Monday, September 7, 2015


“The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.”
– George Bernard Shaw

is in the reasonableness as George Bernard Shaw points out and in the Rationality of the mind, which limits options, as John Nash points out that the stodgy sludge of decadence exists. The reasonable person uses rationale and through that reasoning eliminates the one main virtue of creativity and innovation; Cognitive disinhibition.

Take for example the current vogue in medicine; organizations and associations are placing enormous burdens of their collective rationale on patients and physicians in how to manage healthcare. There are programs, to name a few, being given wide berths: “Choosing Wisely” and “Less is More” and not to forget “Maintenance of Certification” (MOC). None of these programs bear any semblance to the reality that exists between the patient and the doctor. The grand bargain is mostly about costs. But since reasonableness and rationale persist in such syrupy doses, no one actually questions the thickened false narratives, which underlie the premise. All three programs are about money. The first two supposedly to save costs related to healthcare and the latter about enriching the coffers of an organization (ABIM). In the former two concepts that are widely disseminated, through eager and of unequal and limited intelligence digital and print media, the focus is on the over-utilization of services and in the latter it is about physician competence. Yet no one actually realizes the 800lb gorilla in the cost-room that constantly sucks away, admittedly by any standards, around 30-40% of the actual costs of management in Healthcare in the United States.

Additionally another 20-30% of costs are related to redundancy and waste in care:

“More than one-sixth of the U.S. economy is devoted to health care spending and that  percentage continues to rise every year. Regrettably, our system is not delivering value commensurate with the estimated $2.7 trillion spent annually on health care. Experts agree that about 20 percent to 30 percent of that spending – up to $800 billion a year – goes to care that is wasteful, redundant, or inefficient.” ( )

Don’t you just love the words: “Experts Agree…”

Extricate the Insurance industry (the middling middle-man) and the cost of medical care on an individual basis goes down dramatically as well as for the nation. There are physicians already making inroads into the concept of direct pay and transparency of cost without the intermediation from insurers and administrators. The difference the public needs to understand is, what is and what is going to be offered for “free.” That “free” is neither free nor good for the individual…behold high deductibles and denials of care. So as the burgeoning models and concepts (first two premises) look only at the waste and come up with monikers to embed into the minds of physicians and patients, the elites ignore the real cause of such waste: the abolished “Skin in the game” for both the patient and the physician. A simpler model will emerge, should an “Expert” engage in a thought process. - I guarantee it!

“There are many causes of higher health care costs and spending. These causes include higher prices for medical servicespaying for volume over valuedefensive medicine, use of new technologies and treatments without considering effectiveness, and a lack of transparency of information on prices and quality. There is also evidence that provider consolidation is having a significant upward pressure on health care costs. The causes of higher health care costs and spending are not simply or easy to solve, but they must be addressed or the impact will be severe.”

The MOC concept seems to have evolved from utilizing the moniker “do this for the public good.” According to the ABIM organization physicians taking tests, made of unrelated materials and not cogent to their practices, supposedly improves patient care. It doesn’t! It wastes physician’s time and places patients in jeopardy for not having access to the physician, even when excluding the monetary costs to the physician. Without a shred of evidence that any of the “Maintenance of Certification” examinations employed for the doctors has yielded an iota of public benefit or helped enhance public healthcare, the rolling boulder continues to track down the mountain, as the ABIM organization parses its statements and pushes to move the needle by virtue of alliances with industry, hospitals and the government. And in so doing has enriched itself with over $100 million while waging the war on physicians. (here)

So where does that lead us?

It is about the minority opinion, which evolves from cognitive disinhibition that questions the majority’s runaway train carrying bushels of dollars. It is time to review the actual and not the feared, the reality and not the proposed, the individual and not the population, the reason and not the uninformed collective word. It is time to question the sanity of the arguments based on real facts. All too often we fall prey to the predatory influence of the mob mentality and are unable to think for ourselves, because it is easy to follow and more difficult to lead, because it is easy to take orders then to analyze their virtue and change the paradigm, because “life is difficult as it is” so why make waves, because “that’s the way it is.” Yet because of all the preceding “because” it is in the interest of humanity and that of the individual to grasp the truth and consider the “Why.”

The fallacy of building an aircraft carrier with a faulty rudder is obvious, but using strawman arguments to continue building it is a cause for genuine alarm. Using proof of contradiction as a means to validate a process with “proof” being established from unreasoned collective words is equally damaging. Logic and reasoning must prevail when entertaining hypotheses before embarking on the experiment. The current experiment in U.S. healthcare rests on a layer of quick sand waiting for movement.

Conjectures are the green shoot; the gist of human genius is in the knowledge of the seed. Any darkness of ambiguity or false assumption can rock the beauty of the garden.

“Therefore all progress depends on the unreasonable man.”

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