Esther Dyson, Founder of HICCup

(Music)

Mark Masselli: This is Conversations on Health c are. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, Happy New Year, 2015 . A nother year is over and
a new one begins. The year is beginning with a few certainties. More Americans
are gaining health coverage under the Affordable Care Act. Activity on the state
and federal exchanges has been brisk . D uring the second round of open
enrollment and millions of Americans have either renewed their polic ies, gained
new coverage , or qualified for expanded Medicaid . That’s a good new story.

Margaret Flinter: It is and boy what a far cry for the tumultuous start , we had in
the beginning of 2014 , Mark , when the federal and most of the state insurance
excha nges just were plagued by immediate problems . The problems we
remember led to the resignation of HHS secretary Catherine Sibelius in 2014 ,
and so many challenges for the White House over these botched websit es and
dissatisfied customers.

Mark Masselli: The systems have been recalibrated and are doing what they are
supposed to do and the new HHS secretary , Sylvia Mathews Burwell is hoping
for another 9.1 million Americans to join the 10 million Americans who gained
some kind of coverage last year. It’s e ncouraging to see so many uninsured
Americans find their way to coverages. Well its preventative healthcare , which is
the ultimate goal of the Affordable Care Act.

Margaret Flinter: Well as the New Year rings in, there are some changes that we
will see coming in 2015 , Mark, the funding for the popular CHIP program which
provides health coverage for about 40% of the nation’s children is due to run out
in fiscal 2015. Now while most of these children will qualify for coverage under
the Affordable Care Act , they might not get the same comprehensive and
preventive care that CHIP provides for so that program needs to be refunded by
Congress if it is to continue , and we hope it will be though we know that could be
challenging with the current political scenari o in Congress.

Mark Masselli: You know it’s so vital that there would be a program in place to
protect the health of the nation’s children. We’ve seen how valuable this
program has been for so many of our patients over the years. Some experts fear
that relying solely on the insurance exchange plans, some of which have very
high deductibles would put many children at risk for reduced coverage and many
of these plans simply don’t cover some serious congenital and other co nditions
that affect children.

Ma rgaret Flinter: And we are looking at some uncertainty in 2015 , Mark. The
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Supreme Court is set to hear King versus Burwell on March 4 , a legal challenge

to the Federal subsidies that all set the cost of purchasing insurance for millions
of Americans.

Mark Masselli: I still don’t understand how we are this far into it and that we are
having these significant and serious cases being raised. This one centers
around the simple language and the law of it states that subsidies are only
available to those A mericans who purchase insurance through state based
exchanges. Only 16 states opted to set up insurance exchanges. The rest of the
states rely on the federal exchange for coverage. If the court rules in favor of the
literal interpretation of the languag e, it could threaten the basis for providing tax
subsidies for those who qualify.

Margaret Flinter: The decision expected sometime in June and meanwhile I think
all of us who are engaged in health and healthcare will continue to forge ahead
with these re forms that are really aimed at improving healthcare for all Americans
and that’s something that our guest today is very focused on.

Mark Masselli: Ester Dyson is a giant in the tech arena having been an early
supporter of fledgling startups like Google, LinkedIn , and Flicker. She since
turned her attention to the health arena, investing in programs that improve
health not healthcare.

Margaret Flinter: So Esther has launched a new venture and it’s called ‘The
HICCup’ a five city, five year competition t o see who can incentivize improving
the entire population’s health. It’s a big and bold idea of one of many that she
has had , and she will also be telling us about what innovations and health
technologies look the most exciting to her.

Mark Masselli: Lo ri Robertson, Managing Editor of FactCheck.org looks back at
some of the more glaring misstatements about health policy made in 2014, but
no matter what the topic, you can hear all of our shows by going to chcradio.com.

Margaret Flinter: And as always, i f you have comments, e - mail us at
[email protected] or find us on Facebook, Twitter, Google plus and LinkedIn,
we love to hear from you.
Mark Masselli: And we will get to our interview with Esther Dyson in a mome nt. But first, here is our producer , Marianne O’Hare , with this week’s Headlines
News.
(Music) Marianne O’Hare: I am Ma rianne O’Hare with ‘These Healthc are Headlines. ” It’s
2015 and open enrollment numbers continue at a ripping pace with over six mill ion Americans either reenrolling in a health insurance plan or enrolling for the first time via the state and federal exchanges and millions more are being

covered via expanded Medicaid coverage as well. Hospitals and states where
Medicaid was expanded fa red very well in the wake of the initial expansion. Now
the patients who were uninsured, unable to pay for primary care and most likely
to use the emergency room for all manner of care were now getting paid for their
services. More states are seeing the wisdom of taking the federal government’s
100% coverage of Medicaid expansion during the first three years with several
more states queuing up to do so in 2015. But there was also a provision in the
healthcare law that expanded reimbursement for providers who treated these
newly covered Medicaid patients t raditionally access to primary and specialist
care has been a challenge for Medicaid patients but an ACA provision added an
incentive for providers to add on those patients by increasing their payment, bu t
that provision of the law expired at the end of 2014. Providers are worried their
compensation won’t warrant taking on new Medicaid patients and will cut back in
2015. Community Health Center organizations which are traditionally provided
coverage for this population are expected to see some increased demand and
perhaps longer wait times as a result. Meanwhile there is another consideration
for Americans under the Affordable Care Act that’s going to play out an
accountant’s offices across the country. It is the first year Americans who remain
uninsured will have to pay a fine. Accounting experts are lining up for this new
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agenda by April 15 , and what does it take to keep the average American male
happy. Results of a longitudinal 75 - year study of wh at makes a man happy and
fulfilled as the age has come with some interesting findings. The results of the
Harvard study launched in 1938 looks at a variety of data points including IQ,
political orientation, religious affiliation, alcohol use, childhood e xperiences, even
the size of genitalia to determine predictors of happiness and a fulfilled life over
time. The study had some compelling findings that alcohol abuse and alcoholism
were the leading cause of divorce, broken families , and depression among t he
group, bad childhoods could be overcome, but happy childhoods provided the
best basis for long term coping . M en were often found to find their greatest
satisfaction in life and marriage after age 70 , and the liberals were far more likely
to be sexually active into their 80s than conservatives. You can find all of the
detail in ‘Triumph of Experience’ on Amazon. I am Marianne O’Hare with T hese
Health c are Headlines.

(Music)

Mark Masselli: We are speaking today with entrepreneur, writer, cosmonaut and
health and tech industry Angel Investor Esther Dyson. She is most recently
founder of HICCup.co, (health initiative coordinating council) which has launched
the Way to Wellville, a national contest designed to test new business models for
improving healt h or participating communities while rewarding investors.
Ms. Dyson an inter BA in Economics from Harvard has written extensively on the
health and tech industries including the global best seller ‘Release 2.0’ designed
for living in the digital age. Est her welcome to Conversations on Healthcare.

Esther Dyson: Good morning.

Mark Masselli: And you have been named one of the most influential women in
the tech industry and in recent years you’ve shifted your attention to the
aerospace and health industri es with a particular focus on the production of
health as opposed to healthcare. Well new start ups are bound in the health
space seeking to revolutionize our health systems. Only if you have been
successful and you’ve learnt so much from your deep involv ement in the advent
of the digital age. Can you just share with our listeners lessons learned and
ways that we can truly facilitate the transformation and health of this country?

Esther Dyson: Well the first thing is to make the distinction between heal th and
healthcare. Healthcare is necessary because a lot of people are sick or ill .
(Inaudible 8:40) health over time, y ou often save a huge amount of money
because it's much cheaper if you intervene early , and second because you will
are avoid, you know , it’s just not the cost of healthcare that are painful, it’s also
the fact of being ill. It’s human potential, it’s human suffering versus human
capabilities. So over the years I’ve started to focus more on health itself versus
healthcare and that’s mor e difficult because it’s not a question of giving people a
pill. It’s a question of having people eat more healthily, having them exercise,
yeah all the things we know we should do and don’t but for a lot of people, they
are going to have the choice becau se they don’t have the money, they don’t have
the access to healthy food, the places where they live make it difficult to exercise ,
in a sense the society and moderate conveniences erode people to tempt
towards healthy life. It’s not just getting people t o sit and telling them go out and
exercise. It’s making the good choice is easier and more available and cheaper.

Margaret Flinter: Well Esther, one of the pathways it seems to me that you’ve
taken to improve health or to help our society improve their healthfulness, has
been through Angel Investing and you have logged a impressive set of winners
from the early tech days like Flicker which you sold to Yahoo , E ventful, Meet Up,
Twenty Three and Me and many more , and I understand there are actually
article s that circulate on the internet advising entrepreneurs on how to get their
hands on Esther Dyson’s money. So you’ve obviously got a quite reputation for
yourself in that area and you’ve also said that you don’t invest in anything that’s
been done before which certainly seems to speak to your curiosity and desire to
learn. So maybe tell us specifically what are you looking for in your decisions to
back health startups? Is it the idea itself, the team, the infrastructure, what really
captures your interes t and imagination?

Esther Dyson: I just have to say that m ost in my investing was not focused on
health. It’s now , but the big difference between entrepreneurial investing in Q
DABS [PH] and investing in health which is much more systemic and long term
and you know which generates focus, everything from any kind of employment
opportunity that gives people the way with ultimate healthy lives but in terms of
what I am looking for as an investor, the team is most important because almost
no matter what idea they have, it’s going to change , because they are going to

learn something actually during their startup especially if they do something that
hasn’t been done before they have to go out. There is probably a better way to
do it and if it's a good team, th ey know how to do that and change partly because
they are looking at a vision for the ability of the team to both execute and change
direction as a part is the key . Then honestly you won’t be doing something
interesting and worthwhile . That’s not as comm on as it should be.

Mark Masselli: You know I wanted to get back to your thought about making
good choices easier, so much of the innovations in the healthcare space really
hav e not addressed this issue of culture and I want to tie that also to sort of t his
issue of improving health and thinking about the work of people like Robert
Putnam puling alone this is about the cultivation of social capital and
communities , and so I wonder if you have some thoughts about the challenge?

Esther Dyson: Well there i s the culture of healthcare which is persistent and very
traditionally not when we focus on the patient. We are focused on the system
itself and there is also the short term culture. So people don’t tend to invest for
the long term , and if you tell someo ne this is going to pay out huge, but it’s going
to take five years, many of them just aren’t interested , and it takes time for huge
investments to pay off and that’s another cultural problem we have. It’s a world
of instinct gratification. You can retai l ecommerce companies are now competing
to deliver things within an hour in some large cities and telling someone have to
wait five years to see the thing , it’s crazy but the reality is you get f ix ed slowly
and you get healthy slowly or you stay healthy by investing not by renting and in
a sense people rent their house and undermine it and 10 years later, they wake
up and they can't run, th ey weigh too much, they are pre - diabetic or whatever.

Margaret Flinter: Your latest venture is called ‘HICCup’ an acr onym for Health
Initiative Coordinating Council , and it’s based on the promise that you shouldn’t
have to be lucky to enjoy a normal, healthy life , and we would love to hear about
your competition that you have launched through HICCup called the ‘Way to
We llville’ with communities across the country that have some evident support
over a health matrix participating in this experiment create a new model for better
health across the whole population.

Esther Dyson: It’s a nonprofit and the purpose of it is to help these communities
and people around them invest long term in health and some of the investments
will be financial for financial returns, some will be government spending, using
social impact on to help the government’s big fat spending in a long term way.
So it’s five communities that are already trying to become healthy , and we at
HICCup are helping them see their health and healthcare initiatives as something
long term telling them to (inaudible 14:03) more as a n investible sustainable
projects, we are trying to get them to look at the outcomes okay. What happened
to the level of obesity in your community? What happened to the high school
graduation right , as the percentage of obese fifth graders are going down
[Background Noise] what’s the level of transitions today (inaudible 14:20) in you r

communities. So traditionally philanthropy has been really nice , and it’s has
been focused on what you are doing for the community. So we are bringing and
invest your mindset even to if you like public inves tment or philanthropy , and we
believe that doing this at scale in five small places will show that it works
because as you know a lot of so called health initiatives, they are really nice but
they don’t have a lot of impact. If they didn’t, we wouldn’t ha ve the health prices
we have in the country at this point.

Mark Masselli: We are speaking today with entrepreneur, writer, cosmonaut and
health industry Angel Investor Esther Dyson. She is most recently founder of
HICCup, (the Health Initiative Coordina ting Council ) which has just launched a
national competition ‘The Way to Wellville’ to foster innovation and investment in
community wide health improvement. And so, let’s take a look at some of the
disruptive technologies that are poised to transform hea lth in the broad arena.
We had (inaudible 15:13) in our show and he is a proponent of making tiny
changes that can yield big improvements overtime , and could you talk a little bit
about expanding the potential of the quantified health movement and
gamific ation as influencers in the production of health?

Respondent: Okay. It’s really important to make this point that just getting
everybody is fit to will not help , if they don’t have access to healthy food, if they
can't get to the clinic, if they can't g et to work because they don’t have transit. So
I mean I love (inaudible 15:49), I love quantification, I think it ’s very helpful, but
it’s also like first world solution. Health is not simply a question of oh these
people need more self discipline. They need access to what the people who can
afford to have easy access to. That said, understanding what your body does
and tit bits [PH] and the like a job owner are getting much cheaper and more
accurate , and it gives you a better sense of what’s really goi ng on and you have
a speedometer in your car why can't you see something equivalent for your body
and that might help you think about maintaining it better . What is interesting
about gamification is that people are different and part of the trick is going to be
figuring out . S ome people are motivated by collaboration , you know , run with
your friends. You and Suzie and the rest of the team can hit the goal of 10,000
miles. Other people are motivated by competition. You can beat Fred, this is
Fred’s numb er, surely you can do better than that. Some people like financial
incentives. Some people like status to give you out which of these triggers works
with which individual is an important part of making this all work.

Margaret Flinter: And Esther , I wou ld like to dwell a little more deeply into this
“Way to Wellville ’ q uest in that context , and I think my questions about the
interface between the individual focus as we are just discussing and where that
meets up with the policy people at the community le vel or the government people
at the community level and I am , you know , Mark and I am thinking about when
we had Mayor (inaudible 17:16) from Summerville with us a couple of years ago
at our WISENET Symposium , and he used a couple of examples in his small but
densely populated town of the kinds of investments and the two things that really

stand out means it doesn’t cost a lot to buy some white paint and create some
bike lanes in your community, cost more to dig up asphalt and in some parking
lots and make t hem parks , but you add these things up and on the one side,
there is the policy government people doing what they can to advance on the
other side, I will be really curious in these communities as you look at them due
to expect to see or hope to see those sort of two groups coming together, the
individuals and the community and the people who have the opportunity to do
some of that infrastructure work?

Esther Dyson: Yes absolutely. This is what we are hoping to see more of bike
lanes are great , and the b uilt infrastructure but in addition, the people will go to
park and ride the bikes, making changes complicated because it’s you have to
train the kitchen workers, yeah as a kitchen worker I will not only try to be serving
children food that I knew was good but you also have to change the equipment,
you have to renegotiate with your suppliers, you may have yeah some five - year
contract. So this is the whole point which is exactly what you said. It doesn’t
cost a lot , but it takes a lot of effort to make the change to renegotiate contracts,
to get the political buy in because when you paint the bike lanes, some of the car
people are going to object and you need a community wide effort and you need a
complementary thing. You change the food in the schools, no w you also want
the wending machines as a wider change; local grocery store to start selling
vegetables , so that the kids may learn how to cook at school can come home
and their parents can buy the same vegetables so that they can , it’s a
combination of th e community leadership with some of the people, some of the
people I would say they are not going to be interested , but if you change what’s
happening around them, they may get just dragged along and as you know bad
health is contagious so is good health. So even the people you don’t reach
directly are going to be living in a different environment that can make it easier.

Mark Masselli: Thinking about your statement of bad health is c ontagious, so
(inaudible 19:31) at Harvard who is mapping out a social scientist - diabetes,
obesity and sort of looking at sort of the contagion that sort of exist in networks
and thinking about networks because you have been thinking about things in this
next larger context. It’s not the fit bed, it’s the sort of system ar ound that . I
wonder if we go one more context outside of it and it’s really about the social
network that you are in , and I wonder how you can be disruptive in that because
everything else is kind of interesting but it turns out to be that if I don’t have any
friends who have this behavior, I mean, not be influencable and I usually cultural
changes about how my peers and others, my larger network relate to these set of
issues and that may be above all of our pay grades in terms of initiatives and we
work w ith you know special population, so 130,000 people they are all 200% of
poverty and below but we spend a lot of time on thinking about ways to cultivate
healthy social networks for people , i n addition to making sure the infrastructure is
in place.

Esther Dyson: Yeah. You know in the end you can't barge in on people and
change their lives , but if you can get some people in the social network, they will
influence the others. There is no magic. You have to try and try until you reach
some kind of tipping point, sometime it works, sometimes it doesn’t , but clearly
again if you change what’s going on with the life, some people will be influenced
and they will influence others. You have to start somewhere and you never know
where the best place is to start , but if you attract some people, they will help you
attract more , and the laggards may eventually finally caught up , leave up this,
and an example actually is of for profit investment that’s the very key in this
building of social infrastructure and helping people to do everything from learning
together to just the kind of social fellowship (inaudible 21:43) simply being with
other people and having friends statistically leads to better health or less bad
health. People are social animals and being isolated alone is probably the worst
thing you can do for your health.

Margaret Flinter: Esther , we have often asked this question to our guest. But it’s
been a while since we have and I think you are a great person and this is a good
opportunity to get your pe rspective, considering all of the eyes that you have out
there on the leading edge of what is going on, when you look around the country
in the world, what do you see as the real possible breakthroughs in health that
our listeners at Conversations should b e keeping an eye on?

Esther Dyson: Probably the biggest breakthrough technologically t hat’s coming
is going to be non - invasive blood analysis, biomarker detection , you know , real
time glucose monitoring that doesn’t require you to prick your fingers. So
whether it’s (inaudible 22:52) , there is a bunch of these and again the ability to
see in real time the impact of your behavior whether it’s I went for a run and it
was good for my blood sugar or if I do not , oh my God disaster. That both helps
you manag e and helps you understand what you are doing. So for everything
from detecting cancer , I mean , there is a lot of different things we can detect in
people’s blood, everything for knowing gene you know maybe I should get a
colon cancer screening to my bloo d sugar i s persistently a little higher than it
should be, that’s probably the biggest technological thing that’s coming down the
path right now. You know there will be this drug and that drug for this disease or
that disease , but for overall blood based h ealth, it’s going to be simply much
better analysis with biomarkers.

Mark Masselli: We have been speaking today with Esther Dyson, entrepreneur
Angel Investor and founder of many companies including HICCup.co. You can
learn more about that by going to h iccup.co or follow her on Twitter at edyson.
Esther , thank you so much for joinin g us on Conversations on Healthc are today.

Esther Dyson: Thank you very much and we are in the middle of a Happy New
Year , and I hope everybody remembers their New Year’s re solutions and
continue s to follow them.

Mark Masselli: That’s right.

Margaret Flinter: Absolutely.

(Music)

Mark Masselli: At Conversations on Health c are, we want our audience to be
truly in the know when it comes to the facts about health care reform policy. Lori
Robertson is an award - winning journalist and Managing Editor of FactCheck.org,
a nonpartisan, nonprofit consumer advocate for voters that aim to reduce the
level of deception in U.S. politics. Lori, what have you got for us this week?

Lori Robertson: Let’s take a look back at some of the offers of 2014 on
healthcare. In the midterm elections, we saw plenty of ads designed to scare
seniors about Medicare. Democratic ads claimed Republicans would end the
Medicare guarantee , a misleading re ference to the candidate support for
Representative , Paul Ryan’s Medicare plan. Ryan’s plan wouldn’t end the
guarantee of Medicare or Medicare benefits as these ads claimed. Instead it
proposed phasing in a g overnment subsidiary program in which future
b eneficiaries from traditional Medicare or private insurance plans which must
offer the same benefits as traditional Medicare. Republicans meanwhile
continued to push the old misleading claim that the Affordable Care Act would cut
Medicare by 716 million d ollars. That’s a reduction in the future growth extending
over 10 years got a slashing of the current budget. There were also many claims
about premiums sky rock et ing under the ACA. In fact, employers part of
premiums where most Americans have coverage have been growing at
historically low rates in the past few years. President Obama meanwhile
continued to tap the historically low rate of growth of healthcare spending. It’s
true that the total healthcare expenditure since 2009 , have grown at the lowest
rates since the data was first complied in 1960. But Obama implies that the ACA
caused that slow growth and experts say well the law may have had some
impact, the growth rates are mainly due to the slow economy. And that’s my
Fact Check for this week. I am Lori Robertson, Managing Editor of
FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country's major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like
checked, email us at chcradio.com, we will have FactCheck.org's Lori Robertson
check it out for you here on Conversations on Health c are.

(Music)

Margaret Flinter : Each week, Conversations highlights a bright idea a bout how
to make wellness a part of our communities and everyday lives. At one point in
the early 2000s, Oklahoma City was one of the most obese cities in the nation, a

fact that was not lost on the city’s Mayor , Mick Cornett , who too (inaudible 27:07)
le arned that he was in that group.

Mick Cornett: I finally decided I needed to lose weight , and I knew I could
because I have done it so many times before. So I simply stopped eating as
much. I had been eating 3000 calories a day , and I cut it to 2000 ca lories a day
and the weight came off. I lost about a pound a week for about 40 weeks.

Margret Flinter : A decision to lose weight led him to examine what was causing
the high obesity rates of his city’s residents and he learned that development
since the 1970s have removed much of the city’s walkability in favor of cars.

Mick Cornett: We had built an incredible quality of life, if you happen to be a car.
But if you happen to be a person, you are combating the cars seemingly at every
turn.

Margret Flin ter : He took two approaches to the problem. He launched the ‘Okay
See Million Program’ inviting Oklahoma City residents to an ambitious weight
loss challenge to lose a collective million pounds.

Mick Cornett: I decided that the first thing we needed to do was have a
conversation. You see in Oklahoma City, we weren’t talking about obesity and
so on New Year’s Eve of 2007, I went to the zoo and I stood in front of the
elephants and I said, “This city is going on a diet and we are going to lose a
million pounds.”

Margret Flinter : In addition to that challenge, he urged city planners and
developers to improve the city’s walkability , first around the city’s dozens of
school zones and then throughout the entire city.

Mick Cornett: We added New Central Par k 70 acres in size to be right downtown
in Oklahoma City. We are building a downtown street car to try and help the
walkability formula. We are building Senior Health and Wellness Centers. We
put some investments on the river , and now we are currently i n the final stages of
developing the finest venue in the world for the sports of canoe, kayak , and
rowing along with intercity programs to get kids more engaged in these types of
recreational activities that are a little bit nontraditional. We also are bu ilding
hundreds of miles of new sidewalks.

Margret Flinter : Since the issue just challenged a million pounds have been lost
and participants have walked or run a collective 1.2 million miles. The average
participant lost about 12 pounds , but when you fa ctor the tens of thousands who
participated, what a significant public health improvement in a relatively short
period of time. The ‘Okay - See Million Program’ where a city leader took an
entire population on a weight loss challenge, improving the infras tructure,
providing leadership and incentives to facilitate that challenge and ultimately

improving the health and impacting the obesity epidemic throughout the city’s
population in the process. Now that’s a bright idea.
Margaret Flinter: This is Conver sations on Health c are. I am Margaret Flinter.
Mark Masselli: And I am Mark Masselli. Peace and health.
Female: Conversations on Health c are, broadcast from the campus of WESU at
Wesleyan University, streaming live at Wesufm.org and brought to you by t he
Community Health Center.