NOTE:  This blog post was taken from Need to Know: How to Arm Yourself and Survive on the Healthcare Battlefield (2018) by Darwin Hale, COL (RET), USAR, the Founder & CEO of Advocate Health Advisors. Darwin is a respected entrepreneur, author and decorated military officer with more than 30 years’ experience in the corporate world to include serving in the United States Army and Army Reserve (USAR).

Allow me to tell you a sad story about our health care system and how it often fails to serve us as it should. Thomas Breen was 71, a United States Navy veteran who was so proud of his service that he refused to seek medical treatment anywhere but the Veterans Health Administration, the VA. When Thomas saw blood in his urine, his son begged him to get immediate treatment from an outside doctor who would see him immediately, but Thomas believed and trusted that the system would take care of him.

In a visit to a VA emergency room, Mr. Breen’s condition was called “urgent,” and he went home to await a follow-up appointment with a specialist. Some time went by, and he went back, trying to get in to see a doctor. He was told to be patient and was sent back home. Seven months later, the VA finally called to set up that “urgent” appointment, but it was too late. Thomas had died of bladder cancer while waiting for the treatment he deserved.

In this case, it was the VA system that failed Thomas Breen, but his story characterizes a larger pattern of failure in the American health care system.  How can something like this happen in a country blessed with the best resources, greatest talent, and most advanced technology? Our health care system has all these things, but the fact is that that system is broken and failing Americans in three distinct ways that must be addressed

An uncoordinated mess

First, the highly-resourced and talented parts of that system do not work well together. In fact, the American health care system is an uncoordinated mess. When the different parties don’t work well together, bad outcomes (like unnecessary death) are going to occur. As I think about this system, my military background leads me to recall an incident that occurred during the last days of President Carter’s Administration.

Operation Eagle Claw was a mission intended to rescue 52 American hostages being held in Iran. Some of the best military personnel in the world were involved in this mission. Still, when the undertaking was over, eight servicemen had died, and no hostages were rescued. Hoping to learn from and correct this failure, the military conducted an investigation. The Retired Chief of Naval Operations, Admiral James L. Holloway, led the effort. The Holloway Report revealed that the systems used by different military units in the operation didn’t talk to each other. The services didn’t train together or know each other, there were command and control problems, there was no identifiable command post on scene, and instructions had to be questioned until proper authority could be established.

The silver lining of that failed mission was the formation of a multiservice organization, the US Special Operations Command. Teams from the Army, Navy, Air Force, Marines, and Coast Guard would now be able to work seamlessly together. This is a great analogy for what our healthcare system needs to do.

We have the best doctors and health professionals in the world. Surgeons and advanced specialists are the health care equivalent of Delta Force. Nurses and other caregivers are like the air crews that make things happen, but they’re part of a system that doesn’t allow them to work together the way they need to. Unlike the way the military adapted and learned from Operation Eagle Claw, the American health care system has yet to do the same. Until that transformation occurs, the consequences will continue to be dire, especially when you consider the chronic-care needs of our aging population.

The National Council on Aging website, states that, “About 80% of older adults have at least one chronic disease, and 68% have at least two. Chronic diseases place a significant burden on individuals as well as health care systems.” Chronic problems require chronic care, and that demands the coordination of the caregivers involved.  There should always be a plan anticipating and predicting what’s likely to happen. We are only beginning the transition into this new model, and as the population ages, the need will become ever greater.

Difficult to shop for health care services

Second, there is no easy way to shop for and buy health care services. The healthcare marketplace simply has not developed the ability to shop for and buy services based on value or customer service. Usually when we make an important purchase, we shop. But with health care, most people are not good shoppers. In fact, we may not even realize we should be shopping.

Imagine that you need a new toaster, a trivial need compared to health care. I know many people who have become expert consumer goods shoppers. They go about it in a systematic, rational way. These consumers will go to websites for big stores or online services like Amazon and eBay. They can sort all the choices by price or by customer review systems that give star ratings, five out of five stars being the best. They can read the reviews of people who have purchased the product and make a rational choice based on the information available.

I know an individual who always sorts the choices by their star rating, highest first. He would not buy any toaster that had not been reviewed by at least 50 to 100 people and given an average rating of at least four stars. Among those top-rated toasters, he will choose one in his price range. Later we will let you in on a secret that most health care consumers do not know: there is a star rating system for health care plans!

If I want a new car, I may go to more than one dealership to look for the best deal. When looking for a new house, I would thoroughly check out many possibilities, but the American health care system does not come with price tags or make comparison shopping easy.

Today, in our third-party payer system, someone else pays your health care bill. You might pay a premium or a co-pay at the doctor, but for most Americans, another party such as an insurance company or the government pays the remainder of the bill. Often, we do not even consider whose money we are spending.

Choosing health care providers is often a “hit or miss” guess. How did you choose your physician?  Was that choice based on their experience or a stellar track record of outcomes? Do you have a good primary care doctor who is on top of your entire health picture? If you’re like many Americans, you picked the doctor that was down the street because it was most convenient for you.

The inability to shop for and buy health care services based on value is a fundamental problem. As we solve that problem, other things will take care of themselves.

Lacks efficiency and focus on patient experience

Third, our health care system is neither efficient or accommodating. Besides being uncoordinated and difficult to shop, the American health care industry is riddled with inefficiencies that cost us millions of wasted hours (as well as dollars). Customer service and satisfaction are just not at the top of the objective list.

If you need hospital care, you probably have little choice, even for procedures planned well in advance. That hospital may be good at keeping you alive, but it’s not very good at making you comfortable. Hospital workers may be professional and caring individuals, but make no mistake – you’re on their schedule, fitting into their world, not the other way around.

The same is true for outpatient facilities where you might be sent for X-rays, MRIs or other sophisticated tests. You will not find much accommodation in these outside medical facilities either. It’s funny to me that my ATM remembers me, my denominations, balance, quick withdrawal amount, and yet getting my consolidated medical record to anyone remains a major undertaking.

The healthcare system must evolve to improve the ability to shop, to become more efficient, and to elevate the overall customer experience. In some places, the model is evolving, but overall, it’s just not there yet. This transformation must be speeded. There are too many Americans like Thomas Breen who have been failed by a system that was supposed to protect them. We owe it to Thomas, and others like him, to fix this problem.


Holloway Report-

Retired Chief of Naval Operations Admiral James L. Holloway III led the official ……..