Category Archives: Healthcare

How much proof do we need that what we are doing is not working?

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How much proof do we need before we acknowledge what we do in our schools isn’t working and commit to trying something new? A grading period or semester; a year, a decade, or generations? These are our kids we’re talking about, our children and grandchildren.

Not every problem has an easy solution but what is so difficult about giving students a little more time to learn things they will need to know to make a decent life for themselves; things they will need to know to provide for themselves rather than be dependent on the rest of us? Time is an essential variable in the education equation.

Albert Einstein once said, “It’s not that I’m so smart, it’s that I stay with problems longer.”

Is America better off with a system that impedes the ability of teachers to teach and students to learn?

Is America better off with millions of people who do not understand the science of climate change, infectious diseases, and other natural sciences?

Do we benefit from a population of millions of people who do not understand the way a democracy is supposed to work or what the U.S. Constitution means?

How is it working out to have elected officials at every level of government, who are more focused assigning blame than putting their heads together to solve the problems of a troubled society? Leaders who spend more time claiming people who disagree with us cannot be trusted, are conspiring against us, and are trying to get something for nothing.

Are such leaders and other public figures correct when they tell us the only way to keep and protect what we have is to keep other people from getting what they need? The solutions to the problems we face as a people will be found by looking out into the future, not by looking to return to a past that was never as idyllic as we like to think it was. Look at the world around us.

We have an education system in which more than half of our students do not learn things well enough they can use what they know in the real world.

We have a healthcare system that makes a lot of money for a few people but does not allow all of us to get the medical care needed to treat the illnesses and injuries of our families.

We have a justice system that seems incapable of providing justice for every citizen.

We have a society that does not provide equal opportunities for everyone.

The problems we face as a society will not be solved by us. The future will be determined by the efforts and talents of our children. Maybe we should focus our attention on doing a better job of teaching future generations what they will need to know to create a better future for their children and grandchildren.

The only way to accomplish this is to change how we teach all our nation’s children, not a fortunate few. We have great teachers. We need to give them an environment where they can practice their craft  and teach their students what they will need to know. The solution to education is right here in front of us. All we need to do is act.

Schools, children and grandchildren, students, teachers, America, Is America better off climate change, infectious diseases, natural sciences, democracy, U.S. Constitution, elected officials, assigning blame, education system, education, healthcare system, healthcare, justice system, justice, equal opportunities, future generations, change how we teach, education equation, Albert Einstein

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Commentary on these frightening times

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Is it not sad that so many Americans allow themselves to be manipulated by the scare tactics of leaders who rely on such trigger words as socialism, radical left, deep state, and even communism, none of which have a factual basis? It is a simple truth that when we put our heads together, without blame or recrimination, we are able to find solutions to each one of the problems we face as a people. All that is required to find such solutions is to look out on the world in search of all  things we can accomplish rather than focus on our fears and suspicions. Please consider the following.

How can so many Americans:

  • Evidence not the least bit of concern that many American citizens are being denied basic justice and fairness because of the color of their skin?
  • Follow blindly when their leaders reject the science of global warming and climate change; as well as the accepted science with respect to infectious diseases?
  • Be okay with strategies designed to prevent citizens from exercising their right to vote out of fear of whom they might vote for?
  • Seem willing to teach their children it is okay to rely on name-calling and ridicule of people with whom they disagree or choose not to like?
  • Be willing to believe government regulation of the behavior of self-serving business entities is worse than permitting them to pollute the air we breathe and water we drink,  abuse their workers, and defraud their customers?
  • Seem willing to accept the actions of hospitals and insurance companies that put their profits ahead of the health and safety of a population of patients that might, someday, include themselves?
  • Be unwilling to insure payment of a living wage to all who are willing and able to work, on the one hand, and be unwilling to help those same people in their time of need, on the other?
  • Accept the assertions of their leaders that people who do not agree with them are criminals who should be “locked up?”
  • Be so willing to accept, at the word of unknown sources, the existence of conspiracies theories that purport to threaten everything they hold dear, with no evidence, whatsoever.

All American citizens are urged to understand there is no radical left out to destroy America rather there are men and women of good conscience trying to prevent innocent men, women, and children from falling through the cracks of injustice. Similarly, it is  not socialism or communism to seek solutions that provide access to health care for ourselves and others.

We must also understand the only way to protect our rights is to protect the rights of everyone and, that freedom only works when it is balanced by responsibility?

Somehow, we must come to realize that leaders willing to play upon our fears will care about us only for as long as we are willing to pledge our blind allegiance. Such leaders do not want us to think for ourselves, they want us to rely on them as our only source of the truth.

Think about what we can learn from observing our children. What do kids do to distract parents and teachers from their own misbehavior? Kids point their finger and say, “he or she did it.” How is this any different than standing on a stage and branding one’s adversary as criminal. How is this different from repeating over and over “Lock him or her up!” while offering not a shred of evidence?

Consider that whenever we begin to think of people who disagree with us as our enemy, it blinds us to all we have in common and obscures our mutual best interests.

Americans, socialism, radical left, deep state, communism, fears and suspicions, science of global warming, science, climate change, right to vote, government regulation, living wage, conspiracy theories, access to health care, protect our rights, freedom, responsibility

Lessons from a Pandemic

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There are so many lessons to be learned from this Pandemic experience, although it is sad that it takes something like Covid-19 to teach or remind us.

The starkest lesson has been the vulnerability of so many segments of our population. There are inspirational lessons, as well, such as the courage of so many men and women committed to doing their essential jobs even when it places their lives and the lives of their families at risk. We should be immensely grateful for the latter lesson, but it is the former lesson that should give us pause and motivate us to soul-search.

How we can “better prepare ourselves for disasters such as this” is an invaluable lesson as we can be certain this will not be the last global disaster to test our character; both as individuals and as a society.

We must ask ourselves whether it is in our nation’s best interests to have such disparity between those who have and those who can only want. We like to think of the U.S. as a great nation and it is, in so many ways, but we, also, must be honest with ourselves and acknowledge that what we have witnessed, in these trying times, are not all things about which we can be proud.

What are a few of the things we are learning about education and healthcare: two of the essential components of a full and meaningful life? They are also the two issues with which I feel the strongest connection.

All children will be challenged to succeed when learning remotely but many of the students who will struggle the most while learning remotely are the same children who struggle the most in their classrooms. Can we hope this experience will enhance our understanding of the importance of relationships and supportive environments for learning; that these things are more important than determining who can learn the most, the fastest?

And think about what it would be like if hospitals were turning away coronavirus patients because they lack health insurance coverage. Thankfully, we have suspended some the rules in this extraordinary time, but should such rules exist at all? Would turning away patients with other life-threatening medical conditions be more justified than turning away coronavirus patients? Would the converse also be true?

Imagine the turmoil if the families of Covid-19 patients without health insurance coverage, both those who recovered and those who succumbed, begin receiving bills for their hospital and medical care. Is medical and hospital care for the sick and injured a right of citizenship?

The world around us is changing at such a pace that many of us do not even notice that things have changed. Does not this world-wide pandemic demonstrate how interconnected we are, on whichever corner of this planet we might reside?

Maybe it is time to step back and challenge all our assumptions about what is “just” and what is “unjust”; and about what differentiates “inequality” and “equality; about what makes a great nation.” Possibly we should rethink the logic behind all our government’s policies, both domestic and foreign.

We know that people are the same, in many ways, wherever they may live, but is anyone else concerned that Americans seem a little bit more likely to hoard scarce resources; to “not let this thing keep me from partying;” or to protest “shelter-in-place” policies because getting what they want is not only more important than other people getting what they need but also more important than other peoples’ lives?

Make no mistake, the world will never be the same after this 2020 “Covid-19 pandemic.” The question all of us should be asking is “do we want to lead or be led” by the changes that will be taking place around us?

More Than One Kind of Hunger!

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Our society is learning much from its experience with this pandemic, but as the Novel Coronavirus saga plays out, it is revealing so much more. The most obvious lesson to be learned is with respect to our level of preparation for a phenomenon that is proving to have an adverse effect on, not only our health, but almost everything people do. For educators, our concern is with the impact on our nation’s students when our schools are shut down.

In schools, whether public, private, or parochial, we are learning just how vulnerable our nation’s children are in times of distress. One of the first revelations, beyond “how do we deliver subject matter, remotely,” is learning how much our students depend on us. Not only are many students hungry when they cannot attend school, they are enduring more than just a lack of food. We are seeing families unable to insure their children are being cared for when they must go to work. Given the low wages on which many American families must live, many mothers and/or fathers must work forty or more hours per week to provide a decent living for their families. Some must work more than one job, which only exacerbates the hardship s with which their children must deal.

For many kids, when there is no school there may be few, if any,  breakfasts, lunches, or snacks. One would think any doubts people might have had about the prudence of providing meals for hungry kids should be resolved, What is more central to caring for our children than making sure they have the healthy nutrition they need to learn and grow?

The suspension of so many schools will bring many other issues into sharper focus. It is not just how much our kids depend on school for healthy nutrition but also for safety, for social/emotional support, and for physical exercise, in addition to their intellectual and academic needs. We must keep kids safe from Covid-19, but when they return to school, we need to acknowledge that those schools are more than just places of learning.

As I said, in my book Reinventing Education, Hope, and the American Dream[1], “schools  have become the social milieu in which young people live and endure.” Teachers must realize that they are more than just educators. Whether we like it or not teachers and schools are a support system for the whole child, and we must structure the education process to serve all these needs.

Some teachers have expressed reservations about the level of responsibility they would be asked to bear, under such an education process. They are encouraged to think about how much they enjoy working with their favorite students from over the years. Educators are invited to examine The Hawkins Model© that is designed to increase, for both teachers and students,  the number and duration of these special relationships. Might this not enhance the satisfaction of teachers?

We must embrace the coronavirus as the learning opportunity it has the potential to be. It is unlikely this will be the last crisis of such magnitude we will face in the span of most of our lifetimes.

[1] Hawkins, Mel, Education, Hope and the American Dream: The Challenge for Twenty-First Century America, (2013), CreateSpace.

CBS 60 Minutes Report Comparing American and German Prisons

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Visiting a prison in Germany, in a recent telecast, CBS 60 Minutes reported the stark differences between American and German prisons and “stark” barely describes the comparison. Even prisoners serving long sentences for violent crimes have an enormous amount of freedom, compared to inmates in American inmates, and reside in comfortable quarters that are closer in comparison to a retreat spa than to an American penitentiary. Some prisoners, CBS 60 Minutes reported, even possess keys to their own cells; if you can even call them cells.

Some notable questions for the piece were, “how do we explain the contrast between American and German prisons?” and “what can we learn from the German penal system?”

My response would be that there is not much we can learn that can be translated into changes in American penitentiaries because the differences in penal systems are nothing more than a reflection of the differences between German and American society.

Americans like to think that we live in the greatest nation on earth but that is more of a long-held assumption than a reality. This is particularly true if you are Black, Muslim, Mexican or other minority. The same can be said if you are poor, of poor health, or are the victim of a gun related crime. The German government, much like many of the other industrial democratic nations of the world, actually takes care of all of its citizens, rather than a privileged few, and it provides a much safer environment, the threat of terrorism notwithstanding.

Racial tension and prejudice permeates American society. German society is much less diverse and while there are certainly racists among the German people, recent incidents like Ferguson and Baltimore are, arguably, much less likely to happen. The German people, probably, are far more charitable to President Obama and his family than “conservative Americans” who view the President as evil.

I have not been to Germany but I would be surprised to learn that one would find the same long lines that we see at community food banks in cities around the U.S. Similarly, the disturbing failure rates among American public school students, particularly on the part of poor and minority children, are not part of the German socio-cultural experience.

One of the other differences in the two societies is the prevalence of guns in the U.S. There is an old but not very funny joke that, in a country like Germany, citizens have a right to healthcare but will find it difficult to get their hands on a gun. In the U.S., we have a right to purchase a firearm, even an assault weapon, but may well find it difficult to get access to or be able to afford healthcare for our families. The freedom to purchase and carry anything from handguns to assault weapons creates a whole different level of violence on American streets.

It would be prudent for Americans to acknowledge that our over-crowded prisons and the violent nature of our inmates are symptoms of jagged rips in the fabric of the great American democracy. They are evidence of an expanding chasm between rich and poor, healthy and sick, white citizens and people of color. This rift between the haves and the have-nots is a source of the deepening resentment some Americans have for others. It is a division that threatens the very principles of democracy. They threaten our ability to work together and to find solutions that work for common good.

If there was ever any doubt of the divisions between us, the emergence of Donald Trump as a legitimate candidate for the Republican Presidential nomination should settle the matter. Donald Trump’s appeal is his pledge to take drastic action in response to some of the problems we face as a society. As we pointed out in a previous blog post, that so many Americans are willing to embrace the authoritarian nature of such a candidate may pose the biggest threat to American democracy, its principles and traditions in our lifetime.

Donald Trump: The Antithesis of Positive Leadership

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As an American who has spent his entire career as a student, advocate, and practitioner of the principles of positive leadership, it is staggering to think that not only is a presidential candidate spreading a message of prejudice and hatred but also that he is garnering the support of a significant percentage of Republican voters. The man behaves like a bully and a name-caller of the same ilk as a rising political leader in Germany, eighty-five years ago. If you do not agree with someone, call them names, threaten to do harm to them, persecute an entire religious group, or deport millions of others.

Over the last couple of decades we have seen the emergence of bitter enmity on the part of Americans who are so full of hatred and prejudice that they will believe even the most outrageous accusations against President Obama, a man whom they despise. No doubt, someone recently spouted that “Obama probably paid protesters at a recent political rally for Trump” and now those accusations are sweeping across the internet, taken as gospel. Equally ridiculous are the accusations that “Obama arranged and paid for the assassination” of Supreme Court Justice Antonin Scalia.

How can people be so full of hate that they are willing to believe such unsubstantiated nonsense about the President of the United States?

The sad thing about Donald Trump is that the man is correct about some of the things that need to happen to keep our nation healthy and “return it to greatness.” Support of Trump on these few issues becomes impossible, however, when the man preys on the ignorance and prejudices of millions of Americans and when his political strategy poses the biggest threat to democracy in my lifetime.

We do need to put the restoration of the U.S. infrastructure at the top of our nation’s priority list. We do need to take control of immigration. We do need to put people back to work. We do need to replace politicians who have become little more than puppets of some of our nation’s richest and most powerful political action committees. We do need leadership that is beholden to no one other than the American people.

We desperately need positive leaders who recognize that the issues with which we struggle, today, did not just happen rather that they are the consequence of 65-years-worth of ineffectual policies, whether liberal or conservative, republican or democrat.

What we need most of all is a positive leader with a vision for the future. A leader who recognizes that poverty is a consequence of an obsolete educational process that has set generations of American children up for failure and that makes it almost impossible for even our best teachers to do what they dreamt of doing when they chose their profession. It is an educational process that can only be further damaged by reforms focused on privatization and standardized testing.

We yearn for a positive leader who understands that the strongest economy during the latter third of the 21st Century will be the one that has ended its reliance on fossil fuels and has mastered the production of renewable sources of clean energy. It will also be an economy that is committed to responsible stewardship of the environment.

We hunger for a positive leader who believes that all Americans are entitled to comprehensive healthcare and prescription drugs as a right of citizenship and who understands that we can provide such healthcare without socialized medicine if only we open are hearts and minds to a new way of thinking.

And, finally, we need a positive leader who can help us renew our faith in democracy and in each other; a leader who can show the American people that our greatest strength as a nation is, has always been, and will always be our diversity. We seek a leader who can rebuild a nation in which the American dream is an achievable reality for all of its citizens; not just a privileged few.

My novel, Light and Transient Causes, is about one way things could go horribly wrong if a man like Donald Trump was elected President. https://melhawkinsandassociates.com/light-and-transient-causes-a-novel/ The reader is invited to take a look.

Pope Francis – A Remarkable Man, Visit, and Message

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By eschewing many of the trappings of his office and reaching out to all people, Pope Francis has positioned himself to speak with unprecedented moral authority. If one were to boil down the essence of Pope Francis’ ministry it is a message of hope, of respect for the sanctity of life, of the dignity of human beings, and a call to action to leaders everywhere to accept responsibility for finding solutions to the problems of mankind.

His charge to leadership, whatever their venue, is to build bridges that bring people together in search of shared interests. He challenges leaders to set aside personal agendas and to develop a process whereby people can work together toward the common good.

This message is of particular importance to the leadership of democratic governments because democracy demands cooperation among those with opposing points of view. Pope Francis’ support of the negotiations with Cuba and the controversial Iran agreement regarding the use of nuclear power are examples of this process. The Iran agreement is far from perfect but it is the outcome of a commitment of the parties to find common ground and to begin the process of replacing suspicion and mistrust with cooperation and goodwill.

Maybe this is why Pope Francis was chosen at this particular point in history; a time when so much is at stake for humanity. We live in a world that is in desperate need of solutions that benefit all people and not just a select and privileged few. It is almost as if the Pope senses that democratic governments are teetering on the precipice of collapse. This is most certainly true in the U.S.

We have become a people divided at almost every turn, filled with bitterness and resentment for people who are different than us whether rich or poor; white or black; Muslim, Jew, or Christian; citizens or immigrants, legal or illegal; conservative and liberal. The inability of our elected representatives to put the interests of the whole before the interests of the few places our democracy at risk.

When some leaders seem compelled to impose their points of view on others, the very premise of democracy is threatened. The more difficult it becomes to find common ground the more imperative it is that we do find it.

The U.S. population is more diverse than it has ever been in almost every conceivable way and never again will it be less diverse than it is today. As a result, certain segments of our population are at odds with other segments and the differences threaten our society at its core.

Whether issues of race, poverty, government spending, immigration, healthcare, public education, aging, social welfare, or the environment the issues that divide us are cavernous in their extreme. The irony is that each of these problem sets have solutions that will not only serve the interests of all parties but can also transform American society to a new level of prosperity and world leadership. They are solutions, however, that can only be found beyond the boundaries of conventional wisdom.

Not one of us has the right to put our own selfish interests ahead of the interests of others whether we are elected representatives of a legislative body, a president or governor, or even a county clerk in Kentucky. Neither do we have the right to play God and sit in judgment of others. Perhaps sharing this message is one of the things Pope Francis has been chosen to do.

We all have a responsibility to give the best of ourselves to our brethren and to our communities. We have a duty to accept responsibility to do what is right and just, knowing that if any judgment is passed it is we who will be held accountable.

Open Letter to All Presidential Candidates

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What is the matter with you people?

Right now, in this 2nd decade of the Twenty-first Century, Americans are in desperate need of a new kind of leadership. People know, intuitively, that the leadership of the last half century, whether democrat or republican, conservative or liberal is not working. What they do not yet grasp is that the outdated policies of yore are the cause of the problems we face today, not the solution.

The appeal of Donald Trump is an expression of the frustration of the American people and their thirst for a new vision. We can only hope they wake up and recognize that Donald Trump provides only an illusion of new leadership before he actually gets elected to anything.

What we so desperately need is a leader who can articulate a new vision of the future that unites Americans behind a common cause, not leadership that divides us even more than we are already disunited. We need someone who embraces policies of inclusion not exclusion of people who look, think, or worship differently than we do. We need leaders who recognize that our diversity is our greatest strength, not our biggest weakness.

The issue with the county clerk in Kentucky provides a perfect example. While she has an absolute right to her beliefs, she does not have the right to foist those beliefs on others. When one takes the oath of public office, one pledges to abide by the constitution and by the laws of our state and nation, irrespective of one’s faith. If we cannot then we need to exit public life and this principle applies as much to presidents, legislators, judges and governors as it does to county clerks.

The truth is that we cannot turn back the calendar to a simpler time. We must live in today’s world with our eyes on tomorrow.

The world population is exploding and is projected to reach between 10 and 16 billion by the end of this century. Combined with the diversity of the world community; the complexity of its marketplace; the fragility of the ecosystem; and, the speed with which everything is changing we can be certain that the policies of the past will be as ineffectual as first generation antibiotics are in treating the exotic bacterial and viral diseases sweeping the planet.

In the face of the challenges of dealing with international relations, terrorism, hunger and poverty, crumbling infrastructure, civil liberties, immigration, public education, healthcare, overburdened justice system, crime, drugs, violence, the environment, our dependency on fossil fuels, racial and religious discrimination, and the need for unprecedented leaps in technological development people who believe we can solve our problems through cuts in spending are childlike in their naivety.

If we are going to survive the balance of this century as a free and democratic society then we need the absolute best from every single man, woman, and child. We must make enormous investments to bring everyone on board as full and equal partners in the American enterprise and we must forge agreements and partnerships, even if imperfect, with the people from every nation across the globe.

The last thing we need is the kind of encapsulated thinking and uninspired leadership that has been paraded across our television screens in recent debates or that has emanated from our nation’s capitol.

Who knows what the next 80 years will bring but if we cannot elevate our game that future will not be pretty. Most of us will not be here to see what life will be like in the year 2100 but our grandchildren will and they deserve better. Will someone please step up?

Donald Trump: Illusion of Bold Leadership

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The willingness of so many Americans to embrace Donald Trump as a legitimate candidate for President is evidence of just how frustrated Americans are with the leadership in Washington, whether President Obama, whom so many demonize, or a dysfunctional Congress.

Trump’s immediate popularity is also a function of a desire for quick and easy answers to the seemingly overwhelming cascade of challenges facing our nation, its people, and the world community.

We do need bold, new leadership with fresh insight into the unprecedented number of issues of the Twenty-first Century but Donald Trump provides only the illusion of bold and fresh thinking; the kind one would expect to find on any of the inane reality shows on television.

The more frustrated we become with the challenges facing our society the more tempted the masses are to abandon good judgment and also the core principles of democracy. The truth is, the more complicated and critical the issues become the more important it is to cling to our democratic principles. Relinquishing those principles, however briefly we might envision doing so, is the single-most dangerous strategy a free people can contemplate.

The problem is heightened by the fact that we often confuse our democratic principles with over-simplified political dogma, catch phrases, and clichéd solutions. I love, for example, the assertion that we can turn our country around if we just cut spending or balance the budget. How could the logic be any simpler? Is it not common sense? The answer, of course, is only if we ignore the realities of society.

The reality is that a full third to nearly half of the American people depend upon their government for their economic survival. The underlying theme of conservative ideology is to cut off the poor, the infirm, the disenfranchised, and illegal immigrants because we can no longer afford to support their dependency. We quietly include the growing population of the elderly in this sweeping agenda but we are careful not to mention them too loudly. Neither do we draw attention to the fact that so many of the poor are minorities.

It would be one thing if the proponents of such radical spending cuts offered up alternative solutions to the problems facing the unfortunate members of our society but, of course, they do not. Rather they offer up the metaphoric equivalent of “Let them eat cake!” And, we have not addressed the enormous cost of protecting our environment and rebuilding our nation’s crumbling infrastructure.

Sadly, this burgeoning population of Americans, many of whom have lost all faith and hope in the American dream, are the product of 65 years’ worth of dysfunctional policy making; both democrat and republican and both liberal and conservative.

If we cut them off, where do our leaders think these people will go? Will they quietly disappear and let the rest of us go on with our lives?

The growth of this population of vulnerable Americans will accelerate in the aftermath of our nonsensical policies regarding public education, poverty, healthcare, aging, employment, immigration, and Social Security. The greater their number the louder will be their clamor and the more reactionary will be the response of “middle Americans” and the government representing them.

The greater the enmity between the “haves” and the “have nots” the more incendiary our society. The social wildfire that will burst forth as a result of an inevitable spark will rage more furiously than anything we have experienced to date. How can a nation survive leadership that so egregiously neglects the needs and interests of such an enormous segment of its population while claiming to represent and serve the American people?

If we do not find meaningful solutions to these challenges the future will not be pretty and the more vulnerable we become as a nation the bolder will be the response of the nations that compete with the U.S. for economic, political, and military supremacy.

If we are to have any hope of sustaining the great American democracy throughout the balance of the Twenty-first Century we must find a way to bring our entire population on board as productive members of a fully participatory democracy. Not an easy task, to be sure, but it is impossible only if we fail to pull our heads out of the landfill of the past century’s failed policies and outworn platitudes.

Our future can be secured only if we reach beyond the boundaries of conventional wisdom for real solutions to public education, healthcare, poverty, immigration, discrimination, and the environment using all of our imagination and ingenuity. Only when we learn to think exponentially will new and innovative solutions be discovered that can meet the challenges of the Twenty-first Century and beyond.

In addition to this blog, Mel Hawkins is the author of Reinventing Education, Hope, and the American Dream, a nonfiction book offering a blueprint to fix public education and transform American Society; and a novel, Light and Transient Causes, about what happens if we don’t.

The Wide Disparity of Pricing for Healthcare Services is Just a Taste of the Problems Yet to Come

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This past week, ABC News reported on the practice of the Northside Hospital System in Atlanta of charging outrageous prices for their services. They cited the bill of one patient where they did a line by line analysis of charges. What they found were many examples of line items for which the patient was charged exorbitant prices for things that the hospital could purchase through its suppliers for a tiny fraction of the cost. One of the most glaring examples was a pill for which the patient was charged several hundred dollars in spite of the fact that the hospital could purchase it for less than a nickel.

Hospitals across the country engage in such pricing strategies, to one degree or another, in order to make up for losses as a result of low reimbursement rates by health insurance, managed care companies, Medicare, and Medicaid and also as the result of the cost of doing business in a dysfunctional system.

This practice is considered a strategy of necessity by providers of many healthcare services simply because that is the way the fee-for-service, zero-sum billing game has evolved. Payers establish reimbursement rates that enable them to stay in business, which means making a profit. And, do not be confused by hospitals that claim to be not-for-profit for even these providers must be able make money if they want to stay in business. The only differences are the uses of the profits and the bank accounts into which the dollars must inevitably be deposited.

Every billable medical or hospital procedure results in high-stakes competition to determine where those dollars will end up. Health insurance, managed care companies and other payers set reimbursement rates and also make providers jump through hoops as part of the claims processing strategy to look for any reason to justify denial of the claim. This forces providers to develop coding and billing strategies to optimize their revenue generation and also requires them to file and refile claims. It is a zero-sum game in which there are winners and losers in the competition for each and every healthcare dollar, not counting the patients who almost always are losers in the billing game.

What charges are not reimbursed by the various third-party payers are then billed to patients. Some of the money is eventually collected and much of it must be written off. Families burdened by outrageous medical and hospital bills is the single greatest cause for most of our nation’s personal bankruptcies. The write-offs necessitate new and more innovative charging and billing strategies. It is a vicious circle that drives up the cost of care enormously. Although we have seen some improvement, in recent years, in the rate of increase of aggregate healthcare costs, for at least two full generation the rates of increase have been substantially higher than the Consumer Price Index (CPI). There have been many years when the rate of increase has been double- or triple the rate of the CPI. Higher costs require providers to increase prices, which requires insurers to increase premiums on a merry-go-round that is anything but merry to the patients.

When we think about the number of healthcare dollars that never end up in the hands of providers of actual medical, hospital, or ancillary care, it can be a staggering amount. The insurance, managed care, and government payers always underestimate the percentage of dollars that are allocated to the administration process relative to those spent on direct care to patients. That cost is not just the cost of doing business for the private and public payers (which for the private payers must include profits) it also includes every dollar spent by providers for the purpose of coding, billing, claims processing, and management of receivables.

It truly is an outrageous process but it is the inevitable companion to the practice of fee-for-service (FFS) medicine in a market driven by health insurers and other third-party payers and processors.

The process is so complex that, in spite of claims on the part of health insurance and managed companies to the contrary, there is no accountability. Incompetent and inefficient providers pay no penalty for their poor performance and both the best and the worst providers survive no matter what the level of patient satisfaction.

Free market forces, in the true sense of the concept simply do not function in healthcare.

The biggest problems in healthcare in America, whether speaking of quality, cost, or access are the inevitable outcomes of a system driven by health insurance, Managed, care and other third-party providers; both public or private.

That Obamacare or, more correctly, the Affordable Care Act, (or more appropriately the Affordable Health Insurance Act) commits us to a health-insurance driven market is a recipe for continuing and escalating disaster. The motivation of Obama and the members of congress who finally chose to act was admirable if misguided. We have tried to fix a system driven by forces that even our smartest people seem unable to comprehend with a solution that can only aggravate an already tragic reality.

It is, truly, a national embarrassment that so many citizens of what we consider to be the richest and most powerful nation in the history of the world must deal with illness and injury of themselves and their families without access to what we also describe as the highest quality healthcare on the planet.

What makes the situation most ludicrous is that it is our stubbornness and our prejudices that keep us from embracing a solution that will provide comprehensive healthcare and prescription drugs to every single American man, woman, and child, without relying on socialized medicine, at a cost that will save the American people trillions of dollars.

My book, Radical Surgery: Reconstructing the American Health Care System, lays out a healthcare plan that will give us everything we need, at a reasonable cost, without any of the things that the American people seem to fear, pathologically.

Don’t believe me? Check it out!