The Only Four Products of Healthcare Manufactured and Produced With American Patients

Most Americans are familiar with the products manufactured by major industries and businesses.

Exxon Mobile produces gasoline and petroleum products. Goodyear makes rubber products and tires. Lockheed Martin manufactures aerospace and defense products. Unilever manufactures and produces household products for nutrition, hygiene and personal care. Nike manufactures and produces products for sports, exercise and leisure. General Motors manufactures and produces automobiles, trucks and accessories. Novartis manufactures and produces name brand pharmaceuticals used by physicians to treat patients diseases. General Electric manufactures and produces Devices and Machines used by Physicians to diagnose and treat Diseases. All these aforementioned companies and their competition rely on subcontracted and in-house suppliers and finance to enable them to efficiently and productively manufacture and produce products of the highest quality and best market cost enabling access to and delivery of optimal value to both the consumer of their products. In return for their manufacturing, fiscal rewards (profits) are distributed to the companies shareholders, bondholders, executives, employees and their patron politicians.

Medical care or healthcare in America is no different than other manufacturing industries.

Please ask yourself; "what are the products manufactured and produced in medical care or healthcare in America with and for patients (consumers)?"

Clinical outcomes are the sole end-products manufactured and produced by highly skilled, responsible and highest educated workers (physicians) and their teams who hold lives in their hands, accessed-by and delivered-to the consumer (patient) within the healthcare or medical care industry of America. There are 4 clinical outcomes which are the only products manufactured in healthcare by physicians, their teams and entities they manage for and with their patients. These four products are sought by healthcare consumers (patients) and eventually by every Citizen of America; they are preventive, medical, surgical and palliative clinical outcomes.

Physicians use evidence based science and the art of medicine wrapped in empathy balanced by risk and supported by their ancillary staff (nurses, assistants, technicians, therapists, nurse practitioners, physicians assistants and pharmacists) and the ancillary businesses of healthcare (insurers, device manufacturers, pharmaceutical companies, EHR companies and Hospitals/Surgery Centers, Clinics) in order to manufacture and deliver the best possible preventive, medical, surgical and palliative outcomes with and for their patients.

There would be no healthcare industry in America without enabling access to these four deliverable products (preventive, medical, surgical and palliative outcomes) manufactured and produced by physicians with their patients.

Don't let the health insurers (financiers of healthcare) and their tens of thousands of wholly owned vertically and horizontally integrated subsidiary monopolies fool you, insurers are not the workers (physicians) manufacturing or producing the four clinical outcomes with patients. The health insurers and their Pharmaceutical Benefit managers and collusive subsidiary companies do however ration access to, increase the costs of obtaining and diminish the quality of the 4 products manufactured by physicians with and for their patients. There's not a physician or a patient in America who hasn't experienced the dangerous, delaying and demeaning process of insurer directed prior authorization rationing of diagnostics or treatments, a bureaucracy created by insurers solely to diminish insurers fiscal risk and maintain profits of the insurers (financiers) by sacrificing patient access to quality outcomes. Limited healthcare financier (insurer) panels segregate, ration and block access to hospitals, clinics, therapists and physicians per locale to ensure insurer revenue. High access, high quality care would diminish health insurer profits. In order to maintain and protect and alleviate the risk to the medical care financiers (insurers) profits, Access to American healthcare must remain segregated, subsidized and rationed according to age, disease, race, sex, location, net worth, income, job and military status (figure 3).

Don't let the pharmaceutical and medical device manufacturing companies fool you, even with their direct to consumer advertising, they're not the ones manufacturing and producing and delivering the four clinical outcomes with and for patients. Pharmaceutical and Device manufacturers pricing and advertising however does effect the access to, costs and quality of the four products of healthcare.

Don't let the medical malpractice, hospital and EHR industries fool you, they're not the ones manufacturing or producing the four clinical outcomes with patients. However, the medical malpractice, Hospital and EHR industry do deleteriously effect the access to, costs and the quality of the clinical outcomes manufactured and produced by physicians with and for their patients.

Don't let large drug store conglomerates fool you. The same integrated drug store chain that sells you $15 Tennis Balls (figure 1) and prints out 6 feet of paper receipts upon purchase of shampoo does not risk manufacturing or producing preventive, medical, surgical and palliative outcomes with you and your family.

In return for devoting their lives and risking their livelihoods to excel at learning, manufacturing and producing preventive, medical, surgical and palliative outcomes empathically with their patients and peers, physicians and their office staff receive only 7% of American healthcare expenditures (figure 2) from a variety of public and private financiers (figure 3). The Doctors clinical support teammates earn another 20% of all healthcare expenditures (figure 2). The remaining 75% of $4 Trillion per year in healthcare expenditures are taken by the suppliers, institutions, legal entities and financiers of healthcare in America (figure 2). Indeed, if physicians and their office staff worked for free (the dream of healthcare financiers (insurers) and hospital corporations, Healthcare expenditures in America would only decrease from $4 trillion to 3.8 trillion per year.

All manufacturing industries in America and their suppliers, whether subsidized by the Government such as Lockheed Martin or independent of taxpayer subsidies such as Nike, survive by balancing the costs of doing business with the availability, quality and cost (value) of the products they manufacture and produce and deliver to consumers.

If suppliers and financiers to these manufacturers inflate their costs, the manufacturers may have to pass these costs onto the consumers raising or inflating the price of their products to remain viable. This yearly increase in costs to American patients is exemplified by the yearly increases in costs for patients to access the four products of healthcare (preventive, medical, surgical and palliative outcomes) in America (figure 4) with their physicians. In the setting of increased costs for supplies and finance, manufacturers (physicians) may alternatively lower their 'take' or profits in order to continue to produce and deliver their products with and to patients. This has been a common occurrence amongst physicians during the last several decades in America illustrated by decreasing physician reimbursement (figure 4). If the manufacturers (physicians) 'take' to support their business falls below their business (practice) expenses then the manufacturer can no longer supply quality products to the consumer or remain viable. This has also become a common theme amongst scores of physicians closing their practices and leaving the practice of medicine in America during the last decade. Another option for manufacturers faced with increased or impossible costs of supplies and finance is to diminish the quantity, quality of the products they manufacture and produce. This has also been realized in America as demonstrated on the (figure 5) with rising sickness and death catalyzed by increasing healthcare expenditures and associated decreased access to quality affordable healthcare due to redistribution of healthcare resources to enhance the earnings of the ancillary healthcare industries .

If suppliers and financiers of the manufacturers instead deflate their costs to manufacturers these lower costs can be passed onto consumers by lowering the costs of the manufactured products while maintaining the quality or value of the product thereby offering the consumers a 'bargain'. This business interaction has never occurred in American Healthcare except for the creation of Medicare Insurance for the elderly more half a century ago. Traditional Medicare, a Government managed health insurance for the elderly served by private physicians and hospitals enabled the greatest decrease in poverty and morbidity (sickness) and mortality (death) for the elderly in American history (figure 6).

A manufacturer of services used by physicians to create clinical outcomes can also choose to not pass these lower costs from suppliers or financiers onto the consumer with lower costs and increased value of the product and instead redirect their newfound financial resources or wealth to their shareholders, bondholders, executives, workers or their patron politicians. This is a common method used to boost market capitalization amongst the insurers, Hospitals, EHR companies, medical malpractice and Pharmaceutical industries of healthcare in America today (Figure 7) keeping corporate profits high and costs to consumers (patients high).

The healthcare consumer must always keep in mind that comparative clinical outcomes and cost (clinical value) data amongst Hospitals, PBM's, Pharmaceutical, Health Insurers and EHR companies, which should be used for capitalistic comparisons of these ancillary businesses, is never revealed by those businesses as discussed in the article below.

Other manufacturing industries in America inflated costs of supplies or finance need to remain below the cost of manufacturing and producing the products of the business in order to maintain consumer access to the products, to ensure quality and cost of the product for consumers and to ensure the solvency of the manufacturer or consumer of the product. That is true for every business in America except healthcare and the results are deadly and devastating for both patients and their physicians (Figure 5).

What Can We Do?

It would be irresponsible of me, a practicing physician who adheres to the Hippocratic Oath and the moral commandments of other age-old scrolls to suggest the deconstruction of a fraudulent health insurance system without offering an alternative means of ensuring access to quality affordable private healthcare for patients and their families.?With the demise of the insurer-political complex, it would be simple to install a proven Bismarck Healthcare system with some tweaking to offer higher subsidies for primary care physicians and internists who represent patients’ best advocates.?The Bismarck Health Model (Figure 8) successfully utilized by many democracies and developed nations essentially neutralizes and utilitizes health insurers making private health insurance a utility instead of a luxury. The result of Bismarck Healthcare is it enables access to quality affordable private insured and?private delivered preventive, medical, surgical and palliative medical care for-all with transparent access to healthcare data to improve the physical and fiscal health of the nation.