Esther Dyson on public health policies, COVID, and serving underserved communities

Dyson will be a part of Vator's Healthcare in Politics salon on Sept 8 and October 7

With the election right around the corner Vator and HP will be hosting their latest salon on October 7, called Healthcare in Politics (register for the event here!) where multiple panels of experts, policy makers and lawmakers who will be on hand to discuss topics related to healthcare policy and decision making. 

One of the panels will center specifically around the healthcare policies of the two candidates, Donald Trump and Joe Biden, particularly how they will help underserved communities, who have been hit the hardest by the COVID-19 pandemic.

On hand will be Esther Dyson, angel investor and Executive Founder at Wellville. I spoke to her about how Trump had handled COVID so far, which candidate has the best policies for taking healthcare forward and how to best invest in underserved communities.

VatorNews: Tell me a bit about yourself and about Wellville.

Esther Dyson: I started out as a techie and had a newsletter and conference for 25 years. I was on Wall Street for a while, but where I really learned the most important skills was as a fact checker and reporter for Forbes for three years, back when they had fact checkers. So, I'm really good at asking questions and making sure I understand the answers.

After this long career as a techie, I started being an angel investor and got interested in healthcare. When you look at healthcare, the first question you have to ask is, ‘Why are we spending so much money fixing things that shouldn't have been broken in the first place?’ We're just failing to invest in health. So, the premise of Wellville is that we found five small communities and we are helping them, over 10 years, become places where children can flourish and grow into happy, empowered adults in a place where your race and your income don't damage you before you reach maturity. That's what we're trying to do: it’s a 10-year project from 2015 to 2024. Like everybody, we've had something of a wrench thrown into what the communities are doing but, at the same time, as people have also noticed, COVID-19 and this election and all the crazy things that are going on, if we don't use them to make things better coming out of it, we will have failed. So, the question is, how can we not just fix what's going wrong now but build institutions that will last and make things better for the future? 

The five communities are: Lake County, just north of Silicon Valley; Clatsop County, Oregon, which is northwest of Portland; Muskegon, Michigan, on the shores of Lake Michigan, across from Milwaukee; Worth Hartford, Connecticut; and Spartanburg, South Carolina. They’re all under 200,000 people, and they have some very nice, fairly well off people who are trying to help a lot of poor people. There’s no middle class. In a sense, we're trying to foster health and equity and help the community develop its own agency. We're not trying to empower the community, we don't have that power, but we do want to help the communities empower themselves.  

VN: Obviously the big question is: from a health policy standpoint, how would you grade this administration with regards to COVID? Biden and Trump seem to want to go similar things going forward, like free COVID treatment and developing a vaccine, but how has he performed up to now? 

ED: Pathetic. The challenge is you need to win people's trust, you need to have clear plans, you need to have scientific backing for what you're doing. It's just been a mess. To be fair, it's not just that the administration was pathetic; we have a culture that's suspicious of authority, suspicious of science, suspicious of other people. That's not very good when everybody has to roll together and sacrifice for the common good, wear a mask and just behave differently from what they want for the good of the community. So, it's been a mess. What we needed was leadership that encouraged us to join together and fight the pandemic and what we got was a leadership that pretty much tried to ignore it. 

VN: Healthcare is more than just going to the doctor, and many are not taking a more holistic approach, where the social determinants are just as important. Do you see any policies from Joe Biden or Donald Trump that would help move in that direction? 

ED: I'm not a big fan of the word ‘holistic,’ but I definitely see Biden as somebody who understands that we need to invest in human infrastructure and human capital and human health. That's pretty much lacking in the Trump administration. Public health is everybody's health, and most of what the Trump administration is trying to do is kind of reduce costs in the short term, which is going to dramatically increase both bad health and the cost of healthcare for many more people who will be much sicker in the future. I mean, the reason coronavirus has hit so many black people and people of color hard is because they are in poor health, both mentally and physically. They are undergoing stress, they have diabetes at very high rates, and that's costing the country a lot. If we keep on with those policies, it's just going to get worse, and we're going to be paying huge bills for everything from people who are addicted, people who are unhealthy, people who succumb to COVID-19 or some new pandemic.

Forgive me, I'm not prepared right now to list the policies, and a lot of this is just assumptions, but, basically, the Democrats are much more focused on public education and equity and all the things that will create a healthy and productive society long term.

VN: Biden says he would institute mandatory lockdown/shut down, but this could have negative effects to our mental and financial health. If the scientists say we should lock down the entire country, should we do it? 

ED: If that's what the scientists say, but you want the scientists to consider economics and mental health as well. Both my parents are scientists, science is about the truth and science is about asking questions, but there are short term economic costs and long term economic costs. Again, I think we need to think long term, rather than immediate, short term problems. We need to solve the problem with the schools, we need to provide childcare, both for the teachers and for people who have to go back to work, we need to figure out how to do that. Locking things down can be done effectively or ineffectively, but I'd rather shut down the bars and open the schools. 

There are things you can do, everything from social distancing and creating places for people to meet with good ventilation and so forth and so on. I'd rather put those assets to the benefit of children and families, than to people who want to go to the bar late at night. We do need to understand that, as a nation, we need to sacrifice because we're fighting a war. 

VN: In terms of a lockdown, we did it in a piecemeal way, where you had one state that shut down, and another state that didn't, so people could go back and forth and infect each other. Do you think having a national policy would have been a better approach? 

ED: I mean, it's about having some consistency. It might not be everything locks down, but everything where the positive rating is greater than 1 percent or something. Be consistent about the rules; the rules may vary according to local circumstances but what you don't want is governors fighting mayors and neighboring states having different policies so that everybody crosses the border. It's nuts. And, yes, we need to understand there's some shared sacrifice. 

VN: What do you think of Opportunity Zones? The idea with those is to spur investment into underserved communities. Do you think that’s a good way to help reduce inequality?

ED: Opportunity zones are basically a nice model, where you get tax benefits for investing in underserved communities, but underserved communities do not need luxury apartments or casinos. They need local retail, they need things that will provide jobs. They need actual investment in the community, not just in real estate. So, there's a wide range of different Opportunity Zone projects, we're trying to work on ones that actually are supported by the community and provide space for local clinics or food stores or stuff like that. They're a valuable model that can be used effectively or not. 

I hope that by the time of the event next month, that I'll be able to talk more specifically about one of them. 

VN: On the whole, have you seen Opportunity Zone be beneficial so far?

ED: Not that I've really noticed, honestly. I'm sure there's one or two but it's turned out to be more a tax dodge than a huge force for improving equity, which is unfortunate.  

VN: Republicans want to invest in underserved communities, whereas the Democrats want to bring the underserved into more affluent communities. Which direction do you think has more legs?  

ED: It really depends on how well either of them is implemented. Again, it depends on what local people want to do. I mean, the problem is you need to do this with the local community. In general, I'd much rather see people invest in helping a community, invest in the community, and build value in the community, rather than just say, ‘Well, if you don't like it here you can leave.’ Our mission at Wellville is not to have people leave the Wellvilles and go somewhere else and become successful, it's to help them make their home communities places where kids can be successful.  

VN: It seems to really, as you said, come down to really how it's done. The idea can be good but it's all about the execution.

ED: It is all about the execution but, ultimately, I do prefer to invest in the community, rather than just to say, ‘Well, it's a fabulous community,’ and then send them somewhere else. What will happen is some people will leave and then, for the people who are left behind, it’s even worse. It's just like when you say, ‘the smart kids can go to this special school, but the rest of you, you're gonna be stuck with an even worse school because now there's no money to fund public school in your community.’ 

VN: Education is another part of the social determinants of health. What are your thoughts on charter schools? Do they help bridge inequality?

ED: It's the same answer: they do for some kids. Any school that's a good school, God bless it, but, at the same time, to the extent that charter schools take funding and take the best kids away, they think they can harm a community, even though they helped individual kids. I mean, it's the same thing as these pod schools. It's great that some rich people can take care of their kids and hire a teacher but you end up, again, defunding the rest of the community.  

VN: So, how do you do that? How do you help those individual kids, and not abandon the community at large and the kids who don’t that same opportunity? 

ED: Basically, you stop funding schools locally. Poor communities have no money, and rich communities do fine. This is one place where we just need to change the model. We need more federal funding for local schools, because the local funding is insufficient. Imagine trying to go to school when your WiFi isn't working and you can't hear the teacher. You're tremendously impacted. 

VN: Education ties into COVID as well, with many states struggling with the idea of whether or not to reopen schools. If schools remain closed, does that disproportionately hurt underserved communities? Which candidate is best addressing that issue? 

ED: We have yet to see with Biden but I think we're pretty clearly seeing with Trump that it's not being addressed very effectively. I mean, to be honest, this all should have been thought about much more carefully three months ago. It's like one tragedy impounds another. As someone once said in a different context, they have no strategy, they have only tactics. And it’s short term tactics and uncoordinated and so you can't plan ahead or create a consistent policy across the board. I'm hoping that Biden will do a better job. 

VN: What would you like to see Biden do on a policy level to address inequality?

ED: Assuming that he gets elected, I would like to see a lot more federal funding going to schools to ensure that the families that don't have effective WiFi, that their WiFi is subsidized. That there's attention paid to providing child care so they have a place where their children can be taken care of properly. We can't fix this all overnight but, to the extent we use federal funds, we should be saving the schools before we save the airlines. I mean, big business can take care of itself. Small businesses have more challenges.

VN: Is there anything else you’d like for me to know? 

ED: Policies are great, but there also has to be the capacity to implement them effectively, and to have people who are appointed who actually know how to do the job, to avoid huge amounts of turnover, to avoid all the self dealing we've seen. It's not just the policies, it's if the people in charge of them doing their work effectively.

(Image source: sphweb.bumc.bu.edu)