Eyeworld

20 April 2018 EW NEWS & OPINION Insights by J.C. Noreika, MD, MBA money managers wanted to invest in gun-makers, you "don't believe in imposing my views on 370,000 employees and a million sharehold- ers. I'm not their nanny on that." This hands-off leadership approach is ambrosia to physicians. Might we assume that you will permit us the expression of our talents, art, and experience unlike those ne- farious micromanaging insurance companies? You'll gain more than a million new best friends who work untiringly for their patients in spite of incessant meddling. You personally visit companies, speak with managers, and appraise a company's culture before invest- ing cold cash. Well, let's talk. After 40 years in the field, I have a lot of ideas about quality of care, patient satisfaction, best practices, price transparency, and the limitations of technology. You like McDonald's, Burger King, and the occasional Wendy's. What say you? I'll buy. My very best regards, J.C. Noreika, MD Editors' note: Dr. Noreika has practiced ophthalmology since 1981. He has been a member of ASCRS for more than 35 years. Join the discussion on this article and others on the EyeWorld blog at blog.eyeworld.org. Contact information Noreika: jcnmd@aol.com will own AC Wellness. Cook has said that, "AC Wellness Network believes that having trusting, accessible relationships with our patients, en- abled by technology promotes high quality care and a unique patient ex- perience." Employee-patient, think of the nuances human resources departments will weigh in matters of privacy and confidentiality! Too good to be true? Alpha- bet, Google's parent, has difficulty coming up with transformative insights for Britain's National Health Service through its AI permutation, DeepMind. It didn't end well when Microsoft and Google proposed their own EHR. And there's some minutia that requires your attention. For exam- ple, the difference between a not- for-profit company and a non-profit endeavor is subtle. Will shareholders be assuaged by the gratification of doing good at the expense of doing well? Sure, Coca-Cola was a home- run. The thanks you got? Cities levy excise taxes or restrict how much you can buy all because of the obesi- ty epidemic. And there's those pesky cash cows called Restaurant Brands International and International Dairy Queen. Those 11 million guests visiting Burger King every day can add a Whopper to have-it-your- way healthcare costs. Popeyes? We won't even go there. I applaud your stand on gun control. Berkshire doesn't own gun manufacturers. Whew! But if your flight plan, and bible. You deviated subtly from Ben's value-based strat- egy preferring instead reasonably valued companies with enormous growth potential. Who had the prescience to buy a railroad, a 19th century artifact, that happened to serve North Dakota's Bakken shale oil fields? Borrowing Joe Biden's colorful aside, this is a big—um—exciting deal. You will use your organiza- tions' disparate proficiencies and monstrous buying power to benefit more than a million employees. You'll form a not-for-profit company to reduce the cost of healthcare, en- hance patient satisfaction and make the whole enterprise transparent like Amazon's book reviews. Who can blame you? According to the Kaiser Family Foundation, in 1960, or 5 years before you bought the small textile manufacturer Berkshire Hathaway, hospital costs were a mere $9 billion; today, they are $1.1 trillion, or 122 times more. That 1960 figure antedates the federal government's effort to socialize med- icine for all over 65. I know that you are familiar with Harvard's David Cutler who found administrative expenses account for 25% of U.S. healthcare costs. That might have been before EHR because they seem a lot higher in my little practice. But with Jeff Bezos' talent in distribution and artificial intelligence, Jamie Dimon's knowledge of capital asset manage- ment and health savings accounts, and your own mastery of reinsur- ance, who better to eradicate this metaphorical parasite plaguing a system that you concede has "a lot of good about (it)"? The announcement of your col- laboration has the industry quaking. Shares of CVS, Walgreens, and Ex- press Scripts tanked. United Health Group, Anthem, Aetna, and Huma- na are reeling. And you haven't even named the company yet. Look at Apple. Tim Cook, CEO of the world's most valuable compa- ny, announced the formation of AC Wellness. Want to bet the architect of the Mac, iPod, iPad, and iPhone won't remake the iClinic? To tame insurers, Apple had outsourced care of its employees to a third party. Nothing new here. Safeway, Boeing, and others offer innovative varia- tions. What's new is that Apple now Berkshire Hathaway, JP Morgan Chase, and Amazon have formed a co-venture to transform the delivery of America's medical care Mr. Warren Buffett Berkshire Hathaway Inc. 3555 Farnam Street Omaha, NE 68131 Dear Mr. Buffett, As we are soon to be colleagues, may I call you Warren? I have followed with interest the collabo- ration among Messrs. Jamie Dimon (net worth $1.35 billion), Jeff Bezos ($126 billion), and yourself ($90.3 billion) to remedy the tapeworm devouring America's economy, healthcare. Your venture is especially extraordinary when one considers our nation's federal government (total indebtedness $19.2 trillion) has repeatedly failed to prescribe the appropriate anthelmintic. Berkshire Hathaway (market cap $520 billion), J.P. Morgan Chase ($407 billion), and Amazon.com Inc. ($735 billion) are rock stars in insurance, finance and online sales, distribution and technology. Their Wall Street valuation is larger than the GDP of Russia, for heaven's sake. The 2017 revenues of FAAMG (Facebook, Amazon, Apple, Micro- soft, and Google) rank in the top 20 of the world's GDPs and are higher than that paragon of socialism Swe- den by $150 billion. I've done some research on you. It's OK; I'm a doctor. Getting reject- ed by Harvard Business School was the best thing that ever happened. Forests have been felled to illumi- nate the good luck of Bill Gates and Steve Jobs; your matriculation at Columbia Business School was a stroke of the rota fortunae. That deity of investing Benjamin Graham was your lodestar and his classic, The Intelligent Investor, your playbook, Of wizards and shamans J.C. Noreika, MD, MBA

• Cover
• Blank Page
• Blank Page (1)