‘Medical industry’ ran afoul when it adopted manufacturing ideas

Columnist Joe Nocera’s extolling the virtues of Dr. Donald Berwick’s dedication and tenacity not only is generous in accolades for his valiant efforts in attempting to fix Medicare as part of a failing system, but also presents a partially chronologic overview of how and why the U.S. medical system has deteriorated so severely since the inception of Medicare ("The best hope for Medicare sent home by Republicans," Star-Advertiser, Dec. 7).

Serious setbacks began to become more apparent when HCFA (Health Care Finance Administration) was appointed its directorship in 1981.

Nocera’s views misrepresent a truth that no one in charge of what is now properly referred to as the "medical industry," has addressed: the harm done because of mistakes made by the proponents of the Deming model that can never be totally reversed. Especially after HCFA took over the reins in 1984, the malfeasances which resulted in the chaos in which Medicare finds itself today are due to errors too numerous to review in this response.

Promoters of the Deming model as a means of conducting medical care as a business borrowed or invented buzzwords to give the movement cache and an air of legitimacy with terms like "paradigm shift," "evidence based medicine" and "outcome driven practices." These did not represent new concepts for the every day practice of medicine, just new names. They are still used today.

Building upon the federally supported but erroneous concept that HMO-type conglomerates save both money and lives by disease prevention, industrial-sized medical businesses began to spring up composed of multiple layers of non-medical personnel and dendritic agencies designed for various methods of control. Medicare and non-Medicare funds became devoted to supporting armies of middlemen, managers, medical equipment mongers designed to snare federal funds and financial regulators — all of whom consume vast amounts of dollars that never reach the patient’s bedside. Hospitals throughout the country are closed and closing, and office practices as we have known them are dying away because of excessive waste and insufficient reimbursements.

Many or most of the proponents of this "paradigm shift" were not experienced practitioners in the field. I suspect Dr. Berwick, for example, did not spend his career caring for patients in a way that made it clear what the real facts were when he started to promote this system. Their obsession is in great part the reason for the current distress in medicine today.

Many or most of us who were experienced practitioners in 1984 could see the obvious flaw in the Deming model that helped Toyota become so successful in the field of automobile engineering and sales. However, we were unable to stop the oncoming freight train because it was driven by the federal government through its stranglehold on Medicare funds.

The model that Dr. Berwick and others became enamored of, and obsessed by, was flawed logic. It was clear then, and it is clear now, that the industrial model could not succeed without degrading accessibility to thoughtful, affordable health care at the patient level.

Human beings are not engineered vehicles. Mandated use of algorithms and cyber functional equipment as a goal cannot replace well-educated, experience-based medical judgment and intuition in the hands of skilled medical workers at all levels, who are motivated to provide good personal health care. Our current system has reduced practitioners to survival-mode levels of motivation.

I believe the best chance at resuscitation of our health care crisis can only be achieved by studying the most serious errors made over the past 40 years that are amenable to correction.

The study is easy. The correction is not, and it will never take place until those responsible adhere to truth, logic and common sense, vis-a-vis politics, economics and greed.

I wish more people with Dr. Berwick’s knowledge and zeal could have dedicated their last 20 years to that endeavor instead.