Robert Pearl MED ’72 is accustomed to speaking before packed auditoriums and at the fronts of boardrooms. And on Wednesday night, he returned to his alma mater, the Yale School of Medicine, to share his take on the shortcomings of the American health care system before a crowd of around 100.

The talk was the fifth installment in the Yale Alumni Grand Rounds speaker series, which bring together students and alumni of the Yale School of Medicine for career-oriented discussion anchored by a guest speaker. Pearl, former CEO of The Permanente Medical Group, which came out earlier this year, emphasized that the flaws in the country’s health care system make it less effective than those of most other industrialized countries.

“My belief is that change is not going to happen unless the patient in all of us demands it,” Pearl said. “That’s why I give a lot of these talks.”

Pearl said more than 200,000 Americans die each year from preventable medical errors. Among those victims is Pearl’s father, who died of pneumococcal septicemia due to miscommunication and poor treatment planning.

According to the Commonwealth Fund, the United States spends more on health care as a percentage of GDP than any of the other eleven most industrialized countries, despite being last in life expectancy among these same countries.

“The American health system is broken …We tell ourselves it is the best in the world, but we are usually wrong,” Pearl said.

Pearl said he believes four major “pillars” need to change for America’s health care system to improve. First, care has to be integrated — both horizontally within a specialty and vertically between primary and specialty care and inpatient and outpatient care.

Second, Pearl emphasized the need to move away from fee-for-service payment to reward physicians for preventing diseases as well as for treating diseases. Pearl’s third pillar focused on improving medical technology, such as comprehensive electronic health records. Lastly, Pearl said he favored physician-led health care delivery as opposed to leadership solely using executives with no training in the medical field.

The talk drew students from the Yale School of Medicine, Yale College and other graduate schools. Tony Grant ’20, an Eli Whitney student at Yale College who attended last night’s talk, said he agreed with Pearl’s four pillars. Still, he took issue with Pearl’s desire for an electronic health record.

“It wasn’t exactly what he said, it’s just what he didn’t say,” Grant said. “There’s going to be a lot of people that either have what they have and don’t want to move away from it, or you have the stubborn doctors who only use … electronic healthcare records for billing purposes.”

Grant said he considers Kaiser Permanente to be the pinnacle of health care.

Pearl characterized his experience with Kaiser Permanente as positive. He said large, multispecialty medical groups like Kaiser and the Mayo Clinic create a culture that is best for patients as well as for physicians.

“I’m not saying people should become Kaiser Permanente,” Pearl said. “But the things that are embodied inside of it, the structure, how it’s integrated, how it’s paid, how it’s reimbursed, the capitation, the technology, the leadership — those are characteristics that every community needs to have.”

Some of those at the talk remarked on how interesting it was to hear insights on the health care system from someone who has worked in the field for so long.

Michael Fitzsousa, director of development at the Yale School of Medicine, said he admired the perspective Pearl brought to the discussion.

“[Pearl] has a unique vantage point on the American health care system, having been the leader of a really highly functional and innovative health care organization,” Fitzsousa said. “We’re really proud that he’s an alum, and it was a great opportunity to introduce him to our students.”

The Yale Alumni Grand Rounds series at the Yale School of Medicine began in 2015.

Carly Wanna | carly.wanna@yale.edu