Managing the ‘Strong versus the Weak’ – An American Sickness

Go Lean Commentary

“There is a special ‘place in hell’ …”
“… for someone that would steal your wallet after you collapse/faint due to a health crisis; (think heart-attack, epileptic seizure, etc.)”.

Sickness 1Imagine this scenario at the country level; how inconceivable for an advanced society. And yet, this is the actual situation in the United States. This is according to the new book – An American Sickness: How Healthcare Became Big Business and How You Can Take It Back – by Dr. Elisabeth Rosenthal, a former E.R. doctor and current journalist for medical issues.

This commentary asserts that there is a need for the Caribbean communities to reform and transform our healthcare deliveries, yet still, we do NOT want to model the American system. This point aligns with the book Go Lean…Caribbean, which seeks to reboot the 30 member-states of the Caribbean region, to ensure better stewardship of the Social Contract for all citizens in our homelands, strong and weak. The Go Lean book petitions the Caribbean region to do better! It describes the necessary empowerments to optimize the economic, security and governing engines of Caribbean society to ensure a better adherence to the principle of the Greater Good.

In a 4-part series of blog-commentaries on the “Strong versus the Weak”, the pattern from the Code of Hammurabi was detailed and presented as an Old World model that was ignored in the formation of the New World. The Americans got it bad! If that ancient King Hammurabi was around in present day, he would have a harsh judgment for the American healthcare system. It is figuratively like “stealing the wallet when a person collapses”, as many of the financial abuses in American hospitals occur when the patient is unconscious or only concerned about seeking relief from pain and/or discomforts.

This commentary is an spin-off from that series; though it was originally presented as a 4-parter, we are hereby adding this 5th entry. The full series is now as follows:

  1. Managing the Strong versus the Weak – Model of Hammurabi
  2. Managing the Strong versus the Weak – Mental Disabilities
  3. Managing the Strong versus the Weak – Bullying in Schools
  4. Managing the Strong versus the Weak – Book Review: Sold-Out!
  5. Managing the Strong versus the Weak – An American Sickness

The need for this 5th entry arose with the release of this new book today – April 11, 2017. It is ‘spot-on’ for the criticism of the pattern of abuse of the ‘Weak’ in American society. See the review-synopsis of Dr. Rosenthal’s book here:

Book Review: An American Sickness: How Healthcare Became Big Business and How You Can Take It Back
By: Elisabeth Rosenthal (Author)

At a moment of drastic political upheaval, a shocking investigation into the dangerous, expensive, and dysfunctional American healthcare system, as well as solutions to its myriad of problems

Sickness 2

In these troubled times, perhaps no institution has unraveled more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that vulnerable and sick Americans place in their healthcare. Our politicians have proven themselves either unwilling or incapable of reining in the increasingly outrageous costs faced by patients, and market-based solutions only seem to funnel larger and larger sums of our money into the hands of corporations. Impossibly high insurance premiums and inexplicably large bills have become facts of life; fatalism has set in. Very quickly Americans have been made to accept paying more for less. How did things get so bad so fast?

Breaking down this monolithic business into the individual industries—the hospitals, doctors, insurance companies, and drug manufacturers—that together constitute our healthcare system, Rosenthal exposes the recent evolution of American medicine as never before. How did healthcare, the caring endeavor, become healthcare, the highly profitable industry? Hospital systems, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Patients receive bills in code, from entrepreneurial doctors they never even saw.

The system is in tatters, but we can fight back. Dr. Elisabeth Rosenthal doesn’t just explain the symptoms, she diagnoses and treats the disease itself. In clear and practical terms, she spells out exactly how to decode medical doublespeak, avoid the pitfalls of the pharmaceuticals racket, and get the care you and your family deserve. She takes you inside the doctor-patient relationship and to hospital C-suites, explaining step-by-step the workings of a system badly lacking transparency. This is about what we can do, as individual patients, both to navigate the maze that is American healthcare and also to demand far-reaching reform. An American Sickness is the frontline defense against a healthcare system that no longer has our well-being at heart.

Source: Posted and Retrieved 04-11-2017 from:


AUDIO Podcast – Terry Gross interviews Elisabeth Rosenthal – Heard on Fresh Air

Mental Photo 4April 10, 2017 – Health care is a trillion-dollar industry in America, but are we getting what we pay for? Dr. Elisabeth Rosenthal, a medical journalist who formerly worked as a medical doctor, warns that the existing system too often focuses on financial incentives over health or science.

“We’ve trusted a lot of our health care to for-profit businesses and it’s their job, frankly, to make profit,” Rosenthal says. “You can’t expect them to act like Mother Teresas.”

Rosenthal’s new book, An American Sickness, examines the deeply rooted problems of the existing health-care system and also offers suggestions for a way forward. She notes that under the current system, it’s far more lucrative to provide a lifetime of treatments than a cure.

“One expert in the book joked to me … that if we relied on the current medical market to deal with polio, we would never have a polio vaccine,” Rosenthal says. “Instead we would have iron lungs in seven colors with iPhone apps.”

Notice this small sample of the book’s revelations and disclosures, symptomatic of Crony-Capitalism:

  • Healthcare economics do not align with normal economic laws: “Usual & Customary” versus supply-and-demand
  • Hospital systems behave like predatory lenders
  • Consumers cannot decide, as prices may be unknown at the time of delivery
  • Lifetime of treatment preferable for service-providers rather than a cure.
  • Doctors owning Surgical Centers, therefore dictating procedures that they can accommodate at their facilities
  • Unknown and unauthorized “Drive-by Doctors” adding to hospital bills.

This commentary and the previous 4 commentaries in this series all relate to nation-building, stressing the community ethos necessary to forge a society where all the people are protected all the time. While we are analyzing the American system, we clearly recognize that the Caribbean eco-system is equally – or perhaps even more – in a crisis and in need of reform. The premise in the Go Lean book and subsequent blog-commentaries is that “a crisis is a terrible thing to waste”. We can use the acknowledgement of our crisis to optimize our healthcare deliveries once and for all. We must assuredly look beyond the American model. According to the foregoing book and AUDIO Podcast, many more successful models exist.

Dr. Rosenthal’s book asserts that there may be better models in Europe than there is in the US. This is already a familiar thesis for the Go Lean movement – a roadmap for the introduction and implementation of the Caribbean Union Trade Federation (CU) – as the Go Lean book advocates studying all dimensions of the EU:

10 Ways to Model the EU – Page 130.
The CU will emulate the European Union by unifying and integrating the Caribbean region into one market, thereby creating a single economy of 30 member-states, 42 million people and a GDP of over $800 Billion (per 2010). The EU is 28 member-states, 507.89 million people and $16.6 Trillion GDP (per 2012). Though the CU is only a fraction the size of the EU, there is the similarity of divergent peoples (24 languages) putting aside their differences in a quest to confederate. The EU region has quite an ignoble history of contending with differences, spurning 2 World Wars in the last century. Yet they came together to unite and integrate to make Europe a better place to live, work and play. Just like the EU, the CU will not possess sovereignty; this feature remains with each member-state.

Still, there was a previous attempt to reform the American healthcare delivery eco-system. There is wisdom to glean from that development. The Go Lean book provides this excerpt (Page 156):

The Bottom Line on Obama Care
The Patient Protection and Affordable Care Act (PPACA), commonly called Obama Care is a US federal statute signed into law by President Barack Obama on March 23, 2010. It represents the most significant government expansion and regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965. The PPACA is aimed at increasing the rate of health insurance coverage for Americans and reducing the overall costs of health care. It provides a number of mechanisms—including mandates, subsidies, and tax credits — to employers and individuals to increase the coverage rate.Additional reforms aim to improve healthcare outcomes and streamline the delivery of health care. The PPACA requires insurance companies to cover all applicants and offer the same rates regardless of pre-existing conditions or sex. The Congressional Budget Office projected that the PPACA will lower both future deficits and Medicare spending. On June 28, 2012, the United States Supreme Court upheld the constitutionality of most of the Obama Care.

The US, despite its advanced democracy status, has definite societal defects in the healthcare arena. Overcoming the defects – particularly Crony-Capitalism or exploiting public resources for private gains – make solving healthcare challenging.

It is truly heavy-lifting!

This was recently discovered by the new US president, Donald Trump.

After campaigning for the 2016 election on the promise of “repealing and replacing Obama Care”, the administration’s first healthcare legislation attempt flopped. The president’s exclamation:

President Trump: ‘Nobody Knew Health Care Could Be So Complicated’

The truth of the matter Mr. President, everybody – engaged in the process of transforming society – knew!

Transforming the Caribbean healthcare will also be equally complicated. It will engage all 3 societal engines: economic, security and governance. In fact, the prime directives of the Go Lean/CU roadmap includes the following 3 statements:

  • Optimization of the economic engines in order to grow the regional economy to $800 Billion & create 2.2 million new jobs.
  • Establishment of a security apparatus – including emergency management – to ensure public safety and protect the resultant economic engines.
  • Improve Caribbean governance for all people – with empowerments for healthcare – to support these engines.

This comprehensive view – economics, security and governance – is the charge of the Go Lean roadmap, opening with these pronouncements in the Declaration of Interdependence (Page 11):

viii. Whereas the population size is too small to foster good negotiations for products and commodities from international vendors, the Federation must allow the unification of the region as one purchasing agent, thereby garnering better terms and discounts.

ix. Whereas the realities of healthcare and an aging population cannot be ignored and cannot be afforded without some advanced mitigation, the Federation must arrange for health plans to consolidate premiums of both healthy and sickly people across the wider base of the entire Caribbean population. The mitigation should extend further to disease management, wellness, mental health, obesity and smoking cessation programs. The Federation must proactively anticipate the demand and supply of organ transplantation as developing countries are often exploited by richer neighbors for illicit organ trade.

Overall, the Go Lean book stresses the community ethos, strategies, tactics, implementations and advocacies to reboot, reform and transform healthcare delivery in the Caribbean; see this expressed in this one advocacy here:

10 Ways to Improve Healthcare – Page 156

1 Embrace the advent of the CU Single Market to leverage across the 42 million people in the 30 member-states.
2 Organ Procurement Authority
3 Deploy Disease Management Models
4 Universal Health Insurance Care
Much like with auto insurance, there is a need to mandate health insurance coverage for most Caribbeans. The coverage does not have to be $0 deductible and 100% coverage, rather it could be less attractive – low-end terms – like $6000 deductible and 60% coverage. The US model, Obama Care has plans branded Bronze (low end), Silver, Gold and Platinum. The goal for the CU is simply to ensure that catastrophic illnesses or injuries do not imperil the financial viability of individual, families or communities. The coverage risk is minimized with insurance carriers having a larger premium base (42 million) to calculate their actuarial formulas. To maximize savings, individual states may choose to combine their health insurance marketplaces with other states or go at it alone.
5 Wellness, Nutrition, Fitness and Smoking Cessations Programs
6 Medical Tourism
7 Repatriate MediCare Beneficiaries
8 Caribbeans with Disabilities
9 Medical Education Outreach
10 Public Health Extension
Due to the systemic threat, epidemic response and disease control will be coordinated at the federal level. Also, the acquisition of public-bound pharmaceuticals (vaccinations, etc.) can be negotiated at the regional level, using the Group Purchasing Organizations (GPO) envisioned in this roadmap. This will lead to a better supply and pricing dynamics.

The points of effective, technocratic stewardship of healthcare were further elaborated upon in previous blog/commentaries. Consider this sample: Cancer: Doing More Blink Health: The Cure for High Drug Prices Brazilian Shrunken Head Babies: Zika or Tdap? Capitalism of Drug Patents Role Model Shaking Up the World of Cancer The Cost of Cancer Drugs Recessions and Public Health New Hope in the Fight against Alzheimer’s Disease Painful and rapid spread of new virus in Caribbean Cuban cancer medication registered in 28 countries PR’s Comprehensive Cancer Center Project Breaks Ground Tim Armstrong, the CEO of AOL – Health-care Concerns

The opening imagery:

“There is a special ‘place in hell’ …”

… is just an metaphorical reference. There is no assumption of a literal burning abyss of torment. But this does convey the abomination of the “strong abusing the weak”. So many times in the past this abuse has proliferated, for those weaker physically, mentally, economically and sadly, medically.

The movement behind the Go Lean/CU roadmap wants us, in the Caribbean, to do better. Yes, healthcare is not easy, but it is possible to reform and transform. There are so many good examples and models to learn from:

The underlying book reviewed here – An American Sickness: How Healthcare Became Big Business and How You Can Take It Back – considers Switzerland.

We want to “weed out” any bad practices of Crony-Capitalism in our health delivery system. Instead, we want to pursue the Greater Good (greatest good to the greatest number of people which is the measure of right and wrong). Most importantly, we want to proclaim the truth of American life. So many of our Caribbean citizens “beat down their doors to get out” and emigrate to the US. We want to “dull the lights on any American Welcome signs” – considering the reality of American Crony-Capitalism, the “grass is not necessarily greener on the other side”.

Now is the time to lean-in to this Go Lean roadmap to reboot, reform and transform Caribbean healthcare. If we do this, we will make the Caribbean a better place to live, work, heal and play. 🙂

Sign the petition to lean-in for the roadmap for the Caribbean Union Trade Federation.

Download the free e-book of Go Lean … Caribbean – now!

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