While prepping for this Conversation, I ran across this discerning quote commonly attributed to Eisenhower:

“The supreme quality for leadership is unquestionably integrity. Without it, no real success is possible…”

Extending this quote’s emphasis on integrity and success, one could make the case that U.S. healthcare’s higher costs and substandard results for over thirty years (compared to the rest of the developed world) is related to a lack of leadership integrity.

Almost daily, reports of impropriety within the sphere of healthcare lend credence to the charge. This week a report surfaced identifying less-than-ethical payments to FDA expert advisors who were presenting evidence for a new drug with minimal increase in efficacy but with 25 times the cost of the prevailing standard of care.1  A breach in data integrity clearly increases the specific cost of the ill-chosen product whose value is exaggerated.

However, even more concerning is that each breach slowly erodes the very foundational integrity of our healthcare system. Most concerning of all is the harm that physicians unknowingly inflict because the information they work with has been massaged by commercial bias.


In a presentation in 1986, I found myself defending healthcare to a room of angry businessmen who were upset by years of increasing healthcare costs. I presented two case studies with the intent of demonstrating how technology had been a key factor in driving up medical costs.

I added a more recent case to give further perspective to the challenges leaders now face in making effective healthcare purchasing decisions.

  1. Case from 1955

A hearty 66 year old man called his physician one evening complaining of indigestion. The doctor prescribed an antacid and suggested an EKG the next morning. The EKG showed that the “indigestion” had been the initial symptom of an acute heart attack. The man was admitted to the hospital, placed on complete bed rest for two weeks, and discharged home after six weeks in the hospital.

The patient in this case was President Eisenhower. It is startling to reflect how little could be done for a heart attack in 1955, even for the president.

  1. Case from 1985

A 62 year old man came to the Emergency Department with chest pain. Within two hours a cardiac cath was performed and showed a blocked artery. A balloon angioplasty opened up the artery and immediately relieved the man’s pain. He was discharged a few days later in satisfactory condition with minimal heart damage.

The patient, a homeless Wisconsin man, was cared for with very expensive, but state of the art medical care.

  1. Case from 2009

A 52 year old apparently healthy CEO of a technology company was on his daily run when he collapsed from a heart attack and was successfully resuscitated. At the end of his hospitalization, the cardiologist advised that he was well enough to go back to his life “the way it was.”

In this case the patient, John Tanner, was more than a little concerned that his life “the way it was” had led to his heart attack in the first place. So he did extensive research to determine why he nearly died in the prime of his life.

What he discovered rocked his world. Since he exercised regularly, handled stress well, had a good work/life balance, and never smoked – the cause of his heart attack became undeniably clear.  He had been eating the “normal” American diet.

Since his heart attack Mr. Tanner has dedicated his life to teaching others what he learned about healthy lifestyle choices. As John stresses, if the best available scientific evidence were followed, it would prevent hundreds of thousands of premature deaths every year. His work is a clear example of servant leadership solidly guided by integrity.

What can we learn from these three cases?

  1. Before modern medical care, even presidents didn’t receive particularly good treatment for a heart attack.
  2. With widely available technological advancements, even the homeless can receive better care than past presidents.
  3. As John Tanner learned after his near death experience, ignoring lifestyle solutions can lead to poor health, create astonishingly high medical costs, and be responsible for killing nearly a thousand Americans every day with coronary artery disease.

If I were presenting today to a group of business leaders angry about healthcare costs,  I’d say, “You’re right to be angry. But if you’re interested in doing more than just being upset, there are solutions hiding in plain sight.”

What do you think? Would there be one John Tanner in the room ready to hear the truth?

Breakthrough To Better,

1Hidden conflicts? Drug approvals spark ethical concerns by Charles Piller, Jia You
2I Almost Died by John Tanner


Switch Conversations designs healthcare solutions for self-insured employers.




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Edition 1 – Solving a Well-Entrenched Problem
Edition 2 – A Case of Dr. Jekyll and Mr. Hyde
Edition 3 – Best marketing tagline of all time?
Edition 4 – Post-Truth Killed a President
Edition 5 – What’s an employer to do?
Edition 6 – Profiting From the Opioid Epidemic
Edition 7 – The Keys to Unlocking Better Decisions
Edition 8 – When Difficult Things Need to be Done Well
Edition 9 – Fixing Healthcare
Edition 10 – Beware of a Singing Cow
Edition 11 – Wise Reflections
Edition 12 – Warning: Reader Discretion Advised
Edition 13 – Can AI save healthcare? (Part 1)
Edition 14 – Can AI save healthcare? (Part 2)
Edition 15 – Can AI save healthcare? (Part 3)
Edition 16 – Embracing Reality to Improve Healthcare
Edition 17 – Everything I Needed To Know…
Edition 18 – The Eighth Circle of Hell
Edition 19 – So… What’s Our Solution?
Edition 20 – Protecting Integrity as a Core Strategy
Edition 21 – An Unadorned Legacy
Edition 22 – Time to Grow Up
Edition 23 – Against All Odds
Edition 24 – When Everyone Has Stopped Listening
Edition 25 – Focusing on What’s Important
Edition 26 – Don’t Give Up Your Shot
Edition 27 – Join the Goodhood
Edition 28 – Fixing Healthcare (Recycled)
Edition 29 – Taming the Healthcare Beast
Edition 30 – Leadership
Edition 31 – Better Health Requires Good Sense
Edition 32 – Little Decisions With Big Consequences
Edition 33 – Transformational Courage
Edition 34 – Transformational Courage – Part 2
Guest Post – Happy Thanksgiving! By Jeff Novick, RD
Edition 35 – Transformational Courage – Part 3