably used one of the existing frameworks, in fact, I'm sure he did.

Yeah. Yeah. And he had, he had 12 categories, ranked him one through five. He brought in an outside third party, they ranked us. And when I, the first time I saw it, I'm like, I sort of shook my head like, oh my gosh, it's horrible. But it's great to . It's great to have the scoreboard, right? Hey, we're down by 20 points.

We've gotta score three touchdowns in the, in the fourth quarter here. It, it's good to have the scoreboard so you know what you have to do. Yeah. And what you have to work on. Yeah. I have a trainer who, who tells me regularly that it's like, remember the old days of MapQuest or whatever. Just open Google.

Google Maps. You can't, you, you may know where you want to go, but you can't get there if you don't know where you are. And so you have to know where your starting point is and, and that applies to all things in life, but definitely around the cybersecurity issue. You've gotta, you've gotta figure out where you're at so that you can create a plan to get to where you are.

And I can tell you the other thing is that when you're breached and you go up on the HHS Wall of Shame, and OCR comes to talk to you, if you have a plan, . That is a pretty good start on your Get Outta jail free card. You may still have to pay a fine, you may still be in trouble, but if you don't have a plan and you can't produce anything for them that doesn't look like wet ink, you are in big trouble right out of the gate.

Yeah. Todd Roland, Dr. Ted Todd Roland, uh, note Healthcare Systems don't have the resources to secure their network and host OnPrem Enterprise systems. They need, need a more effective partnership with. Not easy. Something has to change to maintain the operating. One of the things I noted is when, when we did that plan, we had 12 areas and we had one to five.

We took it to the board. We presented to the board and they said, well, we want budget for what it would take to. All fives, all fours, all threes. Uhhuh, and the security. The chief security officer looked at me and said that, that's not the goal. He goes, we're never gonna get to all fives. We're never, and we shouldn't even be shooting for all fours or all threes.

There should be, you look at each one, you analyze your, it's a, it's a mix of, some are always gonna be twos, some are gonna be three as a fours, but you know, we're, we're not the military, we're not gonna be fives. And he, he was right. We did put together the budget to go to all fives. It would take better than three quarters of our operating profit every year to maintain all fives for the health system.

Mm-Hmm. . Mm-Hmm. . And, and people are like, well, why don't you do that? Why don't you protect, uh, all your systems at that level? It's like, because you, you really can't afford to. Yeah. You still have to buy, you have to buy MRIs, you have to hire doctors. You still have to, you still have to function. Yeah, and it's a risk conversation, and this is another one of those things that if I was ACEO or Chief operating Officer somewhere, one of the questions I would be asking, one of the things I would be looking at is, have we culturally put all of our security responsibilities on the CIO or the CISO as opposed to understanding that this is really an organizational responsibility to make some judgements about risk because.

That math that you're talking about, like we want really, really tall fences with the pickets really close together and they're waterproof. That almost isn't . Realistically, it just isn't, it isn't a defensible posture long term. You have to make some decisions about risk. Alright, I wanna get to the election, but before we do, yeah, let, let me describe what happened last week.

So, uh, my next post, I said, this is not a drill. A full fledged cyber battle has broken out on a global scale, which it has. And why has it? Well, the US cyber command to protect the election went out to hobble, the trick bot botnet, and we talked about this a little while back. Microsoft was involved in this as well.

And they essentially, and I've read this on Krebs, on security blog, so I don't know, is this credible? Is it not credible? It feels like it is, but essentially 'cause it, it, because it makes, it passes the sniff test. This, this could have happened, a file was sent to the infected computers that changed the malware.

Malware control server to local host, right? So if it's local host, every time it goes to communicate with the, with the malware control server, it's essentially gonna communicate with itself and it's no longer gonna be connected to that malware control server. Essentially command and control. Yep. They lost, they lost control of all those, well, maybe not all of 'em, but they lost control of any of them that they sent that to.

In addition, he goes on to say that there's rumors out there that they stuffed their malware control servers with millions of bogus records, which means they have a significant cleanup, uh, process on their side, which is. This is all well and good. Makes perfect sense. You would do this to protect the election, but their response, which was pretty swift, was to come after hospitals, essentially HHS and the FBI issued warnings early last week.

I. Or, uh, mid midweek last week. Mm-Hmm. about this malware attack. And sure enough, it, it took down at least two health systems that we know of. I think they're attacking University of Vermont as well, and maybe some others. But there's just this significant uptick in threat activity that's going on. I, it, it's interesting because I talk, I I, I was on the phone last week with a lot of CIOs as you were on the phone last week as well, with a bunch of people on this topic.

And, uh, one of the CIOs said to me, it's like, look, if I'm responding now, it's too late. This is, this is all about what I did six months ago, not what I'm doing today. And there's, there's, there's a lot of, that's essentially what you were saying before it gets started now for the attack that's coming six months from now.

Yeah. I, I can't remember the saying, but you know, the first best time to build a strong security program was six months ago. And the next best time to start building a strong cybersecurity program is now it's, it's just the, you're, you're exactly right. If you're trying to hire A-C-I-S-O, if you're trying to build a, a whole security operations center, and that's part of your strategy, it's gonna take too long.

You have to find partners who can help you do this work more quickly. Alright, last one. And this is a little free consulting here. These are smaller hospitals. They're probably Epic Community Connect partners. Yeah. And so let's assume they've been compromised and you are the, the host Epic system. So you're offline, you took them offline.

As soon as you found out you're disconnected, what kind of things are you gonna put in place? What kind of gates or hoops are you gonna put in place before you connect back with them as as an Epic Community Connect partner? You know, I, I think some of this has to do with understanding how the community connect connection may work.

It may very well be that the access that the folks in the community hospital or the private practice have is only to use Epic if they don't have some sort of like significant admin access. But you're gonna have AV vp, you, you will have AV VPN of some kind. Yeah. Point to point V VPN between there and, and the host location.

So you have . At what point are you opening that up and do they have to do something on their end before you're like, all right, we're ready to turn the VPN back on. Uh, um, I think we're risk averse and I think we, we probably are that way for a reason if we have a bunch of hospitals out there and they're all under attack and they clearly demonstrated that they already have ransomware in their systems.

Yeah. Take the conservative approach and then I think you have the sort of hard decision that is . as the host Epic site. How do I help them? Do you have the capabilities in your, in your cybersecurity team to try to figure out how to go help them? Is there some kind of cybersecurity arrangement in your agreement that you can help them or will help them?

These are all so different. It's. E everything is a different e. Everything is set up differently. All these contracts are built differently, but be conservative. That's, that would be my recommendation. Be conservative and, and make sure that your, your, your ecosystem is secure as you can make it, because the last thing you want is for the host to become contaminated, and then that, that breaks out to everybody else who's connected to you too.

The reality is that they want to talk about how they breached Mayo Clinic and Cleveland Clinic and Cedars and, and, and New York Presbyterian. That's, that's who they want to talk about, how they breached them. And they have community connect partners. To see At the end of the day, I think we're gonna see somewhat, we're gonna see some, some new oversight coming out of those larger systems that are, that have partners.

We're gonna see contract language emerge and we're gonna see sort of a, a list if, if it doesn't already exist, a list of. Here's what we want our partners to have in terms of security. All right. Election. Yeah. . Yeah. Ah, let's talk election. You know how much I like talking about politics on this show? I, I try, I try to avoid it like the plague, but, and, and that's only because people are

They're, they're so either or black and white, one side or the other on this. And we try to focus in on health it and that to a certain extent, that's what we're gonna do here. The polls are leaning pretty heavily towards vice president, former vice president Biden's direction, but there's a path to victory.

They're talking about for President Trump, which mainly goes through the state of Pennsylvania. Biden Biden has a, a big lead amongst voters who say covid is their primary, primary issue. Trump has a. A small lead actually amongst voters who say the economy is their top issue. Voter turnout, uh, will be a record.

There's no doubt. Many, many have already voted ahead of the election, including me. I voted this morning. Me too. I voted probably 10 days ago. 10 days ago. Uh, 91 million votes, uh, were counted as of Saturday, uh, according to one news outlet. And just to put that into context, 'cause most people don't know how many votes usually get cast 136 million.

Were cast in 2016 according to the Associated Press. So, uh, there, there's no doubt, I think the 91 million numbers double what the total pre, pre-election day vote was last year. So I think it was like 40, 45 million or cast ahead of the election, and the rest all came in on election day. So clearly it's pretty, it's pretty amazing.

You can look. There's places online, you can look state by, state by state, where they've already outvoted themselves. They've, they've cast more ballots than they did in the 2016 election, and it's not election day yet. And there's several states that are in that category. Yeah. Yeah. So this is, this is gonna be one of the.

Clearly one of the most, uh, active political seasons, uh, we've known of. I, I'm, I'm, I'm actually looking forward to getting on the other side of this. Uh, I, I, I think everyone is fatigued. This could have been the longest election cycle in the history of election cycles. I think they started running for president two years ago.

For heaven's sake, it's mm-Hmm, . It's, it really has been, has been a long time. A lot of political ads this week. If you live in a swing state, you're in California, you're, or no, I'm sorry. You're in, uh, I'm in Washington. You're probably getting, I don't see a lot. Yeah, you're not gonna see as many. I used to live in California, did not see as many.

I'm in Florida now. Yeah. Yeah. I. I, I can't get onto YouTube without watching a, a five, five second commercial for someone. Right. And it's funny because in my mail I'll receive like three Biden things and three Trump things on the same day. And they're identical. It's like they send one to me, one to my wife, and one to my father-in-Law.

Yeah. I'm like, seriously? Are we not this? Are, are we not this advanced to figure out that you're sending all those to the same address? Yeah, yeah, yeah. Um, so anyway. Let, let's start with, I don't know where to start without, without getting too political. It's, there's part of me that wants to talk about the election 'cause I love talking politics, but it's, but let's, let's start with health it and see where it goes.

I. Four more years. So this president, based on what has happened over the last four years, based on what what you think might happen over the next four years, what's the impact on health IT and healthcare? Probably focusing in on health. It, 'cause healthcare is a, a big thing. I. You have Biden care versus, well, we don't know what the, the president's talking about.

We know he is against Obamacare, but that's been one of the gray areas for him over the last four years. Mm-Hmm. . But health, it is pretty interesting. What, what would four more years of this CMS and ONC and this president mean for health? It. So you actually published something maybe, was it today or It was, it must have been maybe last week about the O-N-C-H-I-T plan.

Yeah, it is today. Yeah. Yeah. And and I'll probably, I'll probably put that up on three extracts too, at least once this week. But there's, there's a lot of stuff in that plan and I think one of the ways we could . Think about talking about this would be, what would it mean for the actual enablement of that plan?

Like what, what would be the differences? And, and for me, I think at least part of it is that with Biden, you would probably see this plan move faster than with Trump and . That's just, that's a very high level kind of first take. But as you go through some of these, you know, sections, it's really interesting to see what they chose to address and how they chose to address it.

And that, that there are definitely parts in here that you could see being handled very differently under two different administrations. So what Drex is referring to? Uh, 20 20 20 20 25 plan that O-I-G-O-N-C released. It has, uh, key principles outlined, include folks on person-centered care, enabling value-based care by promoting improvements in care quality, creating culture of secure access to health information, putting research into action, encouraging innovation and competition, developing health IT policy through open, transparent, and accountable process.

So that's, those are the organizing principles around it and underlying that whole thing, whole strategy is really the getting the patient, getting the data into the patient's hands and putting data to work for the patient. You know, to be honest with you, I don't, I don't think either pre it's move fast under Biden versus Trump, I think is a specious argument because this, this plan, literally, this plan could have been when

A niche was CTO for, for Obama. This could have been the exact same plan. This is exactly how he thought HHS at this time. And we saw this, right? We saw the, the four administrations over a 20 year period on the HIMSS stage. Say essentially, Hey, we we're all basically in alignment here. We believe that the patient should have access to their data.

We believe that. That data will help. Research data will help it. It is the next frontier for healthcare to get better, but that's really a bipartisan issue. Wh why do you think it would be slowed down under Trump versus versus Biden? Well, so I think it, it comes down to the component parts of this, right?

This is a strategy, and if you go through the . Whatever it is, 35 pages it's worth of stuff in 16 font. It's not, it's not a huge, complicated document to read. It's super high level strata strategic kind of stuff. But I mean, let's just, we were just talking about security. Let's just go back to security and securing patient information.

When, and this is where I'm gonna get political, right? When we have an administration that doesn't want to admit that the Russians are interfering in the election, . And that there isn't a security problem there, it becomes really difficult for me to wrap my head around the idea that somehow security and security of the internet and electronic health records and patient information would get better under a president who thinks that versus a president who believes that the bad guys are real and they're actually trying to disrupt us and cause us harm.

I think that when you think about the section on value-based care and putting the patient in the middle of the mix, when you have a president who's trying to take away Obamacare, whether you like it or not, at least it provides an opportunity for most people to be covered with health insurance and has no plan to replace it with anything, which means there will be a huge number of uninsured people.

That means that the system probably isn't gonna move as quickly toward value-based care, because those populations aren't going to be in the mix for value-based care. So the system is gonna be incentivized to continue to do fee for service and do it on a grand scale because the only people who will have money for healthcare are people who are insured, which means the wealthy.

Meanwhile, the poor will do what the poor do all the time, which is show up at the emergency room when they're sick. And you can go through each of these and for me, look at it and think about it as component parts, and just think about the policies that exist today. And of course, you're always being hopeful about the policies.

That may be Joe Biden policies, but. , when you look at the, you look at his website, you listen to his stump speeches, you listen to all the folks who probably are gonna wind up with roles in his administration. You read his plans, he seems to have plans for many of these things. Yeah. So that's my politics.

Uh, there you go. Wow. You're, you're diving in deep. Yeah. And so you're gonna force me to, to do the Trump side. Well, thanks . Here we go. Don't cancel me. In fact, that's one of my pet peeves to be honest with you, is Yeah. It. It has become so polarizing that people essentially say, well, if that's what you believe, I can't, I can't listen to you.

I can't be your friend. I can't be anywhere near you. And that's the thing that really has irked me the most. If someone says to me, I voted for Biden, I voted for Trump, I, you know, I don't say, oh my gosh, you must be a horrible father. You must not love your kids. You must. Think and believe all these crazy things, whatever, people are much more than their political ideology, and I think we need to give people the benefit of the doubt if we're gonna get through this thing.

But let me, let me attempt some of this stuff. Pretty, pretty transparently. Clearly, Trump doesn't believe that there aren't bad guys. That's, that's, that's again, a specious argument. Did they interfere in the election is a completely different argument than are there bad guys out there trying to hack into our systems?

Trump talks about bad guys all the time that, you know, the Chinese, he banned China's technology into our country because there's a belief that, that technology would be used to, to infiltrate and take data. So. I, I don't think from a security standpoint that, that, that really holds too much water. I, I'm not sure we would make any more or less progress on security as a result.

I, I think when you look at, I. When you look at, the thing I like about Biden is he spent a bunch of time on the Biden Cancer Initiative. So he got up to speed, he got educated, he met with Epic, he met with Cerner, he met with the players he got, he got educated on it. I think he understands some of the issues maybe at a deeper level than Trump does.

But the reality is. The president hires some people and puts 'em in place. It's more, I think the most powerful people in healthcare are Sema Verma, not necessarily President Trump and, and, and Secretary Azar and whatnot. Uh, I think those people determine what direct, what's gonna be reimbursed, what direction are we gonna take, what is is the direction value-based cares is the, the, is the direction fee for service.

But I don't think that they would say it's fee for service. I think what they would say is. We're gonna take healthcare, which is currently, uh, a, a mashed up mess of a market, right? We have no transparency. We have no choice. And, and we have no a, a again, without transparency, we don't know what it costs.

When we go to see a doctor, we have no idea. They're just saying, Hey, this is broken, and we want to, uh, infuse. Let's capitalist, I don't know. We want to infuse the the things that drive our economy. When people know what something costs, they can make a decision. Now we're afraid to do that in healthcare 'cause we don't want people to look at it and go, oh, well I'm not gonna get this care 'cause it costs too much.

At the end of the day, we have health system, and this is one of my pet peeves. We have health systems that have fought this tooth and nail. Mm-Hmm. , like when they say, Hey, we're gonna do transparency of, of, of your services. Transparency. Yep. Yeah. I mean, I talked to some CIOs and they say, oh yeah, we're compliant.

And I'm like, you're compliant. How are you compliant? I don't see this information anywhere. It's like, oh yeah, you can download this. 3,800, if you can find the link on our page. Yeah, exactly. It's hidden, hidden somewhere, and then when you download it, it's like, oh my gosh. I'd have to have intricate knowledge of how your health system runs to make any judgment as to which one of these codes actually is.

I'd have to be a coding expert. Yeah, for sure. I know exactly what you're talking about. So I don't have any problem with transparency. They're trying to move data. They're trying to, all the things that they look at and they say, Hey, this is what makes the American economy work. They're, this current administration says, we're gonna do those things.

My concern about Biden is they're gonna say, ah, too hard. The road's too long. Let's nationalize healthcare to, to heck with the ec, the economic fundamentals don't work in healthcare, so let's, let's just socialize medicine and we'll head in that direction. So that's the, that's the fear on the other side.

And so that's the rhetoric on the other side is, hey, if you . If you like nationalized and socialized medicine, then you know, biden's your vote. Yeah. Is, that's probably over the line, but I, no, I mean, we're talking about it. So what, what do you think And look from a, from a politics perspective, I. The good old days,

We just said you used to have some good old days. Look, there's a thing that I tell, I tell my teams and I tell my friends all the time, and it's moderation in all things, including moderation. So I think what's gonna happen is that there is going to be such a severe backlash against the Trump administration in this election, and this is me making my prediction, but that.

It may very well be that the Democrats will have the House and the Senate and the presidency and the attempted moderation is going to be very difficult because for at least two years, if they can line up their airplanes to land on the runway in the right order, they're gonna put a lot of airplanes on the runway in short order, and that may very well involve healthcare in some version of what you're talking about.

I don't know that it's gonna be . Turn everything off and go to a pure socialized medicine model, but it may very well be Medicare for all or Medicare for those who want it. And there's a part of me that it it, when you take that and a bunch of other things, again, moderation in all things. We, we may become a very liberal country over the course of the next two years and, and it, and it may happen because of the backlash.

to the president. Yeah. It's interesting. Medicare for all. Just just to dispel any myth, that's socialized medicine, right? That is the government is the payer for. If it's Medicare for All and all is all, then it's the government is the payer for all medicine. So therefore that's, that's, that's, that's the, uh, direction from a marketing standpoint, I think the progressives want you to think that Medicare for all is a, is a nice compromise between socialized medicine and, and, and what we have today.

But really what it is, is it's a compromise that is, is squarely in the socialized medicine category. So that's number one. Number two. It's, it's interesting because prior to Covid, I, I'm just worried about how people are gonna read the election, right? So prior to Covid, president Trump was gonna win in the landslide.

The, the, the GDP was places where the previous administration said that were, it was never gonna get there. We'll never see those numbers again. And we saw those numbers for the better part of, uh, you know, two and a half years prior to Covid, we saw unemployment rate in certain areas. We saw movement.

We're seeing, still seeing movement in the black community towards President Trump. We're seeing movement in the Hispanic community towards President Trump to groups that have largely voted. In lockstep with the, with the Democratic Party for years. And you have to ask yourself why. So he was in that path.

But what you have is you have, uh, it can be interpreted as, Hey, this is a reaction to all of Trump's policies. Or this could be interpreted as, Hey, this is a reaction to, people are scared. People are just flat out scared, and they, they believe that they're gonna be safer under Biden than they are under Trump.

Not necessarily on a national STA stage and those kind of things, but just covid. Just health, I'm gonna be safer under Joe Biden telling me when to stay inside nationalizing masks so I don't have to worry about the crazies at the store who are see themselves as the opposition and not wearing masks.

And he's gonna be more measured. Trump comes off as bombastic, whereas. Vice President Biden comes off as more measured in his approach, uncle Joe as opposed to crazy, crazy Uncle Donald. Yeah. Crazy Uncle Donald kind of thing. I if, if Biden wins this election, that's what it's gonna, that's what I think it says is this is a reaction to his, his Covid policies.

I, I, I, I had a poll. First time. I'm 53 years old. The first time I was ever called by one of these national polls. Oh. Oh really? Yeah. It's one of, it is one of the reasons I always thought they were fake. 'cause I'm like, . How can I, in 53 years, how could I never get called? Never been called. Yeah. And so they went through the poll and they said, which, which would you like to win?

The Congress, the Republicans or the Democrats? And I'm like, are, are those my only options? And they said, yeah, those are your only options. I'm like. I want a split house. They're like, well, that's not one of your options. I'm like, I want a split house. . I'm like, I always want a split house. I never want moderation in all things, including moderation.

I never would. I, I, I never want any administration to have all, you know, all, you know, the, both, both houses of Congress and, and the presidency. It's, it's too dangerous. And if you want my, my case study on this, it's the state of California. The state of California now has a super majority, which means they can do whatever the heck they want and they are doing whatever the heck they want.

Mm-Hmm. . And if, if anyone wants to know, the reason I live in Florida is because that place is nuts. And I'm sorry if I just offended the millions of people who live there, but, but that, that place is out of control and it's just, there's no checks and balances. Yeah. I believe, and the reason I want to have this conversation with you.

In front of everybody is because I believe that the best ideas come. When you have opposing ideas having good discussion, it's the balance. It's, it's the, Hey, you know what, we're not idiots. The the opposing side isn't idiots. You have to have the other side at the table to have the conversation. And if you're just gonna throw 'em out and say, Hey, we won.

It's a mandate. You guys go sit in the corner for the next four years, we're gonna do whatever the heck we want. You have to remember that half the people didn't vote for you. Yeah, this, this applies to like everything else too, right? If you're ACIO, if you're a healthcare executive, you're executive in any business, part of what you want is a bunch of people around you who

Don't necessarily think exactly like you do. That's why diversity's important. That's why you want people from other experiences and other walks of life and maybe even opposing views on your team because they make you better. It makes you think and rethink every one of your positions that I. Inside yourself, you say, of course.

This is so common sense. This absolutely has to be true until it comes under pressure, until it's challenged, until somebody beats you up on it a little bit and you start to rethink it. That doesn't mean everything has to be a compromise, but it means that you go into all of those decisions with your eyes wide open.

You understand what the opposition, what the grumbling is going to be so that you can be prepared for that and . Create plans that make that grumbling less. And whether you're the president of the United States or the director of infrastructure at your health system, these are, these are all really great lessons, right?

Yeah. You know, and to be honest, we're not gonna understand racism, systemic racism, the role that identity pot politics plays in it. We're not, we're not gonna understand any of that unless people . Sit across and have very uncomfortable conversations that I, I need to be educated. I need to understand how people have experienced the, the have, how they've experienced capitalism, how they've experienced the current policies, how they experienced healthcare.

I need to understand all those things in order for me to be educated to, to do the right things, to put the right tools in place, to hire the right people, to promote the right people, to promote the right policies and those kind of things. If, if every time. We get control of something. We just say, all right, this is mine to run.

You go sit over there. We're, we're heading down this path. There, there'll be another backlash, right? It'll happen. I, I talk to, again, I kind of, I talk to clients and teams about this all the time. Get comfortable with your uncomfortableness. The situation you should be in is not to be comfortable. If you're comfortable, something's wrong.

You should . Create that tension. You should create that uncomfortableness that makes you a better leader and a stronger thinker, and a more, uh, agile problem solver. You, you, if you're comfortable, you get lazy and sloppy, and then bad things happen. So again, it applies to politics, it applies to everything that we do.

Yeah. I, I appreciate you having this conversation. It's, it's, it's interesting to go back and forth. I was talking to another person who I know that we're on different sides of the aisle completely. And, and we were, we were just having a conversation, which wasn't gonna lead to me thinking any different of them or them thinking any different of me.

And they said, Hey, think, I think we can come on the podcast and talk about this stuff. And I'm like, I don't know. To be honest with you, PE people, people think the way they do though for some reason, and, and I'm definitely guilty of this myself, the sometimes just like, I just can't believe. I just can't believe.

But what you're dealing with in a lot of cases is social media and little snippets. When I sit down with a friend of mine who thinks differently than me and, and they're still a friend and I know they're a good person, and, and I, and I really do know that. And I start asking them why they think the way they do.

That's the nugget, right? That's the information that you really want. You need to understand why they think the way they do. It's not, it's not unreasonable to them to believe what they believe. Yeah. It's incumbent upon us to try to understand that and then mold that into our own way of thinking. The more

As they say. So it's, it's definitely, it's definitely an interesting time. Yeah. And the next couple of days are definitely gonna be interesting. You got, you got, you have to value people over winning an argument. You have to value people and understand the intrinsic value of every individual, their experiences and their point of view.

I've, I'm lucky enough to have, uh, I have progressive friends who, who would say this president's bad. They would point to covid, they would point to the economy, the PS of minorities and immigrants. They would say he's bad for the environment, bad for civil discourse. I, I have conservative friends who say that, Hey, this president's good.

They would point to his record of doing exactly what he campaigned on. This is probably one of the first presidents, to be honest with you, that we're not saying, Hey, he did follow through. The problem that most people have with him is he followed through on all the things he said, and, and I don't think people thought he was gonna follow through on all the things he tightened.

Borders, uh, renegotiated, bad trade deals, appointed conservative justices. They would go on to say he provided opportunities for minorities and, and legal, legal immigrants, is what they would say. And the reason I know that is 'cause I got someone on the phone and had the conversation before this show and said, Hey, what, what's, what's your, what's your position?

So it's interesting exactly what you say. People. They had different parents, different experiences, different things that shape their lives, different teachers that shape their lives, different events that shape their lives that we have to believe in, in really the good in people to, that we're all trying to make our, our country in this world a better place.

Is the, is the eventual outcome really all going for D diverse? Diversity's hyper powerful. I didn't know that I was, I was a white kid who grew up in a Christian . County in the middle of Indiana. We didn't have any different, we were all exactly like each other until I went into the military. And, and that's where I really figured out like, wow, these, all these people from all these different places have completely different ways of thinking about the same thing.

That problem solving the same, I, it's, it's so amazing and that's really where I got supercharged on how can I find people that are completely different from me? That's the way that you're going to . Find the best solution to really complicated problems and . If we embrace that, that would be awesome. Well, hey, I wanna remind everyone, we are not political pundits.

We, we got into the politics side just because it's, it's hard to ignore that. Today is election day. If you haven't already, get out and vote. It's one of the things that I. In the history of our world, we are one of the few, uh, countries, literally in the history of our world that has had the opportunity to speak into the, into the governing process, into our government.

And, uh, regardless of if somebody's gonna cancel out your vote or not, encourage them to get out and vote, it's a really, is an incredible privilege. Makes a huge difference. Do it. Dr. Drex, thanks for coming on the show once again. Always, always fun. We'll see you. . We'll, we'll check back the next time we talk.

We will have a new President-elect, and we'll see if Donald Trump is doing crazy things, either pardoning people or doing stuff, or if he's now the president and we are dealing with the riots in the streets. I guess these are our two options or those are our two options at this point. I, I think there are probably other options in between those.

Let's hope so. Gosh, . That's all for this week. Don't forget to sign up for clip notes. Just hit the website, sign up there. Special thanks to our sponsors, VMware Starbridge Advisors, Galen Healthcare Health lyrics, Sears Healthcare Pro, talent Advisors Health Next and McAfee for choosing to invest in developing the next generation of health leaders, and it's important to note.

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