Truths About Healthcare

Truths About Healthcare – what you really need to know about the US healthcare system: An Online, Free Book by Dennis L. Angellis, MD.

It’s All About The Money

Yes, folks, if you think health care providers (I’m using the terms generically, not restricted to direct caregivers) primarily care about you, I’m sorry to tell you that’s not the case. The primary concern of the health care providers in the United States is financial. The main reason for this is the U.S. health care systems are based on the fundamental economic model of the Unites States: Free Enterprise/Capitalism. Now, I’m not a Socialist or Communist, it’s just a fact of life that the U.S. health care system is set up just like any other business in the U.S. As a matter of fact, so are lawyers and dentists and any other “professions”. So, health care is not alone or unique from that respect. The unique aspect of health care is: your life is at stake.

In the following posts, I’ll take you through the different provider types where money is king. This may sound crass to you, but I’ve literally been in high-level corporate America health organizations where the CEO and CFO say these exact words: ”Cash is king”. Don’t you think YOU (the patient) should be “king”?

Just to put this in perspective, here are the priorities for the entities I’ll be writing about in these blogs:

  1. Money – greedy, greedy, greedy!
  2. Growth – more opportunity for revenue
  3. Patient Satisfaction – this is based on niceties, not clinical (I have a pretty hospital room, for example)
  4. Clinical Quality (you getting the best care possible) Yep, you’re way down here.
  5. Employee Satisfaction – who really cares what those hard-working staff feel like?
  6. No Charity/uninsured care – I’ve been in border (state line) cities in some states where the entire physician community refused to see uninsured and Medicaid patients. These people either had to move to another state or see someone in the neighboring state.

Here’s the Top 10 list of offenders:

  1. Pharmaceutical industry (herein referred to as Pharma or Big Pharma)
  2. Insurance Companies (whether for profit or not for profit, the bottom line is the main focus)
  3. Hospital based systems including Integrated Systems run by hospitals
  4. Physician Groups
  5. Home Health Care Agencies
  6. Skilled Nursing Facilities and Nursing Homes
  7. Device manufacturers
  8. Durable Medical Equipment (DME) companies
  9. Dialysis providers
  10. Outpatient Physical Therapy Providers

Quite a list. Is anyone not an offender? Does anyone primarily care about patients and their care before money. Well, yes, there are caregivers who are, but, they are usually working in one of the above systems. These folks are salaried or hourly workers who are the foundations of the systems:

  1. Nurses, Nurse Techs, Certified Nurse Anesthetists, etc. (in any venue)
  2. Inpatient Physical Therapists
  3. Respiratory Therapists
  4. Etc. (you get the point)
  5. Depending on the compensation model, employed direct care providers (doctors, nurse practitioners, physician assistants)

These folks don’t directly have the opportunity to get more money when the system they are working in gets more money. Market forces like the Consumer Price Index (CPI) or market supply/demand usually affect their compensation. Most (but not all) of these folks genuinely care about you, although, as I’ll detail and expand on in a future blog, the employed direct care providers now care more about their lifestyle than you. And some of the other staff consider the patient to be like the enemy.

Here’s what’s in this Online, Free Book. Just click on “Categories” below and scroll down to find the chapter you want to read!

Table of Contents


  • Clinical Quality, the #4 Priority in Health Care
  • What Should the Number One Priority Be for the US Health Care System?
  • How Accepted Standard of Practice Has Harmed Patients
  • The Swiss Cheese Model
  • What It Takes to Make Health Care Reliable

Health Care Costs

  • Why The Unites States Health Care System Costs So Much – Part One: Failures of Care Delivery
  • Why The Unites States Health Care System Costs So Much – Part Two: Care Coordination
  • Why The Unites States Health Care System Costs So Much – Part Three: Overtreatment
  • Why The Unites States Health Care System Costs So Much – Part Four: Overtreatment/Technology
  • Why The Unites States Health Care System Costs So Much – Part Five: Prices
  • Why The Unites States Health Care System Costs So Much – Part Four: Administrative Costs
  • Why The Unites States Health Care System Costs So Much – Part Four: Fraud and Abuse


  • The Fractured US Health Care System
  • Why It Is So Difficult for Health Care Systems to Perform to Expectations
  • The Real Story behind the Opioid Epidemic
  • The State of Mediocrity in Medicine


  • The FDA, the USPTO and the Health Care Industry
  • Follow-up on the FDA and Overuse


  • The Rude Awakening about Hospitals and the US Health Care System


  • Why Physicians Prefer Doing Shift Work
  • The “We Need More Doctors and Advance Practice Clinicians” Myth


  • The Opposite Ends of Universal Health Insurance Coverage