Medicine in Crisis

Obamacare by mandate, providing Medicare Advantage and Medicaid to uninsured Americans as an entitlement for the poor will enrich insurance companies and Big Pharma and bankrupt our economy.

Medical Informatics

Medical Computing


Healthcare Reform

Roger H Strube, MD

The American Health Care System crisis is the result of the Darwinian economic evolution of our Medical-Industrial Complex. The crisis is the direct consequence of short term thinking and profit taking combined with global subjective memory based decision making. Add in our for-profit Fee-for-Service (FFS) poorly regulated capitalistic American economic system, and a deadly cocktail results. The cost of health care and the health of the American economy are directly and inversely related. Driven by ever increasing medical costs, our economy is in a death spiral. America is now living through the “Second Great Depression.” To a greater or lesser extent, all providers of medical goods and services are to blame for the economic and medical care crisis as all are guilty of short term thinking and all use memory based decision making. There is more than enough blame to go around. However, playing the blame game is not productive and will not solve our economic or heath care crisis.

Neither my book, nor this web site is about documenting the dollars involved, economic segment by economic segment, as this has been done ad nauseam by many people and reliable research organizations. Let’s just admit $2.49 trillion dollars per year is a really big bill to pay for the mediocre level of care available to most Americans. If we are not willing to do what it takes to fix the problem, kvetching about the cost is a waste of time.

The books and this site are about identifying the reasons medical care is so costly. I also offer the reader insight regarding the main cause of our health care quality crisis. The two are directly related. Cost and quality are the two heads of the same Dragon. Cost and quality problems have driven our economic collapse but what drives cost and quality? How can we fix the disease if we do not know or understand the cause?

Most of the proposed fixes and the recently passed health Insurance Regulation bill passed by congress are a series of Rube Goldberg patches to the ailing economy. They do not address the basic drivers of cost and quality. A Band-Aid over a patient’s malignant melanoma may cover up the problem for a short time but the patient will die if the disease is not properly treated.

We must ask the right questions if we are to identify the real causes our problems. Could it be our dysfunctional Medical-Industrial Complex cannot be patched or fixed. Perhaps America requires an entirely new operating system. Do Americans want to continue patching Windows 95 or is it time to change the entire operating system to Windows 7? Maybe, if we understood our basic problems, we might discover the only way out of the crisis is conversion to UNIX, Linux or even Mac.

We all need to understand one profound principal. If we keep doing what we are doing, the Medical-Industrial Complex will drive the economy further into the death spiral and prolong our Second Great Depression. Albert Einstein defined psychosis correctly as doing what you have always done and expecting different results. We must address the real causes of our medical care crisis and and its relationship to the American economic collapse or suffer the consequences. Our Emperors have no clothes.

The attached pages deal with the causes of our problems. The reader may or may not agree with the cause or my description of the cure as presented in my first book, Discovering the Cause and the Cure for America’s Health Care Crisis, feeling the the concepts are too simplistic. This memoir was written so the lay person might understand the issues and the way out. Some folks may find my second book, Creative Design for Healthcare Reform too technical and the business plan presented for development of the necessary systems too complex. Acceptance or dismissal of these concepts and proposals will depend on your education, training and life experience. If you believe you have deeper knowledge of the subject or have the experience to offer a more pragmatic solution, by all means, write you own book.

The attached pages offer insight regarding some of the cost drivers of our crisis. Dr Wes Wallace allowed me to reproduce some of his writings regarding this topic. His essay maybe viewed by clicking here or on the “Cost of Care” tab at the upper left of this page. I think he is a little easy on the docs, but that’s just me. He is an orthopedic surgeon. As a result most of his patients had reasonably straight forward problems. For the most part they all walked like ducks, quacked like ducks and were ducks. Although specialists and proceduralists have a greater chance to do the “thing wrong” they have less chance to do the “wrong thing.”

He played with all the true believers most of his career. That is to say salaried physicians either in the military or at a staff model HMO. He was the medical director of a staff model HMO, where the physicians believed in managed care. I consider these people the crème de la crème. I am a bit more cynical having worked in the trenches as a private solo family practitioner and as a medical director for group model HMOs. We were in the business of identifying, recruiting and credentialing what I call the “Cream of the Crap.” To paraphrase Martin Short in the movie Captain Ron, “Crème...Crap. Huge difference.” I think our different perspectives on reality is evident in our writing although we have come to very similar conclusions. You be the judge. Review his writings by clicking on “Cost of Care” at the upper left corner of this page.

There is hope. President Obama has appointed Dr. Donald Berwick to the post of Director of Centers for Medicare and Medicaid Services (CMS). He is the ideal match for this position. President Obama was wise not to allow the right wing a chance to scuttle the appointment. Dr. Berwick was appointed when congress was out of session. This appointment has several implications. The first is that President Obama knew what was needed and appointed the best person for the position. Watch the video of his speech he gave to the 1999 National Forum on Quality Improvement in Health Care. His speech is entitled, “Fire Escape.” He was president and CEO of the Institute for Health Improvement at the time.

Escape Fire: 1999 IHI National Forum address by IHI National Forum , IHI President and CEO


After you watch this video, as yourself if President Obama made a wise choice for Director of CMS.

The so called Malpractice Crisis is discussed on a sub-page to this section. To review my explanation of the malpractice issue click here, or click on the “Malpractice” hot button at the upper left of this page. Some studies indicate there are ten medical mistakes resulting in patient harm for every one malpractice claim filed. Considering the number of physician errors, resulting patient injuries and the number of malpractice claims filed, one has to wonder if the only malpractice crisis is America’s lack of enough lawyers to manage all the cases. Of course, this is a deeply cynical exaggerated view. Nevertheless, medical errors, patient injuries and malpractice are serious issues. In the attached page I discuss the real cause of physician errors and how to address this core problem. The physician error rate (patient harm rate) is a real problem and malpractice reform a political issue. If America is to resolve the malpractice political issue, our legislators must understand the underlying real problems to know what must be fixed.

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