And now for something a little bit different. Today, I am excited to welcome Dr. Demetria McNeal, Assistant Professor of Medicine at the University of Colorado, to the show. Demetria’s career has taken a unique path. She has an MBA from the New York Institute of Technology and a PhD in communications from the University of Georgia. She's worked at Johnson & Johnson and the VA and is a certified spin instructor. Today, her focus is on helping health care professionals and leadership teams develop and implement adaptive, sustainable strategies that produce results that address inequities in care delivery. These strategies oftentimes require creative, disruptive, innovative and unconventional ideas. Demetria, thank you so much for joining us.
Thank you for having me. It's my pleasure to be here.
Why is it so hard for health care organizations to deliver equitable care to all of their patients?
You know, that is a great question. And as long as we are actively seeking to answer that, I will be employed for many, many years to come.
Security. Love it.
Indeed. What I will say is because it is such a complex question to try to answer. First of all, when you just think about the healthcare system overall, the foundational premise, right, is to serve all. So inherently we think that's what's happening. But interestingly enough, it essentially serves as a place that people go to to the degree that they feel that they need healthcare, health assistance, and attention.
There is really no consistent measure or someone ensuring that not just folks that are able to make it, but folks that are unable to make it get care. Also, folks that do seek care in person (or through telemedicine now, obviously, with the pandemic) are able to have access to all of the services consistently across the board. And it's just a very complex issue to try to narrow down in terms of who has access to what, for one, and for two: Why are there such great disparities between folks that are seemingly in the same place (meaning in a health care system) but experiencing very different results, outcomes and interactions with the system.
I think, for a lot of women. Serena Williams’s experience in pregnancy and birth was the first time they had realized just how great these disparities are. You had an absolutely world-class athlete whose partner was a tech billionaire and who knew her body intimately, running into disbelief and a lack of crediting her insight from her medical care providers. And that's not an anomaly, that builds on centuries of uses of especially black bodies by medical organizations and at the same time, and probably necessarily a discrediting of black interiority and experiences, these statistics we see where black pain is routinely assessed as lower than white pain. So certainly for me as a white feminist, it's very confronting to look at the state of American healthcare and try to to understand how to even begin addressing this. So can you tell us some strategies that you've seen help improve these conditions?
Yeah, no, that's a really good point. And so you bring up the Serena Williams issue with the healthcare system. And I think that it's appropriate to bring that up because it pulls out a lot of things that are going on in healthcare. So you bring up the historical issues from a racial perspective. So we have that. Then you have as a female within healthcare oftentimes, and again, data supports what I'm saying, that women are dismissed. A lot of times the things that they report are associated with being, “emotional” etc... So you had all of that coming together. But then you also have (obviously, I don't know Serena personally)... But when you think about a class issue, you would think that, as you said, she is wealthy in and of herself, but she's married obviously to a tech billionaire. So from a resource perspective, one would think this wouldn't happen to her. And one of the things that I have found in research, and when I have conversations with healthcare systems or physicians, is that we have to look deeper and we have to get real clear about the conversations that we're having, because here's the deal. If you take Serena as a case example, everything that the system tells us, the reason why there are disparities in healthcare, they did not exist for her. What do I mean? Oftentimes they say, “Oh, a lot of times black people can't even physically access the health care system,” meaning lack of transportation.
Or, “Oh, they don't even have healthcare or the financial resources to engage with the healthcare system in order to ensure that they are able to get the care that they actually need.” When you think about a black woman that's pregnant, oftentimes they are not establishing and having the exact same type of prenatal care, etc., as other women that are not black. So when you look at all of those things, plus there are other factors I didn't even mention, they did not exist for her.
She seemingly overcame all of these obstacles that they say keep black people in the space where they do not have access to care. And yet here we are. She still came very close to death, right? Just giving birth in the United States of America. And so when you look at it from that perspective, there has to be a very deeper issue at play here in terms of why this happened for one, but for two, how it has been able to happen over and over and over again. It is a part of the system. So when you ask how do you kind of get into a healthcare system? How do you kind of make these kinds of changes? I think that a healthcare system is not dissimilar from any other business. When you're talking about having a change in culture and specifically around healthcare, it gets touchy and sometimes people can take particular suggestions as a personal attack. And that's really not what's happening. I think first for a health care system, you have to establish that a problem exists, period.
If there is not consistent buy-in that, for example, as an institution we are not delivering equitable care. You have to get everyone to agree to that. But here's the caveat. By agreeing to that, we are not assigning blame, we are not pointing fingers, we are not name calling. We are essentially saying as an institution we can and we should do better. And in order for everyone to sort of agree to that, then you are at a point where everyone is sort of willing to come together and be able to say, “Okay, what can I do to help? How can I improve this overall system?” And again, that starts though, with identifying what are the weaknesses, where exactly have we fallen short? But more importantly, what are the things that we can identify that we absolutely can change?
There are some things at a hospital level that just cannot be changed from health care providers, and that's OK We have to be able to identify those and accept this isn't something we can text. Some of this stuff is policy, right? Some of this stuff is social. Some of the stuff is culture. Some of the stuff is political, right? Like we get all of that, but you still have to understand the totality of how we got here, because I think that gives you a perspective about where you need to go, but also appreciation for the fact that everyone is in fact not getting equitable care, which is ultimately what you want to be able to do.
I think that's a really intelligent description of both the problem and the way forward. The challenge is health care providers typically come to the field because they want to make a difference and they want to do good and they want to think of themselves as good people. So telling them they're racist is not going to make their day any better and it's not going to inspire them to change. But telling them that they're in a system that's falling short of what it could be, that is a positive message. That's an aspirational message. And it frames the question in a way that gets under some of our cognitive biases as white people, where we like to think that we have all of the answers and we have science and we have quantitative measures that lead us on the right track, because a lot of these subtle things, as you say, miss those measures because the measures were put in place by white people framing white problems.
Rachel I really like that. I think that you bring up a couple of points that I'll extend upon when you said, “Oh, you know, no one wants to be called racist.” And I'll say this and this has just been my experience when I often times speak with doctors, and I always say, “You know, let's just have a conversation.” Any time in my experience, any time we bring up health inequities and things like that, there is a degree of anxiety and anxiousness. And I think part of that could be because of prior experience dealing with these issues. But I oftentimes say, “Listen, we are not here to identify or call anyone a racist. That is not why we are here. We are here to say as a system, we can do better and we can be better. At the end of the day, everyone deserves access to care equally. Period, period.” Everyone can agree to that. And like you said, everyone usually goes into medicine to help people. So let's agree that's what we want to do. No one wants to name-call, no one wants to identify. But we do have to realize and be able to understand and respect, but also consider as part of the conversation there is a historical context that's got us here.
This is not a moment to rehash that, right? So we're not going to go back through everything that went on that got us here. What we can do, though, is say, “Right here in this moment, this is what is happening in our system, and it is part of the shrapnel. It is part of the dangerous effects of what did happen in previous years.” And because we can identify that and realize how it has manifested so many years later, we have the power. We have the agency to say we are going to face this; we are going to manage this. We are going to consistently review this head on so that this does not persist because that's ultimately why we're here. It's not that there has been lack of interest or lack of knowledge that it's happening. It's the fact that it has persisted because there has not been a concerted effort. Whenever there are few people trying to address an issue that has been going on for hundreds of years, it is nearly impossible to address it effectively and to stop it.
So you're going to have to have everyone be able to look at this issue and say, how can I help? What does it look like for me to participate in the process of stopping this from going on? Having said that, again, that creates a very large task for a healthcare system, for a doctor's office, for a community clinic to take on, because it requires you to look at what exists.
So you're going to have to get a pulse for what is working effectively and what is working not so effectively. But then you're also going to have to be real clear about the responsibilities and the jobs that are required to address it and ensure that everyone understands what those roles and newfound responsibilities are, and that everyone is accountable. Right?
In my experience, unfortunately, whenever you deal with these issues, they have been handled almost as a punishment. “Oh, somebody did something. There was an incident, something happened. So now we have to go to this class.” And so because it's been treated episodically and seemingly in some instances as a punishment, it hasn't really been considered as a part of how we serve the patients, because that's absolutely what it is. It is a part of the service. It is a part of the care. It is not a one off. It is not a form of punishment. It is not something that's done episodically or when somebody thinks about it. It has to become a part of who we are as a healthcare system.
The parallels with my own failed venture capital are really striking and maybe nowhere so much as in that sense that even having these numbers looked at as a punishment, 4% of venture capital goes to women. And when you look at black women, it's more like 0.4%. But you raise this in industry forums and people say, are you calling us racist? And when something like the Ellen Pao child boils up, everybody gets diversity training and they trudge into it feeling like it's a chastisement. And that's not the way we create systemic change. You're right that we have to fundamentally change how we approach these interactions. And again, in venture, there's the opportunity to identify founders we're not looking at right now who could create huge new businesses. What frustrates me is all of the potential that we're leaving on the table.
I think you do bring up a good point when you mentioned the parallel of venture capitalism. I mean, yeah, because the statistics are there and I have limited knowledge, but I do know a little bit in terms of the numbers in regards to that industry. But I will tell you, across all industries, that's the other issue of why this has become a problem that's persisted is the point you made, which is the data. Everyone is starting to say, “Well, how much percentage of this particular race do we have? What percentage of this particular gender do we have? What percent?” And so the problem is the management of this issue has become merely checking a box which, again, is not a way to fundamentally address this issue, but it's what we've had in the past, and that's fine.
What I will say as a visionary is that when we have a day where we don't have to check a box or we don't have to announce the first X, right? That is when we know we are truly in a diverse, inclusive and representative society because it's no longer news. Why is it news when we have the first female X? The only reason it's news is in part because, “Oh well, females traditionally haven't had this particular role, this particular position or been recognized with this particular award.” But if that was the standard, then it's no longer news. I remember hearing the late, great Supreme Court Justice RBG, Ruth Bader, and one of the things she mentioned, she was speaking with a colleague and she was talking about the Supreme Court justices and being a woman discussing it, the gentleman that she was another Supreme Court justice, I believe, said,”Well, when will you be happy? I mean, we have a woman on the Supreme Court justice.” She said, “I'll be happy when they're all women.” The reason I like that is because when you can have a Supreme Court justice for all women, then that means that that is a normal thing. Let me give the caveat. I am not making a political statement. I am not saying we should have all female Supreme Court Justices. Not a bad idea, but I'm just merely expressing the point that when having all people be able to function in society in whatever role they are best fit for, then that is when we are all truly inclusive, when we are all truly accepting, and when everyone really has access to equal opportunity.
That's the same thing in healthcare: When we can have a two, three, four or every single patient that presents with a particular disease and they are able to go to all the same specialists, receive all the same medication, be able to receive all the top-notch care. When all of that happens, that is when you have a health care system that truly is for all people.
I love that quote from Ruth Bader Ginsburg. And it points to the deeper issue of we celebrate tokens, we celebrate one person in a particular role, but what we really want is normalization. What we really want is not to have a stereotype of who is a good patient or who is a Supreme Court justice or who is an investible founder. We just take people as they come.
And I think that also speaks to the perception that all of that's behind us. So, for example, because we've had an RBG, “Oh, women are all equal in law.” We know that's not true. Right? “Because we had President Barack Obama. Oh, black people have made it.” That is fundamentally not true. And so to your point that the use of tokenism also is disparaging and complicates the issue because it gives this perception that that's over like, “Oh, we don't do that anymore.” Or, “That was like 50 years ago. Oh, that ended. We had the civil rights movement, Like, that's over.” And it's not. Just ask a colleague that's sitting next to you, ask them what happened, you know, last night in Wal-Mart. To them, that was probably a racially motivated issue. So this stuff is happening.
What is it like to come into a healthcare organization? Typically a very large conservative organization, and to try to drive these kinds of change?
Again, I think, you know, with any health care organization very similar to business, you're talking about a culture change. And the culture change is primarily about mindset, experience, perspective. That's what you have to be able to speak to with the folks that you're working with. I think that you initially have to be able to establish and confirm a common ground. What is something everyone can agree on that's happening here? And again, it's the things that you have to be able to position as such as it's not personally received or someone feels as if it's a personal attack. Right? Because that's not what it's about. When you go into a healthcare system, it's very, very important to ensure that everyone understands that it's not a punishment. This isn't a moment to come together and say, “Oh, this is a result of something we haven't been doing.” That's absolutely not what's happening. We understand that everyone has been doing what they knew to do and what they've been guided to do within the system in which they operate. So now that we understand that, let's look at our patient data and look at who we serve, talk to them, understand their perspective and experience with engaging with your healthcare system.
Because I can assure you what you think their experience is and what their experiences are may not match up, and that's okay. But you have to be able to understand that. And again, things that are modifiable, things that you can address within your respective institution, that's how we get to work.
The things that are outside of your institution. It still is possible that if you cannot resolve it, you may be able to connect with folks that can, right? So if you have a legal team, we have our community, legal policymakers, we have our community in our city council. So there are people that you can connect with that can take this up for you beyond your scope of the health care setting. Having said that, though, it is extremely important to identify the things that the hospital absolutely can take on and change and be able to look at what it looks like to assume this responsibility.
Oftentimes, it's not that great of a lift. It seems like it's this big undertaking. Really, the greatest undertaking is focusing on the people, the team and the perspective. The plan we can execute. It is getting the people to work together and to agree that this is the right thing to do and be able to respect positions, roles and responsibilities.
But also having an understanding for how this affects the internal healthcare system. Right. So in healthcare, oftentimes people do not want to address the business side of healthcare. As you mentioned, I have an MBA, so I have a business mind and you're a venture capitalist, so all you do are numbers all day long. And so it's okay to say that the decisions that we're going to make, yes, they absolutely need to serve our patients. They need to serve the community, but they also have to serve the bottom line. And those things can coexist. It's not an either or. And it seems like sometimes in the healthcare space, that's what it comes down to. And that's also a wall that we can chip away at: it's not sort of the folks on the ground delivering the care versus the folks, you know, in the offices running the numbers. Those are not two very distinct entities. We have to come together and say, listen, we're all here for the same reason and let's get there with respect for what ultimately we all have to be responsible for.
Preventative care; it's magic.
Is it? *Chuckles*
What's fascinating, though, is when you're encouraging those organizations to go out and talk to their patients, it's exactly what we encourage startups to do as part of the process of customer discovery. And when I learned about human-centered design, I fell on this with glad cries because customer discovery, as we run it today, is a way to make qualitative research perceivable by quantitative organizations. It's a way to get those human factors and expose them to an organization that thinks in numbers, as you say. So it is that bridge between the soft sciences and the lived experience of people's reality and how an organization needs to be able to function in order to live. So have you found that transformative effect that I see with my startups when they conduct really good customer discovery?
Yeah. And I am absolutely familiar with the customer discovery process. I teach that in an entrepreneurship course that I teach on my campus. So completely understand that. And that's absolutely what we're doing with hospitals and with patients, is that you have to be able to have the connection between the data and the patient. Why do I say that? Because it's so easy to see a number as just a number without realizing that there are patients, there are families, that is someone's best friend, that is someone's aunt that you're looking at on that page. And so you have to be able to go and have those conversations and understand what's happening to keep a pulse on the changing dynamics of your patient population.
One of the things you mentioned in the customer discovery process that I think is absolutely key and happens in the healthcare setting: The reason why it's really important to not just do this one time, but to ensure that this is built in as the way you do business, is because everyone's circumstance is changing, right? The one thing that's constant is change. And nothing has taught us that more than the past year and a half experiencing and living in a global pandemic.
And so when you have patients who, for example, in one year may absolutely have health care coverage, a vehicle, a home in which they live, a job, they may have all of this. Within six months, it's very possible they could have experienced job loss, loss of health care insurance. A spouse could have died. Things happen and they can happen so quickly. But if you do not understand that, then you are still functioning as business as usual. And oftentimes what ends up happening, unfortunately, is that we attribute the poor outcomes of what's going on with healthcare to the patient. Well, they were unable to or it's their fault they didn't or well, they didn't get this prescription filled when I wrote it for them. So again, that gets into the blame game. And so what we have to be able to do is remove blame and finger pointing on both sides and understand that both contributed to the problem. The healthcare system has things that they've done, and equally the patients right? Oftentimes, patients will not share things that are going on in their life, and there's a host of reasons which can be a whole other podcast about why they do that.
They may not share, “My insurance has changed” or “I don't have insurance” or that “My spouse just recently died” or “I've experienced job loss.” There are certain things that they may not divulge during that medical visit, which really are pertinent to what's going on in terms of managing their care. And so those are the things that can help the healthcare system better help them. So if a health care system understands that a patient's financial circumstances have changed, there are resources to help. Not just from a healthcare perspective, but from a pharmaceutical perspective, right. From a medical perspective, there are resources aligned for that. But if no one knows, then it's difficult in order to help. Right. So, I mean, I think everyone who's involved and engaged with the healthcare system is responsible. Everyone. So there's no finger pointing. There's no blame if the system is broken or it has fallen apart or if it's gone off the rails. Everyone has to look at how did we get here and how did everyone contribute to it being here? But more importantly, how do we take up a role in order to stop it from happening?
How do we get all on the same side, where the same side is the best patient outcome?
Right.
It dovetails beautifully with what's become a constant theme of this podcast, that technology should take care of all of this stuff that machines are great at. So repetitive tasks and boring math in order to free up the humans to do the things that only humans can do, which is to care for one another and empathize with one another.
Indeed, I think you're absolutely right.
Demetria., when you look back on your career today, what are you proudest of?
I think one of the things that I really like about myself or I'm proudest of is my professional agility. I like to feel like in this moment, I'm on my fifth professional life. I want to say, because I started out… it's just been an evolution and I've been open to understanding how do I continue along the path that's true to who I am? I started out, you know, you mentioned I was at a large pharmaceutical company, but I put myself through undergrad as a nurse aide. So I've been on the floor. I've done it. I've wiped the butts, I've walked the halls, I've done it, I've done that. And then on the pharmaceutical side, I looked from a medical perspective, helping patients receive medications that they could not otherwise afford, but then just having conversations with doctors about what's going on. And there's a great deal of frustration within just the medical community around not being able to deliver the care that they want to sometimes because of the bureaucracy that's associated with delivering health care. And then for me to move on, I worked in a mental health space, so that gave me a great appreciation and understanding for mental health for one, the disease, but then also insight, unfortunately, into how it's managed in our healthcare or mismanaged, shall I say, in our healthcare system.
And then to progress to my terminal degree to be able to understand what is the conversation that's happening, what is the communication that's happening and and the conversation and communication that's not happening between the doctor and the patient, between the patient and the health care system, and, frankly, between doctors about what is going on with a patient. And oftentimes, a lot of it is that. It is the fact that there is miscommunication going on, there's misunderstanding going on, there's lack of clarity that's happening. And it's everywhere. It's everywhere. And so there are a lot of ways to tackle the issue. And I like the fact that I just have a very diverse perspective and experiences that usually inform the way I'm able to have a discussion with a doc, with a patient, with a health care system to to give new insight and perspective.
It is such an amazing story of continual reinvention. And I think a lot of us who are drawn to innovation work, you know, use ourselves as our own guinea pigs and have these sort of zigzag paths. But I liked what you said about staying true to your values and getting closer to what you're passionate about. I think it's really important as you navigate through those different roles to identify what feeds you and what brings you joy and what gives you that deep sense of meaning. Because that gives you the sort of retrospective, all of those apparently random career steps making sense.
So true.
If you had a do over, what would you do differently?
To be honest, I would not do anything differently because I think that I am a true representation of my experiences. Their experiences I wish were shorter in duration.
(That lesson has lasted long enough)
*Chuckles* Yeah. I think that there are things I felt I could have moved on from earlier you know, but if anything would have been changed, then that would have changed the outcome in terms of where I am now. And where I am now is a really good place in terms of being able to walk in the things that I like to do and connecting with people in a way to move healthcare forward. So I really am a composition of experience, good and bad. Long and short that it better have happened, which have allowed me to sit where I am now.
How could you distill all of that experience into, say, two or three lessons that our listeners can take away?
Listen more, be open to differing perspectives. Extend grace to yourself and others.
That one's hard.
It is. It is.
Demetria, how on earth do you avoid burnout?
So, you know, burnout has been a buzzword now for the last few years and everyone's trying to tackle it and understand it and eliminate it. And it's interesting you say, how do you avoid burnout? I think the way that I handle it is that burnout is not necessarily something that you avoid. Meaning to me, when you hear a void, it's almost as if, well, I have, you know, the perfect recipe and this is what we do. And so then this won't happen. Almost like a crockpot where you set it and forget it. Like if I do these things, I won't get burnout right? And for me, that's just not realistic. What I do do, though, is I recognize and I understand what burnout looks like for me, or when I'm approaching burnout and being able to tap into what's required for me to refuel, what do I need personally, professionally, spiritually, emotionally in order to refuel and not letting my tank get to empty. Being able to understand the warning signs and being able to say, “Oh, I am reaching a point where we're getting dangerously low” and you can understand that if you have heightened anxiety, sleeping patterns may have changed. You're anxious, short tempered. But those are my personal… That's not a recipe for anyone else. That is me sharing with you some of the things that I look out for. If I go too long, or shall I say too many consecutive days without exercising, those kinds of things usually drain me a lot faster than some other things.
That's a really interesting perspective because I've likened burnout to concussion in that it's cumulative and you're much more vulnerable to it after the first time. You're framing is a really positive way of saying Become aware of what the symptoms are in yourself and take action sooner.
Yeah, because it's going to be different for everyone, right? I mean, you know what? What makes you burn out? You know, I may laugh like you're tired from doing that, right? So you have to recognize what your level of burnout is and what drains you fast or faster than some other things. And being able to kind of tap into and understand your body and your temperament with regards to those things.
Yeah, for me it's lots of agency and or moral injury. Being at a situation where I have to do something I believe is contrary to my values.
Yes, that yeah, that is tough. That is yes. I have been in those kinds of positions and it's extremely difficult. Yes.
And really, the only thing you can do is change the situation.
You do. And that's what I did. So you're. You're right. That's right.
What is the best way for our listeners to connect or follow your work? I want to come and do some classes with you in Colorado.
Well, I would love to have you. So a couple of things. So in terms of the way to connect with me, I can give you my email address because I'm actually in the process of working with someone who's going to establish my whole social media footprint and all that kind of stuff from a research perspective. So that's in the works. But two things can happen. I can give you my email address, which is demetria.mcneal@cuanschutz.edu. And that is an email in which you can reference me. Once my media is all established, I can actually ensure that I connect with you all to make sure that you have access to that to give to any of your listeners if they're interested. I'm not sure how large of an audience you have, but if anyone would, I figured, no, the thing is, and I am going to this is the first time that I've done this, but I'm willing to do it for your audience in case someone really wants to reach me or to work with me. I was listening to the CEO of Chick fil A, and he was giving a great presentation. I mean, in a large this is obviously pre-COVID in a massive conference center. And it was time for Q&A. And he said, you know, it's time for questions and answers. You know, I want to hear from you. And he gave them his cell phone. And right then he took questions from everyone who, you know, pinged questions to his cell phone right in the meeting. And so I will extend that offer to your listeners. This is my direct cell line. This is a real number that I'm giving to you. It is (520) 250-5606. You can shoot me a text if you would like to chat, at least let me know who you are or you can call directly. And if I don't answer, definitely leave me a message and I will get back with you.
That is a power move. We'll be sure to include both of those in the show notes. But listeners, you won't get a better offer than that. What does the future look like for you personally? You mentioned you’re standing up some social media. Is that a prelude to a bigger public debut?
I somewhat am establishing my research in a manner that it will not only be highly disseminated, but open to partnerships to be able to expand the work. I'm not sure if you're familiar, but there's a long standing fact within science that's pretty amazing that there's about a 17 year lag between a scientific discovery or innovation actually reaching the greater public and community space. And that especially at this stage in this year, you know, until we can stand up and and just say as a group, that's unacceptable, we have to be able to get the help, the discoveries, the science to people a lot faster. And we saw that in this pandemic. We saw that with the vaccines. Obviously, that's clinical in nature, but even nonclinical discoveries, we have so many things from a health perspective, we have so many things from an intervention perspective that are at the patient level but also at the hospital and the systemic level, that we need to really be able to introduce a lot faster into the systems in which we work. And a lot of it can be avoiding folks that are recreating the will over and over and over and over again.
It's being able to identify what is absolutely working well and understanding what scaling that looks like. Being able to understand what implementing that at a local level across a variety of contexts look like. And so you're right, it's a bit of a precursor in that my work will begin the initial process of being able to have consistent engagement with not just the academic community but with the communities in which we live, being able as you mentioned, to get the stories from people. So being able to understand that I am someone that is approachable. Oftentimes in science, people feel like, “Oh, it's confusing. I don't understand.” They don't think that they're able to reach out to scientists, to us, to docs and just have regular conversations. And I am here and positioning myself to say, “Yes, let's have those conversations.” That's the only way the entire system gets better is if we continue to have the conversations and have them without the idea that there's some hierarchical system that they have to function in that they don't understand.
Thank you for the perfect setup. For my next question. You get to wave a magic wand and in five years time the industry looks exactly like you hope it will look. Give me 2026.
I think that the healthcare system, the folks that work in it would be representative of the communities that they serve. It will be diverse and it will look like the people that they serve. More importantly, everyone that receives care there will absolutely feel that they are receiving not only the best care that they can receive, but their care is no different than anyone else that's coming into the system for whatever bias that they previously have experienced. I also think that it would look like a space in which we've had very, very genuine conversations with health insurance organizations to really understand and identify what the purpose is and being able to align everyone with that purpose so that we do not have such a gap that exists as such a polarization and politicalization of insurance, something as simple as healthcare insurance. That'll be going. Right, that'll be over. I also think it will look like we’re no longer the country that spends exponentially more money. I mean, we're talking we spend more than most other countries, GDP on healthcare and our outcomes are worse. That wouldn't exist anymore.
Is there anything else I should have asked you?
No. I think that this has been an absolutely wonderful platform. I have enjoyed meeting you and having this conversation. So I can't think of anything else that we could have covered. I think we covered a great deal and we really discussed some pertinent issues.
Thank you so much for coming on the show. This has been a joy.
It's been my pleasure.