A keen mind's thoughts on healthcare reform....
From Intel to Health Care and Beyond
www.nytimes.com
By JOSEPH NOCERA
IN case you missed it, Andrew S.Grove has an article in this week'sissue of the Journal of the AmericanMedical Association. In his 68 years,Mr. Grove has written six books,including a management classic,"Only the Paranoid Survive"; abeautifully rendered memoir,"Swimming Across"; and a new book,published last month, composed ofcase studies that he uses in the classhe teaches with Robert A. Burgelman,a Stanford University professor,entitled "Strategic Dynamics:Concepts and Cases." But it's notevery day that he makes anappearance in an eminent medicaljournal like JAMA.The article, "Efficiency in the HealthCare Industries," was labeledcommentary, but it was more akin toa jeremiad. Mr. Grove took dead aimat the lack of efficiency in healthcare - the amount of time it takes aresearch lab to turn an idea into aworking drug, for instance; and theextent to which medicine lags behindother industries in using technologyto store and retrieve data, to thedetriment of doctors and patients.He compared it unfavorably to anindustry he knows rather intimately,microchips, which has turnedefficiency into an art, thanks in nosmall part to Mr. Grove.The article signaled that Mr. Grove'sobsession with the problems in thehealth care industry, problems hefirst explored in a 1996 Fortunemagazine article about his battle withprostate cancer, has not waned. Itsignaled something else as well: Mr.Grove has been keeping plenty busyin retirement.Did you know that Mr. Grove, one ofSilicon Valley's most iconic andinfluential figures, has retired fromIntel? Well, O.K., retirement may bea bit strong: he still has a desk atIntel, where he describes his currentrole as "internal agitator." (Hisofficial title is senior adviser toexecutive management.) But on May18, at Intel's annual meeting, Mr.Grove resigned as chairman of theboard. For the first time since 1979,when he was named its president,Intel's fortunes are not Mr. Grove'sresponsibility. Although the meetingwas, in part, a public retirementparty for Mr. Grove, the newsgarnered surprisingly little attentionin the East Coast business media.ONE of the great joys of being abusiness journalist over the lastquarter century has been the chanceto listen to Andy Grove. As president,chief executive and finally chairmanof Intel, he would periodically makethe rounds of the business magazinesand the business sections of the bignewspapers, where he would sit in aconference room and take questionsfrom the reporters and editors. Yes,of course, he gave us the Intel spin.But unlike most C.E.O.'s, programmedlike robots to stay on message, Mr.Grove was willing to share histhoughts on all manner of things.With his wide-ranging intellect and hisengagement with the world, hebroadened our understanding oftechnology, strategy, the fall ofcommunism (he escaped fromcommunist Hungary at the age of20), and dozens of other topics.I last sat in on one of his jam sessionsmaybe three years ago, and I'vemissed them. So a few weeks ago, Idecided to bring the mountain toMohammed. I went to visit him inSilicon Valley, to see what he was upto (audio excerpts of my interviewwith Mr. Grove can be downloadedhere).It turns out that he's up to quite a bit."My mind is spinning as fast as it didthen," he said, comparing his new lifeto his old in his mellifluous Hungarianaccent. "But I'm not in meetings allday. I have the ability to pick andchoose what I do, which I never had inmy life. The penalty is that I deal withissues that are mammoth."We met at the office of hisfoundation, which, among otherthings, is financing stem cell research("We are helping to keep U.S. stemcell programs limping along," hesaid), and trying to developprograms that will help people whoare not college-bound acquirevocational skills to allow them to earna decent living.He talked about his quest to findwhat he called "the Rosetta code" forthe health care industry. By that hemeans the development of software"that takes incompatible systemsand translates them into each other,so that one system canautomatically read the other." Hethinks there are few things moreimportant for patients than to haveany doctor, anywhere, be able toaccess their medical records, butbecause the industry is sofragmented, with so many recordsstill in paper form, that is currentlyimpossible.At Intel, most of his time is spent witha new health care group, where hepushes and prods and argues with itsmembers as they try to figure outhow to bring this laggard industryinto the technological age - and withany luck, make some money for Intelin the process.We talked a bit about the centralideas in his new book, which examineswhat happens when a particularbusiness environment suddenlychanges and industries collide, aswhen, for instance, digital technologyturned the music industry upsidedown. Mr. Grove, not surprisingly,had mainly contempt for the musicindustry's early efforts to keep thedigital wave from coming to shore."If the new technology is compellingenough," he said, "it will win out.When the railroads came, Wells Fargowas in trouble. When the printingpress came along, the monks didn'tstay around very long." Music,telephony, media: they've all facedthe same disruptions, and in Mr.Grove's view they are all going tohave to adapt - or else.At the annual meeting last May, helaughingly described the line"Technology will always win" as"Grove's Law."Then he moved to the subject of hislatest obsession: globalization. Will itsurprise you to know that thisrefugee from Hungary, whosecompany derives 70 percent of itsrevenue from places other than theUnited States, is a bear on thepotential consequences ofglobalization on this country? He is."I don't think there is a goodoutcome," he said. "I looked up aquote for you. 'If you don't believethat [globalization] changes theaverage wages in America, youbelieve in the tooth fairy.' Do youknow who said that? Paul Samuelson,age 90."Although mainstream economicthought holds that America's historyof creativity and entrepreneurialismwill allow it to adapt to the rise ofsuch emerging economies as India andChina, Mr. Grove thinks that is somuch wishful thinking. In his view,globalization will not only finish offwhat's left of Americanmanufacturing, but will turn so-calledknowledge workers, which wassupposed to be America's competitiveadvantage, into just another globalcommodity."There is an increasing trend towardslathroscopic surgery being done withrobots," he said by way of example."Once you are doing it with robotics,why do you have to be there?" Theprocedure might just as well be donefrom India. Or China.What particularly bugs Mr. Grove isthat he can't see a way that thiscountry can find the equivalent of adisruptive technology that will allow itto retain is current place atop theeconomic heap. He's always beensomeone who liked to generate big,gnarly solutions that may take yearsto work through, and though it mayseem a tad grandiose on his part tothink that he should be able to devisea way to solve America's globalizationproblem, it is also part of what makeshim such an appealing character."I think Intel and me and the JAMAarticle can move health care a fewpebbles forward," he said. "This lastone, I will be happy just to have somepeople talking about it, and legitimizeit. There are no clear answers."Toward the end of the interview Iasked him whether he liked his newlife. "I love it," he said. "I was veryready for it. I have liked all phases ofmy career. I liked the technologicalside. I liked management. I likeddiscovering strategy." He likes beingable to read history now, somethinghe rarely had time for in his previouslife. He likes not having to worryabout every minute twist and turn inthe technology industry, and how itmight effect Intel.Did that last annual meeting haveany special meaning? I wondered."Nothing emotional happened thatday," he replied. But, he added, hehas been having dreams lately aboutIntel. "It is as if I'm reliving an eventthat happened when I was operationsmanager 25 years ago. It is notspeeches, not limelight, just factoryvisits and arguments, which didn'treally happen. I didn't used to havethese dreams. So I have a lot offeelings."I see a lot of Intel retirees," headded. "They keep company witheach other. There is some nostalgia. Idon't know if it is for the Intel ofthose days, or my younger self."But not on May 18," he said. "Thatwas just a nice event."
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