Some 25 centuries ago, the father of medicine, Hippocrates the Elder, condemned  the practice of patient solicitation by doctor lectures. The violations of his admonitions are rampant today. Medicine and dentistry are "reputational" goods. Such mindless violations have tarnished the profession beyond repair. The 30-year R&D program demonstrated conclusively that the commercialization of a professional service business is not only counterproductive, it's fatal.

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.

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. This ill-timed debacle pushed American medicine into the abyss, from which it would not recover. This historical  event alone is a major argument against the single-payer strategy. This is proof that the government does not possess the requisite level of management sophistication to make the right moves at critical times. Will history repeat itself?

This Is The Creative Destruction Maelstrom: It Is A Scientifically Legitimate And Historically Accurate Portrayal Of The Predicament Now Facing Every Organization In The Powerful Yet Fragile, Unstable, And Vulnerable American Healthcare Establishment!

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 organizations survival.

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.

"A Little Neglect Breeds Great Mischief!"

This is a work in progress: started August 15, 2016. The content has been formally copyrighted: July 15, 2010; Registration Number TXu 1-705-384. All rights reserved. Reproduction without written consent is prohibited. For more information call: Francis A. Toto, in San Diego at 858-278-5050. Email: or visit these websites: and Search Google for: bimodal annihilation catastrophe for the scientific explanation of how the healthcare industry will enter into the maelstrom and violently and suddenly collapse.

Georg Simmel, PhD, (1858-1918) a brilliant sociologists working at the Heidleberg University in Germany was the first to publish, in 1904, how the law of evolution looked (see graphic top left). This collage illustrates the numerous variations that have been demonstrated throughout the years. This evidence supports the argument that there is a huge--up to 100 years--management knowledge gap in the provider side of the healthcare industry. Closing this huge management knowledge gap should be a national imperative, before it is too late.

One of the seven super-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..

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.

The metaphor of a toilet is appropriate: the toilet works by creating a powerful vortex: a maelstrom.

One reason the 30-year R&D program is the definitive authority on the evolution of the three 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 seven, 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 three major industries are the massive US Hospital Services Industry (annual revenues at about $1 trillion), the mainspring US Physician Services Industry (about $500 billion), and the US Dental Services Industry (annual revenues about $120 billion). 

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 time line 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.

One of the seven requirements for producing a scientific explanation is called "resolution."  It's like a high-powered microscope that can drill down and separate one phenomenon or entity from another. 

Surprising to some, out-of-pocket payments to doctors was bigger than payments to doctors from Medicare for most of the history of Medicare, from about 1967 until 1990. Out-of-pocket revenues to private practitioners, physicians and dentists was a overlooked, yet critical component of highly profitable revenues. One question arises from this evidence: did the crash of such revenues trigger, in part, an increase in Medicare charges and the growth of private insurance?

"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."

One of the required conditions for an industry to suddenly and violently collapse is a sudden drop in consumer demand.  While doctors were blaming managed care for shrinking demand, the 30-year R&D program was investigating whether other factors might be responsible. Here is the results of this exclusive investigation. Indeed, HMOs could dramatically reduce demand, yet its influence was actually relatively minor. A single negative media event could implode demand for fee-for-service professional services by 33% and last for an entire year. The impact of negative media is further demonstrated by these collages.

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!  It Suffered A "Little Neglect."

Benignly cloaked in seemingly innocent humor, is it possible that one of the great American icons, Doctor Seuss, identified one of the major threats facing every organization in American healthcare, henceforth?

The Endless Propaganda From The Government Claims That Hospitals, Medicine, And Dentistry Are Expanding Out Of Control. Is It Possible That The Professional Domain Is Actually Contracting To Precipitate A Descent Into The Maelstrom?

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." Pathologies In Organization 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.

Back In The Early 1980s, When The Proponents Of Managed Care Were Telling Private Practitioners 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?

The Entire Healthcare Industry Has Entered A State Of Extreme Instability: Here Is Some Preliminary Evidence Supporting This Claim. Here Is A Visually Accurate Metaphor.

For an explanation that demonstrates how the Obamacare disaster and the Single Payer Mass Delusion will trigger the sudden and violent collapse of the mainspring US Physician Services Industry, please visit this link:

How to successfully make the critical transition was discovered by a brilliant business scholar working at the Harvard School Of Business about 35 years ago. His work was ignored. It's a classic case of a "little neglect that breeds great mischief.

William K. Hall discovered the four principles that firms had to master to survive a hostile business environment. The critical transition phenomenon is the classic case of a hostile environment. His work had one fatal flaw: it did not elaborate on the type of organization that had to be created to make the paradigm shift.  The 30-year R&D program discovered the missing piece; and created a sophisticated management knowledge-base that empowered a private practice to make successfully the critical transition and enjoy spectacular success.

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.

Here Is A Proven Model Of How Industries Go Into The Decline Stage Of Their Life Cycles. Healthcare Incontrovertibly  Demonstrated The Dramatic, Punctuated Change Of Collapse.

The 30-Year R&D Program Demonstrated How There Was In Fact A Dramatic Shifting And Dramatic Sinking Of Consumer Demand For All Professional Services.

Jeff Goldsmith is a highly respected expert in the healthcare industry. His article cited here has been highly influential. Yet surprisingly, he did not develop the powerful discoveries presented here: it's was a typical case of a "little neglect" among the leadership during the past five decades..

One of the seven, super-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 was called the wheel of birth and death and depicts the critical transition. Ancient Asian cultures described this super-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 super-critical phenomenon.

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, and vulnerable to the smallest impact, or "pertubation."

Doctor Seuss comically, yet soberingly, demonstrates what famed social philosopher called "thingification," automaton-conformity, and the resulting dehumanization--treating people as objects--in his exposition of National Socialism in NAZI Germany (1933-1945)

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.

Obamacare--a complex innovation--is 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."

In one year, Humana lost $1 billion in the imploding insurance exchange market; such big losses trigger "consolidation" in an industry. It's a sign of the gross mismanagement that drives the "death spiral" or maelstrom and high vulnerability to sudden and violent collapse.

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 35 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.

Is the Archie Bunker persona--the dogmatic, close-minded, simple-minded, and black-and-white thinking archetype--highly demonstrated among the occupational communities of physicians, dentists, and podiatrists?

Some 70 years ago, the famous Harvard economists, Joseph Schumpeter, was the first modern economist to identify the vital importance of the creative destruction phenomenon in the fruitful evolution of society and a democratic economy.

Doctor Benjamin Franklin (1706-1790),

in Poor Richard's Almanac, c. 1745

"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 story reveals that the only living thing in the whole 
"system" that's demonstrating a little warmth, empathy, and consolation is a cold-blooded animal in the ubiquitous fish tanks that adorn doctors' offices all over the nation!

"Those who ignore the lessons of history will be condemned to repeat it."

                    George Santayana                   (1863-1952)

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!

Google this: Bimodal annihilation catastrophe

The Collapse Of The US Housing Industry Was Caused By  A "Little Neglect," Gross Mismanagement, And Recklessness, Insular Leadership. Will History Repeat Itself In American Healthcare?

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, and to enjoy perennial, abundant prosperity regardless of the growing challenges, the uncertainty,  and the ominous threats.

This article above 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 suffered a collapse; but nobody seemed to notice this unprecedented event and its critical importance. It was business as usual; just a "little neglect." 

Here is one of the monsters that private practices face. A deeper investigation of this trend reveals that it is a pathogenically naive, superficial, pitiful, and simplistic micromanagement hoax. It is forcing the commercialization of a professional business such as a private practice. This is a degenerative, absolutely fatal trend because it promotes the further commercialization, institutional and dehumanization of American healthcare that's widespread. Like managed care, it is forcing private practice down the wrong path: into the meat-grinding maelstrom.

The private, 30-year R&D effort produced the first and only model of a professional service business. This model demonstrates the forces and the critical phenomena behind the managed care debacle, the VA scandal, and this pathetic, pathological misadventure.

Currently one of the deans of American medicine, "Bernie" 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.

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 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.

One of the seven 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 works: 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."  Footdragging, 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.

During 1990 the front edge of the Baby Boomer population (up to 78 million people) started turning 45 an age when a person's lifestyle starts catching up with them. Some claim that the aging of the Boomers is responsible for the explosion in costs; it's mostly a myth.

Will American Healthcare Suddenly And Violently Collapse As Some Claim? Here Is The Real Story About What Has Happened And What Will Happen. The Real Story Comes From A Private, 30-Year R&D Program That Is, For A Dozen Reasons, The Definitive Authority On The Evolution Of The Three Major Components Of The Healthcare Provider Sector.  It's The Real Story Because It Is The Only Scientific Explanation And Scientific Explication That Has Detailed The Rise And Fall Of Healthcare And The Future Of Private Practice In America. It The Real Story Because It Is Based On A Universal Mathematical Law; It Provides High Explanatory Power And High Predictive Validity. It's The Real Story Because It Produced A Valid Timeline. It Is The Real Story Because All Of The Data Supporting The Claims Comes From The Gold Standard US Federal Study That Has Tracked The Industry For The Past 60 Years. Having The Real Story Permits One To Assess Accurately The Claims Of What Objectively Is The Real Problem And To Evaluate The Validity Of Any And All Proposed Solutions.

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.