My Book

Health Care Reform, Insurance Reform, Quality

Roger H Strube, MD

Discovering the Cause
and the Cure
for America’s
Health Care Crisis



A physician’s memoir


Why was I compelled to write this book?

The folks we elected to mind the store in Washington DC seem to be out of touch with the reality everyday Americans are living. They were elected to serve the people but both sides of the isle appear to be acting as shills for lobbyists or in their own self interest.

As a conservative independent voter and centrist I was dismayed when far right hijacked the GOP. The republican ticket following Bush II pushed me over the edge. It was time for a change in Washington. Candidate Obama recognized that our existing health care, economic and foreign policies were destructive. He linked the cost of our health care system with America’s economic collapse. He stated out of control spiraling medical costs were unsustainable. His judgment that economic recovery depended heavily on health care reform was correct.

Following the election of President Obama the political health care debate was filled with irrational rhetoric meant to incite the uninformed and ignorant. Lobbyists for big monied special interests and the politicians they purchased were able to block meaningful Health Care Reform. Big Pharma and Big Insurance lobbyists and their minions on both sides of the isle were successful in assuring the Health Insurance Regulation legislation passed was in their financial interest. President Obama had discovered campaigning and governing are two entirely different animals.

It was not pretty to watch. I knew Otto von Bismark, Prussian/German statesman of the 19th century, was correct when he said, “Laws are like sausages, it is better not to see them made.” Bismark was a social reformer who enacted German health insurance reform in 1883, one hundred twenty seven years before President Obama was able to accomplish similar legislation for Americans.

At the beginning of this process in early 2009 I knew it would be impossible to sit on the sidelines and watch the politicians make a mess of health care reform. I collected many books currently published by people believing they had identified the problems and had solutions to offer. Some of these authors had an understanding of some of the causes of our health care crisis, few had solutions that would work. I began writing my book in February 2009. I thought the process would take 6 months. I would learn that fixing to write and writing are two entirely different animals.

After 35 years of direct involvement with medical education, training, private practice and administrative medicine, I had profound knowledge of the problems with our medical-industrial complex and what could be done to solve our problems. And so the writing began. A brief summary of some of the concepts presented in Discovering the Cause and the Cure for America’s Health Care Crisis follows:

Our present health care crisis (both financing and the quality of health care) is physician driven. Virtually nothing happens in our health care system without a physician's order. Demanding patients and Big Pharma TV ads push the problem but, to repeat, nothing happens without a physician's signature. Our crisis is "just what the doctor ordered." Our physicians error rate is about 50%. Fortunately we only kill 80,000 patients a year through mistakes, errors in judgment, etc. Errors come it two varieties:

    1. Failure to do the "right thing." This includes all the unnecessary medical services usually referred to as “abuse” and all fraud. Most of our financial problems result from physicians failing to do the right thing.

    2. Failure to do the "thing right." These errors include all the sins of omission or commission where physician errors in process, procedure or technique result in harm to patients. For example, patients contracting MRSA infections because physicians or other medical personnel do not wash their hands.

Most physician errors in decision making are result in simple over utilization or medically unnecessary care. Such care is not Appropriate, Effective, or Efficient. Usually no one dies. Only other people’s money (OPM) is wasted. Some call this "abuse" but most of these errors classified as not doing the “right thing” are not the doctor's fault. Physicians have been educated and trained to rely on the flawed global subjective memory based decision making process.

The failure is a systems problem that can not be solved by trying harder or attempting to “know” more. We simply don't know what we don't know and can never know enough. The know-it-all philosophy is the direct result of our medical education and training. Physicians are trained to make memory based critical decisions as we practice incident medicine. "Physician Driven Health Care" would simply perpetuate the error rate and the escalating cost.

Similarly, patients don't know what they don't know. “Consumer Driven Health Care” is not possible. Competition over quality care will not work for patients until report cards documenting scores for quality measures are published for physicians and hospitals. Fat chance this will happen. I have been there and attempted that.

The present bill recently passed by congress and signed by President Obama is not health care reform, it is increased insurance regulation. It looks like the bill was written by Big Pharma and Big Insurance. It is the nose of the reform camel in the tent and recognizes that our present health care crisis is not sustainable, but it will not solve the basic problems driving our crisis.

I have finished the manuscript for my book, Discovering the Cause and the Cure for America’s Health Care Crisis - A physician's memoir. It covers all the real causes of our crisis, the solution, and how to implement real reform. It is written so the lay person may understand the causes and cure.

I have attached sections of my book referred to as, “Front Matter” by my publisher, iUniverse. Dr. Wesley Wallace wrote the Foreword. My book Preface and Author’s Biography may also be viewed. I attached a copy of my resume to document the education, training and experience qualifying me as an “expert” on this topic.

The final draft (version 29) of the edited manuscript and finalized book cover art work were submitted to iUniverse on February 10, 2011. For more complete information and online reference material see my book web site:


Discovering the Cause and the Cure for America’s Health Care Crisis is in the final proof reading process and will be available soon. The ISBN numbers have been assigned:

ISBN: 978-1-4620-0389-1 (pbk)

ISBN: 978-1-4620-0388-4 (cloth)

ISBN: 978-1-4620-0387-7 (ebk)


You should be very interested in the topic, if for no other reason than the medical-industrial complex is driving America toward bankruptcy. However, for those of you tempted to write your own great novel or finally to document your life in a memoir for posterity or just for your family’s consumption, I intend to post a spread sheet accounting for all costs for the production and marketing of my self published book. I have to do so anyway, business and tax purposes, you know. The spread sheet will be posted on my book web site: www.creativedesignforhealthcarereform.us Understanding the cost of self publishing may give you second thoughts about writing your great American novel.

I spent twenty-eight months of my life and five figures in cost producing the first edition. If the deciders understand what I presented as the cause of the crisis and were to implement the cure I prescribed, America’s health care cost ($2.49 trillion per year) could be cut in half. Some of the savings could provide slightly higher wages for the middle class. The majority of the savings would reduce the cost of American labor making business more competitive and able to hire more workers. But, if the message is not transmitted and the vision is not communicated, health care will never be reformed and America will continue in a protracted Second Great Depression.

The most valuable thing we have in life is time. Make sure you spend it well and with people you love. If you believe you have something very important to say, or simply have the time to tell your story for your descendants, get started...if not, go cruising now, my friend, it’s later than you think.


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