Bye Bye Miss American Pie, brought my Chevy to the levee but the levee was dry, 'em good ol' boys were drinking whisky and rye singing this will be the day that I die, this will be the day that I die........
For those young 'uns that never listened to a poet singer, and TSB is not talking hip hop poetry, Don McLean's American Pie, a song that will live on in infamy, was about the loss of innocence in American music. Ironically, it can also be interpreted as a loss of innocence in the America, we once knew it. But this post isn't about music. No fellow bloggers, this is not someone waxing nostalgia. This post is about the fundamental breakdown of America as we once knew it. An America that was built on hard work, a country that prided itself on its ability to lead, a country that understood that everyone deserved an opportunity, an America that once stood proud. Today, whether you like it or not, this once great country is in the throes of a class struggle between two classes, the Corporatist's and the have nots. But before we elaborate, let's keep things in perspective. If you're earning $250 thousand or less, you're not one of the haves, unless you're single, especially in this economy. And unlike the perception that many of our beloved surgeons have, many of you are making $120 to $150 thousand per year, and that doesn't include being responsible for most of your own business expenses. If you are the sole provider in a family of four, have a mortgage, have children that are going to college, need to put food on your table, gas in your cars, pay auto and healthcare insurance, and want to take a family vacation let alone two a year, most of you are living by a thread. And, I can guarantee that many of your wives, unlike surgeons wives, are working, and, you are not living in McMansion's over looking the Pacific Palisades. So why does the TSB write an editorial on Friday morning? Is it because I am looking to provoke you into irrational commentary? Absolutely Not! Because somewhere along this journey called life, we have all lost our sense of balance.
The last three or four years have made it woefully painful that we are heading in the direction of class warfare. Witnessed by what went on in England yesterday when students attacked "the Royals" in their Rolls Royce. No need to worry about the Taliban, or some terrorist organization, we will be the demise of ourselves, based on our greed and selfishness. Any student of history will attest, every great dynasty eventually falls and restructures itself. The good times in healthcare are coming to an end. Today, American is in the initial stages of a total collapse. If balance is not important, just look at our industry. As the cost of delivering healthcare continues to escalate, the new game in town is called the blame game. The insurance industry blames the doctors (those poor helpless doctors), the hospitals blame the doctors, the doctors blame tort reform, the Corporatista's blame the government and high taxes, and the sales people continue to get defecated upon, being blamed by the doctors for driving up the cost of delivering healthcare. Why is it that the guy on lowest part of the totem pole always gets the blame? Is it because some people don't have the intestinal fortitude to stand up to a higher authority? Based on Monday's story in the NY Times regarding a Baltimore cardiologist who implanted as many as 30 stents in one day, and the concern that was expressed by a leading cardiologist at the Cleveland Clinic, isn't it time that some people start focusing on cleaning up their own house, before worrying about someone else's business? Isn't this just a microcosm of what is happening in our industry? There are many surgeons that love their calling, and are exceptional at their craft, and, I am sure that the good doctor in question is a wonderful family man, witnessed by the many testimonials given on his website, but just like any other person, money or the prospect of being the richest man in the room can obfuscate reality. After all, we are human. It happened at Enron, it happened at WorldCom, it happened to Bernie Madoff. So let's not fool ourselves that it doesn't happen in medicine. Once again, this is a photo-op for the government to launch another investigation into improprieties in the medical device industry, led by yours truly Senators' Grassley and Baucus. I am not going to judge Dr. Medei, the legal system will do that, and I am sure that he has the financial wherewithal to hire the best, yet, how can one not be a skeptic let alone a cynic based on what we see on a daily basis?
What this industry needs to do is get back to basics. If that means challenging the system, then the system must be challenged. This means executive management teams projecting realistic forecasts based on current economic and market conditions, and not what happened fifteen years ago when they were selling in a not so saturated market. This means developing innovative products that not only improve patients lives, but improve outcomes, and are not a product looking for an indication. This means thinking long-term and not acting like Wall Street, this isn't a short-term industry. This means telling your shareholders that if they want longevity, everyone is going to have to sacrifice, including those that think the only reason you invest in a company is to generate a major windfall. Maybe that's part of the problem. Too many executives are more concerned with their personal portfolio's rather than the direction their organizations are going. Lastly, stop the hype. How absurd was the total disc market as companies released their products. We didn't have enough of retrospective data on the efficacy of total disc arthroplasty and we were touting our devices as first generation, second generation, third generation. Just for the record, in human terms a generation is usually thirty years and it usually means producing an offspring from the preceding device.
As the first decade of the new millennium comes to an end and a new era ushers itself in, hopefully we will come to terms that we are all in this together, and that its okay to share the wealth, because if you don't, you all will be able to one day say that you live in a socialist state.