At first a feeling of incredulity, and then a strange sadness came over me with the announcement recently that Aetna Life Insurance Company was selling off its life and disability business. I no longer work at Aetna, but I had devoted nearly twenty years of my life to the company in that very division. I had effectively grown up at Aetna, alternatively adoring or vehemently disagreeing with multiple CEO’s and my multiple bosses over that time. At a low point in my life, Aetna gave me a chance, the local HR manager who hired me having seen something in me that I didn’t even know I possessed. Over the years I grew personally and professionally, feeling, on the whole, respected and well looked after by my employer. I was promoted to higher levels within the division, gaining confidence as I met the challenges they presented to me, eventually coming to be known as a subject matter expert, the go-to person to get an answer or get something done. Aetna and I have a shared history. I was there on 9/11. In the days immediately following that horrible event they desperately sought confirmation of the whereabouts of every one of their 60,000+ employees. They made us feel safe and kept us informed. I appreciate their compassion to the thousands of people whose life claims were paid promptly and without questions despite having lost all the records when the towers came down. More than ten years later, they accepted my recommendation to pay a life insurance claim on humanitarian grounds to a young widow and her two small children, even though my customer, the widow’s husband’s employer, had never submitted his enrollment form to us nor paid any premium for years on the workplace policy. Aetna showed their compassion then too. The woman does not know that it was I who was her advocate, and not her employer, who took the credit. At one time in Aetna’s history, people there had affectionately referred to the company as “Mother Aetna” because they were very maternal in their outlook toward their employees. And when my great aunt Irene died, I was stunned to learn that she too, had worked at Aetna in the 1930’s and 1940’s as a nurse, giving me a tangible connection to Aetna’s past. I have a warm feeling toward the company as if they are part of an extended family. My reaction to the news was thus understandable. They were selling the division to which I had devoted nearly twenty years of my life? How could they do that? Why would they do that?
Then in rapid-fire succession, before I had a chance to completely digest the implications of this bit of news, the next bombshell, an even bigger one, exploded. CVS is acquiring Aetna’s health insurance business in a deal valued at $66 billion! If this deal goes through, it will be the biggest in the history of the health insurance industry, and explains the reason for Aetna’s first bombshell, the decision to divest the life and disability side of the business. Oh how things have changed! Who would have ever thought that a drug store chain would buy a health insurer? The Norman Rockwell image of the kindly corner druggist is long gone. The deal makes sense in this brave new world we are navigating. The push to find ways to deliver health care affordably and responsibly means that more deals like this will be forthcoming.
My first novel, The Broker, chronicles the death of the HMO, the rise of consumer-directed health plans, outsourcing and downsizing of jobs in an industry that has seen massive upheavals, and the effect of all this on the poor, hapless patient. It gives the reader an insider’s look at the deals and the decadence rampant in the industry, one in which enormous amounts of money change hands through insurance brokers who do nothing to further the cause companies like Aetna and its customers, America’s employers, are seeking to implement and promote to improve our lives and our health care. Greed motivates outcomes, and the patient, the member, the employee – the ones we are supposed to be in business to protect – often get the shaft. I have written frequently that the healthcare delivery system in this country is broken. Even though I am fully aware of the list of offenses the insurance companies have committed in their long history, I also argue that they are on the cutting edge of innovation in health care delivery and are uniquely positioned to see their members’ needs from all sides. They must be sitting at the table as we figure this out.
Many in the business community, Congress and the White House poo-poo this idea while actively dismantling and destroying the mechanism of health care delivery, whether this is for personal gain or from personal conviction, it cannot be readily ascertained. At the moment, it is difficult to foresee the future. We have taken a step back from the idea that we are in this together and will take care of each other. Members of our government agencies and institutions argue that each individual should be responsible for their own health care and its costs, and that it is unfair for the group to be saddled with the cost and responsibility for people who are older, sicker or will not help themselves through education, diet and lifestyle changes. They argue that the force of a free-market – intense competition among hospitals, doctors, drug companies, insurance companies and pharmacies to deliver healthcare at a lower cost – is the only way to improve on both cost and outcomes. I strongly disagree. Competition alone has not shown to be of any value thus far, and in fact, puts great pressure on health delivery to cut corners to cut costs, and puts the healthcare consumer at a real and measurable disadvantage when it comes to complex decisions regarding care. As long as profit is the sole motive for delivery rather than vision, compassion and yes, altruism, we will never control costs and deliver better outcomes for patients.
The Aetna CVS deal supports both of these arguments. While profit, in and of itself, is not evil, in an industry like healthcare where our very lives are at stake it must be balanced with vision and compassion, which both Aetna and CVS have in spades. I like the leadership at both companies. I applaud the decision by CVS and its Pharmacy President, Helena Foulkes, to stop selling cigarettes or any tobacco product, citing that these cancer-causing products conflict with CVS’s purpose of helping people on their path to better health. I like Aetna’s chief executive, Mark Bertolini. He’s smart. He’s cutting edge. He’s data driven. He’s a breath of fresh air in a staid industry. He has led the company with great care, drawing deeply on his personal experiences, seeing individuals holistically, promoting non-traditional approaches to health, and backing up his beliefs with actions for Aetna’s members and its employees. From a practical standpoint the CVS deal makes sense. Cutting drug costs, delivering quality care affordably, and making it easy to access that care through improved reimbursement, is the #1 driving force behind this marriage. I look forward to the coming years as the combined strengths of these two innovative companies drives positive change in the industry.
But I have a tiny pang of regret as I wave goodbye to Mother Aetna. They were instrumental in my development. They believed in me and I grew up in their care. From them I learned valuable lessons. I learned to work with a team toward a shared goal and to take on new challenges, to expect positive intent from others until proven otherwise, to offer an opinion and value the opinion of those with whom I disagree, to know my strengths and be honest about my weaknesses, to see the bigger picture and still know the importance of the individual, to accept things I cannot change and move on. In short, I learned to live in a community. Something folks in Washington need to learn too.