12 Comments
May 13Liked by William H Bestermann Jr MD

It's all about the $$$, not health care. Created an environment that they can control, eliminate the competitions, and give people no alternative but sick care.

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Thanks Khanh. I want everyone else to know that you are a leading pharmacist in Nevada and president of the Nevada Pharmacy Association. You specialize in ambulatory care and provide superior care for patients with diabetes. When you speak out, it makes a difference. Thank you

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May 13Liked by William H Bestermann Jr MD

Doc, didn't we identify this in the early 90's? Money was diverted from end stage disease specialists to family practice. Are you telling me it didn't work. Of course it didn't work, hospitals and share holders don't make money from healthy people.

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You are correct. That was capitation. The idea was to empower primary care to direct treatment but there was no mechanism to hold clinicians accountable for quality and so the answer was to give less care. Of course, that did not work. Now we have the systems to determine how well clinicians are delivering optimal medical therapy for cardiovascular and related diseases. Is the blood pressure, sugar, and cholesterol controlled to goal and are patients on the right medicine? When you do that, patients with diabetes have one fourth as many heart attacks and one fifth as many strokes. Patient who have had a heart attack are ten times as likely to be alive in five years and that costs $20,000 per patient per year compared with usual care. That is bad for huge hospital systems but fantastic for everyone else. Self-insured employers should be our natural allies because they are being taken to the cleaners. Hospitals and specialists may lose but the everyone else wins. We are the only developed country that has not figured that out

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May 13Liked by William H Bestermann Jr MD

So what are the Portuguese doing that we aren't? We continuously study better healthcare systems then ours. Then we have our healthcare system (insurance lobbies, doctor lobbies, politicos, mega buck doners, mega hospitals etc). They use terms like socialism or communism to rile up certain slices of America and the thing that kills me and them is that they are the ones who really need good affordable Healthcare. Please keep trying. That's how people get to heaven but when people are taught that education is bad and that minimum wage is good you'll never succeed. This is not cynicism its just plain fact.

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Some Americans are capable of discriminating thought and analysis. Those people are our allies and targets.

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May 13Liked by William H Bestermann Jr MD

Here is another thought. Portugal has some of the best and affordable health care in the world. Portugal, really. Most Americans cannot pick out Portugal on a map. I've been to Portugal they don't look fat.

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They eat a Mediterranean diet. They eat real, whole food and their health system is based in primary care. They are not consistently bombarded with ads for addictive foods.

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Agree.

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May 13Liked by William H Bestermann Jr MD

Doc your the best. What ever God that people belief in, most profess to have been granted free will,I think.you have a choice to do what's right or what's not. Given expert advice that excess weight is bad for you, 69 % OF AMERICANS are over weight or obese. Free will. Profiteers that made billions on healthcare will continue to make billions. Free will.

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May 13Liked by William H Bestermann Jr MD

Technology is great and supportive but I believe it all starts with community-based and funded healthcare with prevention & wellness as top priority. Research the “Public Utility Model” by John Silver. All of this must be based on the Social Determinants of Health (SDH) and personal contact and caring supported by, not driven by, technological advances.

The chasm is much larger than just cardiovascular disease or any single body system. Yes this requires a complete change in tactics as in the methods of battle described here. We already have community-based systems that are getting it right such as Nuka for some Native Americans and small nurse-led community health centers.

Depending on tertiary care to solve the healthcare disaster is not working & never will. That’s where the money and power lives. This revolution requires a sea change led by demand of the consumer and creative healthcare providers.

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Thanks Marjorie. I found your profile on linked in and you reposted this piece on your LinkedIn profile. I see that you are an advanced practice nurse consultant and you obviously get it. I buy everything you say and that is part of the comprehensive solution mapped out in Crossing the Quality Chasm 20 years ago. Stakeholders like you, and me, and Khanh must collaborate with other stakeholders to move to a new system. We have replicated the benefits of NUKA in a much smaller practice.

https://www.linkedin.com/in/marjorie-serrano-march-bsn-ra-0852b414/

https://williamhbestermannjrmd.substack.com/p/a-great-story-in-american-healthcare

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