Health Care Reform, Insurance Reform, Quality

Roger H Strube, MD

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


Walter Cronkite once said that America’s health care system was neither healthy, caring, nor a system. Uncle Walt had it right. I have often wondered if American health care was ever any of these things. According to the Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, our society dedicates eighteen percent of the GDP or $2.49 trillion dollars per annum to the medical-industrial complex. This is an extraordinary amount of money considering at the turn of the Millennium, the World Health Organization ranked the American health care system number thirty-seventh in the world. Since then, medical costs have skyrocketed and there is no reason to believe quality has improved.

This book presents an insider’s perspective on health care delivery and financing. My experience with the health care industry spans thirty-six years of medical education, training, practice and administration. I practiced medicine for fifteen years before changing careers. My career in administrative health care continued an additional fifteen years. I am one of few people who have worked as both a family doctor and an insurance executive. I hope that my experiences and the conclusions I have drawn will help you understand why our medical-industrial complex is so costly and profoundly dysfunctional.

Activists and scholars produce megatons of wood pulp in the form of newspaper articles, Ph.D. dissertations, research studies, think tank reports, and books describing our health care crisis. They all reach the same conclusion: The system is broken. Both the delivery of health care and the financing of health care delivery require reform.

If you believe our health care system is fouled up beyond all recognition (FUBAR) but do not understand why or what can be done about it, you will find some answers in these pages. This book may be for you if:

    • You are having difficulty separating reality from hyperbole about health care insurance and about quality health care delivery.
    • You are confused about the health care financing approaches proposed and enacted by our federal government.
    • You want to understand the potential unintended consequences triggered by insurance regulation reform.

This book is about my journey through our medical and insurance non-system. In some instances, I have used sarcasm and dark humor to point out problems we must address. The nurses, who have to deal with the flotsam and jetsam created by the anointed, may think to themselves, “It’s about time someone pointed out our emperors have no clothes.” We must understand what is broken if we are to fix our health care system.

Discovering the Cause and Cure for America’s Health Care Crisis is not academic term paper, destined to gather dust in some professor’s library. It was written so the lay person might understand the causes of our crisis and enjoy the read if not the reality. My story builds understanding of our health care crisis incrementally. The tale, to the best of my memory, is real. In some cases I altered the names and places to protect the guilty. I have tried to limit personal stories to those with relevance. You would be correct in assuming that where I cannot remember the exact details I have made things up to put myself in the best possible light.

Discovering the Cause and Cure for America’s Health Care Crisis is the story of the life experiences that helped to enlighten me and shaped my Vision of the future. This three-part memoir starts with my education and progresses through private medical practice into my administrative career, and explains my epiphany regarding the cause and cure for our health care system crisis.

The Appendix summarizes Deming’s’ Fourteen Points and Seven Deadly Diseases and relates them to our medical-industrial complex. To fix our system, those designing and implementing change must have profound knowledge of quality improvement.

My second book, Creative Design for Health Care Reform, offers more technical information for individuals interested in continuing the story to find out how we got into the mess we’re in and how I think we should proceed to get us out of it. This second book is a must read for staffers, politicians, healthcare providers, and other policy- and decision-makers who might have the ability to actually do something about our health care quality and financing crises.

Many of the people in the medical-industrial complex have forgotten that we are here to serve our patients. Egregious profiteering, increasing the cost of labor to American business, has helped to precipitate our economic collapse. We are no longer competitive in the global economy. Thanks to Wall Street and other short-term thinkers, America is now experiencing a devastating economic crisis. Because of this crisis, this book is timely and urgently needed.

Health care reform is not simply a moral or social justice imperative. The debate about whether access to health care is a right or a privilege is important, but it is not the central focus of this book. As Bill Clinton said, “It’s the economy, stupid.” America is now several years into what economists may someday call the Second Great Depression. The excesses of Wall Street may have been the number one cause of our current economic devastation, but our health care system is certainly number two.

Only American business can pull our economy out of this depression. Business must control the cost of labor to remain competitive in the global marketplace and to get the economy growing again. Benefit packages, of which health care makes up the largest portion, are a major contributor to the cost of labor. must reduce the cost of health care if America is to pull out of our economic depression. This is not a Democratic or Republican issue. It is an American issue.

Enjoy the read. When you are finished, please recommend the book to your doctor and your congressional representative. Your life may depend on it.




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