IV. A Cataclysmic, Chaotic, Dispassionate Hot Mess ꟷ Six Root Causes

The United States Health Care System

(USHCS) Created

Common Sense II

T Michael White MD FACP

www.fixingushealthcare.com

The Realization of Universal Access to ABC-STEEEP

(Affordable, Basic, Compassionate - Safe, Timely, Efficient, Effective, Equitable/Just, Patient-Centered Care)

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IV. A Cataclysmic, Chaotic, Dispassionate Hot Mess ꟷ Six Root Causes

“There are a thousand hacking at the branches of evil

to one who is striking at the root.”

Henry David Thoreau

If in 2025 United States health care is a cataclysmic, chaotic, dispassionate hot mess ꟷ and it is ꟷ it must be immediately fixed. The first order of business is to understand how this disastrous debacle has come to be. How is it that this failure to provide our citizens with universal access to ABC-STEEEP has evolved? How have we gotten here? What is/are the root cause(s)?

A root cause analysis process was convened. The ‘right people’ came together to

brainstorm root causes. The question ꟷ how is it that our fine country spends the most on health care, has the worst outcomes and provides access to only a privileged few? Six root causes were identified:

• Root Cause 1: the current status of United states health care demonstrates our fine, rich, virtuous country has lost its way. Common decency has become uncommon.

• Root Cause 2: over time, the leadership of our fine country has determined that the

  words “that all men are created equal, that they are endowed by their Creator with

  certain Unalienable Rights, that among these are Life, Liberty and the Pursuit of

  Happiness” are merely aspirational. Unless facing existential national crisis, leadership holds we are each all alone and very much on our own to aspire to a good life. As they advise Carpe Diem and caution Caveat Emptor, they insincerely wish us well.

• Root Cause 3: in violation of every industrial engineering quality and continuous quality improvement principle, United States health care is, from its beginnings, a leaderless, unplanned, non-system that has predictably evolved into an unsustainable hot mess ꟷ proving again that W Edwards Deming’s tenet, “Every system is perfectly designed to get the results it gets,” holds true.

• Root Cause 4: the primary objective of heath care ꟷ ABC-STEEEP ꟷ has been supplanted by profit as the primary goal. That slippery slope has engendered a leaderless culture that fosters abuse, bureaucracy, duplication, fraud, greed, inattention and waste and results in inefficient, unaffordable health care.

• Root Cause 5: unqualified politicians are finding personal and professional advantage (profit and power) by actively undermining the public’s trust in our country’s world-class public health expertise, evidence-based medical science and the ‘Better Angel’ practitioners who serve patient’s each day. Predictable downstream suffering and death, which will surely come, worry them not.

• Root Cause 6: simply, health care has been misclassified in our United States as a

  commodity when, in fact, it is critical infrastructure (like highways, bridges, ports and air travel) that enables, advances and protects personal (career education, food, housing and retirement) securities and the public (institutional (hospitals, etc.), community, economy and national security) good.

You may leave an anonymous comment without inserting username and email ꟷ please do. Please share your wisdom, insights and perceptions (your reality) about what I have right, have wrong and/or have omitted. I will be delighted to hear from you as this draft and subsequent chapters will be significantly enhanced. 

Best regards, Dr. Mike