死里逃生、每晚只睡1小时，却打造出医疗帝国的CEO

So we went into hospice. I went down to the chapel, took the scapular off around my neck, took the rosary from around my neck, put it on the altar, and said, “Me for him.” At that moment, I made the bargain. I said, “Let me have his disease. Let me have his pain. Let him live. I’ve lived a great life.”

He came home on February 18, 2003. On February 18, 2004, I hit a tree and broke my neck. I was in level 7–10 pain, sleeping 1 hour a night for 18 years.

How’s that possible?

The right side of my brain literally shut down, so my level of empathy was pretty low. The left side of my brain was a machine. It was like a supercomputer.

So you were just like a business Terminator, effectively.

Yeah.

During this time—18 years?

18 years.

What got you out of it?

1. A Near-Fatal Accident

I would love to begin with the story of this beautiful, incredible ring that you’re wearing. You were just telling me about it, and then we rushed over here to get rolling so that we didn’t lose the story. Can you tell us the story of that ring?

I was skiing one day and had gone into the woods. I caught an edge looking over my shoulder, hit a tree, broke my neck, and slid 60 feet headfirst down into a river in a coma. I broke 5 of my vertebrae, macerated my brachial plexus, and disconnected the nerve root from my left arm from my spinal cord. It took them 2 hours to extract me from the ravine I was in.

They medevaced me to a hospital and gave me the last rites on the way. I was in a coma for 5 days. A friend of mine sent me this memento mori ring. He said, “Remember, you will die.” When you look at Renaissance paintings, you always see a skull. That’s the concept of memento mori: Remember, you will die.

With that in mind, every day when you wear this ring, look at it and ask yourself, “Am I spending my time with the right people, doing the right things?” And if you’re not, run.

Can you mention what the Dalai Lama told you in the same vein?

Yeah. So, I asked the question—

The first Dalai Lama reference on the podcast was, “How do you react to people who frighten you?” Because there’s this thing called loving-kindness meditation, where you should find a way to meditate about those that you fear. And he said, “Well, Mark, in your heart, you need to find compassion for the journey they’re on, because everyone has their own journey in life. But physically, run.” And he laughed. It’s an incredible, beautiful idea.

Going back to the accident, I think there was a crazy detail: The fact that you were in this frozen river was a positive, right? Can you talk about this? Just expand on this insane story.

I lay in the water, and it took them 2 hours to get me out of there, but the water was just running across the back of my neck. As they extracted me, there was a lot of ice, and I had my backpack on. They couldn’t get it off me. I had all this ice and snow in there, and it was that ice and cold water that prevented my spinal cord from rupturing.

I have a quadriplegic injury. In cases like that, there’s often this event where the spinal cord starts swelling, and there is damage created to the spinal cord. It didn’t happen for me. When I woke up 5 days later, I was getting a sponge bath from a nurse, and I said, “What are you doing?” He went running from the room and said, “Oh my God, he’s alive.”

They hadn’t expected me to make it. They were very concerned as to whether or not I would make it. From there, it was this journey to this day of trying to figure out who I was and how to live with the kind of disabilities I had as a result.

2. Bridgewater and Transition Challenges

I want to talk a lot about that period of struggle and exploration, but I would actually love to begin by setting the stage with a 1-minute life story up until that point. You can set the context of what your life was like from when you were little up through then.

3. Growing Up in Detroit

I grew up on the east side of Detroit. My dad was an autoworker. He was a pattern maker in the pattern-making business, and my mom was a nurse part-time. I’m the oldest of 6. There are 6 of us in 7 years, so the youngest is 7 years younger than I am. I’m 69, and Philip is 62, but there are 6 of us in there.

We grew up in a 1,000-square-foot house with 1 bathroom. I slept in a breezeway between—you could see the garage and the back of the house. It was one of those rough-and-tumble situations where you had to compete for space in the household.

Yep.

There were days when there weren’t any real organized sports for kids, so we were sent out of the house and told to come back when the streetlights came on. I always tell people this story of privilege. When we walked down the street, we could pick up 24, 25 kids to go play baseball at the sandlot down the end of the street.

We stood on the third baseline. We picked 2 captains, and they picked the teams. If you didn’t get picked, that meant you weren’t good. There were no participation trophies. Nobody had to play. The only way you got to play was by practicing and improving your own game. I had this little cockapoo named Toby who used to shag fly balls for me when I would hit them, trying to learn how to hit better. When you got better, you got picked.

Wow, what a concept—meritocracy.

So I grew up in that kind of neighborhood. We were loose all the time. We had to make arrangements in the neighborhood to be safe, and we had fights and friends. In that process, I learned that there is no good bully, and the only way to beat a bully is to challenge them. I was the one who always defended my brothers from bullies.

4. From Auto Worker to Business Leader

I took that into my career. I was an autoworker on the assembly line of Ford Motor Company when I flunked out of college. I did rear-axle differential housing on the Mercury Bobcat and got in a fight with my union steward because I changed my work rules. I moved my stuff around, and he didn’t like that.

I said, “That’s got to go to the union.” I said, “How do I get your job?” He said, “You need a degree, kid.” So I looked at my course books and said, “Here are the classes I could keep if I actually passed them. Here are the ones I could pass if I actually went to them. These are the other ones I should never take, like organic chemistry.”

My mother wanted me to be a doctor. I ultimately realized, after working on the streets of Detroit as a paramedic, that I shouldn’t be a doctor. It wasn’t the thing I wanted to do. So I decided to get an accounting degree because that was the quickest way to get a degree so I could become a union steward.

A buddy of mine was studying for the GMATs. I helped him. I have a photographic memory. He said, “You should take the exam.” I placed high on the exams, and I got all these graduate schools of business to say, “Hey, why don’t you come and talk to us?”

I went around, and I went to Cornell. They had these great gorges and water running through the gorges through the campus. It was beautiful. It was in the country. It was very laid-back socially, not very laid-back economically. I said, “Wow. You can drink beer and smoke pot down in the gorges. This is a cool place. I want to go to school here.”

That’s how I went. I was married at the time. My wife and I moved to Ithaca. She worked as a public health nurse in the hills outside of Ithaca, which are some of the poorest Appalachian neighborhoods in America. There’s a great book, Rural Poverty in America, written about that area. She was their angel in the hills who took care of them when they needed health care coverage.

When I graduated, I was talking to Wall Street about investment banking. I was also talking to Mike Milken at Drexel about junk-bond trading because I was at the top of my class in finance. A friend of mine called me and said, “You want to start an HMO?” I said, “What the hell’s an HMO?”

He sent me this note that said it was a U.S. Healthcare public offering. I looked at it and went, “Wow, that looks pretty cool.” We went to Detroit for about a third of the pay I could have gotten anywhere else and went to work in Detroit to start an HMO.

Describe what it’s like to have a photographic memory.

Scary. It makes you lazy. In high school, when I took my exams—I went to a public high school—all I had to do was remember what was on the blackboard, and I could just repeat it and write it down.

When I got to college, I went to the Monteith program at Wayne State. That’s where I flunked out. It was self-study, and that was an absolute disaster for me. There were no blackboards. I remember I had to recalibrate my learning.

In business, when people hand me spreadsheets, I remember them. When a cell changes, I view myself as a forensic scientist looking at spreadsheets to see which cells were changed in order to make the numbers work.

Yeah. And I can see it.

It actually glows on the page for me. When I’m looking at a printed page and there’s something misprinted, I can see that word before reading it.

And it’s persisted. It’s not—it hasn’t changed at all?

No, it gets a little crowded up here at times at my age now. I just turned 69, so every once in a while you have to get rid of stuff in order to put new stuff in.

Spring cleaning.

Yeah.

5. Building and Fixing Companies

Maybe you could describe the key chapters now, starting with the HMO up through what you’re doing now.

My first company ran out of money in 3 years; we were almost out of business. I had to learn that you actually need to implement what you think about, not just think about it. That’s where I developed the concept of Platonists versus Aristotelians.

Right.

Platonists are people who think of the great idea, communicate it, and consider their job done. Aristotelians actually have to translate it into real work. I found that being an Aristotelian was far more powerful than being a Platonist. There are a lot of people with great ideas; not too many people can actually make them happen.

That was that chapter. We fixed the business, turned it around, and ultimately it got sold off. I was sitting at home thinking about what to do next, and New York Life called me. That was my next chapter: going to work in a larger organization to see if I could do what I did with my first turnaround, which was the first company I had.

I went to work there, and that got sold to Aetna. Aetna hired me after they started running into trouble to help them fix the company. They were losing $1 million a day when I showed up in 2002, and we had to fix that. That took us on a whole journey.

My career has had 1 job search, which was my first job search out of graduate school. The rest have been phone calls from people I know who have said, “Hey, I’ve got an idea or a problem.” If it fit my profile—which is to fix broken things and build new things, not to make the trains run on time—then I said, “Hey, I can help you.”

All of my jobs after that came from people who reached out to me to ask for help.

When you go into a new situation, I want to talk about both fixing and building. What is the strategy that you’ve developed for fixing something broken? I’m interested in the deep details of the steps you go through when you encounter one of these new situations, from orienting yourself through getting it fixed.

You have to get down in the mud and crawl on your belly below the pillbox slot so you don’t get shot. It’s literally the work of doing deep, deep thinking.

In the beginning, I can tell you, I was an MBA out of Cornell, and I had all these brilliant ideas. I knew all the answers and didn’t need a lot of help. But ultimately, over my career, I found that while I thought I was right 100% of the time, I’m really only right about 35% of the time.

It’s just the issue of making a decision and moving forward. If you have a good management process around it, it will get better as you go along. It will change because you have to navigate the changes in the business model and the changes in the marketplace.

It’s a lot like sailing. You don’t sail from one point to the next; you actually have to vector because you have the waves, the wind, the sun, and the topography, and you have to manage that. It’s just like any idea.

Instead of waiting for all the perfect information to move forward, you develop a hypothesis, build a process around managing that hypothesis, take in the data as you move along, and then ultimately build a better thing.

If you look at all the great innovations in our society, those things didn’t start as the thing that the entrepreneur started with. Apple, right? Those green, orange, and yellow boxes—you probably don’t even remember them. The first PCs aren’t what they sold and made them successful today. It’s about this sort of navigation.

6. Joining Oscar Health

To do it today, when I went to Oscar, for the first 10 weeks all I did was deep dives with everybody. I met everybody, sat in the room, asked questions, kept a list, and set priorities. Over that time, what I thought was low-hanging fruit in the organization was actually watermelons rolling around on the floor, and all we had to do was pick them up and manage them.

Josh Kushner called me and said, “I hear you’re in meetings asking questions. When are things going to happen?” I said, “Josh, I have screwed up everything this company has screwed up at least twice myself. I’ve broken it all, and I know what I could do. I could walk in here and say, ‘Do this, do this, do this, do this, do this,’ and we’ll be just fine.”

People would look at me and go, “Who are you?” I doubled the average age of the employee population when I walked in the building, right? “Who are you? What is an old man doing in here telling us how to innovate and create new things?”

Yeah.

7. The Importance of Curiosity and Courage

I said, “What I want to do is find out where people are and how they think about it, so that I can figure out how to bring them to a place where they can succeed. I can’t fire everybody. I want to bring them to a place where they can succeed.”

My leadership philosophy is, “We are here to help ordinary people do extraordinary things.” If we can help them by showing them, talking to them, asking questions, and bringing them along, we can fix things. That’s been part of the story at Oscar.

In your experience, do you think that’s actually possible at scale—that ordinary people can do extraordinary things?

Yes.

How?

All they need to do is believe they can do it.

How do you get them to do that?

Tell a story about why it matters. One of the first things I said at Oscar was, “We are a pirate ship filled with cannons among Spanish galleons filled with gold. All we have to do is take their business.”

They don’t think we can succeed. We’re too small. We have none of the ballast that they carry around with them about how they run their business. They won’t go where we will go. That’s how we win.

But how do you derive the “why” that’s inspiring enough? I’m struck by how infrequently even a great, smart, charismatic founder can really articulate the point of the thing they’re doing.

Right. So how do you get one of those that is not just good, but so good it can galvanize ordinary people to do extraordinary things?

It starts with just doing the basics right. It’s a lot like trading in the markets. It all starts with a T-account, right? Someone’s asset is another person’s liability.

You have to show people the connections and the line of sight, instead of looking at each thing and saying, “Here, fix this. Fix this. Fix this.” When they start to see how it all fits together, then you’ve recruited everybody into a mental model about how the world works that we can share.

8. The Evolution of US Health Insurance

You don’t spend a lot of time looking at little things and dealing with them. They now know the intent of the commander, the march, and the mission. Then you start adding on the layers of all the cool things we can do as a result of that.

Can you teach us a CliffsNotes version of the history of U.S. health insurance?

It was started 80 years ago as a result of soldiers and personnel coming back from war. They were worried about wage inflation, and so they said, “We can’t have any increases in wages competing for talent, but you can create benefits. There will be operating expenses that you can expense into your business, and it won’t be taxable to the individuals.”

Health insurance was the first one. People were worried about a baby boom. They were worried about all the support that would be needed. So, 7 years after that, they started the Hill-Burton Act in 1952, where we built hospitals in every community in America. When everybody started having babies, we would have places for these babies to be seen, and everybody would have health insurance.

If you create enormous capacity and give people no sensitivity to price by giving them coverage, you have created a great inflationary monster. That’s what’s happened in large part.

We now have employers who buy insurance for a large group of people, providing a limited range of benefits that, on average, control the price of that benefit without really looking at the individual requirements underneath and what people need. People are stuck with more or less holding their nose and picking a plan that works for them, even though it’s not something they would otherwise buy if they had the opportunity to pick it on their own.

One of the things that you hear all the time is, “This system is so octopus-like.”

Yes.

It’s so complicated and so entrenched that it just feels hopeless—that it’s bad, nobody really likes it, and the ambition to try to change it feels impossible because of the path dependence that you just described going back to post–World War II.

The result is that everyone throws their arms up. Why could that be wrong, and what could we maybe do about fixing this problem that everyone seems resigned to?

We need to eliminate employer-sponsored insurance, and we need to say we’re going to let individuals buy their own. But we need a marketplace to do that, and that’s what the ACA has created: a marketplace where people can buy my network, my benefit plan, for me and my family.

Now we need to help them understand how to do that more effectively. It’s a lot like when we went from defined benefit to defined contribution in pensions. What should I invest in? How do I invest? It’s all based on your age, your risk profile, and what you need to retire in the future. How do we hit that target? They use financial advisors.

Our best opportunity is to have brokers help people understand what they can pick. The second part is that when employers buy insurance, they buy large networks because they have all these employees in multiple places.

And they give a range of benefits, but only a few that sort of fit the average employee. The economics of large networks are that they are inversely cost-effective. The larger the network you have, the less ability you have to negotiate better rates.

When you give an average benefit for employees, the employees have to decide which is the best for them. They settle for whatever it is they get, and they have to pay 15% out of pocket. So, in a small-group employer, that small-group employer with 1 pregnancy in a year will have a double-digit rate increase every year because of a blessed event.

What happens is that a lot of those employees at that employer who didn't spend that kind of money pay 15% of a higher sum every year and don't have any control over their benefits, and they get dissatisfied. For 5 years running, small-group employers have been paying double-digit rate increases. They're now just dropping coverage and saying to their employees, “Go find your own coverage. Go to the ACA.”

Let's make that a more thoughtful transition. Let's help employers go to defined contribution. In the ACA, 75% of all providers are in the networks of some plan. All the plans develop narrow networks.

From our perspective, it's not about Oscar membership. It's about members being able to pick their doctor and their hospital in a more price-effective way, because it's not an employer buying a large network. It's a narrow network. There are narrow networks in every market. It's designed by market, and the benefit plan designs range from bronze to gold, where I can pick my journey.

If I can pick the right plan with my doctor and my hospital, and I can keep it, then I'm going to be willing to pay for it. Last year, 2 out of 5 Americans borrowed $74.9 billion to pay their out-of-pocket costs for healthcare.

From banks. Crazy, isn't it?

What if I get defined contribution from my employer—what they're paying for me today—and I buy a plan that suits me at a better cost for the network and a plan design that works for my family, using a plan-selection tool? Are you going to have a kid this year? Are you thinking about building your family? Are you going to have any surgeries that you need? You build your plan design to support that. You buy it, and you have money left over most often.

I can use that to pay those out-of-pocket costs instead of going to the bank. Or I can buy dental and vision, life insurance, or disability. All of a sudden, it's my plan. It's my choice. It's what I want, which Americans have in every other part of our economy. They buy what they want. They can see it online. They can make their own choices. So that's what we should do.

If I could draft in the smartest skeptics, or the ones that least wanted to have that outcome—other than, obviously, incumbents, where businesses benefit from this or something—are there smart critics who would disagree with you? And if so, how?

There's a concern that sick people won't be well taken care of in that system. It's exactly the opposite. Consumers, when educated, can make a good choice because it's about them, right? It's just like medical care. I want my doctor to take care of me and what I want to accomplish in my medical care, not what the person on the front of Men's Fitness magazine looks like, because I'm never going to be there.

I was at one point, but only for a fleeting moment, and then it was gone.

9. Oscar Health: A New Approach

And so this whole idea of having the tools to allow people to be educated and make this choice—and that they can keep it because it's in their community—as their circumstances change, they can fund that plan from another employer they go to or from the government. They can keep that network and that plan. All of a sudden, it's what I want, and it's mine.

Maybe you can describe the state of the union of Oscar today. Just describe, for those who aren't familiar with the business—I think people know the very broad strokes—but give us a high-level summary of what the business is and looks like, and then we'll talk about directions that we will go.

We currently cover about 2 million lives, and they're all ACA members—Affordable Care Act members. They're all people who, in some way, shape, or form, need to have subsidized healthcare that they otherwise could not afford.

We're expanding to more markets as we speak. The idea is to continue to bring them tools that they can use. We have a chatbot we're about to launch that helps people understand their condition in a deep way. They can talk to it, get information, and go back and forth with it.

We've implemented over 20, almost 2 dozen, large language models on the back end of the business that have reduced our operating costs. We've been able to reduce costs and hold our prices at a lower level than what we would have had if we'd had these bigger costs.

It's a digital-forward, cloud-native platform—the first new platform for health insurance that has been built since 1972. Everybody uses the old HealthEdge platform. I've modified HealthEdge 3 times in my career, and it was built in 1972. Everybody has it. We pretty much have our own platform.

Secondly, we have 1 version of the truth in data, so we can use large language models and AI at scale, which has a huge advantage for us in the marketplace. Digital-forward, working virtually, with AI capabilities on a new platform that is lower-cost than almost anybody else's allows us to put a very unique product in the marketplace.

One of our great products is for diabetes. We actually have a program where we encourage diabetics to join us. It's counterintuitive in the insurance industry, asking sick people who cost $1,600 to $1,700 a month to join your plan. But we know if we give them the tools, the capability, and the understanding, they're going to get better. We're going to get the risk adjustment for it in the system, and we'll be able to take care of them and not have to rate them up as a result of what they've been going through.

Maybe that's a great example. Maybe use the diabetic plan as an example of the flow of funds and how it all works. If I think about the economics of that product specifically, it's a great example to explain a complicated system around 1 patient.

An uncontrolled diabetic costs about $1,600 a month. A controlled diabetic can get down to $900 a month. That's a $700 opportunity.

Yeah, you can invest $699 and get a return out of it per month in that patient to make them better.

So we put together a set of tools and capabilities that they can learn, including wearable glucose sensors that help them manage that care. Because we're digitally forward, people can make their own choices, learn, go at their own course, and work with their doctor. We attract a population that's interested in being better.

Three or 4 times a year now, we submit all of our claims to the government. Those all have risk adjustments on them—the diagnosis codes and treatments that were given. Then that's all compared to each health plan. The health plans that have more risk as a result of that analysis get paid by the plans that have less risk.

We set aside money for risk-adjustment clearance, and we do that throughout the year. We send out money to the government, which then reallocates it to people who didn't get paid as much as they should have.

And so, if you think about the idealized version of this business—not serving 2 million, but 20 million customers or more—what does it look like in the ways that are the most different from how it looks today?

We think we can serve 125 million people. The last group of insured business on a group basis is middle-market and small-group employers. Small-group employers are under 100 employees; large-group employers are middle-market, up to 1,000 employees. Those people all buy insured products. They pay a premium to the insurance company, and they get coverage back.

That is a less effective system because the populations that they underwrite for those groups are anywhere from 10 employees to 1,000 employees. When you compare it to the individual market, where we have 24.2 million people, the ability to manage risk over larger populations isn't there for them. So they are subject to higher rate increases. There are 79 million of those people.

We believe that if we offered a defined-contribution ICHRA product—an individual coverage health reimbursement arrangement—to those employers, we could reduce their costs and keep them sustainable over time. We have an example right in front of us that works.

There are 20 million to 30 million gig workers who can't buy insurance through a group. But if we create hour banking—the ability to set aside hourly rates that you then can aggregate at the month and use to buy your policy—that allows them access to the individual market.

Then there are large employers who are looking at this as well. They want to take their part-time workers, but then ultimately, over time, more of their workers, and put them into the system. That's another 80 million to 100 million lives. So it's a massive market if we get everybody to move that way, where every American gets the choice to pick my network and my benefit plan.

Is it fair to summarize it as the journey to a reformed healthcare system? Sub-inflation cost growth, which I'm sure everyone would want to sign up for, will be the result of personalization and efficiency. That's the style of plan, and personalization and AI and other tools on the efficiency side—those are the 2 major levers.

Spreading the risk.

Yeah, of the sicker people in the population across a larger set of numbers makes it more effective from a risk-management standpoint.

A pregnancy can’t blow up your rate next year, right? Because that gets spread across the whole population. The idea is better risk management—equalizing the risk across the population—and, secondly, having freedom of choice in what I get and what I buy. Now, there will be limits. It doesn’t mean people can take their defined contribution, put it in an account, and spend it on beer.

They actually have to buy health insurance or health care in some way, shape, or form. We don’t want people taking unnecessary risks by saying, “Oh, here’s a great pot of gold from my employer. I’m going to spend it in a different way.” They have to use it to provide that benefit.

If you do a premortem on this attempt to make this 2 million into 120 million, and I say you just have to assume that it doesn’t work, what do you think the most likely reasons are that it won’t work at Oscar specifically?

There’s going to be resistance at the large-end employers. They have benefit staffs of hundreds of people: this person buys pharmacy, this person buys dental, and they just manage the whole process. You don’t need all those people when you give the money to the employees and say, “Hey, go buy your own health insurance.” That’s going to be one source of resistance.

There are consultants that advise large employers and get paid a fee every year. That goes away. Brokers who think they’re disadvantaged by it can help us with the employees picking the right plan, so we can help preserve that model for them. And then there’s just going to be the regulation required to make the changes.

In Indiana, we’ve already made the changes to allow that to occur from the standpoint of that state. We need it on a national basis. It was in the original bill that came out of the House. It was called Choice, which I think is a better name than ICHRA because ICHRA doesn’t sound—

Sounds like Icarus.

Yeah, right. It does. Or icky. It’s called Choice, but that got pulled out by the Senate because of the tax effect of HSAs for all those benefits. But those benefits are being tax-advantaged for employers now anyway, so it really shouldn’t be scored that way. But that’s the way they scored it, so it saved $30 billion, and they pulled it out.

I like this concept of the battlegrounds or competitive frontiers within a given industry. Oscar is fighting other people that are offering other things—incumbent solutions, all this kind of stuff. What are the competitive frontiers? What are the places that you win and lose versus others today?

Size has an impact.

Yeah.

We only have 2 million people. At Aetna, we took care of 54 million people around the world, and that’s a different issue. But size has an advantage as well. We have the A team on this product for these people every day. That’s a differentiator, and most of the other companies didn’t take the time to understand it because they had their C team on it instead of the A team.

Some companies are pulling out of the market because they use their commercial networks instead of narrow networks, because they didn’t really pay attention to it. They had their C team on it instead of the A team. Size is a double-edged sword. We think about this every day. We innovate against it every day. We know it could be bigger. We’re a smaller player, while larger competitors have a lot of other businesses to pay attention to, like Medicare Advantage.

The other is the regulatory framework. We have 51 regulators—50 states and the federal government—and we have to try and react with them all. As you see with changing regulation now by state, it’s almost impossible in some cases to deal with the way these regulators behave because they’re contradicting one another.

Take the abortion issue. You get penalized as a national employer, as a national carrier, if Missouri absolutely forbids abortions and it’s an employee who works for an employer in another state that offers them. You get penalized. There’s a fine for every case. And so you have all of these things that you need to navigate from a regulatory standpoint.

It would be far better if we just said to the states, “You run your own exchange and your own markets for your people in that market,” and we’ll be able to make this work across the country. So we have all of this internecine warfare going on between the states and the federal government over how you spread the cost of this. So that’s an issue.

I think the third one is that there are a whole bunch of actors in the system. If you look at the way the economic models are, physicians—760,000 or so—all work on a cash basis. That’s their accounting model. The hospital systems and the facilities that provide health care around the country work on a revenue basis. As long as I have enough revenue coming in, I can win.

Then you have insurance companies, pharmaceutical companies, biomedical research companies, DME, and all these other companies that work on a margin basis. So you have 760,000 physicians on a cash basis. You have 6,900 hospitals, and add probably another 6,900 facilities as well—so almost 13,000—that work on a revenue basis.

Then you’ve got about 1,300 insurance companies, and add up all the others that are on a margin basis. You put those economic models together, and it’s a wonder people get care at all. When you look at that discontinuity, it really should be the other way around, where the individual buys.

It’s my money, not some employer who’s trying to manage a whole group of people or a small employer who can’t manage their own health care costs because they’ve got so few people. It should be the individuals saying, “Here’s what I want out of the health care system.” Ultimately, the health care system will have to align, but those actors are all going to fight against one another.

There’s a quote I’ve had under my blotter every day of my working career. I’m fascinated with Renaissance Italy, and it was Niccolò Machiavelli, when he wrote The Prince: “There’s nothing more dangerous to effect than to initiate a new order of things, because those who are advantaged by the current order have the laws behind them and experience to continue to support the way it is, and those who would be advantaged by the new order of things really won’t embrace it until they experience it. Between the two, you run great danger.”

But you like to live—

That’s where I’ve lived. I’ve lived right in that place my whole career. I am an iconoclast.

What does that mean to you? What does it mean to you to be an iconoclast?

Yeah, you just challenge everything. Nothing should remain the same unless it can stand on its own.

10. The Role of AI in Healthcare

In that space, in that dangerous space that Machiavelli describes, how much of a grenade does AI feel like to you? Because if I think about—if I try to boil this down to its basics—it’s like, when I’m normal and healthy, kind of nothing happens. Typically, you get older, stuff starts happening, or you’re young, something happens. I have to figure out what it is with experts, with one of the 760,000 doctors or whatever, and then I need to do something about it. And that’s kind of the value chain, or something.

Increasingly, I’ve heard stories about people solving very hard diagnostic problems by themselves with ChatGPT that 15 doctors couldn’t solve, and disintermediating that part of it. Obviously, there’s tremendous innovation I want to ask you about later on, like on the biomedical side and the biotech side, and self-service solutions and screenings and all this crazy stuff. How much does AI plus other technologies represent a grenade?

For a long, long time, we deferred to our clinicians and said, “Whatever you think I ought to do, doctor, I want to do.” Really, what we should understand is that the best-prepared clinicians in the world today are people who just got out of their residency. They know all the latest science.

If they were to read 2 journal articles every night for a year, by the time the year passed, they would be 5 years behind on the latest literature in health care. So how do they keep up? Particularly for an internist, it’s almost impossible.

This idea of using AI as a way of gathering information and giving you insights—I always say to people, the mental model that exists inside your head about how the world works is the most critical tool you have. If you don’t constantly add new information to it and are not a continual learner, you can’t possibly know what you need to know to make good decisions.

I look for 2 things in executives: curiosity and courage. The curiosity to continue to ask questions and learn more every day, and the courage to act on it when you have a hypothesis that might be powerful. That’s where I think AI could help. Better-informed consumers about how health care works and what their options are—that’s a far better world than just deferring.

There are a lot of times we have cases, and I’ve been in these situations, where a patient is dying and the family looks at the doctor out in the waiting room, and they walk in and go, “What can we do next?” The doctor never really wants to say, “Well, I think it’s time to let Grandma go.” They want to say, “Okay, well, we could try this or we could do that.”

11. Son’s Battle with Cancer

We often get those prior authorization requests when the patient is at the end of life. The reason is because they’re stuck in the medical-industrial complex. I had to put my son in hospice on July 15, 2002. It was a horrible decision to make. I had to give up hope. I had to say he’s no longer curable and that we just need to wait for him to die. He went into his hospice room, and then I found a drug for him.

They came to me and said, “Your son has to come out of hospice if you apply this drug.” I said, “Let’s see: dead, maybe living. I think I’ll take the maybe-living route.” He could go back to his room, and we’d work there.

What we found was that, in hospice at the end of life, 60% of your lifetime costs are spent. Medicare rules and most rules in most insurance companies require you to say, “I can no longer seek curative services, and I have to give up hope. I have to say I’m going to die in a certain period of time.” When I was at Aetna, we tried this, and I remember when I brought it into the office, they all looked at me and said, “You’re going to break the company’s back.”

I said, “Let’s not require them to give up hope for curative services. Let’s allow them not to have to say they’re going to die in a short period of time, and let’s just let them go into hospice early.” It was amazing: It went from 18% of people being in hospice to 75% of people going into hospice. The letters we got from people about how amazing the final days were, and how much better it was when they weren’t hanging out in a waiting room waiting for a doctor to tell them what’s next, were incredible. The costs were 75% lower at the end of life.

So changing the rules about how we do these things—AI can help us in these places. There are just certain things that are not going to end well. As my Eastern belief system says, we just change our form and go to a different place as a result of death. It’s not the end of your energy and existence in the universe.

How did you arrive at your Eastern belief system?

It was when my son was in the hospital and needed a bone marrow transplant.

What was happening with your son?

My son had T-cell gamma-delta lymphoma. Only 34 people, all men, had ever been diagnosed with it. He was the youngest at 16, and it had a 6-month end date. I was told he’d only live 6 months.

I said, “Well, not me.” So I quit my job, and I took him around with my wife. We went around to meet all of these physicians. There was this physician, [likely Eva Guinan], at Boston Children’s Hospital, who said, “It’s a deadly disease. Nobody ever survives this. I’ve never seen one. They’re so rare. But I’ve got an idea.”

“If we create graft-versus-host disease, which is a bad bone marrow transplant, it will attack the T cells, which are cancerous in your son’s body. If we can kill all the T cells, we can kill the cancer. But then he’s going to survive graft-versus-host disease, where the body goes to war with the bone marrow that we put in that isn’t his bone marrow.”

The right mismatch happened to be my brother Peter, who’s third in line. John’s 11 months behind me, and Peter’s 10 months behind John. So we’re the Irish triplets, 21 months apart. Peter graciously gave up his bone marrow for Eric.

We put Eric into radiation. We zapped him so that he had no ability to live after his final radiation period unless he got my brother’s bone marrow. We put the bone marrow in, and it killed the cancer. We were getting ready to go home when graft-versus-host disease hit him, and we were in the hospital for a year fighting a horrible scenario.

Graft-versus-host disease is terrible stuff. The skin starts to come off, your gut sloughs off, and you can’t eat. I was living in his room with him. I was sleeping in his room; I made them bring a bed in. I was meeting with the medical team for an hour every morning, going through my Harrison’s Principles of Internal Medicine text and sticky notes.

I had PubMed, and we were talking to NIH doctors on the website about his disease and what to do next. They tried over and over and over again to get me to do a do-not-resuscitate order because they said, “Your son’s just not going to make it.” He wasn’t able to eat. He went from 140 pounds to 80 pounds. He was starving. It was horrible.

His hair fell out. It was just a mess. He was bleeding out his total body volume of blood every day through his bowels. He had gastric dysplasia. There were times when I gave my own blood, because we’re the same blood type, to help him get the blood he needed. He was getting almost his whole body volume of blood for weeks and weeks and weeks.

12. Eastern Beliefs & Personal Transformation

They came into the room one day and said, “We need to talk to you. He’s not going to make it. We need to put him in hospice.” So I went in and sat down with him and said, “Eric, game over.” He said to me, “Do you want to try this crazy thing?” I said, “If you do it with me.” He said, “Okay, I’m in.”

I went into his room and I said, “Game over.” We did the Sorrowful Mysteries of the Rosary together, and he went into hospice. I was meeting with the medical team that morning, and I didn’t have my Harrison’s Internal Medicine text or my laptop. They said, “Where’s your stuff?” I said, “None of that works. We’re in space that nobody knows.”

He was starving. He was allergic to soy, so you couldn’t give him Intralipids to help him come back. I said, “There’s got to be an Intralipid somewhere in the world that’s not omega-3 fatty acid, not soy.” One of the residents ran off and called her nutrition professor at Johns Hopkins. He said, “Oh, yeah, there’s a thing called [likely Omegaven]. It’s omega-3 fatty acid, in Austria.”

She came back and said, “I found it. I found one, but it’s not FDA-approved.” I said, “Go see the FDA. How can I get my son this drug?” They said, “Well, there are these 3 pages you fill out. It’s called a single-patient compassionate-use exception. Have the doctors fill it out, call us, and we’ll approve it.”

They approved it. It was made by Fresenius. The Fresenius CEO was in Austria, and he brought it back with him to Boston. We gave it to my son, and 4 weeks later his hair started growing back. His starvation albumin went from 0.2 to 4, and he came home. This was in August. He came home on February 18, 2003.

Holy.

His kidneys were damaged, so he got my left kidney 2 years later because I had the best match for a kidney. They did it laparoscopically by then. They didn’t have to cut you in half like they used to. They put 2 holes up here and a slot down here, cut it off, and it fell into the slot. The doctor pulled it out of the slot, and I was home the next day.

After that, he and I used to ride motorcycles together. We went down to Rolling Thunder and did all sorts of cool stuff. We were riding around on the bikes one day, and we were sitting at the bar when he looked at me and said, “Dad, why are we both here?”

He came home on February 18, 2003. I broke my neck on February 18, 2004. We went into hospice. I went down to the chapel, took the scapular off around my neck, took the rosary from around my neck and the rosary out of my pocket, put them on the altar, and said, “Me for him.”

Having been trained by Jesuits in my career, we were always taught to be of right mind, to make good decisions, and not to make bargains with God. At that moment, I made the bargain. I said, “Let me have his disease. Let me have his pain. Let him live. I’ve lived a great life.”

There was a friend of mine who was praying for Eric at the Wailing Wall in Jerusalem. He took Eric’s picture every day, put it in the Wailing Wall, and prayed for him while I was sick. He called me and said, “How’s it going?” I said, “Well, Eric’s doing well. I broke my neck.”

I told him the story, and he said, “You made a deal, didn’t you? Send me a picture.” So he started praying for me. He said, “You’re going to be fine.” We were talking, and he said, “Dad, why are we both still here? Why does this matter?”

I told him the Neil deGrasse Tyson thing. I said, “Out of a trillion different genetic combinations, there are only 100 billion people on this earth. We won the lottery, so let’s make good use of it.” I said, “But I don’t know what’s in it for you. You can’t screw it up, because I’m just spare parts. And by the way, you can’t have the other kidney until I’m gone.”

When I gave him the left kidney, I said to him, “You have to drink Bud longnecks, because that’s what it was raised on. Don’t start changing the grease that runs the machine.”

This notion of a father saying that his purpose is to be spare parts for his son—

Yeah.

You told me that when we first talked, and that line got burned into my brain.

We were sitting in this other restaurant one day. It was the Gold Roc Diner in Hartford, and we were sitting there with our helmets on the table and talking. He’s a theoretical physicist. He’s talking about the absence of time and the concepts of physics, and I’m talking about the absence of time in the Hindu belief system.

Everything that’s ever happened is happening now. We’re just too limited in our intelligence to understand it. We don’t see it. We can’t see it. We were talking back and forth on these different concepts, and he said, “Yeah, but mine’s science-based.” I said, “Mine’s science-based too.”

There was a father sitting with his 5-year-old at the table next to us. I got up to leave, and Eric had already headed out to the bikes. The father grabbed my arm and said, “Is this something I have to look forward to?” I said, “Only if you’re lucky.”

Eric was in the hospital. He had his bone marrow transplant, and he was irradiated. It was the most frightening thing I’d ever had. I panicked the first time I went in the room with 12-inch walls. He was wearing these plates over his lungs to protect him, and they irradiated him with Hiroshima-bomb-kind of radiation 5 days straight to kill every piece of bone marrow in his body. It killed it all.

He couldn’t survive without it. One day I walked in, and he had this woman doing Reiki therapy on him.

She's doing Reiki, and she's not touching him, right? They're hovering—this energy thing—and he goes, “Dad, this feels great.” I'm sitting on the bed next to him, and I say, “She's not touching you.” He goes, “Dad, it feels great.”

So I lay on the bed, and she says, “Would you like to try?” She starts it with me, and after about 5 minutes, I think, “This is too much.” When I got injured, I was on 7 different narcotics every day. Everything sounded like Charlie Brown's mother in the cartoons; whenever she talked, it was always, “Wah, wah, wah, wah, wah.” That's all I heard.

My whole world was that I was so high, but I was still in incredible pain. The drugs didn't touch the pain. They just let me not care about it. That was the way it worked.

And so I'm like, “I can't do this.” I'm sitting on the side of the freeway in Hartford in my 740iL, getting ready to run into a bridge abutment. I used to get up in the middle of the night and just drive around like a madman, trying to get police officers to stop me, and they never did. But when I was sitting on the shoulder, they stopped me.

They came over and said, “What's going on?” I was thinking about running my car into that bridge. They're looking at me: I've got a brace on my neck, I've got my arms in a thing, and they say, “What's going on with you?” I told them the story, and they said, “Get in the car.” They drove me home, took the keys, and took my license.

“Your spouse can pick this up tomorrow, but you're not to drive again. It's too dangerous—let alone whether or not you're going to hurt yourself, you're going to hurt somebody else.” I was at my wit's end.

A friend of mine said, “You should try craniosacral therapy.” I said, “What is that?” I read about it, and it's the subtle manipulation of the bones in your head and your sacrum to reestablish a rhythm in your cerebrospinal fluid. I had ripped my dural sheath and all this sort of stuff in the accident, so everything was torquing inside of me.

I went in, got on the table, and this woman put her hands on my head and on my sacrum. All of a sudden, she said, “Give me just 4 visits.” After 4 visits, I started coming off all my drugs. She got the rhythm, because the cerebrospinal fluid is like a heartbeat inside of you. It moves up and down around your spinal cord and your brain all day long.

If you can establish that rhythm again, which might have been distorted by the accident, you can be better. I was feeling better doing that. I started reading about the procedure, and then this therapist said to me, “You should try yoga.”

I couldn't run anymore because I was too unstable. I said, “Yoga's for girls.” She goes, “Oh, no.” She said, “Just give me 4 visits. I'll show you.” She was a yoga teacher. After the first one, I could barely move the next day after my first set of asanas. I started doing it more, and I was doing it on my own.

I said, “There's more to this than just the practice, the physical practice.” So I started reading about the American Viniyoga Institute. There was this great book by Leonard Perlmutter called The Heart and Science of Yoga, and it relates it to Western medicine. I'm going, “This really makes sense.”

I started reading the Bhagavad Gita, the Upanishads, the Yoga Sutras of Patanjali, and all these other sorts of things, and started to realize that this is just rich. Yoga in the United States is not just this physical practice; it's actually understanding the teachings—yamas and niyamas, how you treat others and how you treat yourself.

There are 5 of each, so they come to 10. The first one is, “Treat others as you would treat yourself,” written 5,000 years ago, not 2,000 years ago, and, you know, codified in the Ten Commandments—written 5,000 years ago.

Then there's the physical practice, asana, the movements initiated by breath called pranayama. All of that is to still the body and the mind in a way where you can sit for an extended period of time, meditating. There are 4 limbs of yoga for meditation, so there are 8 total limbs. The ultimate is samadhi: you're one with everything. You move back to the one. You find the creator.

It's built on a model that, in the beginning, the creator existed, and only it existed. Upon realizing that there was no awareness of it unless there were others, it unfolded upon itself to create the world—or the worlds, however many there are—so that those people, through a fog, could find their way back to the creator and learn the lessons of being the one: we're all just one thing; we're all the same.

My mantra, which is across the back of my neck, is “So Hum.” In Sanskrit, it means, “I am that, and everything is me.” It's all just one. If you can keep that in mind when you're with others, you and I are one. It's this model of thinking differently about your place in the world and what you do.

So then I go to work one day and say, “You know what? I think we ought to do yoga for our employees.” I'm the president of the company, and everybody sitting in the room goes, “Oh, sure, boss. That's a great idea.”

13. Yoga and Employee Wellness

The chief medical officer follows me to my office and says, “You know, this is voodoo medicine.” I said, “Lonnie, no, it's not. It's not voodoo medicine. What do I need to do to prove it to you?” He said, “We need to do a double-blind study.”

So we did a bicoastal, double-blind study. We had 795 employees sign up bicoastally. We measured cortisol levels and heart-rate variability in all those employees. The West Coast people were actually more revved up than the East Coast. I don't know if the avocado prices were up or whatever, but somehow they were more wigged out than the East Coast.

We did 12 weeks of mindfulness and yoga classes. Mari, my then partner, who was my wife for a while, was the teacher. She worked with Gary Kraftsow at Viniyoga, and they taught these classes. What we found was that the people in the highest quintile of stress spent $2,500 more a year on health care than the average employee.

So we put everybody through these programs. We had them journal, and after 12 weeks, heart-rate variability and cortisol levels dropped 50%. In this population, they started going home and having their families do it with them. All sorts of amazing things happened. Our health care costs went down—not just the trend; the actual dollar cost went down 7.5% the next year.

I said, “We've got to let every employee do this.” We opened it to employees during work hours, and they got time off to do it. I said, “Go to the classes.”

One day, Mari walks in the house and hands me the journals. She goes, “Okay, Mr. Big Shot CEO, you ought to read those journals.” I said, “Why?” She goes, “Because the problem with their stress is you.”

They're working 2 jobs. They've got their kids on Medicaid because they can't afford the company's dependent coverage. They've got people on food stamps. They're calling bill collectors while they're on break. You're not paying them enough.

So I read these things, and I'm going, “Wow, I'm the jerk here.” I'm now CEO, so I bring in my head of human resources, whom I ultimately had to let go, and say, “I want to know who these people are. I want to know what their life's like and how much they make.”

They made about $12 an hour, and 81% were women. Twenty percent of the families were on food stamps. Twenty-five percent of the kids were on Medicaid because they couldn't afford dependent coverage. This is crazy.

Here we are, a company that's come out of being almost out of business to being profitable. We've got to do something about it. So I said to her, “I want to know what we can do for these employees. I want to raise their minimum wage.”

We started with $15.50 in improvements. I said, “This is just not enough. Let's go to $16.” The CFO goes, “Oh, my God, this could kill us.” We put the $16 in.

One of my other executives came to me and said, “You know, when you raise their wages, their dependent costs—their coverage based on their benefits—are going to change because they're making more money, because we graduated it. I paid, as CEO, 65% of my medical costs, premiums, and everything else, whereas the frontline employees who were at $12 were paying, like, 20%.”

What we did was say, “Okay, let's take all these—there's 7,100 employees—and say to them: If you are below 300% of the federal poverty level, we'll have an independent firm adjudicate that and just say yes or no. I will eliminate all of your out-of-pocket health care costs if you join the wellness programs that are specific to your current needs.”

So I did this program. It was $75 million. The first year, I was at the J.P. Morgan conference on January 12, 2015, and I announced it in front of 240 million of our 340 million shares and said, “We're going to do this.” I didn't ask the board.

Well, how did your board let you do that?

Well, this is one of those things where you ask for forgiveness and not for permission. I just went ahead and did it. I got applause. Our employees all of a sudden realized that we could help one another, and we started doing other things. I never had to make another suggestion.

We doubled our tuition assistance. We paid back student loans up to $10,000 a year. We did dog-pet therapy in all of our offices. The only time I ever said no was when we went beyond dogs, cats, gerbils, and rabbits.

Somebody wanted to bring in mini ponies. I said, “We're not bringing mini ponies into the building.”

That’s just not going to happen. Cool idea, but no. And then it just took off, and all of a sudden we were spending $125 million, $130 million more a year. Our stock price went from $39 a share up to $80 because we then gave permission for our employees to care for our members like we were caring for each other.

14. Raising Employee Wages and Benefits

My last 5 years at Aetna were joyful because I didn’t have to tell people to get to Sandy Hook to help families with critical incident stress debriefing. It all just happened. We were like a company on a mission. And that’s how the Eastern practices changed my company.

If we were to turn that amazing story into a directive to employers—CEOs, let’s say—who want to treat their people the way that you just described, because it’s the right thing to do and because, actually, it’s a selfish thing that you ultimately get a benefit out of, what would you teach them? What are the components of doing that?

So we created a website for them because the spreadsheet would never work if you put the numbers in. The spreadsheet is the worst invention ever created for business, right? If you read the book, The Tyranny of Metrics, or something like that, I put it in the book.

We’ve created a tool that allows us to manipulate numbers on the page to get the answer we want. Then we actually create a belief system that’s not real, and we manage to it. Instead of saying, “What are the 5 risks on this page?”—and this is what we did on the wage thing—we said, “Okay, here are all the hard benefits. Let’s take all the soft benefits: presenteeism, better attitude at work, empathy for our members. Let’s put all those on a page, and let’s discount them by 90%.”

When we did that, the group that we discounted by 90% added up to the exact same amount of savings as we had in the hard savings, which we didn’t discount. What it meant was that we were just not seeing far enough. What I said to the team was, “Let’s not work by what the spreadsheet tells us. Let’s ask ourselves, what are the top 5 risks of making this happen? Let’s rank them by priority, and let’s stand back as a team and say, given this set of risks, do we believe as a leadership team that we can do this well and still make money?”

I said, “If we believe it, then it will happen.” That’s what we did. We put together a whole website for employers, and I would get phone calls from all these employers all over the country saying, “Help me walk through this. Help me understand.”

One of them was a family-owned string of memory care centers. They had employees who were making $12 an hour, and they wanted to raise their wages. They said, “But we’re in the business of getting reimbursement for people with Parkinson’s and Alzheimer’s, and it’s hard.” I said, “Well, what’s your biggest cost?” “Falls. Hospitalizations.” “How’s that caused?” “Anger, combativeness.”

“Does it matter how much your employees know those patients?” “What do you mean?” I worked in an Alzheimer’s ward with my mother. My mother ran a string of nursing homes. What I found in working with them is that if you spent the time to understand how they behaved and got them interested in talking about something they were interested in, you could find a way into them that would make them much calmer. You knew how to talk to them to do it.

I was there for 3 years in that unit. So I said, “If you kept employees for 3 years and they were able to help your patients be much better and reduce falls, anger, and combativeness, would that be worth your money?” They did it, and it worked. It’s not about what the data tells us. It’s about how we can understand the data in a way that allows us to do this effectively and not break the bank.

How long were you in pain after your injury?

I had no pain for a month. Then, all of a sudden, one night I woke up in the middle of the night and felt like somebody had set my hand on fire. I went on a journey that lasted until the end of 2022. I was in level 7 to 10 pain, sleeping 1 hour a night for 18 years.

How’s that possible?

I did it.

Sleeping 1 hour a night?

Yeah. The right side of my brain literally shut down. I would literally walk around in my room. My level of empathy was pretty low, and the left side of my brain was a machine. It was like a supercomputer. I could look at things and say, “Okay, we’ve got to get the group together. Let’s do this.”

Every morning I would get the run of the billions in reserves at Aetna at 6:30. We would run the reserves every night, and I would get that report at 6:30. I’d look at it, and if I found a problem, everybody was in my office at 8:00 in the morning to review how we were going to fix it, because every 50-basis-point change in that trend was $980 million of margin.

That was my key metric. My brain was like that.

So you were just like a business Terminator, effectively.

Yeah.

During this time—18 years—what got you out of it?

I was getting ready to go to Switzerland to end my life at Dignitas. It’s an assisted-suicide organization, but I had to prove I had intractable pain—pain that can’t be cured. So I was sent to a doctor, and the doctor evaluated me. The doctor said, “You don’t have intractable pain. You have neuroplastic pain, and we can fix it.”

I thought, “Here we go again.” I did 7 days in the Hahnemann Hospital ICU, 50 milligrams of ketamine an hour, IV, to try to reboot my system. I had a great time, and it felt better for the first month afterward, but then it came back in a rush.

Yeah.

I said, “Here we go again.” I had worked with Mary to help get her through how that was going to work and what the plans were and all that. I said, “Okay, well, let’s start.”

Part of it was cognitive behavioral therapy, and I had to go back to my childhood. I was not well treated as a child, and I was constantly under threat assessment. Threat assessment is the worst thing you can have when you have chronic pain, because you’re always waiting for one cell to have pain, and then all of a sudden it goes everywhere.

They said, “Also, your 42 pain centers in your brain have wired together from all this chronic pain over the years. So any touch feels like pain.” In essence, I was addicted to pain. They had done MRIs on baseball hitters, and they said that the best baseball hitters’ visual, cognitive, and motor cortices light up instantaneously. There’s no latency. That’s why they see the ball in slow motion. That’s why they see how it’s moving. That’s how they hit so well.

“You have a baseball hitter’s brain on pain. There’s no latency in your system. Something touches your arm, and you’re in pain.” So they helped me understand the system. Then they put me through transcranial magnetic stimulation, and they zapped my brain for 30 minutes to disconnect those pain centers. They put me in a virtual-reality lab with a helmet and repatterned my brain.

And it worked.

And it worked. I’m now out of pain.

How long did that take?

It took about 6 months. My first reaction was extreme anger.

Why?

I was so pissed.

Because you had endured it for so long.

And it was my brain. It was all pain in the brain anyway, as you probably well know. It all happens in here.

The second thing I had was incredible remorse for my lack of empathy for people, how I treated people, and how callous I could be. When I was in pain, it was like, “I’ve got to get this done. I don’t have a whole lot of time here to argue with you, so let’s talk about how we get it done.”

I was patient, but I was not tolerant. It should be the other way around. It’s okay to be impatient, but you have to be incredibly tolerant to get things done effectively. I was going through something like the 12 steps of Alcoholics Anonymous. Then I felt like I needed to reach out to everybody and apologize to them and say, “I’m so sorry if I ever treated you in a way that I didn’t intend.”

Then I had to start controlling my emotions because all of a sudden I had them again, as my amygdala dumped out. Your amygdala stores all trauma, and it doesn’t date-stamp it. It sits there until you work it out.

Once I started doing that, I was watching dog commercials, crying, and going, “What the hell’s going on here?” I had to go through all of these emotional and physical changes as part of it.

During that 18-year period, you made a ton of money.

I did.

Talk a little bit about that process. Your story is so crazy. Any one of these stories is crazy; them together is remarkable. But then the fact that you also had this fairly epic run of business success during this time is hard to wrap one’s mind around.

15. Balancing Success & Personal Struggles

I don’t know how to formulate the question other than it’s really interesting to me that during this period of insane pain and difficulty and 1 hour of sleep at night, you were also somehow one of the more successful business people in the country, and you personally made tons of money. How did that happen? Reflect on that for us a little bit.

So, I never worried about the money. When I was 14 years old, I was working with my father in his plant. He was a foreman in a pattern-making plant, and I was painting walls, cleaning bathrooms, cutting the lawn, and doing all this sort of stuff. I was making $1.25 an hour.

I went to high school where we had the 7 a.m. to 12 noon shift, and I was in that shift. I would catch the bus at 1:30, take it down to his operation about 4 miles away, go to work, and ride home with him in the evening. There was this other guy who worked with me, Jerry. He was 24, and Jerry was not the brightest bulb in the pack. He would work with me, but I was always working circles around him.

One day, Jerry and I were having a cigarette out behind the shop at lunch, and Jerry let me know he was getting $4.25 an hour. So I went into my dad and said, “Dad, I work circles around this guy. I want a raise.” He said, “Well, what happens if I don’t give you one?” I said, “I’m going to quit.” He said, “Do you have another job?” I said, “No.” He said, “Good. You’re fired. Go home.”

So I went home, and we had one of these trestle tables. We’d have the meal, and there were 8 of us around the table. The meal ended, I went to get up, and my dad said, “Sit down.” He looked at me and said, “Let me tell you about Jerry. Jerry’s got a family. He’s got a daughter, he’s got a wife, and he’s got a house to pay for. I’m helping Jerry make his payments because he has a family to raise, responsibilities, and he’s doing a job as good as he can, probably not much better than he’s ever going to be able to.”

“So I have an obligation to Jerry. You’re 14 years old. I know we take some of your money to help the family, but you have spending money in your pocket.” I said, “I understand.” He said, “So, do you get why I’m helping Jerry and why there’s a difference?” I said, “Yeah.” He said, “Were you happy before, when you were making money?” I said, “I was.” He said, “Okay. Do you want your job back?” I said, “Yes.” He said, “Okay. You start tomorrow at $1 an hour.”

He cut my pay, and he said, “This is a very important lesson for you. Never count anyone else’s money. Never compare yourself to anyone else based on how much money you have. When you have it, make sure you share it with people who need it when you have enough. Never threaten to quit a job unless you’ve got another one to go to. It’s stupid, and you’re going to have a family one day, and that won’t work really well for your family.”

The money for me was always something that I got as a result of doing good work versus having to have it up front. As a matter of fact, when I became CEO of Aetna, they didn’t change my compensation. They said, “We don’t know you. We’re going to give you a shot for 3 years.” I said, “Okay. At the end of 3 years, I want you to recognize what I’ve done.” I did a lot of good things in that time.

16. Early Lessons in Work & Money

This is my guidance to most everybody who works with me: Your salary pays for the bills, your bonus pays for the balls, and your stock is never to be touched. It’s part of generational wealth. It’s for the future and to help others. When I left Aetna, I had 3 million shares of stock. I never touched them, and I didn’t expect them to ever be at $28 a share because when I took over, it was $9 a share. But it ended up being a lot of money.

The vast majority of it went into a foundation called Anahata, which is the heart chakra in yoga, where I joyfully help food banks. I do environment, education, and community sustainability, and I give away close to 12 to 15 million a year doing that. It’s a great way for the federal government not to get it and for me to use it in ways that I think are more useful than having it distributed through the tax system.

Every year, I do that same thing. Whatever I make, I take a portion of it and throw it into the foundation, and it’ll be generational, from my son to my daughter. I told them they both have a great responsibility to manage something that’ll be generational. But I don’t have yachts, and I don’t have all those other sorts of things.

As George David told me when I first became CEO, George David came over and spent days with me. He sat down and said, “Mark, I’m here to help you.” He said, “You’ve got 2 Sikorsky S-76s here. You know how they work?” And he described everything, the redundancy and everything. He said, “You know how I know that? I walk the floor, and I’m with the workers every day. They know me.”

Anybody who goes on Undercover Boss should be fired by their board of directors. They know me. When George left, he was banged out. In a factory, in a manufacturing plant, when you get banged out, that’s the workers banging on their machines. They never do it for a CEO, but he got banged out because of what he did for that company.

He made 3 times the total shareholder return that the guy at General Electric made, without having a book and crowing on TV every other week. My view of the money part was, it will come. Whatever it is, I have a responsibility, according to my dad, to share it with others and make sure I take care of those who don’t have it.

Money comes naturally as a result of service.

It is. Yeah. The important thing was that every day I woke up and reminded myself that I had 50,000 families at Aetna who relied on me to be a good leader and to make sure that what we did created opportunity for the future.

In my first company, when I started my first company, Sister Joyce Ann Thibodeaux was on my board. Sister Joyce Ann Thibodeaux ran Providence Hospital in Detroit, and Sister Joyce was the ultimate chairwoman of the Ascension Health System. She created the Ascension Health System, Daughters of Charity, and Sisters of St. Joseph.

I went to see her because we were having a for-profit board. A third was owned by management, a third by doctors, and a third by hospitals. I sat down and said, “I just want to make you comfortable with for-profit governance.” She said, “Mark, we don’t need to do this.” I said, “Why, Sister Joyce?” She said, “At the Daughters of Charity, we have 1 very important mission: no margin, no mission. If we don’t make money, we can’t continue to serve our people and extend our services to more people.”

The only difference between a for-profit and a not-for-profit that are well-run is that the for-profit pays taxes.

She said, “Mark, we don’t need to do this.” I said this at an investor conference one day, and I got a moan in the audience. This young lady in the back stood up, took her sweater jacket off, and turned around. She had “No margin, no mission” on the back of her T-shirt. She said, “We believe this.”

Employees.

It’s about creating something that’s valued. I’ve always finished everything I’ve started, and I made it valuable. How it gets valued and how people perceive it is up to them. One of my other sayings is, “What other people think of me is none of my business. It’s their fault. They just don’t know.”

This idea of creating great companies is about building great teams. Sixty percent of my time is spent on people doing great things and solving big problems.

Before I ask the question of why then go do what you’re doing now at Oscar—

Yeah.

—I’d love you to talk about the Bridgewater chapter. This is a topic that this audience in particular will find fascinating. You went to run Bridgewater and helped Dalio try to transition out of Bridgewater. Describe this story for us.

So, I get a phone call from a guy I know, Rusty O’Kelley, at Russell Reynolds, and he says, “You know, I’m on this assignment at Bridgewater, and Ray Dalio wants to talk to you. Would you go see him?” I said, “Wow. Who would not want to have a conversation with Ray Dalio?” He’s such an iconic guy.

I went to meet him, and we were having coffee downtown somewhere here. He said to me, “I’ve got to get out of here. I’m approaching my mid-70s, and I’m trying to create a deal where I can go. But I really worry that the company will go to hell in a handbasket when I’m gone because I’ve been at the table every day, and it’s been largely me running the show.”

“So, I’d like to get the deal structured. I’d like to create a governance model that includes more independent directors, and I’d like to have a management process in the company that knows how to run the business while I’m gone without blowing the place up. I think they’ll just spend everything if they can if I don’t.” He had the typical entrepreneur-founder kind of thing: “If I’m not here, the place is going to just go to hell in a handbasket.”

So I said, “Sure. Sounds fun.”

It was literally a week after I retired.

What year is this?

Fall of 2018.

So I joined in February, and I was provisional as a board member. I started helping build the committee structure and charters, looking at the bylaws, and working the deal. It was chaotic, to say the least.

Here's a firm that trades all this money by computer every day in 200 liquid markets around the world. It's fascinating, right? As I was doing that, Ray Dalio called me one day and said, “You know, I’d really like you to become chairman of the board. I can’t make this transition as chairman.”

So I became chairman of the company, and we started doing more and more. We’d have these marathon negotiating sessions over his exit deal and all that sort of stuff. There was no detail that was too small to consider.

We finalized the deal on July 15 at 4:15 a.m. We had all these people at 4:15 a.m. I was on Zoom, and I had a bottle of Pappy Van Winkle, Batch B, waiting for me to have a toast. We toasted at 4:15 a.m. We got the deal done.

Then I was hanging out in California. I spent time in the winter in California, in Laguna Beach, and I got this phone call. Dave McCormick had decided to run for the Senate in Pennsylvania, for reasons I’ll never understand, but he wanted to do it. We had created a co-chair role and a co-CEO role for the 2 of us, and he called me and said, “Ray wants to talk to you about being the CEO of Bridgewater.”

I thought, “I don’t want to put in that kind of time because I have to learn the business. I don’t know the business like other people do.” But there was a young guy, Nir Bar Dea, a former IDF commando, and he was working there as the underling to Dave McCormick. I said, “Tell you what: I’ll ride shotgun with Nir until he’s ready.”

So we did an 18-month deal, and I did that. The culture is so institutionalized in that organization that causing any changes at the management-process level, in how we worked, was really difficult. People wanted to operate the way they’d always operated. That was a bit of a struggle.

Nir wanted to make the changes as well, but it was really the investors who run the business and make all the money. They call the shots, and that’s how it works in those places. Ray was getting nervous about getting out, and he wanted to do other things, but he didn’t want to be too far away. There were all of those sorts of machinations.

Nir was ready, so I went back to the board. I had been working with Josh Kushner and Mario Schlosser for 3 or 4 years, and in the last year, an hour a week. They said, “You’re not CEO or co-CEO at Bridgewater?” I said, “No, I’m not.” They said, “Well, could you come and run Oscar?”

And why did you decide to do it?

When I left Hartford, I was digging through these boxes and found this small, flat box of acetates. You know what acetates are?

The projection sheets.

Yeah. They have the red cardboard rim, and then they have the clear sheet, and you have words on it or cartoons. They were from 1991. I would do presentations of health reform and what the future could look like.

I had these acetates interspersed with Gary Larson cartoons to prove points, like one person playing chess and the other person playing checkers at the same table. The one I always liked was a bunch of knights standing on the field, half of them with the tops of their armor coming off: “Why do we have to be skins today?” It was so typical of how things get done in the healthcare system in negotiations.

I was looking through them, and I thought, “The Human Genome Project—I talked about it back in 1991. Virtual healthcare—I talked about that in 1991. Individual markets.” I was looking at all these slides, thinking, “Oh my God, we haven’t accomplished anything in 32 years. We’re not making any progress here, and the system’s still broken. Now it’s 20%. Back then it was 14% or 15%. This isn’t going to end well.”

The CVS deal was meant to deal with that. It was meant to create a presence in every local market and get people to come in and have a conversation in the stores that said, “What is it about your health that gets in the way of the life you want to lead?”

I did work with IDEO, with George Blankenship, who built the Tesla dealerships and the first Apple stores. When we talked to people, they didn’t describe themselves as a disease state. I never say, “I’m a spinal cord injury survivor.” I’ve got certain deficits. My handicap went from 12.7 to 21. I had to have my motorcycles modified so I could still ride them. I can’t play the piano like I used to. I was classically trained. My fly fishing—I just can’t tie flies anymore. That’s my problem with my health.

Yeah.

That’s what bothers me. What we found is that most people described it as a barrier to something they wanted to do.

If you could have a conversation with a diabetic who had peripheral neuropathy and say, “What is it about your feet that gets in the way of the life you want to lead?” they’d say, “I can’t go to the senior center anymore and play cards,” or, “I can’t walk to the senior center anymore and play cards,” or, “I can’t take my grandchildren for a walk in the park and sit on the bench without my feet hurting.”

Well, what if we got your diabetes under control and you could do that again? Now you’ve found a point of engagement with a patient or a member that’s far different than saying, “Here’s what a healthy person looks like. You want to be this.” It isn’t happening, and so they give up.

Forty-one percent of the American public actually has this attitude: “My mother died of sugar. I’m eventually going to get it. As long as I can live my life comfortably, when that time comes, I’ll deal with it.” They just give up. So how can we get people engaged in improving their lives and living the lives they want by helping them be better?

And that’s what you get to do at Oscar now.

That’s what I get to do at Oscar now. Oscar’s smaller and more nimble. We’re like this little pirate ship floating around among all these Spanish galleons filled with gold, and they just look at us and go, “Look at that little company. How will they ever make it?” Most of our class of companies that came out when we came out are all gone and didn’t make it, and here we are.

How do you know what to do? I like this idea that the job of the CEO is to know what to do.

How do you know what to do? It starts with the mental heuristic in your head. We all have a model.

I remember sitting next to Bill Taylor, who was chairman of Cigna at the time, and he was talking about all these people he knew. I thought, “I will never know this stuff. How do I get this?” I said to him, “Bill, how do you know?”

He said, “Mark, you have to have a network. You have to constantly cultivate that network, and you have to add to your mental heuristic in your brain.” All of a sudden, new things will happen and you’ll say, “Oh my God, I didn’t see this, but now I see it.” That’s how it happens for me. I constantly educate myself.

I remember Sir Michael Marmot was coming to Columbia University, and Linda Fried, who’s the dean of the Mailman School of Public Health, called me up and said, “I’d like you to do grand rounds with Sir Michael Marmot on social determinants of health.” I thought, “A Nobel laureate. I’m going to walk around with him talking about social determinants of health.”

I had 9 months. I crash-coursed it and talked to all the experts, and light bulbs went off in my head. I thought, “Oh my God, we’re doing this all wrong.” That’s when I came up with the saying that’s now in the lexicon: “Your zip code is far more important than your genetic code.” Where you live matters more than what you are, and that makes a difference.

So we started building programs around that in the home. We had a 72-year-old lady in Camden, New Jersey, with $2.7 million worth of healthcare costs in 1 year and 45 ER visits in the same year—more than 1 a day.

We finally went to her house. Her thermostat was set at 62 because she couldn’t afford her heating bill. She had blankets and sweaters all over the house to keep herself warm, made of her favorite material, angora. She was allergic to angora. Crazy. We bought her new sweaters and new blankets. The next year, 1 ER visit.

Huh?

It was just learning as we learned more. I said, “We’ve got to do more in the home. We’ve got to get connected to the home. We’ve got to be closer to the customer. We’ve got to make things more convenient for them.”

We are now able, thank God, to look at the pandemic in one way: It taught us how we could do this all virtually, a lot better than we thought we ever could.

I worked with Andrew Weil down in Tucson, who, on his way across the country after graduating from medical school, was going to San Diego to open a practice. His car broke down. It was going to take him 6 months to make the money in order to do it, so he started working with the Indian tribes and learned that medicine in this form, as an integrative way, was far better. He stayed there.

I was working with him, and he said, “We don’t do virtual healthcare. We have to put our hands on people.” That changed with the pandemic. “Wait a minute. We can do something different here.”

I think the pandemic taught us a lot of things about how we could virtualize healthcare. Oscar is really a virtual company. We do virtual home assessments and all sorts of other things. Can we deploy that at scale and make it better for everybody?

A big part of the answer to the question is constant curiosity.

Constant curiosity.

Courage was the other part of this. Can you define courage? What does courage feel like in your experience?

Moving forward without perfect information.

I always tell people 99 out of 100 people sitting around a table in a room are looking for somebody else to make a decision. Often, people search for perfect information before they make it, and then it’s too late. It’s a non-decision, which is as bad as anything. So let’s make a decision based on a hypothesis.

So, another medical story. I am at a public health department dinner in Connecticut, and I get food poisoning. I wake up in the middle of the night by myself, and I’m sick for 3 days—really sick. I finally crawl out of the bathtub, where I had just run the water all day long to keep me clean. I went to work, and I realized I had heart palpitations and an electrolyte imbalance.

So I buy Smartwater, and I’m drinking it. After about a week, it’s getting worse. I said to Bev, my assistant, “Bev, get the nurse from downstairs in the clinic and have her come up and look at me.” She comes up and says, “We’re going to get an ambulance and take you over to the medical center.” I said, “You are not backing an ambulance up to this building and putting the CEO in it and going off to the medical center. This will end badly. I can see the stock price tomorrow. Get my driver and take me to my doctor.”

I have this doctor, Dan Chilton. Love the man. He’s a family practitioner in general medicine, and I call him “Doctor, Don’t Do That” because I used to say, “Well, when I roll my shoulder back this way, it hurts,” and he’d go, “Don’t do that.” So I go see him, walk in, and tell him the story. He looks at me, listens to my heart, looks at the bottle of water, and walks out. He goes, “Wait a minute.”

He comes back with a 16-ounce bottle of Diet Coke. He says, “Drink it.” While I’m drinking, he’s yelling at me about how screwed up insurance companies are. “Well, I’ve got you here.” I drink the whole thing, and after about 15 minutes, he goes, “How do you feel?” I said, “I feel great.” He says, “What happened?” He listens to my heart and says, “It’s gone. Let’s do a quick EKG.” It’s great. “Go home.”

He goes, “Stop. What just happened?” He says, “Well, Mark, for my last 2 years of medical school, my father was the dean of the medical school at the University of Virginia, and his buddy was at the NHS in London. He had a son who wanted to come to the United States for his last 2 years of medical school, and he offered a swap for you to go and for me to go and sit in the UK.”

So I worked in family practice in the United Kingdom, where we don’t have all these machines that go beep and all these blood tests that tell us all the answers. It’s based on having a good hypothesis in your brain and knowing how to test it effectively to decide whether or not you’re on the right track, because we don’t have all this stuff.

“So you’ve got 1 kidney, so your electrolyte balance takes longer to reset, especially after you have food poisoning. That’s number 1. It would have been better to get Ringer’s lactate by IV early on. Had you known that, it would have fixed it a lot quicker. Number 2, Smartwater is for sweating. You have a bicarbonate problem. You had a bad gut thing going on, and that’s a bicarbonate problem. There’s no bicarbonate in this, so you’re actually making your electrolyte imbalance worse by drinking the Smartwater.”

“There are 2 great sources of bicarbonate. There’s Perrier. I can’t afford it because you don’t pay me enough. And Coke. I brought you a Diet Coke because you’re 20 pounds overweight. You need to stop. You need to lose weight. You owe me a buck and a half. Go home.” It was $1 for the Coke, and I went home.

But he says, “We’re taught to understand our patients deeply, know the science, do a great history and physical, and come up with a hypothesis and test it.” That’s how I work. I figure out that there’s obviously something wrong, consider the possible ways of moving forward, test a number of hypotheses to find out what’s truly wrong, and then fix it.

17. Reflections on Personal Growth

We talked a lot about the worldview you’ve adopted through all these experiences. If I rewind all the way back to prior to going through what you went through with your son—this first crazy chapter and then, of course, the subsequent chapter—how do you think your experience of the world today is most different than it was prior to that?

If you could sit down and have lunch with the 2000 version of you, how are you most different? What is it like to experience the world after having been through all this craziness?

I always thought when I graduated from the MBA program at Cornell that I knew everything I needed to know about running a business. I didn’t know anything about running a business.

I used to go to Rulloff’s, which is a bar in Collegetown. Cornell has the largest brain collection, and the largest brain they had was Rulloff’s. He was an axe murderer in the late 1800s, killed 7 people, and was electrocuted. They used to take these brains of criminal minds and try to see if there was any relationship between size and shape and bad behavior.

Underneath the computer lab at Cornell, they have this massive brain collection of all these brains. Somehow, Rulloff’s brain got above the cash register in this bar. Thursday nights, I would go to Rulloff’s, drink beer, and party. Friday morning was my class on corporate governance and building organizational structures, which I slept through most of the time. I just wrote a piece of a paper on it, sent it in, and got the grade I needed to get out.

So I never learned all the subtle sciences of social management of organizations and had to learn the hard way. Over time, every night I would get all my material before I went home for the next day. I’d review it all and come up with a point of view on all of it, so that when I walked into the meeting, I was ready to discuss where we go versus having somebody read me PowerPoints.

I tell people, “Do not read me PowerPoints. I will stop you. I have read them, so let’s get going.” I always thought I had the right answers. I’d ask, “How long will it take the people in the room tomorrow to get to the same conclusion I know is the right one?” Then I’d start asking questions to try to steer them to the right answer—leading the witness.

One day, Ron Williams was sitting there. This was in 2003, before the accident. He goes, “You know, it’s really interesting, the way you operate. It’s very transparent to somebody like me, and I would offer you a suggestion. Just try it. Those questions you put together for everybody—why don’t you actually listen to the answers instead of preparing the next question and coming up with 2 more questions as a result of the answer? You’ll be amazed at how much smarter you are.”

Now I know 35% of the time I’m right, and the rest of the time I’ve got to learn by asking questions. It changed my style completely. So I would tell myself in 2000, or the late 1990s, that a lot more humility and a lot more interest in what others think is a far better solution. You’ll get further along and have support for it, because when you tell people what to do and you stumble, the knives come out and you have no hope.

What’s your unfinished business, if any?

I’m going through this debate internally about why I continue to work. What am I looking for? What am I trying to find? I don’t know what it is. I know I’m not afraid of being alone. I love being alone. I’m an introvert by nature. You probably wouldn’t recognize it, but I’m very introverted.

I hate large groups. When I get up in front of large audiences, I’m sick to my stomach. It really is trouble for me. It’s not because I’m not confident in myself. I don’t feel I need to convince others that I’m a good person. I know who I am.

My unfinished business is understanding how I can be much more effective with what I have than trying to accumulate more, I guess, would be the answer. And what is that? It’s my foundation. We’re rebuilding the libraries and the elementary schools in Harlem. We have created a reforestation plan for our 5 boroughs of New York, and we’re planting trees now.

Harlem Grown was 1 little farm, and it’s now 25 farms across 25 elementary schools in Harlem, helping families eat and learn. We have students who go to the farms and work with the children after school until their parent comes to pick them up. They get food, go across to the school, build a meal together, and review homework instead of watching TV with fast food. All really cool stuff.

I’m really proud of all that work, but I’m unsatisfied, and I don’t know why.

18. The Kindest Thing

What have you learned about enduring impossibly hard things? Lots of people have to do this to varying degrees. Yours is extra extreme and extraordinary.

Never waste a good crisis. There’s opportunity in everything that confronts you. I would say—and it was actually [likely Keanu Reeves] who said this—the challenges that come your way, the things that could break you, are really gifts because they make you a better person.

People who have known me my whole life, including my 5 buddies whom I went to kindergarten, grade school, high school, and college with, and whom I still see, could never imagine I would be who I would be, nor could I. My role was going to be to work in the plant, get home by 3, head up to Northern Michigan, to a little place I have up there, hang out, and just be a good dad and make it.

Here I am, and I have all these other things and a lot of wrinkles along the way that have been very disappointing, and things that I’ve done that I’m not very proud of. In the end, every one of them has been a learning opportunity that’s made me a better person.

And that's the person who's coming out of the other side. What I've learned is that every crisis you face, you can't go back. You can only go forward, and you just have to pick up the pieces and start rebuilding.

I've been excited to ask you my final traditional closing question because of your insane story. What is the kindest thing that anyone's ever done for you?

I've had so many people be so kind to me that it's really hard to distinguish one thing. When I was in the hospital with Eric, they gave me an ID badge so I didn't have to go through security every time and get a pass to the room.

There was this doctor, Dr. Gynan, who came up with this treatment. Every time a dark turn would happen, I'd get a phone call from her, and I didn't know why. She wasn't on the floor; she was the head of the program. But I'd get this call from her, and she said, “I'm really hungry. Would you like to share some fries with me over at the McDonald's at the Longwood Galleria?” It was right next to Children's Hospital.

I used to go over there to work out every day. The only time I left Eric was from 10:00 to 11:00 every day. I went to the gym to work out, and they would give him a sponge bath and do all that other sort of stuff for him. She would sit down with me and say, “You're an amazing human being. Here's what I would do next. Don't let them convince you that he's dead. Here's what I would do next.”

It cost her her job as the head of that program. They put her into research because the hospital tried to take him away from me because they thought I was being unrealistically expectant of his potential. I was halfway to Hartford to go get my daughter when the nurse called me and said, “An attorney, the priest, and the hospital administrator are sitting with your son, talking about emancipating him as a minor so he can make his own decisions.”

I flipped around at one of the turnarounds on the turnpike and headed back to Boston at 100 miles an hour, hoping to catch a cop and say, “My son needs me.” Not one cop.

What is it with these cops and you?

Nobody pulled me over. I would have appreciated the escort, is what I was going to say.

I walked into the room, grabbed the attorney, and said, “This stops right now. I'm the adult. He can't apply for it without my permission.” I threw them out of the room.

Ava lost her role as the head of that bone marrow transplant program, largely because it cost the hospital a lot of money to have him in the hospital for a year and a half in an intensive care unit. They tried to get me to do DNRs. They tried to get me to put him into hospice. They just tried everything.

I had a doctor in the cafeteria one day say to me, “Hey, Mr. Bertolini, have you thought any more about that DNR?” I grabbed him, threw him on the floor, and the next thing I knew, I had security all over me. I said, “How dare you ask me that question in the middle of a cafeteria? What's wrong with you?”

Ava put herself on the line for him, and she didn't know anything about him or me. She's still an amazing friend. If there's any one accomplishment I could point to, it's that he's alive because of my engagement and my advocacy for him, and her partnership in it. That's the kindest thing that anybody's ever done for me.

Mark, your story is crazy incredible. I'm so thankful that you chose to tell it with me and for all that you're building and doing. I'm really appreciative of your time. Thank you.

Thank you so much.