News Day – The Election

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Bill Russell / Drex DeFord

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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:

News Day – The Election

Episode 323: Transcript – November 3, 2020

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

[00:00:00] Bill Russell: [00:00:00] 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 directs the Ford is in the house. My name is Bill Russell, former healthcare CIO, CIO, coach consultant, and creator of this week and health ITa set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. I want to thank Sirius Healthcare for supporting the mission of the show. They continue to be [00:00:30] a great, supporter sponsor of the show. Their weekly support has allowed us to do so many things this year, and we’re really appreciative.

[00:00:36]Don’t forget 3xDrex. And if you, if you do forget it Drex will remind you a little later, but 3xDrex is a service with Drex DeFord, 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 texts, just text Drex to four eight, four eight, four eight, Drex. Welcome to the show. 

[00:00:59] Drex DeFord: [00:00:59] Thank you so [00:01:00] much. I’m always happy to be here. I was really excited to, to see last week. I think that you’ve set up and a referral program.

[00:01:09] Bill Russell: [00:01:09] I did. I did 

[00:01:11] Drex DeFord: [00:01:11] And one of the prizes for being the biggest referrer. 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 

[00:01:23] Bill Russell: [00:01:23] is to replace you 

[00:01:24] Drex DeFord: [00:01:24] A little spot. I know. And it’s through replace me. I was like, that’s a pretty good gig for [00:01:30] somebody. I I’m loving that. 

[00:01:32] Bill Russell: [00:01:32] I, we were, we were hacking around, people like, we have, for 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 week in health IT stuff. It’s actually pretty cool. I, test picks it out 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 they were 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 [00:02:00] where it is not like, Oh, it’s out, it’s out. I know. 

[00:02:02] Drex DeFord: [00:02:02] And I was just thinking the same thing. Cause I was thinking about holding it up and I don’t know. I’m I have an idea where it is, but it’s upstairs. 

[00:02:10] Bill Russell: [00:02:10] 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 want to do this, right. Not, everybody’s gonna want to come on the show. They’re going to be nervous or that kind of stuff. You shouldn’t be. I’ve had so many people on the show who are nervous the first time they [00:02:30] come on.

[00:02:30] And almost everybody, when they’re done, they’re like, 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 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’s pretty cool. But you know, Drex, I noticed that no one has put your name in [00:03:00] yet as the referred by. So yeah here’s what we can 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 it. You can just go to our website, hit subscribe now and put in Drex as name as referred by. So Drex is referring  you to this to the clip notes. And it’s, to be honest with you, I wouldn’t be doing this, but so we’ve gotten so much great feedback from people of, Hey, I love to scanning that I hit a couple of the, The highlights has [00:03:30] been great so. 

[00:03:31] Drex DeFord: [00:03:31] Yeah, Tracey, 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, is hot for you right now. It’s a thing I want to 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. 

[00:03:54] Bill Russell: [00:03:54] Yeah. And today we’re going to talk about the election. So people are going to be like, ah, where did they talk about who’s going to win the election?

[00:03:59] Cause we [00:04:00] want to, we’ll see  Alright so the election is finally here, but before we get there, we really do have to talk a little bit of security. because I don’t think in my memory, I don’t think we’ve had a week, like we had last week with cybersecurity and healthcare. I really appreciate your feedback on that. So I did two posts last week on LinkedIn. The one sort of was oddly enough, it was a precursor was the day before everything really broke open. And I said, [00:04:30] well actually let me just pull it up. Take two seconds. And let’s see, first post was this one. I know your health system, isn’t targeted for ransomware attack, but humor me. Can I see your sovereign response plan? And the reason I posted that, is there’s a lot of health systems. I believe that anonymity 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 hasn’t it. 

[00:04:53] Drex DeFord: [00:04:53] Mm. Mm it’s. it’s interesting. In July we published, at CX [00:05:00] 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. And it was interesting. We took a two year period. We broke it down into six month segments and oddly enough, In the first half of 2020, the number of reports were down by 10%.

[00:05:18] And the number of individuals effected, I mean individuals effected me in the number of records breached was down 83% over the previous period. And it was a real head scratcher, right. Because why? So we went [00:05:30] through a bunch of stuff like, well, maybe cybersecurity has just gotten better and, but what we ultimately concluded was the first half of 2020 was super distracting.

[00:05:40] 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 in 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, [00:06:00] because they were using people in different places and they stood up new points of service.

[00:06:03] 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 in the first half of 2020. So in that report, I predicted that the second half of 2020, it was probably going to 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.

[00:06:26] And that really turned out to be the case with UHS and [00:06:30] Blackbaud 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 a cyber response, for incident response?” 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 [00:07:00] plan?

[00:07:00] Have we exercised that? Who should be involved? Do we have the phone numbers for the FBI? Do we have all those things that we need?” Because it really is now not if you’re going to be breached, but when you’re going to be breached. And so you really should be exercising and prepare preparing that challenge.

[00:07:17] Bill Russell: [00:07:17] So let’s, 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, you could Cindy McDowell. Posted we’re finding most health [00:07:30] systems don’t have an adequate response plan, not, most and the word adequate.

[00:07:35] Those two require some definition. what does most mean what is an adequate response plan, but, I’ve heard that statement a fair amount, like, 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?

[00:07:51] Drex DeFord: [00:07:51] I think a lot of it is just start with the intention of doing something, right? Call your local FBI guys. [00:08:00] If you don’t know them, you should know them. They should be on speed dial, ask them for help, look around. I mean, call me, I can hook you up with some guys who do this. Yeah. As a profession you use an outside organization who, this is exactly what they do.

[00:08:17] They run incident, response exercises. They help organizations build incident response plans. And it’s not like you’re going to go from zero to a hundred overnight. You’re going to go from zero to 10 overnight, and that’s going to be [00:08:30] better than where you were. And then you’re going to have a pathway to make these programs better and better and better over time.

[00:08:36] But don’t. Oh, just ring your hands because you don’t have something that’s perfect. As with, as we talk about in a lot of stuff, not just cyber security, just start, doing something. Get down the road.

[00:08:51] Bill Russell: [00:08:51] Yeah. So I was, two weeks into my interim. So yeah, I’ll roll in my first healthcare job. And we were breached and we brought in a chief security officer.

[00:08:59] I [00:09:00] took the CISO role 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 going to split that out for accountability with the chief security officer who oversaw not only cybersecurity, but also physical security, which was an interesting combination.

[00:09:14] We had a great guy do it, but one of the first things he did is exactly what you said. He created a, it probably used one of the existing frameworks. In fact, I’m sure he did. He had, he had 12 categories, rank them one through five. He brought in an outside third-party they ranked us. And when the first time I saw [00:09:30] it, 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?

[00:09:36] Hey, we’re down by 20 points. We’ve got a score three touchdowns in the, in the fourth quarter here. It’s good to have a scoreboard. So you know what you have to do. I want you to have to work on. 

[00:09:45] Yeah. 

[00:09:46] I have a trainer who, 

[00:09:47] Drex DeFord: [00:09:47] who tells me regularly that, it’s like, remember the old days of MapQuest or, whatever, Google, just open Google, Google maps.

[00:09:55] 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 [00:10:00] 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 got to, you’ve got to figure out where you’re at, so that you can create a plan to get to where you are.

[00:10:13] And I can tell you the other thing is that when you’re 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 out of jail free card. You may still have to pay [00:10:30] 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.

[00:10:40] Bill Russell: [00:10:40] Yeah. Todd Roland, Dr.  Todd Roland at notes, healthcare systems don’t have the resources to secure their network and host on premise enterprise systems. They need more, they need a more effective partnership with hosting vendors. Not easy. Something has to change to maintain operating.

[00:10:57] One of the things I noted is when we [00:11:00] did that plan with 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 a budget for what it would take to get to. all fives, all fours, all threes. And, the security, the chief security officer looked at me and said that that’s not the goal because we’re never going to get to all fives. We’re never, and we shouldn’t even be shooting for all fours or all threes that it should be. You’re looking at each one, you analyze your it’s a mix of some are always going to be two. Some are gonna be threes and fours. but you know, we’re, we’re not the [00:11:30] military. We’re not going to be five. And he was right. We did put together the budget to go to all fives. And it would take better than three quarters of our, operating profit every year to maintain all fives for the health system. And, and people are like, well, why don’t you do that? Why don’t you protect, all your systems at that level. It’s like, cause you, you really can’t afford to, you still have to buy, you have to buy MRIs. You have to hire doctors. you still have to still have to function. 

[00:11:55] Drex DeFord: [00:11:55] Yeah, and it’s a risk conversation. And this is another one of those things that [00:12:00] if I was the CEO 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 CIS, as opposed to understanding that this is really an organizational  to make some judgments 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 [00:12:30] almost isn’t, realistically, it just isn’t, it isn’t a defensible posture long-term you have to make some decisions about risk, 

[00:12:38] Bill Russell: [00:12:38] Alright? I want to get to the election, but before we do, let me describe what happened last week. So 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 bought botnet. And we talked about this a little while back. Microsoft was involved in this as well, and they essentially, and [00:13:00] I’d read this on Krebs on security blog.

[00:13:02] So I dunno, is this credible? Is it not credible? It feels like it is. But essentially cause it, cause it makes it passes the sniff test. This could have happened. A file was sent to the infected computers that changed the malware control server to local hosts. Right? So if it’s local hosts, every time it goes to communicate with the malware control server, it’s essentially going to communicate with itself and it’s no longer going to be connected to that malware control server, essentially 

[00:13:30] [00:13:29] Drex DeFord: [00:13:29] Command and control.

[00:13:31] Bill Russell: [00:13:31] They lost, they lost control of all those. Well, maybe not all of them, but they lost control of any of 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 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 [00:14:00] issued warnings, early last week. Early mid midweek last week about this malware attack and sure enough, 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. It’s interesting cause I taught, 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. [00:14:30] And one of the CIOs said to me, he’s like, look, if I’m responding now it’s too late. This is all about what I did six months ago, not what I’m doing today. And there’s just, there’s a, there’s a lot of that’s essentially what you were saying before is get started now for the attack that’s coming six months from now.

[00:14:46] Drex DeFord: [00:14:46] Yeah. I, I can’t really 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 cyber security program is now. It’s just, the [00:15:00] you’re exactly right. If you’re trying to hire a CISO, so if you’re trying to build a whole security operation center and that’s part of your strategy, it’s going to take too long. You have to find partners who can help you do this work more quickly. 

[00:15:14] Bill Russell: [00:15:14] All right. Last one. And this is a little free consulting here. These are smaller hospitals. They’re probably, Epic community connect partners. 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 [00:15:30] as you found out you’re disconnected. what kind of things are you going to put in place? What kind of gates or hoops are you going to put in place before, before you connect back with them as an Epic community connect partner?

[00:15:42] Drex DeFord: [00:15:42] You know 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 [00:16:00] don’t have some sort of like significant admin access.

[00:16:03]Bill Russell: [00:16:03] You’re going to have a VPN? You will have a VPN of some kind, right? Four 20 VPN between there and in 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. 

[00:16:20] Drex DeFord: [00:16:20] I think we’re risk averse and I think 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 [00:16:30] 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?

[00:16:45]Do you have the capabilities 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 [00:17:00] help them ? These are also different. It’s everything is different. Everything is set up differently. All these contracts are built differently, but being conservative that’s, that would be my recommendation. Be conservative and make sure that your, your, your ecosystem as 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. 

[00:17:25] Bill Russell: [00:17:25] Yeah, the reality is that, they want to talk about how they breached [00:17:30] Mayo Clinic and Cleveland clinic and Cedars and, and New York Presbyterian that’s who they want to talk about how they breach them and they have community connect partners to see at the end of the day, I think we’re going to see somewhat, we’re going to see some new oversight coming out of those larger systems that are, that have partners. We’re gonna see contract language merge, and we’re going to see, it’s sort of a, a list. If it doesn’t already exist a list of, here’s what we want our partners to have [00:18:00] in terms of security.

[00:18:01] All right. Election. Yeah. Let’s talk election. You know how much I like talking about politics on this show? I try to avoid it like the plague but, 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 going to 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 [00:18:30] president Trump, which mainly goes through the state of Pennsylvania, Biden has a big lead amongst voters who say COVID is their primary issue. Trump has a small lead actually amongst voters who say the economy is their top issue. voter turnout will be a record. There’s no doubt. Many have already voted ahead of the election, including me. I voted this morning. 

[00:18:51] Drex DeFord: [00:18:51] Me too. I voted probably 10 days ago, 

[00:18:54] Bill Russell: [00:18:54] 10 days ago, 91 million votes were counted as of [00:19:00] Saturday, according to one news outlet. And just to put that into context, because most people don’t know how many votes, usually are cast, 136 million were cast in 2016, according to the associated press. So there there’s no doubt. I think the 91 million numbers double what the total  pre election day vote was last year. So I think it was like 40, 45 million were cast ahead of the election and the rest all came in on election day. So [00:19:30] clearly 

[00:19:30] Drex DeFord: [00:19:30] It’s pretty amazing. you can look, there’s places online. You can look state by state, by state where they’ve already out voted themselves. 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. 

[00:19:48] Bill Russell: [00:19:48] Yeah. yeah. So this is, this is going to be one of the, clearly one of the most active, political seasons we’ve known of. I’m actually looking forward to getting on the other side of this. [00:20:00] 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 sake. It’s it really has been, it 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 no, I’m sorry. You’re in Washington. You’re probably not getting a lot. Yeah. You’re not going to see as many I used to live in California did not see as many. I’m in Florida now. 

[00:20:30] [00:20:30] Drex DeFord: [00:20:30] Yeah. 

[00:20:30]I, I can’t getBill Russell: [00:20:32] onto YouTube without watching a, a five, five second commercial for someone.

[00:20:37] Drex DeFord: [00:20:37] Right. 

[00:20:38] Bill Russell: [00:20:38] 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 I’m like, seriously, are we not this, are we not this advanced to figure out that you’re sending all those to the same address?

[00:20:59] Drex DeFord: [00:20:59] Yeah, [00:21:00] yeah, yeah. 

[00:21:01] Bill Russell: [00:21:01] So anyway, Let’s start with, I don’t know where to start without getting too political, it’s, there’s part of me that, wants to talk about the election because I love talking politics but it’s, but let’s, let’s start with health IT and see where it goes. 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 [00:21:30] healthcare? Probably focusing in on health IT because healthcare is a big thing. You have Biden care versus well, we don’t know what the president is talking about. We know he’s against Obamacare, but that’s been one of the gray areas for him over the last four years. But health IT is pretty interesting. What would four more years of this CMS and ONC and this president mean for health IT?

[00:21:53] Drex DeFord: [00:21:53] So you actually published something, maybe was it today or this [00:22:00] week about the ONC IT plan?

[00:22:01] Bill Russell: [00:22:01] Yeah, it is today. 

[00:22:03] Drex DeFord: [00:22:03] Yeah. Yeah and I’ll probably, I’ll probably put that up on 3xDrex too. at least once this week. But there’s a lot of stuff in that plan. And I think one of the ways we can 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 for me, I think at least part of it is [00:22:30] 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 sections, it’s really interesting to see what they chose to address and how they chose to address it.

[00:22:49] And that there are definitely parts in here that, you could see, being handled very differently under two different administrations. 

[00:22:57] Bill Russell: [00:22:57] So what Drex is referring to a 2020, [00:23:00] 2025 plan that, OIG OMC released. It has a key principles outlined include focus 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. You know so that’s, those are the organizing principles around it and underlying that whole strategy [00:23:30] is really the, getting the patient, getting the data into the patient’s hands and putting data to work for the patient. To be honest with you, I don’t think either it’s gonna move fast under Biden versus Trump, I think is a specious argument because this plan, literally this plan could have been when Aneesh 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 [00:24:00] the four administrations over a 20 year period on the HIMMS stage say essentially, hey, we were all basically in alignment here. We believe that the patient should have access to their data. We believe that data will help research. Data will help .It is the next frontier for healthcare to get better. but that’s really a bipartisan issue. w why do you think it would be slowed down under Trump versus versus Biden? 

[00:24:26] Drex DeFord: [00:24:26] Well so I think it comes down to the [00:24:30] component parts of this, right? This is a strategy. And if you go through the, whatever it is, 35 pages worth of stuff and, 16 font, it’s not a huge, complicated document. It’s super high level strategy, strategic kind of stuff. But 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 going to get political, right? When we have an administration that doesn’t want to admit that the Russians are [00:25:00] 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.

[00:25:29]I [00:25:30] 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 going to [00:26:00] 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 going to 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 to the emergency room when they’re sick.

[00:26:25] And you can go through each of these and for me, look at it [00:26:30] and think about it as component parts, and just think about the policies that exist today. And of course, you’re just being hopeful about the policies that may be Joe Biden policies, but when you look at, 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. So that’s my politics. 

[00:26:58] Bill Russell: [00:26:58] There you go. Wow. You’re diving [00:27:00] in deep. And so you’re going to force me to, to do the Trump side. Well thanks. Here we go. I don’t cancel me. In fact, that’s one of my pet peeves, to be honest with you is, it’s become so polarizing that people essentially say, well, if that’s what you believe  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 who says to me, I voted for Biden, I voted for Trump. I don’t say, Oh my gosh, you must be a horrible father. You must not love your [00:27:30] kids. You mus t  think and believe all these crazy things, whatever, people are much more than their PR political ideology. And I think we need to give people the benefit of the doubt if we’re going to get through this this but let me attempt some of this stuff, Pretty pretty transparently. Clearly Trump doesn’t believe that there aren’t bad guys. That’s again a specious argument.

[00:27:52]Did they interfere in the election is a completely different argument then, are there bad guys out there trying to hack into our systems? [00:28:00] Trump talks about bad guys all the time, but you know, the Chinese, he banned China’s technology into our country because there’s a belief that, technology would be used to infiltrate and take data. So I don’t think, from a security standpoint that really holds too much water. I’m not sure we would make any more or less progress on security as a result. I think, when you look at, [00:28:30] 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 up, 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 them in place.

[00:28:53] It’s more, I think the most powerful people in healthcare are Seema Verma, not necessarily president Trump and [00:29:00] Secretary Azar and whatnot. I think those people determine what’s going to be reimbursed. What direction are we going to take? What is the direction value-based care 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 going to take healthcare, which is currently a mashed up mess of a market, right? We have no transparency. We have no choice. And, and we have no, again, without transparency. [00:29:30] We don’t know what it costs.

[00:29:30] When we go to see a doctor, we have no idea. they’re just saying, Hey, this is broken and we want to infuse, let’s, capitalist, I don’t know. We want to infuse 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 because we don’t want people to look at it and go, oh, well, I’m not going to get this care because it costs too much.

[00:29:54] But at the end of the day, we have health- and this is one of my pet peeves. We have health systems [00:30:00] that have fought this tooth and nail, like when they say, hey, we’re going to do transparency of your services. 

[00:30:06] Drex DeFord: [00:30:06] Transparency. Yeah. 

[00:30:08] Bill Russell: [00:30:08] Yeah. I talked to some CIOs and they said, Oh yeah, we’re compliant. I’m like, you’re compliant. How are you compliant? I don’t see this information anywhere. It’s like oh yeah, you can, 38 hundred 

[00:30:17] Drex DeFord: [00:30:17] If you can find the link on our page.

[00:30:20] Bill Russell: [00:30:20] Yeah, exactly. It’s hidden somewhere. And then when you download it’s like, Oh my gosh, I’d have to have intricate knowledge of how your health system runs to make any [00:30:30] judgment as to which one of these codes actually is.

[00:30:32] Drex DeFord: [00:30:32] I’d have to be a coding expert. Yeah, for sure. I know exactly what you’re talking about. 

[00:30:36] Bill Russell: [00:30:36] 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 there. This current administration says we’re going to do those things. My concern about Biden is they’re going to say, ah, too hard, the roads too long,  let’s nationalize healthcare. To heck with the, the economic [00:31:00] 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 fear on the other side. And so that’s the rhetoric on the other side Hey if you like nationalized and socialized medicine, then you know, Biden’s your vote. That’s probably over the line, but we’re talking about  it. So what do you think? 

[00:31:20] Drex DeFord: [00:31:20] And, look from a politics perspective, the good old days. We just said you used to have some good old days. [00:31:30] Look, there’s a thing that I tell, I, I tell my teams and I tell my friends all the time and it’s moderation in all things, including moderation.

[00:31:38]So I think what’s going to 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 [00:32:00] the attempt at 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 are going to put a lot of airplanes on the runway in short order. And that may very well involve healthcare and some version of what you’re talking about. I don’t know that it’s going to be, turn everything off and go to a peer socialized medicine model, but it may very well be Medicare for all or Medicare [00:32:30] for those who want it. And there’s a part of me that, when you take that and a bunch of other things. Again moderation and all things, we, we may become a very, liberal country, over the course of the next two years. And it may happen because of the backlash to the president. 

[00:32:52] Bill Russell: [00:32:52] Yeah, it’s interesting Medicare for all. Just to dispel any myths. That’s socialized medicine, right? That is the government is the [00:33:00] 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 the direction, from a marketing standpoint, I think the, Progressive’s want you to think that Medicare for all is a nice compromise between socialized medicine and, and, in 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 [00:33:30] two.  it’s interesting because prior to COVID, I’m just worried about how people are gonna read the election. Right? So prior to COVID President Trump was going to win in a landslide. The GDP was places where the previous administration said that it was never going to get there. We’ll never see those numbers again. And we saw those numbers for the better part of two and a half years prior to COVID. we saw unemployment rate in certain areas. We saw, [00:34:00] movement, we’re seeing, there’s still seeing movement in the black community towards president Trump. We’re seeing movement in the Hispanic community towards president Trump, two, groups that have largely voted in lockstep with the, with the Democratic Party for years. And you’d have to ask yourself why. So he was in that path, but what you have is you have. Yeah. 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. [00:34:30] People are just flat out scared and they believe that they’re going to be safer under Biden than they are under Trump. Not necessarily on a national  stage and those kinds of things, but just COVID. Just health. I’m going to 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 see themselves as the opposition and not wearing masks. And he’s going to be more, measured. Trump comes off as [00:35:00] bombastic, whereas  Vice President Biden comes off as more, measured in his approach, uncle Joe, as opposed to crazy Uncle Donald. Crazy Uncle Donald kind of thing. If Biden wins this election, that’s what it’s going to that’s what I think it says is this is a reaction to his COVID policies. I had a poll. First time, I’m 53 years old. The first time I was ever called by one of these national polls. 

[00:35:26] Yeah. It’s one of it’s one of the reasons I always thought they were [00:35:30] fake. Cause I’m like how can  in 53 years, how could I have never been called? And so they went through the poll and they said which would you like to win the Congress the Republicans or the Democrats. And I’m like, 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 always want to split house. I never want

[00:35:58] Drex DeFord: [00:35:58] Moderation in all things including [00:36:00] moderation. 

[00:36:00] Bill Russell: [00:36:00] I never would. I never want any administration to have all the both the houses of Congress and the presidency. It’s too dangerous. And if you want my case study on this, it’s the state of California. The state 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 and if anyone wants to know the reason I live in Florida, it’s because that place is nuts. And I’m sorry if I just offended, [00:36:30] the millions of people who live there but that place is out of control and it’s just, there’s no checks and balances. 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 the hey, you know what? We’re not idiots. The opposing side isn’t idiots. [00:37:00] You have to have the other side of the table to have the conversation. And if you’re just going to throw them out and say, Hey, we won, it’s a mandate. You guys go sit in the corner for the next four years. We’re going to do whatever the heck we want. You have to remember that half the people didn’t vote for you. 

[00:37:14] Drex DeFord: [00:37:14] Yeah. Yeah. th this, I used to like everything else too, right? If you’re a CIO of your 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. [00:37:30] That’s why diversity is 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 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. And 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 [00:38:00] that you go into all of those decisions with your eyes wide open.

[00:38:03] 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 all really great lessons, right?

[00:38:24] Bill Russell: [00:38:24] Yeah. Do you know, and to be honest with you, we’re not gonna understand racism, systemic racism, the role that [00:38:30] identity part of politics plays in it. We’re not gonna understand any of that. Unless people sit across and have very uncomfortable conversations. I need to be educated. I need to understand how people have experienced, the, how have how they 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 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 [00:39:00] policies and those kinds of thing 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 heading down this path. 

[00:39:10] Drex DeFord: [00:39:10] There’ll be backlash right? it’ll happen. I talked to, again, I of, I talked 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 [00:39:30] uncomfortableness that makes you a better leader and a stronger thinker and a more agile problem solver. Or you, if you’re comfortable, you get late, easy and sloppy and then bad things happen. So again, it applies to politics. It applies to everything that we do. 

[00:39:48] Bill Russell: [00:39:48] Yeah. I appreciate you having this conversation. 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 [00:40:00] completely. And, and we were, we were just having a conversation, which wasn’t going to lead to me thinking any different to them or them thinking any different to me. And, they said, hey, I 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. 

[00:40:16] Drex DeFord: [00:40:16] Cause 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 [00:40:30] lot of cases is social media and little snippets. When I sat down with a friend of mine who thinks differently than me. And they’re still a friend and I know they’re a good person. And and I really do know that. And I started 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.

[00:40:55]It’s not unreasonable to them to believe what they believe. [00:41:00] It’s incumbent upon us to try to understand that. And then mould that into our own way of thinking. The more, as they say, so it’s, it’s definitely, It’s definitely an interesting time. And the next couple of days are definitely going to be interesting.

[00:41:17] Bill Russell: [00:41:17] 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, I have [00:41:30] progressive friends who would say this president is bad. They would point to COVID. They would point to the economy of the plates of minorities and immigrants. They would say he’s bad for the environment, bad for civil discourse. I have conservative friends who say that hey, this president is good. They’d 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 didn’t follow through. The problem that most people have with them is he followed through on all the things he said. And I don’t think people thought he was going to follow through on all the things.

[00:41:58] He tightened borders. [00:42:00] I renegotiated bad trade deals, appointed conservative justices. they would go on to say he provided opportunities for minorities and, and  illegal immigrants, is what they would say. And the reason I know that is because I got some of them on the phone and had the conversation before the show and said hey, what is your, what’s your position? So it’s interesting. Exactly what you say. People, they had different parents, different experiences, different, things that shaped their lives, different teachers that shaped their lives, different [00:42:30] events that shaped their lives that we have to believe in really the good in people that we’re all trying to make our country in this world a better place is the, is the eventual outcome really all going for. 

[00:42:44] Drex DeFord: [00:42:44] Diverse diversity is 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 [00:43:00] and that’s where I really figured out like, wow, these, all these people, well from all these different places have completely different ways of thinking about the same thing that, problem solving the same 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 [00:43:30] awesome. 

[00:43:31] Bill Russell: [00:43:31] Well, hey, I want to remind everyone. We are not political pundants we got into politics side just because it’s hard to ignore that today is election day. if you haven’t already get out and vote, one of the things that, in the history of our world, we are one of the few countries, literally in the history of our world that has had the opportunity to speak into the governing process into our government. And regardless of if somebody is going to cancel out [00:44:00] your vote or not encourage them to get out and vote, it’s, it really is an incredible privilege. 

[00:44:05] Drex DeFord: [00:44:05] It’s a huge difference. Do it. 

[00:44:07] Bill Russell: [00:44:07] Drex. Thanks for coming on the show. Once again always fun.  We’ll see. W 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 riots in the streets, I guess these are our two options.

[00:44:28] Drex DeFord: [00:44:28] Are those are two options at [00:44:30] this point? 

[00:44:30] Bill Russell: [00:44:30] Think there are probably other options in between them. 

[00:44:33] Drex DeFord: [00:44:33] Let’s hope so. 

[00:44:35] Bill Russell: [00:44:35] 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, Sirius Healthcare, Pro Talent Advisors HealthNXT and McAfee for choosing to invest in developing the next generation of health leaders. And it’s important to note that they’re choosing to invest in developing the next generation of leaders. They do not support any of the political views talked about on the show today. We focus [00:45:00] on health IT for the rest of while it’s focused on health it for the next four years outside of the election show four years from now. This show is a production of This Week in Health IT. For more great content check out our website this week, health.com or the YouTube channel. If you want to support the show, sign up for clip notes, share with a peer participate in the referral program. Please check back every Tuesday, Wednesday, and Friday for more shows. Thanks for listening. That’s all for now.