If Healthcare Went to a Karaoke Bar…

During the last Tech Tonics episode (released September 23 and featuring the inimitable Tanisha Carino of FasterCures), David Shaywitz and I delved into Tanisha’s underground obsession with Karaoke. While admitting that Madonna’s “Dress Me Up” is her go to song on the microphone, I got it in my head to ask her what song exemplifies the US healthcare system. Her answer: Abba’s”Winner Takes It All.”

Then, as if by some magical summoning, I had just finished listening to the newly-released podcast on my drive to the airport when I turned on the radio to a rousing chorus of…Abba’s “Winner Takes It All.” I know they say that everything electronic is always listening to you, but now I think I have proof. Hello Hal? Are you out there?

Anyway, I continued driving along and, given the obvious provocation, started thinking about that karaoke question and wondering what others would say. I know that for me, the answer would be a photo-finish between Avril Lavigne’s epic teeny-bopper hit, “Complicated” (lyric: Why’d you have to go and make things so complicated?) and “Greed of Man” by Grand Funk Railroad:

Well, I don’t understand, there’s no rhyme or reason
I know the greed of man has no season
He never stops to think about the outcome
He don’t look back to see the damage he’s done

Close runner-up: “Money Becomes King,” by Tom Petty, himself a failure of the healthcare system:

If you reach back in your memory
A little bell might ring
About a time that once existed
When money wasn’t king
If you stretch your imagination
I’ll tell you all a tale
About a time when everything
Wasn’t up for sale

But enough about me and my obscure music trivia fixation, I thought to myself as I crept along on Highway 101, I wonder what other people would say? After boarding and paying the absurd $25 wifi fee on United Airlines (motto: Wait, you still have some money left? Let me take care of that for you…), I fired off an airborne email to a cross-section of my healthcare pals (investors, doctors, entrepreneurs, payer execs, health system leaders, patients, the works) to ask them this most essential of work-day questions:

1. In your personal opinion, what song most exemplifies the U.S. healthcare system? In other words, if you were out at a karaoke bar with the entire US Healthcare System in all its multifaceted glory, what song would it pick to sing about itself? Don’t overthink it – ok to go with your first thought.

2. If you feel like it, give me a sentence about why you picked that song.

Wow! I got so many responses so fast my iTunes overfloweth. In fact, I got 80% of the responses within 15 minutes, which either means people are thrilled to be diverted at work or they love a chance to think creatively for a minute (or C, all of the above). I think that the songs below would make one hell of a healthcare playlist if you felt a little too happy. It would also be the basis for some excellent psychoanalysis. Yes, I’m talking to you…

In any event, there seemed to me four clear themes that came through: Chaos and Structural Failure, Money/Greed, Stress, and Hope (pure and simple optimism that the future will/must be better). It was kind of fascinating, particularly since so many of the people who responded took the time to quote lyrics and explain their logic in quite a bit of detail. I was going to do a bunch of excerpting and editing, but then I thought that my colleagues’ words actually spoke best for themselves.

So here you go – my entirely unscientific survey results, including, when allowed, the names of those who they agreed to let me use their name (the few, the proud, the maybe-about-to-regret-that-decision). It’s a long post, but fun and pretty interesting (aka worrisome at best) to see how people’s minds really work:

Songs about Chaos and Structural Failure

OK, it wasn’t a contest, but the most creative response with a bullet came from Susannah Fox. She called out Iron Butterfly’s “In-A-Gadda-Da-Vida” as the perfect song for this occasion, and here’s why (capitalization all hers): “It was written as a typical-length song entitled “In the Garden of Eden” but the creator was so drunk that he slurred his words and the lyrics were written down as the nonsense phrase “In A Gadda Da Vida” AND THEY KEPT THE MISTAKE AS IF IT COULDN’T BE CHANGED. They baked that %#@$ into the final record. Not only that, the song morphed into a 17-minute jam for the album and…wait for it…nobody ever knew how long the song would take whenever the band played it — could be 15 minutes, could be 30, who knows? AND EVERYONE SAID IT WAS AWESOME NO MATTER WHAT NONSENSE HAPPENED, BECAUSE ROCK AND ROLL, MAN. Can’t you just see the American health care system taking the mic and clearing the bar with an endless, incoherent rendition? Meantime the UK, Canada, Australia, and Germany head out the back to a piano bar with a Cole Porter songbook under their arm. Oh, and “In-A-Gadda-Da-Vida” was brought to us and enshrined by the Boomers. That’s also super on brand for the American health care system.”

NOTE: I originally reported that the above response came from my friend Virginia Giddings, but I was wrong – moving too fast I am so sorry to say!  Virginia, my dirndl-wearing co-conspirator, had offered up “Hopelessly Devoted to you, ” Because…no matter how the system fails us, poor customer experience, low quality of care, sky-rocketing costs, we seem hopelessly devoted – this sums it up:”

You know I’m just a fool who’s willing
To sit around and wait for you
But baby can’t you see there’s nothing else for me to do
I’m hopelessly devoted to you

Susannah has forgiving me my transgression and offered to wear a dirndl with me anyway (thanks Susannah!)

Joe Kvedar, digital health guru and Partners Health physician leader, offered up “Helter Skelter.” I’m not sure if Joe was going for the original Beatles version or the ones by Aerosmith, Pat Benatar, or Rob Zombie, but it really doesn’t matter. As he says, the song works “because the combination of the music and lyrics create a feeling of chaos.”

“Everybody Knows,” by Leonard Cohen, was selected by my Tech Tonics compadre, David Shaywitz, because “the problems with system are an open secret and reflect everyone’s self-interest.” There are so many perfect lines from this song it’s worth going to check it out.  A sampling:

Everybody knows that the dice are loaded
Everybody rolls with their fingers crossed
Everybody knows that the war is over
Everybody knows the good guys lost
Everybody knows the fight was fixed
The poor stay poor, the rich get rich
That’s how it goes
Everybody knows
Everybody knows that the boat is leaking
Everybody knows that the captain lied
Everybody got this broken feeling
Like their father or their dog just died

Pardon me for a moment while I root around in my briefcase for the cyanide capsules….

Oliver Keown, physician and VC at Intuitive Surgical, offered this Elton John/Kiki Dee gem: “Don’t Go Breaking My Heart.” He notes, “obviously a stretch but if you check out the lyrics it covers everything (metaphorically speaking!) from the iatrogenic burden of disease (% HC cost introduced by errors or mismanagement in the system), to the connectedness of mental health, disease prevention (weight loss) and social determinants (loneliness)!” Diagnosis confirmed!

Molly Coye, also a physician and entrepreneur, Avia advisor, Board member and general healthcare renaissance woman, called out The Talking Heads, “Cross-Eyed and Painless” from the movie Stop Making Sense (which I saw recently on the big screen and it was as awesome as when I saw it in the 1980’s). She points to these lyrics:” Facts all come with points of view, Facts don’t do what I want them to,” adding, “I study these lyrics and keep discovering new ways they’ve slyly nailed our health system, cutting right to the heart of our “patient experience.” It’s a constant source of grief and motivation.”

Matthew Holt adds his pick, Barry McGuire’s “Eve of Destruction,” with such cheerful lyrics as:

Take a look around you, boy, it’s bound to scare you, boy
And you tell me over and over and over again my friend
Ah, you don’t believe we’re on the eve of destruction

Says Matthew, “I guess we thought the world was going to blow up in the 60s, the 80s and probably now. But it didn’t. Same with the US health care system…” And that’s the happiest part of the song.

And if you weren’t depressed enough, try on the entry from Tom Rodgers’ of McKesson Ventures “Lightning Crashes” by Live.  As Tom says, “It’s about birth and death- the two life events that our healthcare system infrastructure seems to be built around (one of which we do a lot better than the other) and the fact that everything else in between is inevitably confusing and chaotic, and that the cycle just keeps repeating.”

And the downers continue with this suggestion from a European VC friend: “All Apologies” by Nirvana. She says, “Closest thing to a suicide note. – There’s some serious re-birthing needed here. Transformative changes the likes that can be had from burning the phoenix and hoping something better is born from its ashes. Not going to happen, but that’s why I picked the song. What else should I [healthcare] be? And in the meantime, patients are All [alone] is all we are.

“I Will Survive” is another good choice, provided by Dana Safran from Haven, I like the double-entendre — in that it could be both the patient view (trying to survive dealing with a dysfunctional system that is not actually dedicated to producing good outcomes for patients) and the system view (fighting to maintain the status quo no matter what efforts to disrupt the “machine” we introduce from a policy and business perspective).

Dorit Donoviel, Executive Director of the Translational Institute for Space Health (TRISH) suggests “Tainted Love” by Soft Cell – “The healthcare system says it loves the patients but does it???” On a similar note, another colleague suggested “Bad to the Bone, because you can’t just fix stuff on the surface and have it work. It goes all the way to the bone.”

Liz Fowler, newly appointed Executive Vice President for Programs at the Commonwealth Fund, nominates Springsteen anthem “Born in the USA” because, “…our system is so uniquely American – nothing like it in the world (and that’s probably a good thing). I also thought about that song because it speaks to middle America, and I feel like middle America is who gets squeezed the most by our current crazy system.”

And several people referenced the Talking Heads “Once in a Lifetime,” mainly for the perfect “Well, how did I get here?” reference. Same as it ever was….

My awesome colleague at Manatt, Jared Augenstein, sums it up thusly: “(I Can’t Get No) Satisfaction” by the Stones. ’Cause I try and I try and I try and I try.’”

Songs about Money and Greed

A particularly creative choice from Sage Bionetworks’ John Wilbanks: “Federal Funding” by Cake (lyrics here). Because it clarifies that we focus on building buildings, getting grants, and accessing information in that order.” (emphasis his)

Two other entries: “For the Love of Money” by The O’Jays, “Money, money, money, money…because of all of the dysfunction in helping patients is because of the money.” Pink Floyd’s “Money” also made an appearance. One who selected this song said, “Everyone agrees we spend far too much in the US for middling outcomes. Many believe that good ole American ingenuity can fix those problems through a combo of delivery system reforms, adjustments in financial incentives, new technologies that will cure diseases and allow people to make cost comparisons, etc. But every dollar in our bloated system goes to someone, and those folks don’t want to give up their piece of the pie with that ‘do goody good bullshit.’ There, I’ve said it.”

Marty Felsenthal, General Partner at HealthVelocity Ventures, chose “Domo Arigato Mr (Dr.) Roboto” by Styx. Why? “Here comes AI. Projected to grow by $2b to $36b in healthcare over next 7 years.” Boom! He covered both dystopia and total available market in one blow. Now that’s a VC.

Note to self: I am concerned that more venture capitalists did not provide entries in this category. Talk amongst yourselves.

Songs about Stress/Fear

Alex de Winter, a hilarious (and crazy smart) former GE Ventures colleague of mine, jumped in with Bon Jovi’s “Livin’ on a Prayer,” saying, “I picked Bon Jovi because, whoa, the US Healthcare system is “halfway there” to a decent system. Like 8.5% of Americans, Gina and Tommy in the song are likely uninsured (she works in a diner, and he used to work on the docks), and so the two of them are “livin’ on a prayer,” hoping not to get sick. Recently Bernie Sanders (and other candidates) have asked voters to “take my hand, we’ll make it, I swear.” The indefinite antecedent to “it” in Bernie’s promise, is obviously a single-payer, Medicare For All healthcare system.” Getting a little politically controversial – good stuff Alex—I love a good controversy.

Bayer’s Eugene Borukhovich came up with the Scorpions’ song “Miracle” with the lyric “Now all I’m hoping for…is a miracle” He said, “The lyrics (which I had to pull up) speak for themselves, though my original reason was that we all do need a miracle aligning stakeholders to really be patient centric.” He also added a smiley face emoji.

Kristi Ebong, of Orbita.ai, came in with Alanis Morisette’s “Ironic,” which is a great song on so many levels. Kristi says, “The song is a testimony to how healthcare breaks the rules and doesn’t follow neoclassical economics the way most industries do.”

Well, life has a funny way of sneaking up on you
When you think everything’s okay and everything’s going right
And life has a funny way of helping you out when
You think everything’s gone wrong and everything blows up
In your face

Ouch.

“Tomorrow Wendy” by Concrete Blonde is next up, “Because it’s about the patient’s reality versus the system, and because that song kicks ass,” in case you couldn’t already tell, that one was from Amanda Goltz at Amazon. She also kicks ass.

Stacy Feld at Johnson & Johnson nominated U2’s “Still Haven’t Found What I’m Looking For.” She adds, “Why (if it’s not obvious)? Even in the privileged position that I am in with good access to quality care, I often have unrealized expectations about physicians’ ability to identify roots causes, diagnoses or explanations for conditions/ailments.” Amen Stacy.

And Jane Sarasohn-Kahn, trend weaver and sister-from-another-mother adds, “To me, “Under Pressure” is the song that currently embodies the U.S. healthcare Zeitgeist. Why? Healthcare/costs…Split a family in two, stress us as Americans, underpin bankruptcy and homelessness – ‘When it rains it pours.’ BUT, on the brighter side…’Love dares you to care for the people on the edge of night…’ Which is all of us.” Jane is always all about love, which is, naturally, why I and everyone else love/s her. This also happens to be one of my very favorite songs and, for quite a long time, was my cell phone ring tone. I know, scary. I have since moved on to Marley’s “Three Little Birds,” but I digress…

And to leave you on a positive note, there were several people who chose….

Songs about Hope (even if mildly ambivalent)

The Stones reappear on this list, with “You Can’t Always Get What You Want,” …but if you try sometimes, you might just find, you get what you need. This one comes from Jeff Rideout, physician and CEO of the Integrated Healthcare Association (and my UC Berkeley Haas partner in crime), because “Good and high value healthcare is unpredictable and seemingly a random (and rare occurence).” At least it’s possible in this scenario!

Jody Holtzman of Longevity Venture Advisors suggested “Message in a Bottle,” by The Police. “Why? The answer is out there for the health system. And more and more are sending the same message in their own bottles to be found.” Jody is himself an accomplished guitarist and can, no doubt, play this song really well.

“Don’t Stop Believing,” is the nominee from HealthXL’s Martin Kelly. He adds, “We cannot continue with the current status quo.” I know from his work that he is convinced change can happen.

Here’s a good one: “Wait For It” from the Hamilton soundtrack. As the physician/non-profit executive suggests, it’s the “Same discussions over and over. Why is health care for everyone is so complicated or such a debate along political lines? Substitute Hamilton’s repeat lyrics with the word ‘health’, as in ‘health doesn’t discriminate between the sinners and the saints….are we willing to wait for it..’ Ultimately- it’s something worth striving for and debating about.”

Ever the sunshiny optimist, my partner at Manatt, Patty Boozang, suggested “Things Can Only Get Better” by Howard Jones. She sums it up like this: It’s a great karaoke song for a gal who was teenager in the 80s and contains this lyric:

A thousand skeptic hands won’t keep us from the things we plan
Unless we’re clinging to the things we prize
And this one
And if we threw it all away
Things can only get better
I mean, c’mon….”

I agree Patty, hard to argue with that logic. Patty has a beautiful voice, so I am going to make sure she sings this at our next staff meeting.

And ever the world’s most lovely and talented optimist, Alex Drane, CEO of Rebel Health and ARCHANGELS and (yes, it’s true) part-time WalMart cashier, came up with this: “I’d choose ‘Amazing Grace.’ Because that’s what the system needs. And that’s NOT what we offer. People are lost – we need to help them feel found. Amazing Grace was my walkup for the keynote I did last week – and I LOVED that it made people uncomfortable and felt weird – because people CHANGE when they feel uncomfortable. [I like this song] because of the level of emotion it elicits in people – which – in a business setting – usually starts with feeling deeply uncomfortable….but then for MOST it triggers in them a memory of something deeply beautiful, and reminds them that we are all part of something bigger than ourselves… that there is no great gift than being alive, then loving on others, than finding our way with grace in whatever very best way we can. Which is critical to remember – because often in the healthcare space we operate as though we are one person, and then we go home, and we are someone else… As an industry we are lost – and we are the place that is with people when they are at their darkest hardest moments… we sang this song to my grandmother as she was dying… piled into bed with her, loving on her…. She was not in pain, she was where she wanted to be, she was surrounded by love… that is what the healthcare needs to do… provide grace in the hour of our greatest need – in whatever way works best… we need to get back to the essence of what it is to be in healthcare…which is health AND care… because caring for others and being cared for ourselves is the most basic element of humanity. LOVE IS THE NEXT BIG INDUSTRY!!!”

This is Alex’s favorite rendition of Amazing Grace – worth a nice quiet and contemplative listen. This is a perfect place to leave it.

But as DJ Casey Casem used to say, “Send us your long-distance dedications.” I welcome your further song nominees in the comments section of the blog below. I’m sure we missed some good ones.

Ps – if you don’t know who Casey Casem is, that is sad.