“Shift Left” — Andy Grove Takes on Health Care

Andy Grove is one of the smartest business minds in America. His 1996 book, Only the Paranoid Survive, is a business classic I have found deeply helpful. He introduced the concept of “strategic inflection points” (which I’ve heard Romney use several times) when the choice becomes: change the fundamental model and prosper or don’t and die. Grove is now getting interested in health care, as today’s Wall Street Journal column indicates. His ideas or often riveting, and whether he’s right or wrong, he’s definitely worth hearing.
John McDonough

PORTALS
By LEE GOMES
Andy Grove Enters New Post-Intel Role As Activist Capitalist

It’s a busy week for Andy Grove, even by his normally hectic standards; this lion in winter still holds sway over a sprawling pride. While no longer on its board, Mr. Grove remains an informal adviser to Intel, where he was CEO for many years. Tomorrow marks the official publication of a new biography, by Harvard historian Richard S. Tedlow. And tomorrow night, in a speech at Stanford University, he will present his ideas about reforming one corner of health care in the U.S.

His prescription is for medicine to “Shift left.” The advice has nothing to do with the traditional political spectrum, though some of Mr. Grove’s business chums do think that at 70 years old, he’s going liberal on them. Instead, it involves applying lessons from the history of the computer industry that Mr. Grove himself helped write.

He talked about all this last week in the exceedingly modest offices of his family’s charitable foundation, located about 15 miles from Intel’s headquarters. His involvement in health care isn’t new; Mr. Grove endured a very public bout with prostate cancer 10 years ago. But his current work has little to do with the “Please-I-don’t-want-to-die” school of philanthropy, in which gazillionaires fund diseases with which they are afflicted. Instead, Mr. Grove says he is alarmed by several structural issues involving health care in America, notably, the huge number of uninsured, who are often forced to get primary care in emergency rooms.

To explain “Shift left,” Mr. Grove describes the bottom axis of a scale in which products and services grow more full-featured, complicated and expensive as you move to the right. To “Shift left” on this scale is to, in effect, “Keep it simple, stupid.” Specifically, Mr. Grove is a big fan of low-cost, walk-in clinics, the sort beginning to appear in stores like Wal-Mart. He says they provide basic medical care for the uninsured, and also take some strain off of America’s overloaded emergency rooms. But one thing missing from this emerging clinic infrastructure is a good system of medical record-keeping. Mr. Grove, naturally, thinks technology can help. But rather than designing an elaborate and technically sophisticated medical-database system, something practically every tech company is now trying to do, Mr. Grove suggests the exact opposite. Shift left; keep the record of a patient’s visit in, for example, a generic but Web-accessible word-processing file.

Just like the early personal computer, it will be far from ideal, but it will be a start, and it can get better over time. The alternative, he says, is to wait endlessly for a perfect technology. Students of business history will recognize the idea of a plain-vanilla medical record as an example of a “disruptive technology,” which is initially opposed by powerful incumbents with a vested economic interest in shifting ever-rightward. So which powerful incumbents might oppose him now?

“Intel, for one,” Mr. Grove shoots back. His old company, he explains, has become fully invested in backing complicated, expensive systems for medical records. In fact, Mr. Grove says with a sigh, he has trouble getting former colleagues to buy into his ideas on health care.

Mr. Grove is involved in a political effort, too; it may indeed be his first fit of social activism. With venture capitalist John Doerr, he is helping fund FirstFreedomFirst.org, which is trying to collect a million signatures to support the First Amendment’s separation of church and state. Some of the concerns of First Freedom First are, at least by the standards of Silicon Valley, safe ones, notably support for stem-cell research. Others are a little edgier, like the teaching of creationism and restrictions on reproductive health.

This is where it gets personal. Mr. Grove has a mild form of Parkinson’s, and his right hand often shakes as he talks. (He got nearly speechless with rage when describing the recent attacks on his friend and fellow Parkinson’s sufferer, Michael J. Fox.) Mr. Grove has never been associated with the pro-Democratic wing of Silicon Valley, and he denies he is joining it now. His politics, he says, are those of a “rational capitalist.” They are also, he says, those of the eternally grateful immigrant.

Mr. Grove arrived in America from Hungary after the 1956 uprising, and he says he is greatly saddened by what the health-care crisis and the divisive use of religion are doing to the American middle class, which for him is the essence of the country he loves.