Exploring Human Potential

Can We Make Sense Of American Health Care? And How Would We Do That?

Posted on | August 29, 2023 | 6 Comments

Mike Magee

This past week my wife and I were at a family event to celebrate a 70th birthday. Our extended family has more than a few doctors. One who had read CODE BLUE and had a strong interest in health policy asked if I felt I (and others) were too hard on doctors. My response was yes, but that it was intentional and came with the territory. Combining scientific, sometimes life and death expertise, with high-touch compassion, understanding and partnership has always been a “big ask,” but that was what we and others had signed up for as “health professionals.”

But can a health professional be “professional”  in a fundamentally misaligned health system? And,if not, does a health professional have a responsibility to engage in an effort to reform and transform the system to behave professionally?

Professionals are generally members of a vocation with special training, highly educated, enjoy special trust and work autonomy, abide by strict moral and ethical obligations, and in return are generally self-regulating. Their academic training is expected to reliably provide those they serve with special skills, judgement, and services. When they deliver, society responds with confidence and trust and durable long-term relationships.

My inquiring family member and many of his contemporaries have come to believe that this is nigh impossible under the current heavily corporatized, profit driven, inequitable, under-insured, and widely inaccessible system. They have begun to voice that being an ethical and competent professional in an unprofessional system is not possible, and not their fault.

When system redesign guru, W. Edward Deming, the father of Quality Control Management, and the man credited with assisting the Japanese in transforming their auto industry, he had this to say in 1993 about transformation: “The prevailing style of management must undergo transformation. A system cannot understand itself. The transformation requires a view from outside…The individual, once transformed, will: set an example; be a good listener, but will not compromise; continually teach other people; and help people to pull away from their current practices and beliefs and move into the new philosophy without a feeling of guilt about the past.”

Six years later Don Berwick MD, Emeritus President of the Institute For Healthcare Improvement and now Harvard Health Policy professor, delivered a classic speech, “Escape Fire: Lessons for the Future of Health Care”,  sponsored by the Commonwealth Foundation. In it Don recounted the events surrounding the tragic fire at Mann Gulch, Montana which claimed the lives of 13 “smokejumpers” on August 5, 1949. He reviewed the lessons learned in a system analysis by Professor Karl E. Weich of the University of Michigan, in his paper titled,“The Collapse of Sensemaking in Organizations: The Mann Gulch Disaster.”

Berwick explained, “Sensemaking is the process through which the fluid, multilayered world is given order, within which people can orient themselves, find purpose, and take effective action. Weick is a postmodern thinker. He believes that there is little or no preexisting sense of organization in the world—that is, no order that comes before the definition of order. Organizations don’t discover sense, they create it…In groups of interdependent people, organizations create sense out of possible chaos. Organizations unravel when sensemaking collapses, when they can no longer supply meaning, when they cling to interpretations that no longer work.”

Now roughly a quarter century ago, Berwick concluded, “I love medicine. I love the purpose of our work. But we are unraveling, I think… I love the purpose of our work. But we are unraveling, I think. Sense is collapsing… We need to face reality…Why did it take the Mann Gulch crew so long to realize they were in trouble? The soundest explanation is not that the threat was too small to see; it is that it was too big. Some problems are too overwhelming to name. I now think that that is where we have come in health care; I have been radicalized.”

Clearly the profit-driven visions we are currently using are under-powered, and we seem to be heading in the wrong direction with information technology and AI which are fully prepared to make permanent a system that is moving patients to despair and doctors to early retirement. What are the questions my family member and his health policy colleagues should be asking now?

1. How do we make America and all Americans healthy?

2. What will be our national health care plan, and who will be in charge?

3. How do we balance national and state responsibilities?

4. How do we maintain balanced humanistic and scientific care, and preserve patient and health professional autonomy over complex life and death decision making?

5. How do we advance healthy behaviors while providing high touch access to health professionals for acute and moderate issues?

6. How do we use information technology and AI to expand human and social, rather than just financial, capital?

7. How do we prioritize investment in human contact between patients and health professionals over wealth enhancement and brick and mortar expansions.

8. How do we put a smile (independent of money) back on the faces of doctors, nurses and patients.

9. How do we separate hospital and physician profit driven research from direct patient care?

10. How do we move to geographic annual budgeting of comprehensive care and eliminate individual billing/reimbursement operations?


6 Responses to “Can We Make Sense Of American Health Care? And How Would We Do That?”

  1. Douglas Henley, MD
    August 30th, 2023 @ 2:47 pm


    This was one of your best commentaries! And great questions for all of us in health care to ponder, along with policy makers, payers, etc.

    If I had the magic wand in all this, I would begin to focus on these three things first:

    1) There needs to be a nationally driven effort/legislation to finally achieve affordable health care coverage for everyone in the US – affordable to individuals and the nation.

    2) Our nation (at the state and federal level) needs to invest much more in social support services (think social determinants of health) than we do now (I saw a statistic a while ago that when the other OECD nations spend $1 on health care, they also spend $2 on such services. In the US, we spend only 50 cents on social support services for every $1 spent on health care). Tragic!

    3) And, our system needs a much greater investment in and be reoriented toward access to and coverage for (without co-pay and deductibles) foundational and comprehensive primary care

    Obviously there are many additional pieces to this puzzle for the current health care enterprise in the US in order to actually transform it into a true system that supports the overall health of our people and improve its health care.

    Just felt the need to thank you for this piece and express some of my thoughts.

    Be well.


    Douglas E. Henley, MD, FAAFP
    President/CEO, Henley HealthCare Consulting, LLC
    Executive Vice President/CEO Emeritus
    American Academy of Family Physicians
    16313 Turnberry
    Village of Loch Lloyd, MO 64012
    [email protected]

  2. Lawrence Williams
    August 31st, 2023 @ 7:34 am

    Wow Michael. That’s a lot of questions. So where do we find the answers? I’m not sure we can find suitable answers within the species Homo Sapiens. Why is that? Because the suitable answers all contain one common thread that seems to be missing in an alarming number of the members of our species. And that common thread is “Care more about others than you care about yourself.”. Certainly there are certain individuals within our species who believe in and practice this belief but they seem to be an exceptionally small sampling of the group. That characteristic of selflessness is almost always learned at a very early age from the example set by parents. You learned it from your parents and I learned it from mine and we were fortunate to be brought together during our 4 years in college. But I’ll tell ya what, the other side has us vastly outnumbered.
    As always I send you, Patricia and your family my very best thoughts and wishes.
    Lawrence Williams

  3. Bob Kamm
    August 31st, 2023 @ 9:19 am

    spot on, thanks Mike. I feel for the docs and other health care professionals who feel trapped in a system they know is not functioning as it should.

  4. Mike Magee
    August 31st, 2023 @ 9:24 am

    Thanks for sharing your wisdom, experience, and insights. I think you hit the nail on the head by focusing our attention on “healthcare for everyone,” proper funding of social determinants, and access to both insurance and actual contact with caregivers. As you suggest, we could do better!
    Best, Mike

  5. Mike Magee
    August 31st, 2023 @ 9:27 am

    Thanks so much for this, Bob. I think you’re right on focusing our attention on “feeling trapped.” We need to shift from there to actively embracing change. The resources are adequate, but misapplied. Thanks for your hard work in this arena! Best, Mike

  6. Mike Magee
    August 31st, 2023 @ 9:33 am

    Thanks for this, Larry. As I get older, I appreciate more and more those frigid years in the warmth of the Jesuit embrace at LeMoyne. That community did, and continues to do, a very good job in emphasizing “Do unto others as …”, and putting those words into action. I am hopeful that what I believe to be true actually is … that Homo sapiens, once exposed to kindness, compassion, understanding and partnership will seek to replicate it. Best to you and your’s, Mike

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