Overshoot 2

What Follows Is The First And Only Scientifically
Legitimate, Historically Valid, Extensively Proven,
Eminently Authoritative, Scientific Explanation
Disclosing Irrefutable Evidence Why Obamacare
Must Be Immediately Repealed And Not Replaced.
Plus, the exploding single payer mass hysteria must be
exposed because it is both a major threat and a looming
disaster to the American people, especially the sick, the
elderly, and the children. Worst of all, time–precious time–is
rapidly running out. The situation in a ticking-time bomb.
Obamacare must be totally and surgically repealed: not only
because it is one of the greatest management fiascos in
American history, not only because it has wasted and
purloined unseen billions of taxpayers dollars, but most of
all because brining more people into the extremely fragile
industry given the real predicament will absolutely trigger
the sudden and violent collapse of the mainspring US
Physician Services Industry. It’s the classic and infamous
“Overshoot-and-Collapse” disaster as demonstrated here.
The US Physician Services industry is huge: posting annual
revenues in 2015 (the most recent data from the gold-
standard Federal study started in 1960) of $503 billion.
Plus, this catastrophic event, technically a “bimodal
annihilation catastrophe,” will in turn trigger killer, domino-
effect shockwaves throughout the provider sector destroying
the mammoth US Hospital Industry (annual revenues more
1

How is it possible that a sudden five degree
drop in the ambient temperature can trigger a
steam-rolling avalanche? It’s more than a million
tons of snow moving at 100 miles per hour!
than $1 trillion). A bimodal annihilation catastrophe is what
causes the avalanche, the wild fire, the stock market crash,
and the combat ambush. Once this type of catastrophe gets
started, it is impossible to stop until everything in its path is
wiped out. It’s the little bang that triggers the big bang.
Finally, the steam-rolling killer shockwaves will destroy the
mammoth US Pharmaceutical Industry and the lucrative US
Clinical Laboratory Industry. Not only that, but the domino-
effect, killer shockwaves will suddenly and violently
pulverize tens of thousands of supplier firms, large and
small, all across the nation and put millions of talented
workers on the streets.
That these disastrous events will foster a great tragedy is not
a theory, it’s not a opinion, it’s certainly not malicious
propaganda. It’s hard, incontrovertible scientific and
historical evidence that is topically presented in this draft.
Now, intelligent, prudent leaders have the unprecedented
opportunity of playing a key role in stopping this looming
disaster and giving the American people the real story of
what is happening and what will irrefutably transpire. Plus, it
is an opportunity to put the nation on the right path to
preventing the destruction of a ailing, yet deeply embedded
American institution.
2

The Private, 30-Year R&D Program That Is
Undisputedly The Definitive Authority On The
Evolution And Devolution Of The Healthcare
Provider Industry Debunks Yet Another Hoax: The
Single-Payer Scheme.
There are many claims that the US healthcare establishment
will collapse and is headed “into the toilet.”
So far such claims are anecdotal and intuitive because
sufficient scientific evidence is lacking. Presented here is
overwhelming scientific evidence to confirm the claims that
the provider sector of the mammoth US healthcare system is
rapidly approaching the dreaded “tipping point” and will
collapse. The scientific evidence compiled during the past
three decades by a private, R&D program is today
incontrovertible.
3

The Bastion Of Fake News, CNN, Published An
Article Entitled: “Why Warren Buffett Says Single-
Payer Care Makes Sense (by Jill Disis, June 28,
2017). The Truth Is That IT Does Not Make Sense.
While the article made the bold headline, later it backed off.
“The Berkshire Hathaway chairman cautioned that health
care was ‘way outside of my circle of competence’ and
stressed that he was speaking with ‘limited knowledge’”
He intuitively recognized the fact that in every industry the
management knowledge-base during the past five decades
has become complex and sophisticated. He might be
surprised to learn that there is a 100-year management
knowledge gap in the healthcare industry. Likewise, he
would be astonished to learn that single-payer care would
actually trigger a unprecedented national disaster.
He did cite the widespread cost-escalation hoax by saying
“Health care is gobbling up will over $3 trillion a year.” And
said: “it’s just about the same as the federal budget–I mean
it’s getting up there.” The answer to such concerns is that
healthcare is a labor-intensive, capital intensive, and
technology intensive industry that supports millions of well-
paying jobs and millions of innovative supplier firms. Plus,
no other industry has the promise of delivering such high
social benefit. Like Dr. Benjamin Franklin said: “Health is
your major source of wealth.” It is imperative that this
industry is kept growing so that the carrying capacity is
boosted to keep it from suddenly and violently collapsing.
4

Three Decades Ago A Private Research And
Development Effort Was Launched In San Diego.
The Goal Of This Effort Was To Create An Exclusive
Management Knowledge-Base That Would Produce
A Scientifically Legitimate, Historically Accurate,
Eminently Authoritative, Ethically Bulletproof
Solution To The Ever-Mounting Healthcare “Crisis.”
This work produced the first and only scientifically legitimate
explanation and explication (a detailed explanation) of the
powerful evolutionary forces and the super-critical
phenomena that caused the predicament.
The predicament is a “crisis.” A crisis Is a “turning point”
with the prospect of unfavorable outcomes. This work
produced an accurate portrayal of the “problem space”
based on three mathematical laws. It means that the
explanation has achieved high predictive validity. Plus, it has
achieved high explanatory power.
Most importantly, this exclusive work conclusively
demonstrates that implementation of the pernicious, wolf-in-
sheep’s-clothing, single-payer mass delusion will trigger the
sudden and violent collapse of the mainspring US Physician
Services industry. This crash will generate domino-effect,
steam-rolling, killer shockwaves throughout the entire
industry. Given the hard evidence, keeping people out of the
unstable American healthcare industry for the foreseeable
future is incontrovertibly the lesser of two evils.
5

The scientific evidence is incontrovertible. This disastrous
avalanche--technically a bimodal annihilation catastrophe--
will trigger domino-effect, steam-rolling, killer shockwaves
that will collapse the keystone industries, such as the
hospital industry, and the supplier industries especially the
ailing pharmaceutical industry and beyond.
Again, this classic type of catastrophe is the same powerful,
deadly force that triggers the avalanche, the stock market
crash, the wild fire, and the combat ambush.
The Single-Payer Initiative In California And The
USA: Will It Be Another 200lb Wristwatch Fiasco?
The collapse of the Swiss watch industry is a classic case
study in every business school on the planet. This 200-year
old industry, venerated for it financial success, suddenly and
violently collapsed in about five years. About 82% of the
firms failed. When faced with the challenge of digital
watches, the leadership did not make the mandatory critical
transition, the breakout, and the paradigm shift.
Faced with a classic evolutionary transition, the leadership
called together their engineers and ordered them to create a
mechanical watch prototype that would match the extensive
capabilities of the digital watch. After precious months
passed, the prototype was presented. The retail cost would
be $200,000.00 The watch would require monthly
maintenance. Worst of all, it would weight about 200 lbs.
6

Of All Of The States In Which To “Test Market” A
Single Payer Scheme, California Is The Worst. It’s
Highly Unstable. Plus, The Costs Of Healthcare (Per
Treatment Episode) Are Among The Highest.
The entire provider sector of the US healthcare industry is
extremely unstable. It’s a super-critical phenomenon known as
unstable equilibrium. This classic phenomenon is extensively
demonstrated in the physical, social, and economic worlds. This
condition makes the entire industry extremely vulnerable to small
“perturbations.” It’s the “little bang that triggers a big bang.”
7

Fortunately, For Those Who Seek The Right Solution To
The Healthcare Crisis, This Looming Catastrophe
Presents An Unprecedented Opportunity Not Only Gain
The Recognition For Bringing To Americans The Real
Story About What Is Really Happening In American
Healthcare, But Also For Stopping A Looming,
Monstrous, Steam-Rolling, Cataclysmic Disaster.
Draft #: ruff
Previous Draft Date:
Revision Date: August 14, 2017
Copy-Editing: TBD
Proofreading Status: TBD
File Location: C:Phoenix Practice Development Model Overshoot
SalientOvershoot 1.wpd
It’s An Unprecedented Opportunity To Bring The
American People The Real Truth About This Looming
Disaster That Should Be The #1 National Priority. Plus,
Your Organization Has The Exclusive Opportunity To Be
Among The First To Bring The Real Truth About The
“Repeal And Replace” Nightmare.
Plus, Intelligent, Prudent Leaders Have The Exclusive
Opportunity Not Only To Expose The Massive Problems With
The Single Payer Hoax, But Also To Put The Nation On The
Right Path To Building An Admired Healthcare System.
The claims made in this draft are based on the work of some of the
best thinkers in the world going back about 35 centuries. They are
the “masterminds” of the private, 30-year R&D program that’s
been a trusted source of intelligence and advisement for decades.
8

The “mastermind” group’s well established, scientifically
legitimate, extensively proven, and eminent work has been
integrated into a comprehensive management knowledge-
base, or armamentarium, during the course of a private, 30-
year R&D effort conducted in the greater San Diego area.
For at least six reasons, this exclusive R&D effort is today
the definitive authority on the evolution and devolution of the
major sectors of the American healthcare establishment.
Here’s an example.
Professor Kim Cameron, Who Is An Eminent, Highly
Respected Business Scholar And Management
Scientist At The University Of Michigan, Developed
Some Three Decades Ago A Model Of How
Organizations, Industries, And Institutions Collapse.
This Exclusive Work Has Endured The Test Of Time.
From the chart posted above, the major industries in the provider
sector of the healthcare industry irrefutably suffered a predicament
that was clearly the “punctuated change” illustrated by this model.
The implosions were worse than some of the biggest collapses
historically. The most implosive stock market crash ever (1987) was
dwarfed by the implosions suffered by the three major components
of provider sector of the healthcare industry.
9

One Reason The Private, 30-Year R&D Effort Is The
Definitive Authority On The Evolution Of The
Provider Sector Of The Healthcare Industry Is
Because It Produced The First And Only Legitimate,
Eminently Authoritative, Scientific Explanation.
This explanation reveals the powerful, classic forces and
super-critical phenomena that have been responsible for the
fulminating crisis historically and that today has created a
ticking time-bomb that is ready to explode, more
precisely–implode, causing irreversible, extensive damage to
a major, once-beneficent American institution–healthcare.
The scientific explanation has achieved high predictive
validity (near 100%) because it based on mathematical laws.
The claim that the entire $3+ trillion industry is at the
infamous “tipping point” is historically, mathematically, and
scientifically accurate. The doctors and the nurses are
extremely stressed out because they are learning the real
truth about what is happening: their industry and
subsequently their careers
are ready to “implode.”
Given the hard evidence, this
looming predicament is a
“ticking time-bomb.”
And time, precious time,
is rapidly running out!
10

One Reason The Private, 30-Year R&D Program Is
The Definitive Authority Is Because It Used This
Time-Honored, Management Law To Determine The
Factors Driving The Deeply Embedded, Pathological
Disengagement Among Doctors And Caregivers.
The stress levels have reached a pathological level. Studies
say that at least 50% of doctors and nurses want “out!”
Burnout is epidemic, affecting 70% to 90% of workers.
Burnout is manifested as a lack of prosocial engagement,
withdrawal, lowered feelings of professional self-worth,
clinical depression, and callous treatment of other persons.
The widespread organizational decline signs and symptoms
confirm that the stress levels have skyrocketed and surged
passed the breaking point. The high levels of stress among
caregivers confirms that the carrying capacity of the provider
sector of the healthcare industry has been exceeded and the
industry is, indeed, incontrovertibly facing the overshoot-and
-collapse catastrophe. Chronic stress produces high levels of
cortisol which eventually causes brain damage and executive
function disorders that impair planning, decision-making,
engagement, and attention.
11

One Reason The Epidemic Of Burnout Among
Caregivers In American Healthcare Is A Very
Serious Predicament Is Because It Affects The
Younger Population Of Caregivers And Thereby
Subjects Them To High Rates Of Stress-Induced
Brain Damage Early In Their Careers.
The great American icon, Dr. Seuss, adroitly portrayed the
depersonalization of the healthcare system and the
institutionalization-commodification-dehumanization
syndrome which is central to the fulminating patient safety
debacle, the quality of care debacle, the widespread fraud
and abuse, and the epidemic of malignant decline.
In this powerful story, Dr. Seuss illustrates that the only living thing
is the healthcare system that demonstrates the appropriate,
empathetic care and concern is the cold-blooded fish in the fish
tanks that are ubiquitous in the offices of doctors and dentists.
12

The Definitive Authority On The Rise And Fall Of
The Provider Sector Of The American Healthcare
Industry Is Because It Developed The Wisdom Of
One Of The Most Highly Respected Deans Of
American Medicine.
He is Bernard Lown, MD, Professor Emeritus of Medicine at
the Harvard University School of Medicine. More than two
decades ago, he identified a critical bombshell predicament.
He said that there is a “lack of engagement among
physicians.” In retrospect, given the scientific evidence, it
was a sobering under-estimate of the real predicament–the
“Big Stuck!”
13

One Barrier That Keeps The Occupational
Community Of Physicians, Of Dentists, And Of
Caregivers In The Widespread “Stuck” Predicament
Is Their Universal Lack Of Problem-Focused Coping
Behaviors.
This claim is demonstrated by high rates of substance abuse
among professionals in the provider sector of the healthcare
industry.
Groupthink is the non-deliberate suppression of vigilant,
critical thinking and decision making in order to conform to
constrictive group pressures, norms, etc. Denial and wishful
thinking is epidemic. So is disengagement. The ultimate form
of disengagement is suicide.
Suicide rates among doctors and dentists, despite the
whitewashing, is sobering. The suicide rate among male
doctors is about 200% above the general population. The
suicide rate among female doctors is about 400% above the
suicide rate of the general population. As a nation, the USA is
spending billions of dollars to educate doctors only to have
far too many of them “pulling the plug.” The high suicide
rates gravely diminishes the huge national investment.
Given the already dangerous “overshoot-and-collapse”
catastrophe in the healthcare provider industry, bringing
more patients into the “system” is going to increase the
dysfunctional emotion-focused coping of caregivers. It’s a
looming tragedy that’s headed for the toilet, the maelstrom.
14

Using The Science Of Knowledge Management, The
Private 30-Year R&D Program Developed An
Exclusive, Evidence-Based Model Of Engagement
That Simultaneously Improves The Health Status,
Both Physical And Mental, Of Both Patients And
Caregivers. This Model Combines The Brilliant Work
Of Ancient Pundits And Modern Leading Scientists.
Plus, this knowledge-base reverses the super-critical
phenomenon of widespread organizational and personal
decline. It maximizes the “carrying capacity” of the front-line
caregiving organizations.
15

One Reason The Private, 30-Year R&D Effort Is The
Definitive Authority On The Evolution Of The
Provider Sector Of The Healthcare Industry Is
Because It Has Painstakingly Identified The Super-
Critical Phenomena That Have Been Ignored And
Mismanaged For At Least Five Decades.
One of the first people to acknowledge and describe the
critical transition was Homer (about 800 BC) in the famous
Odyssey. The centripetal vortex he described is a real
physical, social, and economic phenomenon
sometimes described as the “death spiral.”
In 1841, the famous poet Edgar Allen Poe described a
Norwegian sailor’s story of the maelstrom. Recently, two
university astrophysicist would declare that his
description was “exactly analogous” to the photon
sphere of a black hole. The descent into the vortex is a
real threat that’s now a clear and present danger.
16

The Super-Critical Phenomenon Known As The
Critical Transition Goes Back To Antiquity. In
Ancient Asian Cultures This Phenomenon Is
Represented By The Beautiful And Powerful
Phoenix Bird Being Re-Born And Escaping From
The Fire And Ashes Of Its Former Life Cycle.
In the Christian tradition, the critical transition is
portrayed as the Ascension–the rebirth of the
prophet Jesus Christ. The critical transition is
represented by this beautiful painting by the
seventeenth century painter, Sebastiano Ricci.
17

The Single Payer Scheme Has Great Appeal To The
Well-Meaning Ignorant. Yet This Concentration Of
Power Of The Purse Now Is More Than
Misguided–It’s Disastrous--Given The Real Story Of
What Is Happening In American Healthcare As It
Travels Inexorably Toward The Dreaded Maelstrom.
The real name for Obamacare has been whitewashed into the
“affordable” care act. The real name of the legislation is the Patient
Protection and Affordable Care Act.
Why was it necessary for the Fed to render legislation to protect
patients? Studies coming from such prestigious organizations as
the Institute of Medicine claim that as many as six million people are
being “seriously harmed” by the explosion of iatrogenic errors each
year. Some people in the industry claim that there is an “astounding
levels of errors and no quality.” One person (pictured here) is
Professor Emeritus and long-standing president of the Association
of American Medical Colleges, a truly powerful group.
Others say that these astounding levels of errors carry up to a 40%
fatality rate. It means that about 2.4 million are killed by our
healthcare system each and every year. It could be considered to be
genocide. It’s astounding, but a direct consequence of hundreds of
pathologies demonstrated by the super-critical phenomenon of
widespread organizational decline.
It is easy to demonstrate based on the historical performance of
Medicare that the Single Payer Scheme will not resolve the
shattering quality and safety problems: it will make the predicament
worse. It’s because Single Payer Schemes promote the diabolical
institutional, commodification, and dehumanization syndrome.
18

Historically, The “Little Neglect” Syndrome Has
Always Been Antecedent To Major Disasters. One
Of The Great Scientist Of His Time--Awarded Two
Honorary Doctorates--Dr. Benjamin Franklin In 1745
Warned Of This Super-Critical Phenomenon.
“ A Little Neglect Breeds Great Mischief!”
“For the want of a nail, the shoe was lost,
For the want of a shoe, the horse was lost,
For the want of a horse, the rider was lost,
For the want of a rider, the message was lost,
For the want of a message, the battle was lost,
For the want or a battle, the war was lost,
For the want of a war, the nation was lost.”
The miscreant, ignorant, pathological leaders who are
pushing for the Single Payer scheme are creating a mass
hysteria. In truth, and based on the compelling scientific
evidence, this maligned movement is mindlessly and
inadvertently propelling the entire nation to a looming
disaster. It’s another looming national disaster because the
proponents of single payer healthcare demonstrate the 100-
year management knowledge gap. It’s tragic.
19

The Annual Rate Of Industry Growth Is A Critical
Phenomenon That Reveals What Happened During
The Evolution Of The Mainspring US Physician
Services Industry.
Here Is A Closer Look At The Data Taken From The Gold
Standard Federal Study, The National Health Expenditures
Study, Started Back In The 1960s.
In short, when the industry rate of growth falls to the 4%
catastrophic threshold, the industry becomes extremely
unstable (unstable equilibrium) and is highly vulnerable to
sudden and violent collapse or whiplashing correction. This
chart demonstrates the extreme boom-and-crash cycles that
are characteristic fluctuations of an unstable industry. Stable
industries have annual rates of growth that are dependable,
stable, and predictably growing.
In 2015, probably because of the influx of patients due to the
Obamacare debacle, the rate of growth surged upward. This
may look good but if rate of growth is not sustained such
surges will induce greater instability into the fragile system.
It’s analogous to the “chatter” demonstrated before a stock
market crash. It’s the infamous “last gasp.”
The last gasp is a widespread phenomenon and signals that
death is imminent. Dying people take the last gasp just
before they “crump” as a young physician resident explained
in an interview. Historically, industries and societies have
demonstrated the last gasp–before they collapse.
20

The Obamacare debacle may have triggered the last gasp of
the entire healthcare establishment. That may be why the
establishment politicians and bureaucrats are insistent on
not revoking what is, irrefutably, one of the greatest
management fiascos in modern history.
One Reason the Private 30-year R&D Is The
Definitive Authority Is Because It Produced An
Exclusive Computer Model Demonstrating The
Profound Importance Of The Annual Rate Of
Industry Growth On Survival.
This model mathematically
demonstrates what happens
with the industry annual rate of
growth drops to a catastrophic
threshold.
It also demonstrates the impact
of market share when the rate
of growth drops. Like corks in a
turbulent ocean, smaller
organizations demonstrated
greater survivability. The
catastrophic threshold
manifests earlier for larger
organizations (i.e. having a
larger market share).
21

The dynamics presented in this exclusive computer model
explain why there has been, and is today, such bad news
about the US Physician Services Industry for decades.
When the annual rate of industry growth declines slowly over
time, firms can adjust by cutbacks, market exits, early
retirement, or other closures. But when the drop is sudden
and unexpected, great turmoil prevails driving the
catastrophic forces of sudden and violent collapse.
Meeting The Requirement Of A Scientific
Explanation Called “Universality,” The Private, 30-
Year R&D Effort Produced The First And Only
Scientific Explanation Of The Predicament Driving
The “Crisis” In American Healthcare Based On A
Mathematical Law–The Law Of Logistic Function.
One of the seven requirements for producing a scientific
explanation is called “universality.” In short, the explanation
must be based on generally accepted concepts, laws, etc.
Most people are surprised to learn that there is a law of
evolution like there is a law of gravity. The law of gravity says
what goes up, must come down. Plus, this law is illustrated
by a mathematical formula.
Likewise, the law of evolution says what is born, must die.
There is also a mathematical formula that describes this
universal phenomenon.
22

The law of logistic function presented here describes the
evolution of every major provider industry in American
healthcare.
Surprisingly, the review of thousands of published articles
about what’s happening in American healthcare, not one
refers to the plain fact that the industry has moved through
its natural life cycle. The reason: the 100-year management
knowledge-gap. It should be on “everybody’s lips.”
In short, Western Allopathic medicine and dentistry based on
the biomedical, or bio-mechanical, model is in the decline
stage of its life cycle. Workers in organizations in the decline
stage demonstrate anti-social, malevolent, and criminal
behaviors. The climates become “toxic.”
The Biomedical Model Of Medicine Is At The End Of
Its Life Cycle. The Physician Services Industries In
Every Nation Are Facing The Mandatory Critical
Transition To The Biopsychosocial Model. If They
Do Not Make The Breakout And The Paradigm Shift,
Their Industries Will Fail And Collapse. And History
Will Repeat Itself.
Why is the demand for the traditional, allopathic,
professional services of mainstream doctors in decline?
Patients as consumers are “voting with their feet.”
23

What Is Truly Amazing Is That The Biopsychosocial
Model Was Advocated By Hippocrates The Elder,
The Father Of Medicine, About 25 Centuries Ago. In
The Modern Times, This Model Was Developed
Between 1960 And 1980 By An Internist At The
Rochester University School Of Medicine–George L.
Engel, MD. Their Work Suffered A “Little Neglect”
Despite Much Published Work In Numerous Fields.
That fact that this model has not been universally
implemented is proof of the sobering failure of knowledge
diffusion in the healthcare industries all over the world.
Overloading American healthcare will postpone indefinitely
the adoption of this overdue “innovation.” It’s backwards.
24

Most Front-Line Doctors Will Admit That The
“System” Is In Decline, Is “Sick,” Requires Major
Surgery, And Is Due For An “Overhaul.” However,
As “Captains” Of The Healthcare Establishment,
Very Few Understand The Underlying Cause: The
100-Year Management Knowledge-Gap. This Claim
Was Substantiated After Privately Interviewing In
His Office The Doctor Holding The Placard.
25

That Everything In The Universe Goes Through A
Life Cycle Was First Presented In Hindu
Scriptures Such As The Vedas And The
Upanishads Some 35 Centuries Ago.
It Is Called The “Wheel Of Birth And Death.” The
Symbolism Of This Phenomenon Is Widespread In
Eastern Cultures.
In the scientific literature the first scholar to present this
phenomenon was Georg Simmel, in 1904. His depiction of the
product life cycle is classic (upper left hand corner).
How the life cycle phenomenon evolves was brilliantly
presented by Connie Gersik, PhD working at UCLA. It’s called
punctuated equilibrium: its long period of quiet followed by
very short periods of upheaval and chaos. It’s called “Punk
Eke” and it disproves Darwin’s claim of gradualism. Clearly,
the nation is facing the dreaded Punk Eke critical transition.
Professor Joe Tainter’s work is a classic on the collapse. His
book is in it’s 18th edition. The Romans tried to make the
breakout in the decline stage of the life cycle but the effort
failed. They did not raise the carrying capacity sufficiently.
Will history repeat itself in the US healthcare industry? Not
repealing and not replacing Obamacare or passively
implementing a single payer scheme, given the scientifically
legitimate evidence confronting the healthcare industry, will
incontrovertibly trigger a sudden and violent overshoot-
and-collapse super-critical phenomenon and a steam-
rolling, domino-effect disaster.
26

Here Is Another Infamous Example Of Ignoring The
Law Of Logistic Function. Common Parlance Calls
Them “Bubbles.” Bubble Are Generated When The
Mathematical Function Reaches, And Exceeds A
Maximum Point And Is Ready To Burst.
Some Workers In This Science Call The Bubble An
Asymptote. It’s A Saturation Level Than Cannot Be
Surpassed. It’s The Upper Limit. There Is Only One
Way To Go: Down.
Fortunately, “windows of opportunity” do open and vigilant,
skillful managers prepare their organizations to make
Homer’s passage, the “breakout,” and the critical transition.
Fortunately, this predicament can be managed and reversed
if managed appropriately, which is seldom accomplished
historically.
This predicament mandates a breakout and a “paradigm
shift” into a new life cycle.
It’s fascinating to observe that the housing industry stalled
but the bubble did not burst after the big stock market crash
of 1987. Somebody did something right. And the industry
pulled out of the bubble and resumed its growth stage. Such
renewals do not happen fortuitously. Such critical transitions
are managed correctly.
27

The Newspaper Industry Is In The Decline-Death
Stage Of Its Life Cycle. Traditional Revenues Have
Plunged Dramatically. People In Organizations
Faced With This Predicament Demonstrate
Pathogenic, Maladaptive, Anti-Social, Self-
Destructive Behaviors. It’s A Toxic Place To Work.
Also, during the year 2000 this industry reached its tipping
point, took the “last gasp,” and suffered a bimodal
annihilation catastrophe: it was the little bang that triggered
a big bang. Subsequently, this industry, once-stable for 40
years, crash about 300% in about 15 years.
Again, the bimodal annihilation catastrophe is the same
super-critical phenomenon that triggers the avalanche, the
stock market crash, the wild fire, and the combat ambush.
Learn more and Google “bimodal annihilation catastrophe”
for an explanation. Read the first two articles. Then select the
“images” option to see some of the relevant graphics.
Arguably, the leadership in this failing industry made the
same mistake the Romans made back in circa 450 AD; they
tried to make the breakout in the decline stage of the life
cycle. The rest, as they say: “Was history!”
Furthermore, this chart suggests that the leaders and their
organizations could not successfully implement a digital
innovation. It’s a repeat of the Swiss Watch industry. “It’s
deja vu, all over again,” as Yogi Berra would recognize.
28

Like The Avalanche And The Wild Fire, A Stock
Market Crash Demonstrates The Super-Critical
Phenomenon Called A Bimodal Annihilation
Catastrophe. It’s The Little Bang, Or The Relatively
Small Perturbation, That Triggers Suddenly A Major
Change.
Stock traders claim that a single negative media event can
trigger a stock market crash. One of the most implosive
stock market crashes was the crash of 1987. It also
demonstrated the “last gasp” before imploding.
Scientists claim that these hair-trigger, implosions are very
difficult to predict. Yet it appears that there is a subtle
“chattering” or “flickering” phenomenon that signals a major
change. Also, instability in the “system” increases the hyper-
sensitivity of the system and increases the probability of a
sudden and violent movement that is a response to restore
stability. The system seeks a more stable state and somehow
“senses” that stability can only be restored by plunging to a
lower energy or activity state.
The American healthcare system is in a highly vulnerable,
highly unstable condition called unstable equilibrium. Any
attempts to bring more people into the already unstable
healthcare system will “overload” the system and trigger a
cataclysmic crash or “correction” that is demonstrated by
this graphic. This overshoot-and-collapse scenario is
homologous. The 100-year management knowledge gap has
prevented the leadership from this critical knowledge.
29

Here Is The Life Cycle Portrayal Of The 3+$Trillion
US Healthcare Industry. Per Capita National
Expenditures Are Used To Eliminate Any Influence
From The Possible Fluctuations Of Population.
When an industry goes into the mature stage of its life cycle,
industry leaders and the managers should be preparing their
organization to make the “breakout” and the paradigm shift
into the new life cycle. The breakout effort must take
precedence, but it is usually ignored as leaders take a fatal
“wait and see” position.
Emphasis must shift from operations, efficiency, and
effectiveness to organizational adaptation, resilience, and
getting the organization on the right path so as to escape the
maelstrom, and the lurking “monsters,” and the creative
destructive forces represented as a bimodal annihilation
catastrophe like the avalanche or the wild fire, or the combat
ambush.
One of the best historical examples of the bimodal
annihilation catastrophe, the little bang that causes the big
bang, is the battle of Midway Island, June 4-6, 1942. In fewer
than six minutes, 13 well placed bombs sunk three enemy
carriers; the remaining carrier was sunk later the same day.
This phenomenal defeat (the little bang) ended Imperial
Japan’s ability to conduct an offensive war (the big bang).
The war in the Pacific was technically ended six months after
Pearl Harbor.
30

Any and all attempts to “reform” healthcare must start
with reversing the widespread, deeply embedded decline
pathologies. Otherwise, reform agendas will continue to
backfire, to boomerang, and inexorably push the entire
healthcare industry toward the maelstrom. It’s an endless,
shoot-yourself-in-the-foot, Catch-22 fiasco. And time,
precious time, is running out.
One Of The Five Principles Of Survival In A Hostile
Economic Environment Is That Leaders Must
Develop The Hardy, Healthy, Resilient, Responsive,
Innovative Organization That Can Manage Quantum
Change Sufficient To Make The Breakout.
Each organization must endeavor to produce a healthy,
hardy, organization that embraces quantum change and
employs the right management knowledge-base.
The super-critical phenomenon of widespread organizational
decline must be circumvented, escaped, and duly reversed or
the organization will get “sucked” in the vortex, overwhelmed
in the chaos, a predicament which makes adaptation
increasingly difficult–if not impossible.
For an industry with very high stress levels such as
American healthcare, making the breakout and the paradigm
shift is especially challenging. A pathological level of
disengagement is one reason. This predicament must be
reversed first and is essential to implementing the
real solution.
This predicament pushes the stakes to the highest
possible level. Creating healthy, hardy, resilient
provider organizations is the first step in proactively
managing the widespread organizational decline
super-critical phenomenon.
31

Keeping an organization predictably in the eustress condition
requires a sophisticated, evidence-based, management
knowledge-base. Just showing up for work and going through
the traditional routines is a prescription for disaster.
The Definitive Authority Is Because This Exclusive
Work Has Used Three Mathematical Laws To
Explain And Portray The Powerful Forces Driving
The Evolution Of The Healthcare Industry. One Of
The Laws Is Present Here. It Is The Yerkes-Dodson
Principle Developed At Harvard University And
Published In 1908.
This graph is one proof that there is a huge, 100-year
management knowledge-gap that is at the root of the
healthcare “crisis.” Closing this gap is mandatory before
any further “reforms” are implemented. Or as did
Obamacare, such reforms will boomerang and backfire,
producing the opposite of intended effects.
The 30-year R&D program produced the management
knowledge-base, or armamentarium, that empowers and
enables the professional service business such as medical
or dental practice, or a surgicenter, or a hospital to keep the
organization is the eustress condition and thereby maximize
performance regardless of the centripetal forces on the
meat-grinding, maelstrom.
One of the requirements for producing a scientific
explanation is predictive validity. Because mathematical laws
are employed, predictions are as close to 100% as possible.
32

When Workers Are Forced Beyond The Breaking
Point Because Of Malignant Mis-Management, A
“Little Neglect,” And Obsessive-Compulsive Micro-
Management They Universally Start To Develop A
Plethora Of Dysfunctional, Counter-Productive, And
Antisocial Behaviors.
The Critically Important Social And Psychological
Climate Of The Healthcare Organizations Become
“Toxic.” It’s Not Healthy For Patients, For The
Patients’ Families, For Doctors, And For All
Caregivers.
This is one reason that organizations must be
managed at the requisite level of sophistication to
avoid such pathological, counter-productive
circumstances.
Bringing more people into the profoundly
dysfunctional healthcare establishment will
aggravate this malignant predicament. Sadly, it is
time to keep people out because of the extreme
dangers of sudden and violent collapse. Keeping
people out of the healthcare system is the lesser of
two evils and demonstrates the gross
mismanagement that has tainted the healthcare
industry for at least five decades.
33

Arthur Kleinman, MD Is Professor Emeritus At
Cornell University In New York City. His Work Is
Surprising Because It Demonstrates That The
Traditional Healthcare Industry Is Not Where Most
Of The Healthcare Takes Place.
There is mounting evidence that the traditional
“professional” domain is contracting because it increasingly
demonstrates hundreds of the signs and symptoms of
widespread organizational decline.
Even more surprising is that the 30-year R&D program has
identified at least ten phenomena, such as patient self care,
that can dramatically reduce the demand for traditional
medicine.
These ten factors help to explain why the relative demand for
traditional biomedical treatment is in the decline stage of its
life cycle. This predicament is difficult for some people to
imagine since the media hype is that the cost are escalating.
The cost escalation crisis is a hoax: the cost are growing but
at a decreasing rate of growth- called logistic growth.
Based on the mathematical law the costs will peak and will
start to decline as the industry plunges into the decline stage
of its life cycle, the maelstrom. Far too many people
mistakenly believe that the American healthcare system will
go on forever, since everybody will have to travel through it
at some time in their lives. But the law of evolution says:
what is born, must die.
34

Because Their Practices Have Been Experiencing A
Decline In Patient Volume, The Occupational
Community Of Doctors May Acquiesce And Accept
Or Even Encourage A Single Payer Scheme.
Here are some proof of why there has been a decline in
patient volume in the practices of California medical
professionals.
There are numerous strong arguments against the
speculation that increasing the availability of a minority of
people with the Single-Payer Scheme will, in fact, increase
the demand for physician/hospital services.
One argument is that there have been very high levels of
delay. Remember, the industry is in the decline stage of its
life cycle and patient-consumers sense what is happening
and are super-cautious. Word-of–mouth among Medicare
patients is rapidly moving the dismal performance of the
workers throughout the population of seniors.
This graph demonstrates that the combined effect of the
typical types of delay can snowball. Ten days of delay can
turn into six months of delay.
One speculation is that the delay among Californians is very
high because of the catastrophic failure of the HMO industry
in Southern California 1986-1989 before the first big crash
starting in 1990.
35

Is There A Mis-Perception That Single-Payer
Scheme Will Build Patient Volume For Doctors, And
Subsequently For Hospitals And Pharmacies?
Here are ten factors that are responsible for the
drop in patient demand represented during the fist
big crash starting in 1990. They continue to grow.
One unrecognized factor driving the drop in
consumer demand is called “a single negative
media” factor listed here.
A single negative media event can reduce demand by
about 33% and the effect lasted for about a year when
the study was eventually ended. Imagine the effect of
the bombardment of daily negative media for the
healthcare establishment?
Almost completely unknown among doctors and dentist is
the extremely powerful forces that combine synergistically
to dramatically reduce patient demand for their services.
When the healthcare system plunges into the maelstrom, the
negative media will explode as the number of people harmed
will skyrocket. The Single-Payer Scheme will greatly
aggravate the Overshoot-and-Collapse predicament and
boomerang, backfire, and produce the opposite of intended
effects. It’s a ticking time-bomb.
36

The Occupational Communities Of Doctors And
Dentists Have Sustained Incredible Levels Of
Negative Media For Years. Healthcare Care Is A
“Reputational Good.” Negative Media For A
Reputation Good Can Implode Consumer Demand.
37

The Professional Service Business Of Healthcare,
Such As The Private Practice, The Group Practice,
The Surgicenter, The Hospital, And Health System
Are Considered To Be Selling A “Reputational
Good.” A Single Negative, Damaging Event, Can
Ruin Permanently A Professional Service Business.
It’s Why Many Of The Real Problems In American
Healthcare Are Concealed, Covered Up And
Whitewashed. It’s A Pathological Predicament That
Requires A Sophisticated, Evidence-Based Management
Armamentarium To Prevent And To Keep The Potential
Damaging Events Under Timely Control.
This predicament is itself one reason that the 100-year
management knowledge-gap must be closed. The outcomes
of a single damaging event can produce the organizational
and personal pathologies presented here. Trying to
implement major, complex, disruptive innovations given the
toxic organizational climates is a major mistake, a regrettable
misadventure that will magnify the pathologies and
compound the looming disaster.
This predicament is alone sufficient reason to repeal and not
replace Obamacare and to postpone permanently any single
payer initiative. Otherwise such toxic behaviors will fulminate
into the necrophilia that Erich Fromm, PhD identified.
38

One Reason That The Private, 30-Year R&D Program
Is The Definitive Authority On The Rise And Fall Of
The US Physician Services Industry, Posting Annual
Revenues In 2015 Of $503 Billion, Is Because This
Seminal Effort Produced The First Model Of The
Professional Service Business, Such As A Medical
Or Dental Practice, Based On The Transaction-Cost
Economics Knowledge-Base.
Despite the managed care debacle, there has been a strong
and pathological agenda from the Fed to institutionalize the
practice of healthcare. This obsessive-compulsive micro-
management has created the behaviors listed here. It’s
clearly backward. Single Payer Schemes will greatly
aggravate this insidious, pathological predicament.
This model explains the reasons for the unrelenting
dehumanization exposed by the VA scandal. Managers were
shredding the patient files of veterans with serious, traumatic
brain injuries while they were
nefariously gaming the system
to earn bonuses and to gain
budgets to buy expensive
statuary and artwork for their
offices.
39

The Model Of A Professional Service Business
Developed During The Private, 30-Year R&D
Program Demonstrates Why Pay-For-Performance
Schemes Will Fail. Plus, This Model Demonstrates
What Caused The Outrageous, Fulminating And
Shocking VA Scandal. It’s Also The Most Promising
Candidate To Debunk The Single-Payer Scheme.
In the world of management, goal congruence is the
“centerpiece” of all management control models.
Goal Congruence, One Of The Main Dimensions Of The
Model, Has Been Drastically Corrupted By The
Pathological Leadership In The VA System. The Goals
Of The Veterans And The Leadership Have Become
Totally Inverted. Goal Incongruence Has Been “Maxed”
Out.
The VA scandal demonstrates that the government
politicians, bureaucrats, managers, and front-line workers do
not possess the requisite level of management
sophistication to effectively manage, or reverse, the
widespread, malignant organizational decline–and the
institutionalization, commodification, and dehumanization
syndrome. It’s a prescription for disaster. And
it’s a ticking time bomb.
40

Educational Levels Have A Profound Effect On
Consumer Demand. In This Study, Doctors Were
Considered To Be The Best, Most Informed,
Consumers. The Next Best Informed Consumers
Were Attorneys.
This work demonstrated that increasing educational levels
along can produce up to 250% drop in consumer demand for
surgical services which are considered to be services where
this is significant concern and vigilant decision making
among patient-consumers.
One feasible argument is that the Single Payer Scheme will
bring into the providers people who are of lower educational
levels. People with lower educational levels are very heavy
users in the consumption of surgery services–which are
costly and risky.
Lower educational levels is one factor that indicates that the
Single Payer Scheme will flood the industry with people who
are “heavy users” of the professional services of doctors and
hospitals. Another factor that will bring in heavy users is the
disease gradient phenomenon discussed later in this draft.
Bringing in heavy users will magnify the widespread
organizational and personal decline predicament that has
already reached a malignant, pathological level. Heavy users
will impact the carrying capacity sufficient for the mainspring
physician services industry to suddenly implode.
41

One Of The Super-Critical Phenomena That Has
Been Mismanaged For At Least Five Decades Is
Widespread Organizational Decline. Here Are The
Signs And Symptoms That An Industry Or An
Organization Is In the Decline Stage Of The Life
Cycle. This Is The Short List.
When an industry or and institution traverses into decline
stage it demonstrates hundreds of pathologies. This
predicament explains why there is an “astounding” level of
errors, poor safety (that’s why the formal name of Obamacare
is the Patient Protection and Affordable Care Act). Why must
the Fed pass laws that protect the people? It’s shocking, yet
one estimate of the number of annual Iatrogenic deaths may
be as high as 2.4 million.
Professor David Whetten, PhD is probably the best candidate
to be called the “father” of the organizational decline
phenomenon.
It is easy to demonstrate that the
Single-Payer debacle will indeed
generate high levels of organizational
decline, including the extremely high
rates of corruption and fraud and
abuse demonstrated by the Medicare
Single Payer fiasco during the past
five decades.
42

Best Selling Author And Management Guru, Patrick
Lencioni, Identified The Five Dysfunctions Of An
Organization. The Dysfunctions Of Organizations In
American Healthcare Demonstrate Many More
“Dysfunctions” Than Regular Business Firms.
43

Because Of Five Decades Of A “Little
Neglect,” Pathological Foot-Dragging By The
Doctors, Obsessive-Compulsive Government
Micro-Management, And Leadership
Incompetence, Disengagement, And
Mismanagement, The American Healthcare
Industry Has Become A Classic Hostile
Business Environment.
Most doctors will readily agree with this claim despite
the fact that they do not know what are the historical
characteristics of a hostile business environment.
Here is a composite list of the behaviors
demonstrated by people working in the healthcare
industry. The extremely small print was necessary to
get all of the fatal signs onto one page. Sorry for any
inconvenience.
The good news that for firms that can take the right
path during the critical transition and make the
breakout and the paradigm shift into the new industry
life cycle the opportunities are abundant.
Successfully making the critical transition yields a
strong prognosis. The prognosis is not only survival
but also perennial prosperity for organizations, for
the caregivers, and for patients.
44

Of The Many Reasons For Not Bringing More
Patients Into The Failing, Ailing, American
Healthcare System At This Critical Time Is Because
The Entire Industry Is Extremely Fragile And
Vulnerable.
Extreme vulnerability is one of the cardinal
syndromes that are characteristic of widespread
organizational decline. It is imperative for the
leadership to fully understand the simple fact that
the widespread organizational decline predicament
must be completely reversed so that the industry
carrying capacity is stabilized, then expanded and
enriched. It means high quality, transparency,
prudence, and economy. The key is closing the 100-
year management knowledge-gap that is the major
barrier to survival and prosperity.
Continuing to manage the industry with the
antiquated, outdated, and obsolete management
armamentarium will drive every organization into
the meat-grinding maelstrom. This claim is not a
theory, not an opinion, not propaganda, but is a
claim with high predictive validity, nearly 100%.
45

There is now incontrovertible scientific, historical,
and mathematical proof that bringing more patients
into the healthcare system, given the current status
of the healthcare establishment, will trigger the
sudden and violent collapse of the mainspring US
Physician Services Industry. As Doctors Say: The
“sequella” will be disastrous.
One of the main arguments to consider is that contrary to the
“cost escalation hoax” the consumer demand demonstrated
in the healthcare industry is actually shrinking. It’s because
the doctors, selling an obsolete model of medicine–the
biomedical model, have not made the paradigm shift to the
biopsychosocial model.
This model was developed by George L. Engel, MD
at the University of Rochester, New York, between
1960 and 1980. This work has suffered “a little
neglect that breeds great mischief” that Benjamin
Franklin would recognize back in 1745
This model is the basis of the “patient centered” movement
that is sweeping the industry. Patient centeredness has
become one of the six goals of the healthcare reform
movement documented by the Health and Human Services
Agency. Achieving patient centeredness means achieving
high goal congruence based on the Fiduciary ethic: putting
the patient’s welfare before any other considerations.
46

Those Proponents Pushing For The Repeal And
Replacement Of The Obamacare Debacle Like Those
Proponents Pushing Single Payer Schemes Have
Put The Entire Nation At High Risk For A Looming,
Autocatalytic Disaster. Once It Starts It Will Be
Impossible To Stop. The Disaster Will “Go To
Completion” And Wipe Out Everything In It Path.
The Prophecy Of Creative Destruction Comes True.
The Same Ardent Proponents Will Face Charges
And Prosecution For Malfeasance And Reckless
Endangerment.
The looming overshoot-and-collapse catastrophe in the US
Physician Services Industry will in-turn trigger a domino-
effect, implosion and send steam-rolling, killer shock-waves
through the massive US Hospital Services Industry and all of
the supplier industries especially the ailing US
Pharmaceutical industry. Then the catastrophe will spread
malignantly throughout the regional economies of the states
and the nation. To say the least: Much embarrassment and
regret will result for all the people.
Technically, the steamrolling, disastrous super-critical
phenomenon described in the catastrophe theory knowledge-
base is know as a “bimodal annihilation catastrophe.” This
type of catastrophe is also known as the little bang-big bang
catastrophe as is demonstrated in the avalanche, the wild-
fire, the stock market crash, and the combat ambush.
47

Please let me introduce myself: I am a 46 year
veteran of the healthcare industry and a privileged
insider.
I am a privileged insider because I have experienced both
consulting and business engagements with all types of
providers from solo practitioners of every type, to
surgicenters, to hospitals, and to national health systems.
These engagements lasted for a few days, a few weeks, a few
months, a few years, and continuously for three decades.
Early on for about a dozen years, I worked for leading organizations
such as Lederle Labs (invented broad spectrum antibiotics), G. D.
Searle (invented the birth control pill) Johnson & Johnson, and
Boehringer Mannheim, a multi-billion dollar company.
One innovation that I helped introduce was radioimmunoassay. This
groundbreaking innovation gained such prominence that it
eventually led to the Nobel Prize in Medicine (Rosaylin S. Yallow,
1977; second woman ever to win the prize).
Since the early 1980s I have been conducting a private, R&D
program which has been a foremost source of industry intelligence
and advisement. For example, when the HMO industry was claiming
that managed care would “dominate medicine” astute industry
intelligence debunked this claim and demonstrated that if the
industry stayed on the same course, it would suddenly and violently
collapse-- which happened in Southern California, 1986-89.
The private R&D program developed the nascent field of knowledge
management. One knowledge base developed the science of
innovation diffusion and implementation.
48

Knowledge Management Was A Fairly New Science.
A Knowledge-Base Has Structure And
“Architecture.” Building A Knowledge-Base
Requires Bringing Together And Integrating
Scientific Literatures So They Produce “Synergy,”
“Leverage,” And Generativity– Multiplying The
“Yield” Of Each Separate Body Of Knowledge.
Here is an example of one of the early management
knowledge-bases that was created to implement a high-
performance patient outreach model. The effectiveness of
this knowledge-base was extensively demonstrated in a
rigorous, highly successful, 12 year demonstration project.
49

The Knowledge-Base On The Critical Transition
Phenomenon Is Very Recent. It Has Taken Modern
Science Almost 30 Centuries To Resolve The
Dilemma That Homer The Poet Portrayed Back
About 800 BC.
Nevertheless, it is important to note that each of the major
components of the healthcare provider industry are at the
exact same point in the evolution of their life cycles and
henceforth are facing the same critical transition that, having
been mismanaged, caused the failure of the HMO industry
1986-1989.
Professor Marten Scheffer Is Probably The Modern Father Of
The Knowledge-Base On The Critical Transition. His
Groundbreaking Work Has Helped To Forecast The Fate Of
American Healthcare.
.
50

One Of The Requirements For Producing A
Scientific Explanation Is “Universality.” The
Explanation Must Be Based On Universally
Accepted Phenomenon.
People are surprised to learn that there is a universal law of
evolution much like the universal law of gravity. The law of
gravity says that what goes up; must come down. There is a
mathematical formula that defines the phenomenon of
gravity.
The universal law of evolution says: what is born, must die.
Plus, there is also a mathematical formula that defines this
phenomenon. The law of evolution defines five stages: birth
(or lag) stage, growth stage, mature stage (stagnation),
decline stage, and death stage.
In the mature stage of an industry life cycle, every
organization must make the breakout, or the critical
transition. It’s called it the “paradigm shift.” More that 70
years ago, the famous Harvard economist, Joseph
Schumpeter called it creative destruction–the “gale.” It’s a
paradox. For some firms it meant decline, disaster, and
death; for other firms (the ones that could make the
breakout) it meant survival, unprecedented opportunity, and
great success.
This graph is incontrovertible proof that the US HMO industry
demonstrated the law of evolution–logistic function.
51

Despite The Widespread Propaganda That Managed
Care Would “Dominate Medicine,” The HMO
Industry Failed And Collapsed In Southern
California. The Telltale Signs Of An Industry
Collapse Are High Rates Of Sudden Business
Failures And Heavy Losses.
Why Did This Heavily Supported, Promising Industry Fail?
And More Importantly, Will History Repeat Itself, Now? Will
The Entire Healthcare Establishment Suddenly And Violently
Collapse Because Of The Increased Volume Of Patients?
Despite the overwhelming scientific and historical evidence,
it is extremely difficult for workers in the healthcare
establishment to come to grips with the fact that the industry
will suddenly and violently collapse. Threat rigidity, denial,
defensive avoidance, and fear paralysis are widespread and
deeply embedded dysfunctions. It’s a pathological
predicament with fatal consequences. Each of these
dysfunctions can be scientifically measured and managed in
specific worker populations.
Back in the 1980s the leadership in the HMO industry ignored
the critical transition facing the entire industry.
They failed to make the breakout and the mandatory
paradigm shift. The HMO industry had catapulted into the
mature stage of its life cycle and reached its mathematical
ceiling, called the carrying capacity. The results of such
mismanagement and foot-dragging were disastrous.
52

One Of The Key Characteristics Of An Industry
Collapse Is Heavy Losses In A Short Period Of Time.
Keep In Mind, These Losses Were The Tip Of The
Iceberg. This Data Comes From A Study Of Court
Documents Of 57 Firms That Declared Bankruptcy.
The Losses Were Almost $2 Billion.
Firms that did not file for bankruptcy also experienced heavy
losses: Such losses were in the bottom of the iceberg, and
undisclosed.
Contrary to the government and industry propaganda,
studies demonstrated that the American people did not want
managed care. It was dehumanized.
That’s why the people called it “cattle car medicine.” It is
easily demonstrated that the American people were rejecting
the institutionalization- commodification- dehumanization
syndrome.
The Single Payer Scheme will pathologically foster and
propel American healthcare into the this insidious, malignant
dehumanization phenomenon.
Historically, dehumanization (threat people as things)
combined with scapegoating led to genocide.
53

One Of The Major Reasons The HMO Industry Failed
And Collapsed In Southern California Is Because Of
The Nefarious Institutionalization-Commodification-
Dehumanization Syndrome.
The type of patient this institutionalized form of medicine
attracted were extremely price sensitive and disloyal and
would switch plans for the saving of a few dollars in
premiums. It’s the mark of commodification.
Back then, during interviews, the doctors were exasperated
by this insult. The doctors were totally oblivious to the fact
that they were promoting the institutionalization of the
practice of medicine. The same is true for dentists.
The HMO industry demonstrated extreme levels of dis-
enrollment. Patients and doctors called it: “cattle-car
medicine.” It became in a few years highly dehumanized. It
treated patients as “things.”
Similar to the national health system structure of the VA
system, the Single-Payer Schemes will generate high levels
of pathogenic, malevolent institutionalization and the
dehumanization of all professional services businesses,
such as a private practice, a surgicenter, or a hospital. More
innocent, unsuspecting people will be harmed and killed.
Whitewashing this disaster will be difficult.
The private, 30-year R&D program produced a legitimate
model of the professional service business based on
transaction-cost economics.
54

To Push The Nefarious Agenda To Institutionalize
The Professional Services Businesses Of The
Provider Sector Of The American Healthcare
Establishment, The Bungling HMO Leaders Had To
Lie About The Enrollment Of Patients Into The HMO
Marketplace.
The HMO culprits lied about the enrollment statistics of the
managed care, HMO product innovation. But the ruse led to
their disgraced downfall.
The innovation diffusion and implementation of this debacle
was grossly mismanaged because the proponents of
managed care and the government bureaucrats, with their
ever pathological, obsessive-compulsive propensity to
micro-manage the industry, did not exercise the appropriate
level of management sophistication to successfully
implement this unwanted, boomeranging innovation.
Hence, the fledgling US HMO industry couldn’t get off the
ground and suffered a nose-diving, catastrophic collapse
during 1986-1989. Monetary losses, which were hushed up
and buried, where in the hundreds of billions of dollars.
Because the fledgling Single Payer Scheme is being foisted
onto the American people at the worst possible time given
the scientifically legitimate overshoot-and-collapse
predicament in the industry, failure is highly probable,
producing a meat-grinding, domino-effect, steam-rolling,
catastrophe.
55

The proponents of this fragile, single-payer innovation are
oblivious of the extreme risks to which they are exposing
unsuspecting Americans. When the American people are
presented with the irrefutable, incontrovertible evidence they
will reject this ticking time-bomb Single Payer Scheme the
same way they rejected the skulduggerous HMO scheme.
“Vox Populi!” Once They Actually Experienced The
Phony HMO Promises, The American People
Rejected This Camouflaged, Malignant,
Institutionalization–Commodification–
Dehumanization Agenda That The People Called
“Cattle-Car-Medicine.” Consumerism Killed It.
Hence, once they experience the Single Payer Scheme, the
American consumers will likewise reject this camouflaged
institutionalization of the healthcare. Only this time the
stakes are much, much higher. It will be too late to reverse
the implosion. The level of required management
sophistication does not exist among the people in the
government or the people in healthcare.
It’s another morbid example of the “little neglect
that breeds great mischief” predicament that Dr.
Benjamin Franklin recognized back in 1745.
56

Commodification Is A Marketing Phenomenon That
Is Ubiquitous. When A Product Or A Service-
Product Such As Healthcare Goes Through Its Life
Cycle, The Product Starts Out Its Life As Being
Highly Differentiated. It’s The New Product In The
Marketplace And Is Unique. It’s Called The Premium
Product. It Has Little Competition And Commands A
Strong Position In The Marketplace.
However, over time as the product goes through its normal
life cycle, and competition introduces copies of the product,
the product eventually becomes a generic product with very
little, or no differentiation, in the marketplace. It’s the “me-
too” product or service. Prices fall dramatically.
Marketing is the science of constantly reversing the
commodification process and smart firms are continually
finding new ways to return the product to its former premium
position in the marketplace, or to introduce a
replacement–the “new and improved...”
One shining example of creating the premium service
product is a well known retail vendor of brewed coffee.
Coffee is a rank commodity. But this well-known vendor has
managed to take this commodity and turn it into a highly
unique service offering. This well-known vendor of the highly
differentiated brewed coffee retail service has recently
reported a specular increase in annual revenues of 42%,
demonstrating the power of reversing and enhancing a
commodity. Here is their trademark.
57

One Reason The Private, 30-Year R&D Effort Has
Been A Foremost Trusted Source Of Industry
Intelligence And Advisement Is Because This
Exclusive Work Not Only Debunked The
“Dominance Of Managed Care” Hoax Back In The
Early 1980s, It Also Debunked The “Cost Escalation
Crisis” Hoax That Has Reached A Malignant Level
Despite The Overwhelming Evidence To The
Contrary.
It’s truly amazing yet distinguished business scholars have
to yet to identify Pareto’s Law as the real cost escalation
predicament in American healthcare. Fact: Relatively few
people, about 10% of the patients, account for more than 70%
of the total healthcare expenditures. Today the dollar amount
is about 2.3 $trillion.
It is inconceivable, but true, that only 1% of the people who
use the healthcare system account for a whopping $1 trillion.
Reducing utilization among the “heavy users” (the top 10%) by
about 20% will allow all of physician services in the US to be given
away to all patients free with the society still paying the same bill. If
this is the first time you are hearing the argument, you are among
the majority who are 100 years behind. It’s another example of the
huge management gap.
Vilfredo Pareto, (1848-1923) created what people today know
as the 20-80 rule. The phenomenon is truly ubiquitous
throughout the world of management.
58

One Reason The Private, 30-Year R&D Program Has
Been A Trusted Source Of Industry Intelligence And
Advisement Is Because Early On The Program
Identified And Portrayed The Real Cost Issues.
Likewise, the R&D program demonstrated why the cost
escalation crisis was a hoax and that healthcare spending
was in a downturn–a permanent downturn because the
traditional model of healthcare, the biomedical model was in
the end of its life cycle, ready for the creative destruction, the
maelstrom, and the challenges of taking the right path and
successfully making the critical transition–the “breakout.”
Despite evidence to the contrary, the deeply embedded “cost
escalation crisis” hoax had infected respected scholars and
pundits at prestigious American institutions.
As demonstrated in this news article, the implosion of 1990
was still gathering momentum to become the most severe
crash in the modern history of the US economy.
It sounded great: “There was an abatement is spending on
physician bills.” The term “abatement” was used to describe
a sever implosion. The term “abatement” implies that the
catastrophic event was a “cushioned decline.” In any other
context, this “explanation” would be comical; in this context
is was a comic tragedy.
Who was trying to cover-up this catastrophic event and why?
One speculation is that the facts would deflate the cost-
escalation hoax.
59

The Mainspring US Physician Service Industry In
The USA Has Entered Into The Mature Stage Of Its
Life Cycle. This Mainspring Industry Is Facing The
Most Critical Transition In The Modern History Of
Medicine. This Formidable Challenge Must Be
Managed At The Requisite Level Of Management
Sophistication Or The Steam-Rolling, Domino-
Effect, Killer Shockwaves Will Destroy This Ailing
American Institution.
In this condition, the industry has reached its carrying
capacity, it is at its limit. Mathematically this industry has
reached an asymptote and cannot rise any further. It’s highly
unstable. This industry is headed into the decline stage of its
life cycle. In short, Western Allopathic medicine (and
dentistry) based on the biomedical, or biomedical, model is
obsolete. As the industry plunges into the decline stage of its
life cycle, the collapse will intensify as the industry gets
“sucked” into the death spiral–the maelstrom.
60

Here Is A Dramatic Historical Example Of The
Overshoot-And-Collapse Catastrophe. It’s The
Sudden Collapse Of The American Computer
Industry.
The historical record of the number of firms in the industry
was demonstrated to be about 300 firms–the carrying
capacity. In 1984 the industry started to take off probably
based on speculation of the rising demand for computers.
The number of firms peaked to about 700 firms. Then the
industry experienced a sudden and violent collapse.
One of the cardinal signs of an industry collapse is a violent
contraction in the number of firms. In just a four year period
some 400 computer firms disappeared. Again, high rates of
failures in a relatively short time period is a bimodal
annihilation catastrophe, the little bang that triggers the big
bang. The graph below was taken from a scientific paper on
the overshoot-and-collapse super-critical phenomenon.
61

The Entire US Healthcare Industry, Posting Annual
Revenues Of More Than $3 Trillion, Has Stumbled--
Unaware--Into The Mature Stage Of Its Life Cycle.
Each And Every Organization Must Make The
Vaunted Breakout, Or Paradigm Shift, Or Be
Annihilated By The Powerful, Relentless, Steam-
Rolling Forces Of Evolution. It’s Truly Survival Of
The Fittest. It’s The Creative Destruction Super-
Critical Phenomenon. It’s The Bad News.
The good news is that a brilliant business scholar working at
the Harvard school of business identified the principles of
survival and prosperity that must be implemented and
mastered for each and every firm to successfully make the
critical transition–or perish. The bad news is that his work
has been totally ignored for more than three decades.
In this graph the expression: “degraded carrying capacity” is
analogous to widespread organizational and personal decline.
62

Back In 1980 A Brilliant Business Scholar Published
The Results Of His Groundbreaking Investigation Of
How Some Firms Not Only Survived In Hostile,
Challenging, And Turbulent Business
Environments, But Also Prospered. In Fact, The Few
Surviving Firms Outperformed Some Of The Best
Run Companies In The Nation At That Time.
Jeff C. Goldsmith is a highly respected management guru in
the healthcare establishment. In the very same issue of the
eminent Harvard Business Review, his article presented the
challenge. The answer to his inquiry was dramatically
presented in the very same publication. But surprisingly, this
discovery was ignored! Not only that, this eminent, timely,
groundbreaking solution to the survival threat has been
ignored for the past 37 years! Is this sufficient proof of the
existence of a huge management gap in the healthcare
industry?
What is worse, if this huge
management knowledge gap is not
closed is a timely, purposeful
manner, the disaster will trigger.
The leadership must be able to
competently manage the powerful,
super-critical forces that are
propelling the looming threats.
Otherwise, the result will be a
meat-grinding national disaster–the
collapse of the healthcare system.
63

One Burning Question Is: Exactly When The Major
Components Of The Healthcare Industry Will Suffer
Another “Big Bang?” The Probability Is Absolutely
Certain Because The Prediction Is Based On The
Relentless Law Of Evolution–What Is Born, Must
Die!
This data confirms that likely event of a snowballing, domino-
effect, killer shockwaves with happen.
Incontrovertible evidence says that these industries already
suffered a big bang, but this event was absorbed and not
noticed. But it was surely felt.
The history of the massive industry proves that this industry
is vulnerable to sudden and violent changes in the driving
forces of the industry.
Plus, this graph demonstrates how there was a domino-
effect, steam-rolling crash in the US Hospital Services
industry right after the mainspring US Physician Services
Industry suffered its first big implosion.
Did Obamacare trigger the dreaded, tell-tale last
gasp? Did Obamacare produce greater instability of
the industry? Did Obamacare backfire? Did
Obamacare magnify the pathological boom and
crash cycles.
64

Here Is More Proof. The US Dental Services Industry
Is Essentially A Cash-Based Professional Service
Business. Dental Insurance Is Not An Indemnity
Form Of Insurance, But Classified As A Pre-
Payment Form Of “Insurance.”
The evidence shows that this industry, currently posting
revenues of $117 billion demonstrated the same evolutionary
phenomenon. The biomedical model of dentistry is also at
the end of its life cycle. It’s actually best described as the
bio-mechanical model and the sobriquet is “drill, fill, and
bill.”
The US Dental Services Industry is highly unstable. It also
now faces a sudden and violent bimodal annihilation
catastrophe and a sudden and violent collapse.
It is important to use US Dentistry as a comparison in the
discussion of the evolution of the American healthcare
industry. The evolution of this industry does parallel the
evolution of the other provider sectors. Using the dental
industry helps to clarify the role of insurance in the
professional services business in the provider sector.
What is truly sobering is the finding that the majority of
doctors and dentists refuse to believe that their beloved
industries will fail and suddenly collapse. After all: “people
will always get sick and will have to go to doctors!” They
refuse to acknowledge the powerful forces of the law of
evolution. They refuse to remember the past.
65

The Definitive Authority On The Evolution And The
Devolution Of The Mainspring US Physician
Services Industry Is Because This Exclusive Effort
Produced A Legitimate Computer Model That
Explains And Demonstrates The Vital Importance Of
The Annual Rate Of Industry Growth On The
Survival And Prosperity Of All Professional Firms.
Basically, when the industry is growing robustly as it had
during the growth stage of the industry life cycle, all the
doctors has to do was show up for work. They did not need
to manage their practices; the rising tide was raising all
boats!.
But when the rate of growth reached the critical threshold of
4%, now the doctors have to work hard to get the patients
and grow their businesses at the most desirable level (10%
per year). When the rate of growth drops below the 4%
threshold, the industry becomes extremely fragile, unstable,
and vulnerable to rapid “correction” that happens when a
stock market crashes. At 2% the doctors have to capture all
of the new patients.
What this model demonstrates is that big firms, contrary to
conventional wisdom, are less likely to survive due to their
market share (bigness). The truth is that smaller firms are
like corks in a violent ocean and will have greater
survivability. For a more detailed explanation of this model,
Google “bimodal annihilation catastrophe.”
66

The baby boomer population are those people born between 1946
and 1964. Boomers are estimated to be between 76 and 78 million
people. Therefore, the “front” edge of the baby boomers started
turning 65 during the year 2011. What caused the exponential
growth of Medicare payments to American doctors starting in
1992–almost two decades before the front edge would kick in? In
the decade of the ‘90s, the elderly population was declining. Could
the curious anomaly presented here be called mis-management by
Medicare that promoted cheating among otherwise honest people?
Single Payer In The US Has An Awful Reputation.
Medicare Is A Glaring, Sobering Example Of Why
Any Form Of Single Payer Should Be Vigorously
Opposed And Eliminated. The Track Record Of The
Medicare System Has A Seriously Flawed History
That’s Been Whitewashed, Covered Up, And Denied.
People are surprised to learn that out-of-pocket payments
(cash money) to doctors was bigger than payments to
physicians for most of the history of Medicare. It is
interesting to speculate this possibility: Did out-of-pocket
payments to doctors exert a “damping effect” on Medicare
payments to doctors for such an extended period–about 30
years?
And second, is it possible that the violent contraction of out-
of-pocket payments to doctors at a critical time and the
drastic cut-backs of reimbursement made by Medicare for
major treatments cause the occupational communities of
doctors to start extracting payments from Medicare by
milking and bilking? The abuse was called “creative billing”
by some opportunists selling computer programs to facilitate
the scam. A treatment that normally is reimbursed at $2,000
could be manipulated to garner reimbursement of $8,000.
Did Medicare cutback policies induce abusive behaviors
among doctors who were forced to keep profits in their
practices at the expected levels? What explains the dramatic
growth of Medicare payments to doctors when the Medicare
population was actually shrinking?
67

One Reason The Out-Of-Pocket Revenues Plunged
At A Critical Time Was That The American People
Did Not See The Value Of Paying For Services From
Medical Doctors In The US Physician Services
Industry.
Keep in mind that out-of-pocket payments, cash money, were
larger in annual volume that payments made to doctors from
Medicare for most of the history of Medicare from 1967 until
1990 when the first big crash triggered.
When the first big crash triggered, provider organizations
started to demonstrate the widespread organizational decline
super-critical phenomenon. Organizational pathologies
skyrocketed. The US Physician Services Industry had
reached its carrying capacity in 1990.
Seventeen years later most industry incumbents and
government bureaucrats are still oblivious to what happened.
They are responsible for triggering the massive collapse of
the entire industry in 1990. It was the beginning of the end.
68

What Caused The Implosion Of The Out-Of-Pocket
Payments To Doctors At A Critical Time? Healthcare
Is A “Reputational Good.” Public Confidence In The
Occupational Community Of Doctors Crashed.
Hence, Reputations Crashed. Then Demand
Crashed.
The collapse of managed care and the widespread
dehumanization reported in the media as “horror stories”
shook the industry to the core. Doctors claimed that
managed care “ruined” medicine. They were correct. Yet the
very same doctors fail to identify that they themselves were
responsible for the reprehensible actions demonstrate by the
HMO debacle.
Crimes of obedience is a symptom of an pathological
authoritarian, autocratic social system. Such pathologies are
symptoms of the widespread organization decline that
generated antisocial behaviors among workers.
This deeply embedded predicament must be reversed and
managed intelligently and thoroughly before any major payer
“innovations” are attempted, or history will surely repeat
itself.
Like moral disengagement, crimes of obedience result from
the institutionalization- Commodification- Dehumanization
syndrome.
69

This Roper Survey Tells The Story Of Why Out-Of-
Pocket Revenues To Doctors And Hospitals
Crashed. Doctor, Dentist, And Hospital Charges Are
At The Bottom Of The Value “Iceberg.”
This effect has been demonstrate in the private, 30-year R&D
program been due to the “Institutionalization, commodification,
dehumanization syndrome that has ruined the private practices of
medical doctors.
Surprisingly, this dehumanization syndrome was brilliantly
portrayed by one of the great American icons, Dr. Seuss, in his
brilliant book: “You’re Only Old Once.” He was dead serious about
the evils of the dehumanization syndrome.
70

Take A Closer Look At How Dr. Seuss, The Great
American Icon, Would Portray The Doctor Persona.
Why Do These Doctors Exhibit Such Stern Facial
Expressions–And Funny Mustaches?
Keep in mind that during his lifetime,
Theodore Seuss Geisel would be
credited with selling more than 650
million books published in dozens of
different languages. Early on, before
and during WWII he was a political
cartoonist in New York City. He was
well familiar with the dehumanization
syndrome produced by the malignant
authoritarianism of Fascism.
His sagacious warning suffered from a “little neglect!” These
two men are said to be among the most evil people in history.
71

The Great Social Philosopher Of The 20th
Century,
Erich Fromm, Powerfully Demonstrated The
Destructiveness Of The Institutionalization-
Commodification-Dehumanization Syndrome. He
Coined The Terms: “Thingification,” “Autism,” (low
social competence) And “Automaton-Conformity”
To Describe The Antecedents Of Dehumanization.
It’s an appropriate label for the looming single payer atrocity.
Using the term autism, he anticipated what is today
described as the “geek syndrome” which is a growing threat.
The ultimate form of dehumanization he described as
“necrophilia.” In this context it means “the love of death and
destruction.” Necrophilia succinctly describes the brutal
terror of Nazism. Dehumanization and necrophilia are lurking
deep in the bowels of the Single Payer malignancy.
72

Surprisingly, Out-Of-Pocket Revenues To The
Professional Service Businesses In American
Healthcare Is A Substantial Market. As Presented
Here The Total Volume During The Late 1990s Was
More Than $171 Billion.
This out-of-pocket segment is bigger than the US Dental
Services Industry today. The annual revenues generated in
American dentistry was more than $117 billion as of 2015, the
latest data.
Intelligently managing out-of-pocket revenues would have a
strong, positive effect on the profitability of the professional
services business of the healthcare provider sector of the
healthcare industry.
An important factor is creating the right solution to the
healthcare crisis becomes obvious. The private practices of
doctors and dentists must start offering cash-based services
and products which will increase the health status and
reduce the illness burden of people in a given geographical
area, the doctor’s service area.
Plus, one hypothesis is that this solution will dampen the
Medicare payments to doctors.
73

This Data Demonstrates That The American People
Were Willing To Pay Out-Of-Pocket For Other
Professional Services From Such Providers As
Dentists, Chiropractors, Podiatrists And Other Non-
MD/DO Providers.
This graph is validated by the robust growth of one sector of
Non-MD professional services industry: Chiropractic.
74

When A Major Historical Source Of High Profit Out-
Of-Pocket, Cash Revenues Into The Professional
Service Businesses Of Healthcare Such As Private
And Group Practices Imploded, The Fed Drastically
Cut Reimbursement To Doctors. The Timing Of This
Fiasco Could Not Have Been Worse. Such Gross,
Blinded Mismanagement Alone Is A Condemnation
Of Any And All Single Payer Schemes.
Once Medicare cuts reimbursement, the private insurance
companies follow suit and cut reimbursement for the same
procedures. This replication further cut revenues flowing
into the professional service businesses of the US Physician
Services Industry.
As referenced in this graph, the 30-year R&D conducted a 12-
year demonstration project which demonstrate how this
disaster can be avoided by private practitioners.
This crash was demonstrated during the five years since the
1990 crash. Medicare actions were to produce and magnify a
catastrophic evolutionary event. The question remains did
the leadership at Medicare take such damaging action
intentionally or did they simply demonstrate the “little
neglect” that Benjamin Franklin warn about back in 1745?
What this historical event demonstrated is that the
government was reckless and mindless in its administration
of the flow of revenues. These cutbacks plunged the industry
into a fragile state that was vulnerable to collapse.
75

One reason the private, 30-year R&D program is the
definitive authority is because it has developed the
first and only scientific explanation of the evolution
of the professional services business in American
healthcare. One of the requirements for producing a
scientific explanation is “resolution.”
Resolution is like a strong microscope that can visualize and
discriminate between structures that are not visible to the
naked eye.
Baby boomers are the people who were born between 1945
and 1964. Baby boomers are the largest population group in
the nation.
One of the deeply embedded myths is that the baby boomers,
as they age, will overwhelm the traditional healthcare system
and flood the system and degrade ready access to needed
healthcare for all people.
However, the evidence does not completely support the
contention that the baby boomers are “heavy users” of the
healthcare system. In fact, during 1990 the baby boomers
started to turn 45 years of age, when the demand should
have surged, the mainspring US Physician Services Industry
experienced an unprecedented crash--one of the worst in US
economic history. What happened? Did this event trigger an
surge in demand that caused the carrying capacity of the
industry to implode?
76

This chart reveals the truth about aging and disease
prevalence. There is a dramatic increase among most,
but not all common diseases, with advancing age.
As some doctors claim, age 45 is when a person’s life
style catches up with them. There is a surge in
hypertension, a root cause of a major killers, such as
strokes and heart disease. However, chronic sinusitis is
relatively high at all age groups.
Therefore, demand for healthcare services should have
surged in 1990 when the leading edge of the baby
boomers started turning 45 years of age. In 1990 the
mainspring US Physician Services Industry crash; it
was the most severe decline in US economic history.
One clue may be that the baby boomers are the most
well educated population group in the nation. There is a
dramatic inverse relationship between education
(represented as income levels) and disease prevalence.
This anomaly is know as “disease gradients.”
Another consideration is that the need may indeed rise,
but the demand may not follow in an orderly, predictable
fashion. And remember, a very small percentage of
people, about 10% consume up to 70% of the health
services in the nation.
77

The Double Whammy Effect: The Single Payer Scheme
Will Bring In Patients Who Are Very “Heavy Users” Of
The Professional Services Of The Ailing Healthcare
Establishment. The Sudden Increase In Consumer
Demand, Given The Real Predicament Of Overshoot-
And-Collapse, Will Magnify The Impact And Trigger The
Sudden And Violent Collapse Of The Physician Services
Industry. Then The Catastrophic, Domino- Effect, Chain
Reaction Kicks In And Plunges The Entire Mega-Trillion
Dollar Industry Into The Dreaded Maelstrom.
One of the demographic and socioeconomic disease
prevalence anomalies are called “disease gradients.”
There is a dramatic inverse relationship between income
levels and disease prevalence. Income levels are strongly
related to educational levels and can be determined from the
local demographics data easily obtained from the Census
data.
Common diseases such as diabetes have one of the steepest
disease gradients which is understandable because of
socioeconomic and cultural factors that are associated with
this disease. Hispanics demonstrate up to three times the
disease prevalence of diabetes compared to Caucasians.
Surprisingly, bunions is a hereditary bone disorder and is not
subject to socioeconomic factors yet this pathology
demonstrates one of the steepest gradients of common
diseases.
78

With respect to the nefarious Single Payer Scheme,
one argument to develop further is that this scheme will
attract people of lower socioeconomic status and
therefore a much higher prevalence of a given disease.
People of lower socioeconomic status are heavy users
of healthcare services. Under the Single Payer Scheme
the heavy users will dramatically overload the system
that is already in the infamous, well documented
Overshoot-And-Collapse predicament.
The Disease-Gradient Predicament Will Guarantee That
The Mainspring Physician Services Industry Will Hit The
Catastrophic Tipping Point and Suddenly and Violently
Collapse And Trigger Domino-Effect, Killer Shockwaves
Throughout The Provider Industries, Then Into All The
Supplier Industries, And Then The General Economy. It
Will Produce The Worst Tragedy Ever.
There is already a wealth of evidence, irrefutable evidence, that the
entire provider sector of the ailing US Healthcare establishment is
fast approaching the tipping point. The super-critical phenomenon
is the bimodal annihilation catastrophe. It’s like an avalanche; an
avalanche can trigger due to a small drop in temperature, a very
small “perturbation.” Once the process starts, it is impossible to
stop. And the avalanche “goes to completion” destroying
everything in its path and quietly stops.
Plus, because there is a 100-year management knowledge gap, the
leaders are likely to panic, over-react, and compound what is
already a severe predicament.
79

Criticism of the healthcare systems in other countries is not
publicized the way the faults of the American system are
frequently exposed and dissected.
One reason is that these foreign healthcare establishments
suffer from the Institutionalization- Commodification-
Dehumanization syndrome. If the workers, including the doctors,
criticize the system they get kicked out. It’s the infamous three
monkey syndrome that is symptomatic of authoritarian,
autocratic work systems. Hear no evil, see no evil, speak no evil.
And most of all: “Don’t make waves!”
One Of The Specious Arguments For The Single
Payer Scheme Is That Many Other Countries Have
Implemented The Single Payer Innovation And It Is
“Working Fine.” Why Is The US Lagging Behind?
So What! What makes such people think the healthcare
systems of other countries are working at the desired level of
quality, compassion, and effectiveness? They are not. The
medical institutions of these countries are still delivering and
obsolete model of medicine, the biomedical model. Their
healthcare industries are facing the very critical transition
facing American healthcare. If they are not addressing this
mammoth challenge, they are probably unaware of it or
whitewashing the threat which is common characteristic of
authoritarian, single-payer systems and national health
systems as they age and ossify.
Some people confuse the national health system with the
single payer system.
The British NHS is a national health model; it’s where the
government owns the facilities, the equipment, and the workers are
government employees. American examples of the national health
system are the VA and the Indian Health Service. It’s government
run medicine to the Nth degree. The British system is moving to a
market-based system, like the US. They have had enough of the
“political incompetence.”
The single payer model is where the facilities and the equipment are
privately owned and the workers are civilians. The facilities care for
the patients and bill the one entity–the state or the federal
governments. Medicare is a long-standing, rueful example.
80

There Are Lots Of
Rumors That Wealthy
Canadians Are Coming
To The US To Get The
Healthcare That Is
Denied To Them And To
Their Fellow Citizens!
What Is Happening To
Their Fellow Citizens
Who Can’t Afford To
Come To The USA?
Canadian healthcare is
at the tipping point and
facing the creative
destruction paradox. It
appears that they have
not anticipated and duly
prepared themselves for
this classic super-
critical phenomenon.
It’s a ticking time-bomb,
and time, precious time,
is rapidly running out for
our neighbors.
81

The State And Federal Governments Are Challenged
With Implementing A Major Innovation–In Fact, A
“Disruptive”Innovation--With Any Single Payer
Scheme.
Unfortunately, the governments track record is appalling;
Obamacare is a glaring example. The managers ignored
totally the ten factors which must be acknowledged and
managed appropriately (presented later in this draft).
Not only did the implementation fail; it cost billions of tax-
payer dollars and wacked big insurance companies with
billion dollar losses (that they would admit to).
What’s more, the healthcare industry has an equally
appalling track record for implementing innovation.
This news article demonstrates that it takes about 17 years
for a clinical implementation to be implemented and often
not successfully.
The next reasonable question is: How long does it take to
implement a management innovation? It’s shocking, but it
takes about 100 years to implement a management
innovation. The claim that there is a huge management
knowledge gap is easily demonstrated. For example, the use
of Pareto’s Law to demonstrate the surprising stratification
of healthcare cost is never used in the discussion of the
“escalating cost crisis” hoax. Pareto’s law should be on
“everybody’s lips.”
82

Here Is A Hypothetical Graphic Portrayal Of The
Sobering Innovation Diffusion Failure In American
Healthcare.
The research capabilities of the healthcare establishment is
awesome given the work at such places as NIH and the
dozens of medical schools conducting grant-funded
research. These organizations are like big knowledge-
generating factories. They are pumping out more data than
the practitioners can absorb.
The academic institutions with medical or dental schools rely
extensively on a constant flow of heavy grants. The tuition
revenues for a typical medical school are only about 5% of its
operating revenue needs. No medical school (or dental
school) in the USA could operate with out massive grant aid.
Knowledge creation is so deeply embedded and politically
protected that it is impossible to pare back the flood of
grants. Without the big grants the medical schools would fail
massively and generate massive unemployment of very
talented people.
The people who do knowledge creation, are different than the
developers. The developers are different from those who do
diffusion and implementation--the sales people.
One project of the private 30-year R&D program was called
the Right Moves Project. The goal was to implement an
elegant model program developed by NIH starting in 1972.
83

Why Has The Knowledge Transfer, Or Knowledge
Diffusion, Process Failed Miserably In The
Mammoth Healthcare Establishment? One Reason
Is The Continued Use Of The Antiquated Flexner
Model.
Early on, one of the projects of the private, 30-year R&D
program was called the Right Moves Project. The goal of this
seminal work was to provide the management knowledge-
base to empower private practitioners to make the vaunted
“break-out,” and to escape the emerging maelstrom.
In part, this project would replace the antiquated Flexner
model, established in the early 1900s. It was the first major
transformation of traditional medicine.
He was authorized to implement the closure of hundreds of
“medical schools” because they were a serious health threat.
His work instituted the creation of the journal system which
by today has spawned hundreds of professional journals and
journal clubs. He instituted the creation of regular local and
national meetings where the latest innovations
would be presented.
Having worked for many years, today this
model is widely considered to be obsolete. A
potential new model was created by the Right
Moves Project. This seminal work suffered from
the pathological “little neglect” syndrome.
84

The Right Moves Project Attempted To Implement
Locally A Groundbreaking Program Developed At
NIH. It Is Called The National High Blood Pressure
Education Program And It’s Still In Progress.
To make a long story short, the Right Moves Project was an
abject failure despite the fact that it was advocated health
policy of the USA and 100% legitimate. The main reason for
the failure of this promising effort was attributed to the lack
of “early adopters” who are the critical link in the diffusion
and implementation process.
There was almost a total absence of the early adopter
persona. This fact was discovered in the greater San Diego
region but is probably true for the rest of the nation.
It is relatively easy to spot early adopters because they tend
to demonstrate many of the characteristics listed here. They
have a high tolerance for ambiguity. They are open to
experience, and non-dogmatic. They are the “movers and the
shakers.”
It is proposed that in the decline-death stage of the industry
and organizational life cycle, the early adopters vanished and
morphed into the laggard personas. One of the best
examples of the laggard persona is a well known TV icon. His
comical characteristics were defined as “psychometrically
accurate.” Laggards are close-minded, narrow-minded,
dogmatic, simple-minded (black and white thinkers), rigid,
and inflexible. They are reluctant foot-draggers and they do
not innovate.
85

With The Failure Of The Patient Protection And
Affordable Care Act (aka Obamacare), What Was
Clearly Demonstrated Is That People In The Federal
Government, The People In The Healthcare Provider
Industry, And The Leadership In The Insurance
Industry Do Not Posses The Requisite Level Of
Management Sophistication To Successfully Launch
And Successfully Implement A Complex Innovation.
This Nagging Defect Is The Main Reason The Legislation
Failed Miserably, Backfired, Boomeranged, And Made The
Industry Fragility Much Worse.
Obamacare Stands As One Of The Greatest Management
Fiascos In American History. It’s An Easily Proven Scientific
Fact. This Flagrant Mis-Management Debacle Has Pushed
The Healthcare Provider Industry To
The Maelstrom–And Closer To
Sudden And Violent Collapse.
Obamacare is hard evidence of the
huge, 100-Year management
knowledge gap. It must be closed
before any major innovations are
attempted. The stakes have never
been higher and the domino-effect
consequences have never before
been more disastrous.
86

The Astonishing 100-Year Management Knowledge
Gap Must Be Closed Before Any Major Changes, Or
“Innovations,” Are Attempted. Otherwise, The
Nation Will Suffer A Major Societal Disaster That
Will Not Only Waste Billions Of Taxpayers Dollars,
This Looming, Steam-Rolling, Meat-Grinding
Disaster Will Cause Physical And Emotional Harm
To The Nation’s Most Vulnerable People: The Sick,
The Elderly, And The Children.
Likewise, Single Payer Schemes Will, Irrefutably, Trigger The
Violent Collapse Of The Provider And Supplier Industries.
Reforms take decades and centuries. The Single-
Payer Schemes have the potential to inflict grave,
permanent, and irreversible damage on the existing
healthcare system.
It appears that the proponents of Single-Payer Schemes have
not properly evaluated the extreme risks presented by such
“innovations.”
In fact, proponents of the Single Payer Scheme, such as
Bernie Sanders, based on media accounts, are so oblivious
to the enormous threats that their arguments constitute
reckless endangerment of a major American institution and
the American people. It’s time to expose these dangerous,
mindless actions and the monumental Evil that’s now unseen
but nevertheless embedded is the superficial, illusive Good.
87

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