Can We Manage to Save Healthcare?: Lessons From the Zombie (Coronavirus) Apocalypse

We learn about issues in health care system/ industry in everyday life. However, we do not understand well or materialize specific problems because we hear from various sources by piece meal. Dr. Cybulski explained issues in health care system in every possible angle i.e. hospitals’ business model, health care inequality, government interventions, economics point of view, physicians and providers’ themselves, etc.By the time I went through about half of the book, I could clearly understand major problems in health care system. He explained issues very plain language with humor so that various readers could understand easily and clearly. Since he had been a surgeon, he did not get into other major industries such as pharmaceutical or insurance industries in depth. But he explained those industries impacts on health care system.He had used clear expressions, that helped understand issues. For example, “The elastic demand for medical services crashing into inelastic supply of health service is unattainable.” (P76) or “Access to health care does not guarantee that patient get equal access to quality, safety, or the best care.” (P80).It seems to me that most serious barrier to improve health care service is “Hospital business model shift” by recruiting businesspeople who have no idea in medical area since, Dr. Cybulski allocated more pages than any other issues. I absolutely agree with him. When Michael Jensen with the help of Kevin Murphy developed “Agency Theory”, the main topic was “To align Principal’s (stockholders) interest with Agency’s (management)”. The Agency Theory was for for-profit-organizations, whose ultimate objective is to maximize profit and to increase shareholders’ return on investment. But in my understanding, non-profit organizations like hospitals do not have stockholders. Then, whose interest those management (agency) try to align? Or, somehow those management have become “Principal”, and “Agency” roles have been pushed down to physicians and nurses. For me the principal should be doctors, nurses and patients.Until I read this book, I understood that government health systems like Medicare and Medicaid were beneficial to general public. But I understand now that those systems only enable access to health care system. And that has partly caused “Moral Hazard”, which in turn has contributed to high health care expense.Before I read this book, I understood most of issues incorrectly. I have acquired so much knowledge about health care system and underlying issues. Though I do not think health care system would improve in the near future, educating general public about health care is very important.I understand this is Dr. Cybulski’s first book and would like to congratulate on his achievement.

The healthcare market is dysfunctional. Dr. Cybulski asks can “we” manage to save it? He details nicely how this mess started up to the COVID chaos. Medicine has become a marketing mania of fear mongering suggesting you get tested for any three or four letters of the alphabet. Technology, pharmacology, and the increased complexity of government regulations and interference are detailed in the book. All the players want as many dollars as they can strip away from patients’ insurance and the government. Dr. Cybulski does not think the Rubicon of “healthcare” that makes the patient first (primary) has been crossed. Patients are without adequate advocates in an adversity patchwork of medicine no matter how much the persons delivering care are noble and against the forces with a different agenda and “hope” is not a strategy.The book will help persons not know how we got here to become more aware of the complexity of the situation. All the actors, including patients share complicity in where we are. The drivers are throughput and margin for those making money. The noble pursuit of patient care has been stripped to a spreadsheet analysis of squeezing the last drop of blood out of the endeavor. Yes, erroneous public policy needs to be reversed but politicians are part of the problem. Management needs to get back to the patient first, but they are rewarded for helping the conglomerates squeeze to dollars out of patients pockets; feckless leadership is what the system wants to be blameless for the scheme of the scam and doing away with greed requires going back to go to instill morals and ethics. I do not think the system can be reformed on its immoral treacherous tenants. Rebuilding needs to be done by abandoning the system and restarting, otherwise the demons left behind just resurface.

Please pardon the author for pointing out that the most important persons involved in healthcare are the patients and those who directly care for patients, not the administration. The humans who compose the bloated bureaucracy called hospital administration are clinically clueless yet they routinely make decisions that adversely affect patient care. They are overpaid, sometimes embarrassingly high salaries that Dr. Cybulski aptly points out with $$$ that could and should be diverted to deliver more and better care to patients.As my former surgical partner said to me one day in the late 1970's, "How did we let this happen to us? The office boys are running the office?"Dr. Cybulski skillfully dissects the ailing burgeoning US healthcare system with the level of precision that I have seen him apply in his neurosurgical operating room. He identifies and lucidly explains complex non-medical interrelationships in plain language that keep a stranglehold on quality, safety, risk, innovation in medicine and surgery, and more access to care for patients.The author pays homage to the havoc the pandemic wrecked on the healthcare systems which further exposed old and new defects in the healthcare system infrastructure.All is not lost. Dr. Cybulski offers this sage advice in his conclusion. "There’s no sugarcoating for the arrogance and self-interest that dominates health care. Can we manage to save health care? Only if we admit that patient care is on the wrong track due to erroneous public policy, misguided management, feckless leadership, and outright greed."

I’ve known George for a number of years and while being a healer is his calling his focus on improving healthcare drives a different sense of purpose in his being. Taking the time to break his insight and observation of what has been a long brewing storm that got the jolt it needed to take hold through the Covid pandemic takes the reader on a journey of discovery and understanding to where we are today and why the question needs to be addressed.Bravo George for this excellent roadmap of where we are and how we got here.Now to get on with fixing it.