Growing up, I attended pain-management conferences with my father. It was, improbably, how our family vacationed.
He was a physician and an early leader in pain medicine. His purpose was straightforward: teach other doctors better ways to treat cancer pain. He shared new evidence. Clinicians learned. Patients suffered less. Whether it worked as well as he hoped, I cannot know. But the line from the meeting to the mission was clear.
I have spent my own career at healthcare conferences — as a physician, a policy adviser, an executive. I have spoken on countless panels. My company sponsors meetings and sends employees to them. I am not an outsider to conference culture. I am one of its beneficiaries and one of its producers.
Healthcare has a convening reflex. We recognize a problem and our instinct is to assemble people to discuss it. A summit. A commission. A roundtable. Another panel. Then we convince ourselves that convening is acting.
Sometimes it is the beginning of action. Too often it is where action ends.
I could name conferences here. I won’t, and the reason is not high-minded: I speak at them, sponsor them and depend on the relationships they produce. That reluctance is part of the problem.
We gather in chandeliered ballrooms to discuss how expensive healthcare has become. We hold panels on inequity from stages few patients could afford to approach. We lament burnout, invoke transformation, applaud a moving patient story — and then retreat to invitation-only dinners with expensive wine, seated beside people whose institutions profit from the arrangements we spent the day condemning.
The next year we reconvene and say the same things.
In my forthcoming book I describe a moral alibi as a true statement that does false work. “The system is broken” is true. It also excuses each of us from examining the part we control. Physicians blame insurers. Insurers blame hospitals. Hospitals blame pharmaceutical companies. Pharmaceutical companies blame pharmacy benefit managers. Everyone has evidence. Everyone is partly right. And everyone locates the greatest moral failure outside their own walls.
Conference culture gives this ritual a stage. That is what makes these gatherings emotionally satisfying and operationally inconsequential. We denounce waste without naming whose revenue depends on it. We celebrate value-based care without admitting how little financial risk has actually moved. We talk about equity without asking whether our own policies deepen inequity.
Convening can be valuable. It is not, by itself, progress.
The problem in healthcare is rarely that nobody knows what is wrong. We know patients cannot understand their bills. We know clinicians spend more time documenting than caring. What is missing is not another articulation of the problem. It is ownership of it.
So let me own something.
The invitation-only dinners I just described are not something I have observed. They are something I host. I have sat at the head of that table on the same evening I spoke from a stage about affordability, and felt nothing more complicated than the pleasure of a good night with people I like. The wine was expensive. The conversation was excellent. It did not occur to me until much later that this was strange.
This year we committed to plainer corporate events and tighter entertainment budgets. That is not courage. It is the cheapest concession available to a health plan, it took years longer than it should have, and I made it only after admitting we had been keeping up with the Joneses rather than trying to be good.
I have not stopped hosting the dinners. I have only made them less expensive. That is the honest shape of most reform in this industry — including mine, including the reform I will spend a book recommending to other people.
I should say what comes next, too. When the book publishes in February, I will spend a year on exactly the stages I am describing here. Some of it will serve the ideas. Some will serve sales. I do not always know which is which, and that difficulty is the problem itself.
A better conference culture would close the distance between the stage and the Monday after. Make speakers describe not what they believe but what they have changed. Deplatform the perpetual pundits who move effortlessly from topic to topic with little progress to show for it — a description I am not confident excludes me. Make panels on affordability name which revenues participants are prepared to give up. Ask every gathering for a few concrete commitments, and open the following year by reporting back. What policy was eliminated? What process got simpler? What incentive changed? What failed?
My father went to conferences believing knowledge could relieve suffering. That faith was not misplaced. Medicine advanced because clinicians shared discoveries, challenged one another and brought new practices home.
But our greatest problems now are not failures of knowledge. They are failures to act on what we already know. Conferences can help us name them. Books can help us understand them. Neither should be confused with fixing them.
The next time we gather to declare that healthcare is broken, each of us should arrive prepared to answer a harder question: What did I personally stop doing that was helping to break it?
Sachin H. Jain, MD, is president and chief executive officer of SCAN Group and SCAN Health Plan
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