Calling Up Nashville’s Healthcare Leaders

Over the last five years, I’ve received an immersive education in the business of healthcare, and I owe that to the city of Nashville. While Nashville presents the brand of Music City to the world, the initiated know that the city’s largest economic sector is healthcare. Healthcare in America has three major segments: Pharmaceutical companies, insurance companies, and healthcare services companies. Nashville’s strength is in healthcare services.

According to a study conducted by the Nashville Chamber of Commerce, released in September 2018, the Nashville healthcare industry had a $46.7B economic impact on the city that year. When you look at coverage across the United States, no city’s industry cluster owns and operates more hospitals, physician groups, ambulatory surgical centers, and behavioral health centers than Nashville. In that way, Nashville is a central player in the US response to COVID-19, as well as the state of the US economy, as health systems are the largest employers in most towns across the country.

The history of Nashville’s healthcare dominance starts with Thomas Frist Sr. and Jr., and Jack Massey co-founding Hospital Corporation of America (HCA) in 1968. HCA has grown to become the largest healthcare services company in the US. Over the last 50 plus years, HCA has spun off, either directly or indirectly, hundreds of very successful companies. The city of Nashville has significantly benefited from the strength of its healthcare industry.

While HCA was being founded in 1968, Interstate 40 was being built directly through North Nashville, significantly impairing Nashville’s Black community’s ability to prosper. And the most iconic civil rights leader in the history of the US, Martin Luther King Jr., was assassinated just three hours away in Memphis. Nashville’s healthcare industry was launched in an era when America was openly racist in policy and practice, especially in the South.

Healthcare is the largest sector of the US economy. According to the Centers for Medicare and Medicaid Services, in 2018, healthcare spending represented 17.7 percent of the GDP. There is more money spent on healthcare than any other area of the US economy. As a result, Nashville’s healthcare industry has produced multiple billionaires and many, many millionaires. Enough to fund three country clubs with spare change, one of which I’m not allowed to join.

Over the last five years, I’ve become friends with several CEOs and Presidents of large healthcare companies. The fund I co-own has worked to raise money from successful healthcare businesspeople (with limited success). I’ve been invited to become a member of the prestigious Nashville Health Care Fellows, and notably received a scholarship for participation in that program. And (I believe) I hosted the largest homegrown healthcare conference in Nashville’s history.

I say all that to say that I know quite a bit about this industry, and I know a good number of the people who lead it. I genuinely call many of them friends. I see them as people who want to do the right thing.

That’s why after a long week of fielding calls from White friends in powerful positions, processing my emotions, and trying to get my work done; I realized something on Sunday morning. I realized that I didn’t remember hearing anything about Black Lives Matter from the Nashville Health Care Council.

In this moment when the world stands in solidarity on the need for justice in cases of police murdering Black people, and deep reform in the system that allows it to happen repeatedly… no message from the Council?

I checked LinkedIn, nope. I searched my inbox, nothing.

I figured they were just trying to get the words right, like so many people are right now…

And that’s when it clicked.

You all need to be called up to the moment.

I get it. You don’t have anyone around you, who doesn’t have too much to lose, that will say to you in public what needs to be said.

Ugh, except me.

Because I don’t work for you. When invited to, I work with you.

That freedom empowers me, and my own privilege requires me, to tell you the following:

I say, with firm conviction, that the Nashville healthcare industry’s success has roots in White supremacy, and its leaders have to make a commitment to internal diversity, equity and inclusion work a priority. Doing this work is necessary for the future of this country and specifically, the future of Nashville. To put a finer point on it, Black people in America and especially in Nashville, CAN’T achieve equity until you do this.

And I think the past two weeks have shown that we’re done with Black lives not mattering.

For a moment, I want to focus on the consolidation of wealth and power dynamics in Nashville’s healthcare industry. I personally know only one notable Black multi-millionaire whose success can be primarily attributed to Nashville’s healthcare industry, and that’s Darrell Freeman.

However, over the years I’ve heard several stories of successful Black healthcare businessmen who’ve had their businesses seized by the government. If you’ve never heard of Samuel Howard and Phoenix Holdings, read this page and specifically watch the video there titled “Samuel Howard recalls his exoneration from criminal charges.”

If Nashville’s healthcare industry isn’t suffering from systemic racism, tell me then:

• How is it possible that the nation’s leading healthcare services cluster has generated incredible wealth for White people in Nashville but no meaningful wealth for Nashville’s Black community?
• How is it possible that in a city where Black people make up 27% of the population, the board of the Nashville Health Care Council representing the industry leaders has one Black person at the table out of thirty filled seats.
• How is it that Nashville is home to HBCUs Meharry Medical College, one of the top five producers of Black primary care physicians in the US, and Tennessee State University which has a Public Health, Health Administration & Health Sciences bachelors program, yet there is no formal pipeline from those institutions into significant leadership positions within the industry-leading companies that Nashville is home to?

We also have to look at the healthcare venture capital community, of which I am a member. The only other Black venture capitalist that I can remember working in the healthcare industry is Chris Poole, who worked at Solidus with my partner Vic Gatto before Vic and I went full-time at Jumpstart Foundry together. Chris is now CEO of a company, so I think it’s just me left. I could be wrong and may have missed someone, and that would be an even bigger tragedy. But in my experience, Nashville’s healthcare VC world is almost exclusively comprised of White men.

Nashville’s healthcare industry generates more wealth than any other industry here, and Black people are not proportionally part of that wealth generation.

This institutional inequity cannot be separated from the disproportionate disadvantages that Black people in Nashville experience in education, healthcare, and criminal justice, and I fear it has negative implications for Black people across America. Let’s not forget that Black people are dying from COVID-19 twice as often as White people in America. How can the healthcare industry not share some of the responsibility for this fact, when it consumes almost 18% of the economy’s GDP in exchange for the promise to care for the citizens of the United States equally?

Allow me to get personal for a second.

I know how hard I work and how much value I can deliver if given the opportunity. But I know that a critical role in my success over the years has happened in moments when a White man in power committed to share power with me. I’ve managed to be reasonably successful in this industry so far, but if Vic wasn’t my partner, I’d never have gotten a break into healthcare venture capital here in Nashville. That required a White male partner.

I can say this to you because I’m not on your payroll. I’ve built my Creative Power platform (which I own 100%), my book comes out in a few weeks, and quite frankly while I hope to do more business with the Nashville healthcare industry, I’ve learned that depending on it for my livelihood is an awful position to put my family in.

And it’s because of that, that I’m saying this to you.

Nashville’s healthcare industry leaders must name the systemic racism that has not yet been dealt with, resulting in an outsized imbalance in power, that is broadly disadvantageous for Black people in America and particularly oppressive to Black people in Nashville. It must stop protecting its fragility, and start doing real work in diversifying leadership to reflect the employees and communities it serves. You can’t have a company full of Black people at the bottom with only White people at the top and not acknowledge the systemic racism in that.

I know you all have worked hard in your careers, and up until now, you may have been unclear about how much of your success was connected to the racism that we all abhor. But after last week, I hope it’s starting to become more apparent to you. You have tremendous power, wealth, and influence, and if you don’t find the courage to use it to change things, your legacy will be complicity.

I’m not here to write the rules on where we go from here. I know that’s a conversation that will take time, and quite frankly, it’s not my work to do, it’s yours. I’m too busy taking care of myself and living my purpose. But you all know I know who you are, and you know deep down I’m right about this. No one expects you to fix it in a day, week, month, or even a year. But it’s time to fully acknowledge the problem so we can start the long process of fixing it.

I’m calling you up, not calling you out.

Rise to the occasion. Be on the right side of history. Be allies. Start truly taking care of the people you’re privileged to serve yet have neglected and ignored for far too long. When you want to talk for real, about putting your money where your mouth is, you know where to find me.

It’s time to take the high road and lead on this, we’re depending on you. You’ve got the power to change the world.

With belief and purpose,

Marcus