Thinking of our constant push to deliver “health as it should be,” I keep coming back to two memes that I think should be brought together.
First, most everyone is familiar with the legendary speech from President Theodore Roosevelt when he described the Man in the Arena:
It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows the great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.
What has always struck me about these lines, and why they resonate so deeply with me, is that anyone that has “nobly ventured” to build a company is faced with a million reasons why their venture cannot succeed. Some reasons are due to the sheer difficulty or audacity of the task, the length or dangers in the journey, or the relative value and ultimate worth of the prize related to the cost and the sacrifice required to obtain the objective. The journey is “performed” in the open arena, often for all to see and judge, and there is a certain “sport” in how the game is played that attracts a very public audience. The countless jeering spectators, comfortably cat-calling from their seats, whose only commitment and contribution to the event consists of intermittently raising the ambient noise—they are definitely not who the entrepreneur is playing for. And, the sooner you learn this as an entrepreneur, the faster you will be able to tune out the noise to focus on the craft at hand and the better you will perform.
If you ask most founders, they will often tell you that if they had known the type and duration of the desert they were required to walk through, they are not sure they would have ever started the journey. However, I’ll bet those same people who have traversed and travailed would say they would do it all over again and again and again. Standing open in the arena, “marred with dust,” and often fighting for survival is tough enough. Having the jeering crowds, the healthcare dandies, and the related assortment of “voluptuaries” evaluating your every move but never lifting a finger in the real work…that’s just plain irritating at best and bitterly ironic at its worst. But, this is part of what is required, as well as what is the reward to “have put forth all their heart and strength” to venture forward while avoiding the shadowlands that “knows neither victory nor defeat.”
The second, maybe less familiar, but no less impressionable, is the scene of the fictitious Maximus Decimus (portrayed by Russell Crowe) from the film Gladiator. Having been forced to sacrifice everything, having been thrown into the arena, and having been pushed to the extremes, he silences the crowd not only with his undeniable skill, but with his even more potent defiance. Having defeated all the enemies—all the fears, all the doubts, and every foe—he challenges the crowd with the callous castigation, “Are you not entertained? Is this not why you are here?” The furtive looks of the equally shamed and silenced crowd is a near perfect cinematic moment.
The day-to-day drama of evolving a fundamentally different healthcare delivery model with a sustainable health payment approach is much like a contest of wills being played out in the arena. I hear the crowd chanting for “value-based care” when what they really want is just another veiled wrapper on a fee-for-service stand-in. They came to see red after all, and even the red ocean filled with decades of fee for service failures, does not seem to slake their thirst for “more of the same.” The year 2022, however, is not the time for incrementalism. Instead, we need to “dare greatly” to acquire the willpower to pay “more and different” for foundational primary health. The evidence for comprehensive, integrated, and accountable Primary Health models are overwhelming, and yet I wonder when the crowd will ever catch on that “you get what you pay for.”
The innovation game in many ways is a fight to the literal death of businesses, of business models, of financings, of endurance, and is a contest full of dust, blood, sweat, and tears. Like Roosevelt said, “It is war-worn Hotspur, spent with hard fighting, he of the many errors and the valiant end, over whose memory we love to linger, not over the memory of the young lord who ‘but for the vile guns would have been a valiant soldier.’”
And, to my fellow gladiators, from someone who considers himself one as well, much respect to you no matter the outcome. Keep fighting for the future of healthcare and health as it should be. Spitting and moving on!
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This writing from TR is so good I am including some bonus material:
Shame on the man of cultivated taste who permits refinement to develop into fastidiousness that unfits him for doing the rough work of a workaday world. Among the free peoples who govern themselves there is but a small field of usefulness open for the men of cloistered life who shrink from contact with their fellows. Still less room is there for those who deride or slight what is done by those who actually bear the brunt of the day; nor yet for those others who always profess that they would like to take action, if only the conditions of life were not exactly what they actually are. The man who does nothing cuts the same sordid figure in the pages of history, whether he be cynic, or fop, or voluptuary.
There is little use for the being whose tepid soul knows nothing of the great and generous emotion, of the high pride, the stern belief, the lofty enthusiasm, of the men who quell the storm and ride the thunder. Well for these men if they succeed; well also, though not so well, if they fail, given only that they have nobly ventured, and have put forth all their heart and strength. It is war-worn Hotspur, spent with hard fighting, he of the many errors and the valiant end, over whose memory we love to linger, not over the memory of the young lord who “but for the vile guns would have been a valiant soldier.”
Scott Shreeve, MD 