Health Care: The View from France…

Chris Wilder, in front of what probably isn't a French hospital.

The British author Terry Pratchett, in one of his early books, has a character describe the concept of “insurance” thusly: “It’s like a bet. You’re betting that something bad will happen to you, and the insurance company is betting that it won’t.”

With that in mind, I spoke with a few folks last week while travelling around rural France. It comes to this: They think we’re just bonkers. The average French citizen keeps well-versed with world news, and they are mystified that so much of Obama’s health care reforms are being challenged, skewered and hostilely vilified. “It seems like if you can afford it”, one wine maker told me, “you get good health care. If not, you have a problem.”

That simplistic assessment is about right, and his next guess was too: “If someone who doesn’t have insurance gets really sick or hurt, don’t you basically have to pay for them anyway?” Well, yes, I told him. We have laws that ensure that if you are having a heart attack and get yourself to a hospital, they will stabilize you.

“Yes, but then what?” My wine maker friend asked.

 “Well, depending on where you live, and whether you can qualify for a government program, you either get follow up care, or you don’t.”

“And if you don’t, won’t you wind up back in the hospital with maybe another heart attack, and then everyone pays all over again?”

Simplistic, and again, true.

I have travelled a lot,” said the wine maker, “and have been called a Communist in some places for supporting the French social medicine. I am surely not a Communist, but ours is a good system. The government pays, we are taxed, and that’s that. Everyone should have good care, and it’s just our way.”

We talked further, and what was clear to him was that our system is more expensive (true) and not as humanistic. Ouch. The truth can hurt, but it helps remembering why I’m so proud to work in Santa Clara County, which has a great public health and hospital system…thanks to our local political leadership and a supportive community. The dedicated team at VMC is even working to solve the problem described above – to offer all needed preventative and follow-up care to the insured and uninsured alike, which is better for them and cheaper for all of us. For much more on this topic, check out the brilliant blog post by Ezekiel Emanuel called “Saving by the Bundle”. It truly reads like what Valley Medical Center is doing – and speaks to the human element of what we’re on about.

Or, to remember Terry Pratchett’s assessment, the French have decided a better wager is for EVERYONE to bet that something bad will happen to SOMEONE, and that since any of us could be that someone, we should all look after our own.

Anyway, it’s good to be home with a head full of memories…and perspective.

Our report to the community…VMC 2.0!



Welcome to VMC 2.0 – the most comprehensive and best-looking publication the VMC Foundation has ever produced.

We’re not just proud of this report, of course…we’re proud of the men and women of Valley Medical Center who spend their lives saving ours every day. We’re proud of the innovations that make VMC a world-class medical center, and probably the finest public hospital in the state.

We’re proud of the fact that, after nine consecutive years of budget cuts, we’re still able to serve our community…and those same nine years have seen the patient population grow and grow.

…but you, alert “Wilderside” reader, already know that.

What you may not know is the value proposition that VMC provides the taxpayers of Santa Clara County – but you will when you see page 33. You may not have seen the breath-taking renderings of our “new VMC” that’s being built as we speak – but you will if you look at 44.

And you may not know what VMC is doing to prepare for health care reform…so please, take a few moments to peruse VMC 2.0. I think you’ll find it a beautiful and educational publication. Let’s face it: Not all the media attention VMC has received this year has been positive…and to be frank, not all has been accurate. This report, in part, helps tell the full story.

A huge thanks to The Health Trust and the Silicon Valley/San Jose Business Journal for assistance in getting VMC 2.0 released, and to PRx Inc. for making it look so beautiful.

As always, if you have questions about what you’re reading, call me any time at 408-885-5299. If what you learn has you considering a donation to support our work, well then we’ve done our job! Thanks so much.

Capping a political week…



Today our Congresswoman Zoe Lofgren paid a visit to Valley Medical Center, a place she knows more about than I do.

That’s because, among other reasons, she helped save it.

Back in the mid-90’s, there were some who wanted the County of Santa Clara to get out of the medical center business. Zoe, a county supervisor at the time, said, essentially, “nope – that ain’t gonna happen” and fought to keep VMC open and available to everyone.

Today, she came to learn about our Medical Legal Partnership Clinic. The alert reader of this blog knows about how we have attorneys from the SV Law Foundation on hand to help our patients with problems that doctors cannot solve. She was really excited about this innovation, and pledged to help us keep the program going.

She’s not the only one impressed by VMC’s creativity.

Yesterday, we had a visit from Michael Blake, who does intergovernmental affairs for the White House. Yes, THAT White House. He was also blown away by what he heard from our team of doctors, nurses, and administrators who never stop thinking about how to serve Silicon Valley better than the day before. Big thanks to Supervisor Liz Kniss who made sure Mr. Blake came to see VMC during his whirlwind tour of Silicon Valley.

Both Michael and Zoe also had a lot to say about health care reform, but to keep from getting TOO political, let me just say that not all the good news about it has made the papers, and not all of it is even worked out yet. I’ll just quote Congresswoman Lofgren who said, about those on the fringes who oppose ANY reform at all: “We’re living on the same planet, but we’re breathing different air.”

Visits like these certainly demonstrate one thing: VMC has a lot to show off, and many of our programs and ideas can (and should) serve as models for medical centers across the nation. Wanna hear more about what VMC is doing? Visit our website and see what’s new!



On the eve of the President’s health care summit, I spent a day in Sacramento with my American Leadership Forum class. We’re a small group, but represent a cross-section of industries at fairly high levels – so we got a high-level look at how things roll at the state-level.

In short, things are NOT rolling well.

Whether you care about health care reform or solving the $20B budget shortfall mess, Sacramento is “broken”. We heard this consistently, starting with Senator Joe Simitian, who painted a grim picture of what he called Hyperpartisanship. “If you even appear to reach across the isle”, he told our group, “you wake up to find you’ve been stripped of committee assignments or that no one will support ANY bill you author – regardless of the topic.”

We met with Possibly-Maybe-Soon-to-Be Lieutenant Governor Abel Maldonado, who agreed. “Used to be,” he said, “that we were Republicans or Democrats when debating on the floor, and then Californians when spending time together after hours. No more.” I agree that he should be confirmed, and that the hold-up is a great example of Simitian’s Hyperpartisanship. It’s also silly. It’s the Governor’s choice, and unless Abel has a screw loose, they should give him the job and move on (his screws aren’t loose; I’ve gotten to know him and although I don’t agree with him much of the time, he’s a good man and incidentally, really loves Valley Medical Center).

Speaking of the Governor, I got to visit his cigar-smoking tent. Yes! No one gets to do that! More importantly, we had lunch with his Chief of Staff, Susan Kennedy, who is one of the most experienced and brightest bulbs in the chandelier. A career-long Democrat, she risked (and lost) life-long friendships when she agreed to work for Arnold Schwarzenegger.

She lost ME only when I asked her if she could provide her opinion of just how the partisan divide grew so wide over the past dozen years or so, as described by every legislator we’d met with that day. Ms. Kennedy shot back that it hadn’t; it’s always been this way, and in fact we’ve gotten lots of great stuff done in the past couple years. I kept myself from reminding her that 2007 was supposed to be the Year for Health Care Reform in California. Other than supporting Obama’s plan, let’s be honest: Schwarzenegger hasn’t shown up for health care at all.

So we cannot even agree on the problem.

Can we agree on any solutions? Possibly.

Pretty much everyone we met with understands that term limits have screwed everything up (I agree) and should be extended or even abolished. We met with many moderate Dem’s and Rep’s who all want the “Open Primary” to pass in June (I’m not sure yet). Pretty much everyone opposes the idea of a Constitutional Convention (me too), and I have to disagree with Assemblywoman Fiona Ma’s suggestion that “Democrats dislike public/private partnerships”. This Democrat doesn’t, and in fact many VMC Foundation successes have come from them.

We ended the day with a final meeting with Joe Simitian, where he handed out hankies to dry our crying eyes. We’ve got to change the system – we all agree. How long has it been broken, you ask? Well, in thanks for reading this far, two quick stories offered by Assemblyman Nathan Fletcher: He was asked recently how he felt about California’s legislature having a 9% approval rating. His response: Who are those 9% and what could they possibly be thinking?

Second, he took us back to the 1850’s and why Mount Whitney is called that. It’s the highest peak in our state, and is named for a geologist/surveyor named Josiah Whitney. When legislators moved the State Capitol to Sacramento, it was to be near and with the railroads. Railroads attracted mucho dinero in Federal subsidies to build track, and building in mountainous regions cost more – and therefore meant the fed’s paid more dollars per mile than those built on flat ground.

Can you guess? According to Assemblyman Nathan Fletcher, our legislature (largely controlled by railroads then) benefitted greatly when Mr. Whitney reported to the federal government that all land east of Sacramento in California was mountainous. Cha-ching! To show their gratitude, our elected officials named our highest peak for Mr. Whitney.

So some things change…and some don’t!

How about some EXTREMELY local health care reform?


Alert readers of this blog remember that Measure A, passed a year ago by the oh-so smart and good-looking electorate of Santa Clara County, provided not just $790M to rebuild VMC, but $50M for health services in downtown San Jose.

So you want progress? Here’s progress – and a huge congrats to San Jose residents and thanks to the team that negotiated this deal…from today’s Mercury News:

Surprise deal for downtown San Jose hospital site
By Joe Rodriguez

Five years after downtown San Jose lost its hospital, Santa Clara County on Tuesday announced a surprising $28.3 million deal for the site in a plan that promises to bring back more than doctors and nurses.

“It gives the downtown a shot in the arm,” said Sam Liccardo, the neighborhood’s city councilman. “I know the community will be thrilled to hear that medical care is coming back.”

Read the full story here!

Mr. Wilder goes to Washington…


…Don’t worry, I haven’t been elected to anything – the country need not panic.

Tomorrow I’m flying to Washington DC, to give a presentation on how social media can help promote your medical center. You are reading this, so you helped…thanks!

Heading to our nations’ capital has me thinking about politics, especially since the health care debate has continued simmering all summer long. Last week, VMC’s executive director Robin Roche was talking to the management team about “the public option” – because that’s what we are, really. And about how Medicare is a pretty successful example of the public option, as is the VA hospital. I took the moment to shout “You LIE!” from the back of the room, Congressman Wilson-style. Everyone laughed, getting the joke, which was lucky because 1) the joke expired pretty much last week, and 2) if they hadn’t laughed, Robin would have kicked my butt.

But we have to laugh at the health care debate…for one thing, finding common ground is harder. From Senator Kyl’s “I don’t need maternity care” to death panels, to “health co-ops” (???)…well, I thought the circus came to town at our gala two weeks ago (see previous post).

My fave, though, came today in the report of House Minority Leader John Boehner’s comment: “The public option is about as unpopular as a garlic milkshake.” Leave it to our own Mike Honda to send him a basket of Gilroy garlic along with a poem praising the public option – and garlic – as being good for you. Congressman Honda admits to never having a garlic milkshake, which has me planning.

I’ll whip one up for him (soy milk, of course) and deliver it next week when I visit the Capital. If you have any unusual deliveries or messages you’d like me to take with me, let me know in the next few hours as I pack. I’ll be preparing for a week in DC by reading Dan Brown’s latest novel on the plane…it’s reputed frantic and over-the-top plot should be just the thing!

Health Care Reform: Just the facts, Wilder…

As the director of the VMC Foundation, it’s not my job to weigh in on our nation’s health care reform debate…but as an engaged member of our community, it is my responsibility to have an opinion.

So, when Congresswoman Zoe Lofgren and PACT (People Acting in Community Together) asked me to speak at their news confrerence last week, I did so, on my own time, and stuck to the facts. Mostly.

But it’s really HARD keeping one’s cool when VMC’s Emergency Dept. is so crowded, or when I see VMC’s Dr. Lee and Dr. Helman work so hard for culturally appropriate end-of-life care, only to have it distorted by those crying “Death Panels!” Can somone please put a tent over this circus?

Anyhow, if you can’t see YouTube at work, send this to your home email. Finally, here’s a letter in today’s Mercury News from my good friend Gary Ater who blogs about issues of the day at American Chronicle:

Health care crisis must be addressed
It’s very disturbing that there are so many Americans misinformed about the country’s health care issues. Every day, more than 2,000 Californians alone lose their health care coverage due to either losing their job or they just flat can’t afford it. At the current rate of increase, for the average family of four, in less than 10 years, annual health care coverage will cost over $22,000.

The “Palin Dunces” who talk about “death panels” and “forced euthanasia” or say that we’re going too fast (after this issue has been in discussion for the last 60 years) don’t deserve low-cost health care. But, if we do nothing, we will still pay double for their health care in America’s hospital emergency rooms.

Gary Ater

Santa Clara