The Institutionalization--Commodification--Dehuman-ization Syndrome Caused This Disgusting, Reputation-Busting Debacle At The Very Birthplace Of The Deeply Embedded Yet Obsolete Biomedical Model Of Medicine, The Johns Hopkins Institution. It Was The Largest Malpractice Settlement In US History, So Far.

This predicament also demonstrates that the entire healthcare "system" is inherently extremely unstable and extremely vulnerable to the bimodal annihilation catastrophe--the little bang that triggers the big bang. It's because a small drop in demand among the 10% of consumers (the heavy users) in the tip of the iceberg could trigger huge decline in revenues. For example, a mere 10% drop could wipe out about $290 billion in revenues.

The 30+ year R&D program has drawn gratefully from the dedicated, groundbreaking work of hundreds of brilliant American scholars such as Kim Cameron now working at the prestigious University of Michigan. 

​  Decades Ago There Was A Critical Transition From Exclusively Managing Tangibles (Outputs, Outcomes, Accounting Measures) To An Emphasis On Managing “Intangibles.”  Two Iconic Firms Missed This Critical Transition And Suffered Major Setbacks, But Survived. IBM Lost $10 Billion In 1992,  Alone. General Electric Is  Making A  Major “Turnaround,”  A Critical Transition.

One of the main dimensions of a professional service is performance ambiguity that is compounded by complexity.  The fatal flaw of the value-base models of healthcare is the wrong assumption that there is a direct, linear relationship between performance and quality.

Around 800 BC, Homer described the challenges and the threats in making the dangerous passage: It's the super-critical phenomenon known today as the critical transition--making the breakout.

The private, 30+ year R&D program developed an evidence-base management knowledge base on how the behaviors of organizations can be proactively and humanistically managed and maximized to achieve high performance, a beneficent, hardy, innovative (adaptive), and healing organizational climate, resilience, survival, and perennial prosperity, especially in a hostile environment.

​American Healthcare Is Plagued With Skyrocketing Corruption.  It’s A Significant Threat That Has Been Mismanaged For Decades.  An Ignored, Yet Significant Milestone Event Started In 1990. The Physician And Hospital Services Industries Suffered Sudden, Domino-Effect Crashes. This Event Triggered The 500% Explosion Of Prosecutions Starting In 1991.

Published studies by respected institutions reveal that there is an "astounding" level of errors in the healthcare establishment, especially in the hospital sector.  American healthcare is now the third leading cause of death. What is the reason for such bad performance?  Again, the root cause of this sobering problem is the huge management knowledge-gap in the healthcare establishment.

​Patient Centered Care Requires Caregivers To Gain An In-Depth Knowledge Of Patients Including Demographics, Geographics, Psychographics, Personalities, Plus Their Health And Illness Beliefs. It Was Advocated By Hippocrates But Generally Ignored By Modern-Day Physicians, Dentists, And Their Handlers..

"Now the doctor, by virtue of accepting science so totally, creates a total imbalance: forgetting the art of healing, forgetting the art of engagement, forgetting the art of listening, forgetting the art of caring, and ceasing to invest time with the patient. So I believe that medicine has lost its human face."

The US Hospital Services Industry during the past century has achieved an astounding, unprecedented level of technological achievement. In fact, the American hospital is indeed one the technological marvels of the 20th century.  How is it that the American people rank hospital value-for-money last?  Is the institutionalization- commodification- dehumanization syndrome of a professional service organization the answer? 

 ​A Warning From History:  During the universal, critical transition of the Roman Empire, it was common for the emperor to be assassinated. While traveling, this emperor left his heavily guarded coach and went into the bushes to "relieve" himself and was assassinated. His story is the origin of this old saying that is still relevant today: "Don't get caught with your pants down."

At the age of 45, the increase in bunions can surge from 200% to 700% depending on income status. Bunion disease is a hereditary disease that is not hugely affected by lifestyle factors as are diabetes, cardiovascular diseases, and obesity.

Back In The Early 1980s, When The Proponents Of Managed Care Claimed That HMOs Would "Dominate" Healthcare, The 30+ Year R&D Program Debunked Such Claims. Those Who Responded To The Scientific Evidence Were Spared The Losses And The Setbacks Others Suffered.

Will History Repeat Itself?

​“In 2014, Johns Hopkins in Baltimore, Maryland had to pay a settlement of $190 million to 8,000 plaintiffs. This settlement was awarded after it was revealed that Dr. Nikita Levy, a gynecologist who had worked there for 25 years, had been using surveillance equipment
to photograph his patients (ie: their private parts) secretly. Dr. Nikita was fired in 2013 and committed suicide less than a fortnight later.”   The Baltimore Sun

Using the circumplex model of emotions would have helped this physician manage his patient's emotions and deliver the best patient centered care. This long-standing research has been ignored by the doctors, the dentists, and their handlers.  

​Thanks to Google Alerts, a review of hundreds of published articles covering healthcare cost likewise failed to mention Pareto’s Law as critical to
solving the skyrocketing “cost crisis.”

American healthcare is a knowledge intensive industry. However, knowledge management is a massive failure. The deeply embedded model of knowledge management, called the Flexner model, is more than a century old.  Although it is totally obsolete, it has not been replaced. The failure of timely knowledge management explains why it takes up to 17 years for an innovation to reach the front lines of American medicine as demonstrated in the report cited here.

​Was It Purely A Coincidence That Major Malpractice  Claims Exploded About 130% After The Critical Event That Started In 1990?  Did This Predicament Signal That  American Healthcare Was Plunging Into The End Stages Of Its Lifecycle, And  Facing The Classic Maelstrom: The Death Spiral And The Extinction Vortex?​

​Roman Emperor Caracalla
(188-217 AD)


​Surprisingly, from the 1960s up until the 1990s, out of pocket (cash) payments to physicians was larger than payments from Medicare..

One of the century-old laws used in the formal scientific explanation is the Yerkes-Dodson law discovered back in 1908.

If this law had been prudently and proactively implemented after the industry deregulation the suicide disaster plaguing American healthcare would have been avoided and the "psychic costs of caregiving" would have been managed appropriately.  This blunder is another sobering example of Ben Franklin's warning: "A little neglect breeds great mischief." .

​Solar flare activity is on average an 11-year cycle (5.5 years up, and 5.5 years down. The range can be from 7-14 years. Solar flare activity increases human vulnerability.  It is directly correlated with high combat casualties during wartime.  High  solar flare activity increases the incidence and severity of mental illness.  It’s also positively correlated with epidemics going back to the 14th century. When solar flare activity soars, the demand for healthcare services will increase dramatically and is one of the unseen forces that will drive the healthcare industry to the tipping point and the overshoot-and collapse national disaster. During the Covid pandemic solar flare activity was low. If the pandemic spread during high solar flare activity, the impact would have been much greater, and many more people would have suffered and would have died. The raging controversy over the legitimacy of mask mandates would have vanished.

The power of the principles of survival that were discovered decades ago were demonstrated in a 12 year demonstration project conducted when the US Physician Services industry experienced a collapse-size, catastrophic implosion in the industry rate of growth that was about three times more intensive that the worst stock market crash in US history.

​Why is it important to include the knowledge base that is built on centuries of symbolism?  The collective, symbolic, deeply embedded human experiences of dealing with challenging events gets physically “coded” into the human genome which helps future generations deal successfully with the challenges of making the critical transition and escaping the maelstrom. It’s a fact, the science is called: trans-generational epigenetic inheritance. Tacit knowledge is in the bottom of the knowledge iceberg; It's also called the collective unconscious, or collective memory. Surprisingly, tacit knowledge is coded into what was once mistakenly called "junk genes."  Symbolism allows people to tap into this vast meta-physical warehouse.  Organizations that encourage and allow workers to tap into the knowledge base are the most successful, the most resilient, and the most innovative. They also enjoy strong growth especially in an industry facing the hostile business environment of the maelstrom, the death spiral, and the extinction vortex. 

Doctor Benjamin Franklin (1706-1790),

in Poor Richard's Almanac, c. 1745

​The patient, the doctor, and the pharmacy are closely linked marketplaces, mutually dependent, or “mutualistic” communities.  It’s likely that what happens in one industry (critical slowing down and failed recovery), will happen in the other industry. What happened in the retail sector of Big Pharma happened in the US Physician Services Industry and vice-versa. This strong reciprocal phenomenon has been extensively, and convincingly  demon-strated.

​Hippocrates’ Warning About The Impact Of “Airs, Waters, And Places” (The Biosphere) On Health And Mortality Has Been Scientifically Authenticated But Generally Ignored And Downplayed By The Healthcare Establishment.

Pierre Francois Verlust first published the law of logistic function back in 1845. This universal mathematical law has described the evolution of every "system" from enzymes to empires. Most people know it as the "S" curve.

​Professor Daniel J. Siegel, MD, University of California, Los Angles

There is a well-developed, yet virtually unknown, management knowledge base about this fatal trap. Those folks who refuse to believe the scientific evidence and hide behind the high walls of denial, defensive avoidance, fear paralysis, procrastination, disengagement, Pollyanna (blindly optimistic), the Dunning-Kruger effect (inflated self-image, self-ignorance generates bliss), Anosognosia (an inability to perceive threats and a lack of concern about current difficulties, or impaired self-awareness), the Three Monkey syndrome (hear no evil, speak no evil, see no evil, mindless compliance), the Ostrich syndrome (having one’s head in the sand), the Geek Syndrome (Nerds, tech-nerds, people who lack basic social and motor skills, seem unable to decode body language and sense the feelings of others, dehumanization), the Icarus Syndrome (becoming so obsessed with novelty or technology that one ignores repeated warnings and suffers grave consequences), and Groupthink (non-deliberate suppression of critical thinking, common wisdom, or the obvious facts in order to conform to group norms and achieve group harmony).

As it goes through its life cycle, every product and service product devolves from a new, highly differentiated, highly valued, exceptional offering to a generic, or common, undifferentiated product. This process can be reversed by proactively and constantly managing innovation to keep a service product highly differentiated. It becomes the ideal product. 

One of the projects in the 30+ year R&D program found a significant lack of early adopters and is a leading cause of the failure of innovation diffusion, implementation, and knowledge management. In the field of innovation, there is an old saying: You can always tell the Pioneers; "they are the ones with the arrows sticking out of their butts." The Laggards demonstrate the Archie Bunker syndrome: close minded, narrow minded, simple minded, and the lovable bigot.  

Why would the great storyteller portray the doctors in this story as two of the most evil people in history? Was he trying to warn us to be aware of the evil that is purported,  proposed, and presented to be good?

​Decades Ago, This Distinguished Surgeon Accurately Identified How The Human Side Of Caregiving Was Mismanaged.  The Technology Obsessed, Institutionalized, Biomedical “System” Failed To Teach Its Doctors How To Become What Patients Call “Good” Doctors.

It Was Only One Of The Greatest Failures.

​American Healthcare Is Now Facing The Same Challenges The
Roman Empire Faced.  When A Technologically Advanced “System”
Devolves Into The End Stages Of Its Lifecycle, It Becomes Highly
Unstable, Violent, Fragile, Corrupt, And Dehumanized.

Will American Healthcare Suddenly And Violently Meltdown And Collapse As Some Claim? Here Is The Real Story About The Decline And Fall Of American Healthcare.

The real story emerged from a private, ground-breaking 30+ year R&D program that Is now

the definitive authority on the evolution, and devolution, of the major components of the provider sector of American healthcare.  It's the real story because it is the first and only formal scientific explanation.  It's the real story because the scientific explanation is based on three mathematical laws discovered more than a century ago. Hence, the explanation provides both high explanatory power and high predictive validity. Predictions are 100% accurate.  Plus, it's the real story because it produced a valid timeline. What's more, it is the real story because the data supporting the claims comes from the gold standard US government study that has meticulously tracked the healthcare industry for the past six decades. Creating a scientific explanation allows all claims to be objectively challenged and proposed solutions to be evaluated prudently.

​Professor Herbert Adler, MD,

Jefferson Medical School

Big Pharma is one of the richest, smartest, most influential organization in the world. Yet the retail sector has demonstrated more than a decade of instability. High instability is a systemic condition preceding a collapse. 

Diabetes, considered to be one of the most expensive diseases, demonstrates the strong age onset phenomenon. Plus, it also demonstrates a strong income-disease gradient. Thus, it proves that bringing into American healthcare illegal immigrants will put extremely high demand on the system resources and trigger the universal, overshoot-and-collapse phenomenon. 

Erich Fromm, PhD 


There is an old saying that demonstrates the concept of high performance ambiguity of a professional service:  "The surgery was a resounding success, but the patient died." In other words, you can do everything right and get a bad result. Conversely, you can do everything wrong, and get a good result.

When An Industry Is Grossly Mismanaged And Plunges Into The End Stages Of Its Life Cycle, The Climate Becomes "Toxic" And "Turbulent." The Climate Is Described As "Hostile."  Destructive And Deviant Behaviors In Organizations Skyrocket. The Industry Suffers From Widespread Organizational Decline. Behaviors Shift From Constructive To Destructive And Malignant.

When an industry--an organization of organizations--is widely mismanaged and travels into the end-stages of its life cycle, there is a dramatic increase in pathologies affecting organizations. Widespread organization decline is one of the seven super-critical phenomenon that must be proactively managed at the requisite level of sophistication to reverse this predicament and to empower organizations to make the breakout, the paradigm shift, and to survive and to enjoy perennial prosperity.

​Netflix offered Blockbuster a deal: Netflix would run Blockbuster's brand online and Blockbuster would promote Netflix in its stores. The CEO of Netflix, Reed Hastings, got laughed out of the room.   Blockbuster went bankrupt in 2010 and Netflix is now a ~$28 billion dollar company, about ten times what Blockbuster was worth. Sadly, of 1,700 stores, only one store is left.

Plus, this demonstration project took place when the California Medical Association reported that 90% of physicians were facing bankruptcy and about 43% were planning to exit from California.

Up until 1988 when the HMO industry suddenly crashed, the elites said managed care would "dominate" American healthcare; But patients called it "cattle car medicine," or technically it was suffering from extreme commodification.

From The Organizational Development Knowledge Base,The 30+ Year R&D Program Created A Proprietary Five Dimensional Model Of The Intanglble Asset Of Organizational Climate. 

The Four Humors Model Advocated By Ancient Physicians Has Evolved Into The Powerful Interpersonal Circumplex Model That Empowers Workers To Accurately, Prosocially, And Proactively Manage Human Engagement.

The Sober Warning Revealed By Dr. Seuss Was Shockingly Played Out Bigtime. ​The Malignant Institutionalization--Commodification-- Dehumanization Syndrome Caused A Major Tragedy And Deeply Embedded Corruption At The Largest Government Run US Healthcare “System.” 

Given The Hard Evidence, The Claims That The Healthcare Industry Is In The "End-Game" And That The Industry Will Suffer A "Collapse" Is True Yet Antiquated. The Industry Went Into The End Stages Of Its Lifecycle More Than Two Decades Ago. This Predicament Is Another Example Of A "Little Neglect." This Classic, Textbook Event Was Grossly Mismanaged By The Leadership And By The Government.

One of the deans of American medicine, "Bernie" Lown, MD is professor emeritus, Harvard University School of Medicine. Responsible for several technical innovations in cardiology, he is one of the inventors of cardiac defibrillation--which has helped, and saved, millions of people so far. Plus, he accepted the Nobel Peace Prize for his work in nuclear disarmament. He warned us of the threat of the institutionalization and dehumanization of American medicine. But his admonitions were generally ignored. 

The US Retail Prescription Drug Industry And US Dental Services Industry Have Reached The Dreaded "Tipping Point" And Now Face The Universal Collapse Predicament.

​The best example of the institutionalization of a professional service organization is the prison. The goals of the inmates is to be free. Conversely, the goals of the guards is to keep them confined. The institutionalization and dehumanization of American healthcare that is fostered by Single-Payer and Medicare-4-All agendas are absolutely the wrong path, in fact, it's backward.​

​Value-Based reimbursement models are impossible to work because of a fatal, hidden flaw.  The proponents ignored the essential nature of a professional service business.  They claim: Value = clinical outcomes / total costs.  It sounds great but it is a costly blunder and a yet-another failed innovation that has not only wasted billions of tax-payers dollars, it diverted national attention away from the real, steam-rolling, looming disaster.

​Hippocrates The Elder

​(460-370 BC)

​Here’s Another Sobering Example Of A Once-Dominant, Powerful, And Experienced Retailer That Failed To Make The Critical Transition (Into The  Digital World) And Got “Sucked” Into The Maelstrom: The Death Spiral And The Extinction Vortex.

​If Pareto’s Law was rigorously implemented when it should have been, after the industry deregulation (1972-1978), the United States would have paid off the entire national debt, today about $30 trillion. Plus, employing Pareto's law would have produced a huge surplus. It's another example of the huge management knowledge gap in American healthcare.

Delivered with seemingly innocent, yet black humor, Dr. Seuss' last best-selling children's book for old people, You're Only Old Once!, revealed one of the greatest threats to the American people, the increasing technological dehumanization of the healthcare "system."

One of the projects in the 30+ year R&D program developed this symbolic knowledge base.

The healthcare industry crashes started in 1990 when the then-largest cohort, the Baby Boomers (about 76+ million persons), was turning 45 years old. The demand for services should have surged. Luckly, this phenomenon buffered the crashes which would have been more severe..

The private, 30+ year R&D program demonstrated the factors that contributed to the punctuated drop in the growth rates of the major components of the healthcare industry.

The history of the Roman Empire demonstrated that trying to make the breakout, or the critical transition, in the decline stage of the life cycle would fail. 

From more that 160 published studies researching patient satisfaction, the 30+ Year R&D Program collected the nine dimensions that characterized this phenomenon. The hypothesis was that if patient satisfaction could be measured and managed to maximize patient satisfaction, it would boost the perceived quality of care. This work demonstrated that neither patient satisfaction nor clinical outcomes could be measured accurately and consistently. This flaw is why the Donabedian model must be replaced.

The Knowledge-Base Of Work And Patient Engagement Has Been Evolving Since Antiquity.  Unfortunately, The Doctors, The Dentists, And Their Handlers Ignored This Valuable Work.  Beneficent Personal And Work Engagement Improves Your Brain, Your Body Chemistry, And Your Longevity.

Avedis Donabedian, MD
University Of Michigan 
The Father Of “Quality” In
American Healthcare.

Work In Progress

One of the American firms that has brilliantly demonstrated this challenge is Starbucks. It's considered to be one of the best run firms in the nation. Starbucks took a rank commodity, coffee, and turned it into a highly differentiated, premium, service-product offering.​

One of the defining outcomes of an industry collapse is high rates of organizational decline and failure. Here when the computer industry crashed, the number of firms went from about 700 down to about 300 in about five years. The firms that survived managed to master the five principles of survival and engagement. The 30+ year R&D program has developed an exclusive management armamentarium based on the five principles and the seven stages of engagement that empowers organization to manage the last gasp, to make the breakout, to make the "paradigm shift," to achieve sufficient "escape velocity," and to enjoy stability and prosperity.            

One of the major goals of the current critical transition, called "Crossing the Quality Chasm," is to maximize proactively the quality of patient care.  Fortunately, the management knowledge base on maximizing the quality of a product or a service product has been evolving for many decades. The critical phenomenon is called "differentiation."

​American Economist (1899-1967)
Harvard University

This article appeared in November, 1994. It said the slowdown was: "an abatement in spending on physician bills." It was a prime example of pernicious propaganda. The word "abatement" means a cushioned decline. Here is the data from the gold-standard Federal study tracking the evolution of the healthcare industry for 60 years. The three major components of the healthcare provider industry suffered an unprecedented implosion in a critical factor: the industry rate of growth.

The collapse of the Swiss Watch Industry is a classic case study in every business school on the planet. US Medicine, US Dentistry, And The US Hospital Industry technically suffered a huge collapse; but nobody seemed to notice this unprecedented event and its critical importance. It was business as usual; just a "little neglect." 

The consumer demand for professional services among more educated people is significantly lower than consumer demand among people who are less educated.

One major critical transition was the industry deregulation (1972-1978). It was the paradigm shift from an authoritarian, paternalistic model to a consumer-driven, market-based model of American healthcare. In 1981, two distinguished healthcare economists published a landmark article describing the factors propelling the market-based model. One of the factors was the "physicians psychic costs."  Unfortunately, this factor was ignored by the doctors, the dentists, their handlers, and the bureaucrats. It was a major blunder with devastating consequences, namely the skyrocketing explosion of caregiver suicides.

Eyes that don’t blink and the forked tongue gives serpents the dramatically heightened abilities to sense their environment, identify prey, recognize kin, choose mates, locate shelters, follow trails, and maintain high vigilance, foresight, sharp focus, alertness, diligence, and the readiness that is required for making the critical transition successfully, for survival, and for perennial prosperity.

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Here is one healthcare innovation that is a good example of beneficent engagement.​ Numerous studies claim that Certified Therapy Dogs have a significant positive impact on human health, wellbeing, and rapid recovery from serious illness.

​The famed, Harvard economist, Joseph Schumpeter (1883-1950), argued back in 1939 that the universal, creative destruction “maelstrom” was painful in the short term, but necessary, and beneficial in the long term.  The story of creative destruction is presented in the Hindu Vedas

(~ 1500 BC) featuring the gods Shiva (Destruction), covered with the classic symbol of transition--the serpent, and the ever-vigilant (four faced) Brahma (Creation).​

​Their Pioneering Work Confirms How Costs Have Been
Mismanaged.  However, These Brilliant, Harvard Scholars
Did Not Identify Pareto’s Law As Central In Solving The
Cost Crisis In American Healthcare. Despite 
Their Work's Major Contribution, It Was A Huge, Missed Opportunity.​​

​  When Making The Critical Transition, One Of The Critical, Universal Phenomenon To Manage, And To Escape, Is “Creative Destruction.”  It Has An Ancient Past And Is Central To Modern
Economic And Social Evolution.  It’s The Maelstrom: The Universal, Powerful, Self-Breeding, Domino-Effect, Centripetal Forces Of The Death Spiral And The Extinction Vortex.

The serpent is embedded in the symbolism of the legendary story of the Holy Grail appearing in churches all across Europe. The burning question is what was this serpent symbolism trying to convey to future generations? 

Maybe it was: pay attention to the serpent for it may save lives. Recent, private research is demonstrating that the chemicals in serpent venom cure cancer. 

To gain more evidence supporting the claims made in this website, please visit: 

An industry is a diverse collection of organizations. When an industry gets "sucked" into the creative destruction maelstrom, in organizations that are not managed with the appropriate level of management sophistication, the working climate shifts from prosocial to antisocial. Workers' behaviors collectively become increasingly "toxic" and increasingly counter-productive. Good citizenship behaviors must be objectively identified, measured, and nurtured to insure enduring prosocial engagement.

You can play a role is stopping the looming national disaster by making a contribution to my Go Fund Me website by using this link:

American dentistry is considered to be the best in the world. One reason is that the US spends twice as much as all other countries combined on research and education. Plus, this industry is also the most consumerist. Most shopping centers have a dental office. It's also the leader in prevention. Yet, It's headed into the maelstrom: the death spiral and the extinction vortex. It has reached the universal, predictable, mathematical asymptote (the limit of growth). It's facing the breakout, the bailout, or the shakeout.

Unfortunately, the US Dental Services Industry Is the first to start the collapse phenomenon. Astonishingly, it lost almost one billion dollars in one year. And it's not because of the pandemic; it's caused by the huge management knowledge gap.

The root cause of all the problems in American healthcare is a huge management knowledge gap. The main focus of government policy should be to reduce the gap before it's too late. 

Because of restricted access to services, more than 307,000 veterans unnecessarily died.  About 8,000 workers have been fired, and tip-of-the iceberg costs to taxpayers: $4 billion.​​

For a more information on my work background and a more detailed discussion of the predicament facing the industries, especially the precarious US Dental Services Industry, you can safely access this document in my Dropbox account:

As An Industry Moves Into The Mature And Decline Stages Of Its Life Cycle, Every Organization Is Faced With Making The Critical Transition, And The Breakout, Or The Bailout And The Shakeout. Critical Transitions Occur Routinely.  Here Is One Dramatic Example Of Not Prudently Making The Critical Transition And Taking The
Right Path At The Right Time.  Blockbuster Got “Sucked” Into The Maelstrom: The Death Spiral, The Extinction Vortex, And Vanished.​

In hostile business environments, organizations and people demonstrate a wide variety of pathologies that are characteristic of the decline stage of the industry life cycle. These pathologies cause highly dysfunctional behavior that threaten an organization's survival.

Professor Dennis Wayne Organ

Indiana University

In 1841, Edgar Allan Poe (1809-1849) published a short story entitled "A Descent into the Maelstrom." His narrative of the ocean vortex in this work is "exactly analogous" to the "photon sphere" around a black hole according to two published university physicists!

Big Pharma Is In Big Trouble. Starting in 2013, this powerful industry demonstrated an explosive effort to reverse the stagnating growth rates and contracting revenues. However, this effort did not last; there was a stunning crash from 2014 and 2017. It was a whopping 97% crash.  Big Pharma has now incontrovertibly demonstrated the universal early warning signs of a sudden and violent collapse. Innovation will nosedive. Consolidation will spread; firms will fail. History will repeat itself.

​Another Reason To Keep The Healthcare Industry In The State Of Robust Growth Is Because It Creates High Income Jobs Which Collectively Can Also Improve The Health And Wellbeing Of The American People.

Impaired risk perception is a very common problem, especially among people who are at very high risk. It's presented as the myth of invulnerability. It's a fatal trap.

One of the phenomena that can dramatically reduce consumer demand for professional services is patient delay. These are the factors that can influence patient delay. Pain can reduce patient delay significantly, yet a person's beliefs in the efficacy of the "system" can have a profound effect on delay. These factors can cause a massive increase in patient delay; 10 days can become about six months of delay. Not proactively managing patient delay is cause by the huge management knowledge gap.

A Private, 30+ Year R&D Program Created A Formal, Legitimate Scientific Explanation That Proved The American Healthcare "System" Is Reaching The Dreaded "Tipping Point," And The Fatal Maelstrom: The Decline-Death Spiral And The Extinction Vortex. This Huge, Critical Industry Now Faces A Universal, Sudden And Violent, Self-Breeding, Domino-Effect Collapse. It's A Ticking Time Bomb And Time Is Running Out!

This groundbreaking work took place back in the 1970s. It proved that "great success is possible in a hostile business environment." One shortcoming was that this work did not identify the type of organization that could implement the principles of survival. Decades later, two iconic organizations,

GE and IBM, did not demonstrate the organizational attributes and suffered billion-dollar setbacks and major turnarounds.

Value-based” healthcare is absolutely, positively, incontrovertibly the wrong path.  It’s yet another failed, impossible-to-work, dead-end, government “innovation” that has wasted billions of dollars.

If a single negative media event can trigger a 33% drop in consumer demand for professional services, what did the relentless flood on negative media cause?.

You can play a role is stopping the looming national disaster by making a contribution to my Go Fund Me website by using this link:

This goal of this effort is to ascertain what is fundamentally causing the surge in violence toward the dedicated workers especially doctors and nurses who are the "backbone" of the American healthcare "system." The working hypothesis of this effort is to determine the "root cause" of this dysfunction. The increase in violence in the healthcare industry is being blamed on the Covid pandemic. But it is likely to be more to this ugly, disconcerting, growing pathology. Professor Fromm, a Jew who escaped NAZI Germany in 1934, coined the terms "thingification"--treating people like objects, and "automaton conformity" -- acting like mindless robots in this compelling exposition of Hitler's apocalypse.

One of the super-critical phenomena that has been ignored and grossly mismanaged by the industry leadership and the government is called punctuated equilibrium. It's the way evolution happens: long periods of quietude and short periods of chaos, disruption, and catastrophe. The breakout, or the paradigm shift, must be made during these short "windows of opportunity."  Foot-dragging, withdrawal, and waiting to see what happens are prescriptions for disaster. The 30+ year R&D program conclusively demonstrated that the typical private practice does not posses the requisite level of management sophistication to make the breakout which is why disaster results. The backfiring and boomeranging government policy and decades of leadership neglect have seriously handicapped all organizations.

"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 of a battle, the war was lost.

For the want of a war, the nation was lost."

        (a 14th century nursery rhyme)

​The Roman Colosseum (built, 70-80 AD) is an example of
a complex, technologically advanced “system” that
produced the enduring symbol of great dehumanization. 
Some 400,000 humans and 1 million exotic animals were
brutally tortured, raped, and murdered for entertainment.

Their flesh was distributed to the attendees by lottery. 

The Romans created the entertainment industry. Today, an estimated six million people visit its ruins each year.

One reason the 30+ year R&D program is the definitive authority on the evolution of the four major components of the provider sector of the healthcare industry is because the program produced the first and only scientific explanation of the fundamental evolutionary forces and the powerful, super-critical phenomena that have been both ignored and mismanaged by the leadership and the government for five decades and that have at this moment driven the industries to the "tipping point" and the bimodal annihilation catastrophe. It's the little bang that triggers the big bang.

It's the same super-critical phenomenon that causes the avalanche, the stock market crash, the combat ambush, and the tsunami.

The 30+ year R&D program produced the first computer model that accurately and precisely predicts the conditions that trigger the tipping point and the ensuing sudden and violent collapse. Likewise, the R&D effort produced the first historically valid, eminently authoritative, extensively proven management knowledge base that demonstrates what actions every organization must master to escape the steamrolling, domino-effect disaster--and to prosper despite the mounting challenges.

The 30+ year R&D program produce the only accurate timeline that has tracked the evolution of the provider sector of American healthcare. Hence this claim has high predictive validity: The predicament is a "ticking" time bomb; and time, precious time, is rapidly running out. For a few, the predicament represents unprecedented opportunity.

In The World Of Management, Professor Newman's Legitimate Criticisms Have Evolved Into The Concept Of Work Engagement. The Private, 30+ Year R&D Effort Produced This Evidence-Based Model Of Work Engagement.

Here Is Solid Proof That The “Costs”  In American Healthcare Have Been Mismanaged For A Century.  The Most Effective, Focused Way To Significantly, Humanistically, And Systematically Reduce Cost Is To Treat Patients In The Top 10% Using Specifically Trained, Certified, Committed, Highly Paid, “Elite” Caregivers.

​Understanding A Patient’ s Unique Health Beliefs  (Psychographics), Especially, Their Evaluation Of Their Care, EV, And Their Susceptibility (SU) Is Critical For Achieving High Service Quality, High Performance, And High Patient Motivation And Engagement.  Why Did Practicing Physicians, Dentists, And Their Handlers Ignore This Growing Knowledge Base For Eight Decades?​

​This Damming Report Labeled The Looming Critical Transition As 
"Crossing The Quality Chasm."   More Than Two Decades Later, This Monumental Effort Is Struggling And Failing. The Leading Cause Is Presented Here As The "System" Has Failed Because It Cannot Translate Knowledge Into Practice And Implement Innovations In A Timely, Safe Manner. In Short, The Failure Is Because Of The Huge Management Knowledge Gap. This Gap Must Be Closed Before Any Innovations Like Single-Payer, Medicare-4-All, Obamacare 2.0, And Valued-Based Models Of Healthcare Are Implemented Or Billions Of Dollars Will Continue To Be Wasted And Millions Of Americans Will Continued To Be "Severely Harmed."

The price of GE's stocks dramatically imploded..

​The Source Of The Current Focus On “Quality” And “Value” Is The
Donabedian Model Of Quality Care (Quality = Clinical Outcomes X
Patient Satisfaction). It’s Based On An Entirely False, Universally
Overlooked Assumption That Makes This Value Proposition Invalid. This Model Must Be Replaced.

Another benefit from producing a legitimate scientific explanation is that it identifies the real threats and the looming risks. The Single-Payer and Medicare-for-All pathological agendas are mass delusions which will exacerbate, if not trigger, the sudden and violent, snow-balling, self-breeding, universal overshoot-and-collapse phenomenon.

One of the critical phenomena that has been ignored and mismanaged during the past five decades is the critical transition. This phenomenon first appears in the Hindu Vedas about 1,500 BC. It is called the wheel of birth and death and depicts the critical transition. Ancient cultures described this critical phenomenon as the beautiful Phoenix arising from the ashes of its own creative destruction. Marten Scheffer, PhD is one of the leading researchers who has develop the modern version of this critical phenomenon..

The management knowledge base on innovation is extensive. Rigorously implementing this work is essential for each and every organization to adapt, to survive, and to prosper.

What is truly astonishing is that there is a large majority of folks who refuse to believe the shocking evidence that the American healthcare "system" is now facing the dreaded "tipping point" and a sudden and violent, domino-effect, self-breeding collapse into the universal creative destruction maelstrom: the decline-death spiral and the extinction vortex.   This addendum will present more evidence. 

Professor David A. Whetten is a brilliant business scholar who has spent decades studying the organizational decline process. His seminal and impressive work must be an integral part of the mandatory management knowledge-base in American healthcare.

Surprisingly, long-standing research has demonstrated that the admonitions of Hippocrates were accurate. There is a strong relationship between a person' time of birth and their disease vulnerabilities.

​Patricia J. Newman, MD,
Distinguished Professor Emeritus
SUNY, Upstate Medical University,
Former President Of The American
College Of Surgeons​

The private, 30+ Year R&D program created a legitimate, formal scientific explanation base on three century-old mathematical laws. One on the laws is Pareto's law. Most people know it as the 20-80 rule. 

​Theodor Seuss Geisel,
(1904-1991) He coined the term Nerd

(a social misfit) and identified this American predicament in this book. circa 1950s.

What Is Truly Astounding Is That The Scientifically Legitimate, Historically Valid, Eminently Authoritative Solution To The Collapse Of American Healthcare Industry Was Discovered More Than Three Decades Ago!  Unfortunately, This Seminal Work Was Ignored By The Doctors, The Dentists, Their Handlers, And The Bureaucrats. By Today, Organizational Decline Is Widespread. Most Provider Organizations From Private Practices To Huge "Systems" Lack The Requisite Level Of Management Sophistication To Implement Successfully The Principles Of  Survival In A Hostile Environment. 

Mainstream media demonstrated the universal law of logistic function. This industry got "sucked" into the maelstrom and the decline-death stage of its life cycle. The ethical, or metaphysical, domain of the organizational climate was not proactively managed, and the integrity of journalism crashed and created the scourge of fake news. Now the mainstream media has the legitimate opportunity to tell the real story about the looming collapse of American healthcare. Plus, it's a legitimate and timely opportunity to reveal how the sycophantic healthcare leadership, the government bureaucrats, and the politicians have mismanaged this vital industry for a century.

The phenomenon of empathy has been extensively developed in the field of healthcare. The number of published studies demonstrated the law of logistic function and have skyrocketed since 1980. But the diffusion and implementation of this innovation have stalled and failed. It's another example of the huge management knowledge gap. The doctors, the dentists, and their handlers can't implement innovations successfully.

​This Distinguished Economist Was One Of The First To Identify (~1930s) How To Create Real “Value.” His Work Has Become The Bedrock  Of Marketing Science.  Sadly, The Doctors, The Dentists, Their Handlers, And The Government Bureaucrats Ignored This Knowledge-Base.  It Was A Major Missed Opportunity.

​The Big Idea: How To Solve The Cost Crisis In Health Care.

One proof of the claim that the innovation-diffusion process was grossly mismanaged, is the fact that a prototype, or multiple prototypes, of this complex innovation were not created and field tested. The government does not have the requisite level of management sophistication to implement successfully an innovation. This model can be used to assess accurately and scientifically any and all proposed solutions to the crisis in American healthcare, henceforth.

The fifth stage requires the management of the intangible of readiness and commitment. This profile was developed from the world of management science to track the progress of making the critical transition.

One reason that contributed to the dramatic drop in the growth of revenues for orthodox physician services was the constant advances in medical science. .

"A Little Neglect Breeds Great Mischief!"

"Healthcare is an industry with an astounding level of errors and no quality." 

"It is better to know that patient who has taken on the disease than the disease that has taken on the patient.".

The US Physician Services Industry, Also Known As American Medicine, Starting In 1990 Has Demonstrated Huge Boom And Crash Cycles. It Is A Highly Unstable, Volatile Industry. Dramatically Reducing Payments To Doctors, Given The Circumstances, Will Exacerbate The Looming Crash. Such Government Policies Are Harmful And Reckless. They Must Be Reversed And Stopped Immediately.

​At one facility, an inspector reportedly caught a clerk “shredding” the files of a recent combat veteran suffering with traumatic brain injuries. Investigations revealed that the elites were "cooking the books" and systematically faking performance and patient volume so that they could extort more money for their own greedy pockets.

William K. Hall

University of Michigan

​Asclepias, The Son Of Apollo And The Ancient God Of Physicians, Appears With The Serpent-- The Ancient Symbol Of Healing, Metamorphosis, The Critical Transition, And The "Wheel Of Birth, Life, Death, And Rebirth (Born Again, Reincarnation, The New Version, The Paradigm Shift, The Corporate Turnaround). Taking A Closer Look At This Image Brings Up The Question: Why Is He Holding A Big Stick With A Big Snake Wrapped Around It? Maybe He Was Revealing That The Critical Transition Has Definitive Stages.

​The Private, 30+ Year R&D Effort Investigated And
Integrated The Hard Scientific Evidence, The Strong
Historical Evidence, And The Enigmatic Metaphysical
(Symbolic) Evidence That Explains And Validates The
Universal, Critical Transition Phenomenon. The R&D 
Program Created A Formal Scientific Explanation Based On Three Century-Old Mathematical Laws.

Johns Hopkins 

Today, The Entire Healthcare Industry Is In The Exact Same Position That The HMO Industry Was In During 1986-1989--The Super-Critical Transition, The Breakout.

One Of The Critical Phenomenon That Was Emerging, But Totally Ignored, Happened In 1990 When The Growth Of This Mainspring Industry Started Go Through Huge Destabilizing Boom And Crash Cycles. It's A Classic Phenomenon Called Unstable Equilibrium. A "System" Instability, Or Shakeup, Is One Of The Signs That It Is Facing A Critical Transition And That Every Organization Is Facing The Mandatory "Breakout" Or Risks Get Violently "Sucked" Into The Maelstrom And The Self-Breeding, Decline-Death Spiral And The Extinction Vortex.

In recognition of his achievements, the University of California in San Diego named this futuristic library after the iconic storyteller, Ted Geisel

​Robert E. Kaplan 

Obamacare--a complex innovation--has been backfiring, boomeranging, failing, and imploding into the maelstrom because the government leadership ignored every single factor that drives successful implementation of an innovation based on the extant management knowledge base. It is a classic case of a "little neglect."

​Why Did Public Confidence (Trust, Assurance) In US Medicine Implode About 70% Since 1965?  Medicine Is A “Reputational Good.” When Trust Falls, Consumer Demand Falls, And Revenues Decline.  Proactively Managing This "Intangible Asset" That Is One Dimension Of The Organizational Climate Would Have Avoided And Reversed This Far-Reaching Debacle.

You may also view my LInkedin profile: Francis A. Toto

​The subtle and progressive institutionalization of a professional service business such as a medical or dental practice or a hospital fosters low goal congruence which produces pathological, contra-indicated  behaviors. Proactively managing and maximizing goal congruence will produce highly favorable behaviors among all stakeholders. Here are two hypothetical, dynamic models.  

In the physical world, when a "system" reaches the asymptote (the highest point possible), It becomes unstable. Likewise when an industry reaches the mature stage, it becomes stagnant because of a slowdown in the forward momentum, or growth. The industry becomes unstable, fragile, hypersensitive, and vulnerable to the smallest impact, or "pertubation."

​Professor Everett Rogers, (1931-2004),
The Father Of
Innovation Diffusion

The cardinal signs that mark the collapse of an industry are: high rates of failure, heavy losses, and mass exits in a short period of time. There is also great social and political turmoil and upheaval. The climate and "culture" of organizations becomes "hostile." Work behaviors in organizations trapped in hostile environments turn from constructive and prosocial to destructive and antisocial.

​One of the principles of survival is managing and fostering innovation using the evidence-based management knowledge base. 

The only thing in the whole story that is demonstrating some empathic, care and concern is the cold-blooded animal in the fish tanks that adorn the offices of doctors nationwide.

One of the critical phenomena that have been ignored and mismanaged for decades is called unstable equilibrium. Here is a compelling graphic of the phenomenon.  It portrays the extreme fragility of structure and its vulnerability to relatively small impacts-the little bang that triggers the big bang. Notice the dog in the right-bottom of the picture.

​It's Irrefutable, American Healthcare Is At The "Brink." The Knowledge Base On How To Anticipate Critical Transitions Is Relatively New.  A Critical Slowing Down And A Failed Recovery Are The Two, Universal Early Warning Signs Of A
Critical Transition That, If Mismanaged, Will Trigger A Robust
“Regime Shift," Commonly Known As A Sudden, Violent Collapse.​​

Professor Bernard Lown's claim that there is a universal lack of prosocial, proactive engagement among doctors Is an accurate diagnosis. Because of the great uncertainty and betrayals of the past, the occupational communities of all types of doctors demonstrate a pathological lack of engagement. They are "stuck." Such inertia, burnout, and disengagement is one of the pathological conditions of widespread organizational decline.

Michael E. Porter 

This is a sobering example of the gross mismanagement demonstrated by the government, notably CMS (Medicare), at the most critical time in the evolution of the US Physician Services Industry. Briefly, when this mainspring industry was wracked by an unprecedented catastrophic implosion in the rate of growth, the government dramatically cut back payments to doctors. It was the absolutely the wrong action at a critical time. 

​Here's yet another example of the "little neglect" syndrome. These critical phenomena have been ignored and mismanaged for at least five decades. This knowledge base must be made available to every organization in American healthcare. This knowledge base is not only the key to survival but also the path to perennial prosperity.  

The Addendum: For The Skeptics And The Deniers. 

​After three decades, Sears has put its sprawling, 273-acre corporate headquarters up for sale.

Einstein's definition of insanity: "Keep doing the same thing over and over and over again while expecting different results."

​​“The physician who does not use the Zodiac, has no right to call himself a physician.”

Hippocrates the Elder

The first crash (1990-1994) of the mainspring US Physician Services Industry was about 70% and highly implosive; the first rebound (1997-2001) was a robust 126%. The second crash (2001-2009) was about 73% and was much less implosive than the first crash. However, the recovery was weak and took longer, and most importantly, this recovery was not sustainable. This critical industry has taken its "last gasp."  The other three main industries have demonstrated the critical slowing down and failing recovery.

One of the critical phenomena that dramatically magnifies the risks and the threats for all organizations, especially private practices, during the critical transition is the "little neglect" fatal trap. Decades of a little neglect have by today forced providers down the wrong path and headed into the maelstrom.

Considered to be among the greatest scientists and statesman of his day, Benjamin Franklin understood that ignoring a seemingly minor event during a period of critically could have snowballing, self-breeding, auto-catalytic, disastrous consequences--the bimodal annihilation catastrophe--the little bang that triggers the big bang. The 30+ year R&D program is to develop this management knowledge base.

Managing innovation at the requisite level of sophistication is absolutely mandatory for organizations, particularly the biggest and most well-established, to escape the creative destruction maelstrom, to achieve stability, to survive, and to enjoy perennial, abundant prosperity regardless of the growing challenges, the uncertainty, and the ominous threats.

The government's and the leadership's response to this unprecedented disaster was sobering: the catastrophic failure of this highly touted, forced and rigged "innovation" was a typical cover-up.

One Reason The Private, 30+ Year R&D Program Is The Definitive Authority On The Evolution Of American Healthcare Is Because It Has Created An Exclusive Management Knowledge-Base That Integrated The Work Of Hundreds Of Authorities Going Back 30 Centuries. Here Is A Small Sample Of The People Whose Work Has Been Used To Build The First And Only Scientific Explanation Of The Predicament Facing Every Organization In The Healthcare Industry, Henceforth.

Yertle the Turtle is Dr. Seuss' children's book about the menace of fascism.