乌鸦传媒

When they made their bold announcement in mid 2018, three corporate powerhouses -- Berkshire Hathaway, Amazon, and JP Morgan Chase -- were going to . They would lower costs and improve quality and overall outcomes for their 150,000 workers.

After all, they had author, innovator, and surgeon , at the helm. It would show the rest of the country and world how healthcare should work.

But less than three years later, the companies acknowledged the effort known as Haven would . Gawande had already stepped down as CEO in May 2020. What went wrong?

In an hour-long Thursday with Robert Wachter, MD, chair of the University of California San Francisco's department of medicine, Gawande provided a post-mortem.

In a nutshell, the concept was fatally flawed, he said, in so many words.

On the good side, he said, the effort accomplished a lot. In its two and a half years of existence, Haven's thought leaders designed a coverage model with no co-insurance, no deductibles, no cost for 60 critical drugs, and low-cost mental health services and primary care.

But the pandemic brought home a critical point. "We have an employer-based system. A job-based system is a broken system in a world where people are moving every couple of years to different roles and many, many, kinds of jobs," he said.

"The pandemic has really brought this out in spades," he said, as the lockdowns cost many workers their jobs, and thus the health insurance that came with them.

"The vulnerability we have of tying your healthcare to your job, that remains still a big hill to climb, and the government has to solve it. That is a public core issue that we still have not faced up to," Gawande said.

A job-based healthcare system, he said, only cares about costs this year, not over the life of the worker. "That's why we have fights over whether we'll pay for a hepatitis C treatment that costs $50,000 and up but avert $1 million in costs over the course of a life. We need that life-course commitment and view, and we have not aligned around that," he said.

That wasn't the only reason Haven is dissolving, however. Making an insurance plan work for three different companies whose employees were in different cities, with different populations and organizational cultures, was a daunting task.

"Once that became clear, then Haven threatens to become a very expensive think tank," Gawande said. The original thought was that it would assume responsibility for benefits management at the three companies, he explained. But it eventually became clear that "didn't have the potential to say we'll take over all of the benefits and running of the insurance for all you three organizations and then add more and more and more and more."

But Gawande doesn't think Haven was a failure. Not at all.

"It definitely did not become what we thought it would be," he acknowledged. But it did give him certain skills and organizational knowledge that enabled him to start a new effort, called , which launched COVID testing efforts in the Boston area last fall and now has major COVID vaccination efforts at Fenway Park and another site later this month.

Gawande has written several best-selling books about healthcare and numerous articles for The New Yorker. from Feb. 8, describes the conflicts in a North Dakota county where politics and resistance to mask-wearing and physical distancing through this fall led to the highest rate of COVID spread and hospitalizations in the country.

He also was a member of the Biden-Harris COVID-19 Transition Advisory Board until last month.

Gawande remains heavily involved in , a research lab run jointly by the Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital that designs and tests healthcare delivery innovations. Gawande, who founded and was former executive director of Ariadne, is now the chairman.

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