Thursday, December 29, 2011

They Think We are "Imbeciles," and They Run Health Care Organizations

Arrogance seems to fuel many of the problems with health care leadership that we discuss, particularly hostility to the mission, often driven by self-interest; a sense of entitlement to lavish compensation out of proportion to any measure of performance; and a lack of accountability shading into impunity.  Some recent stories hint at some of the origins of such arrogance. 

The Occupy Wall Street movement drew attention to the plight of the poor and middle class, who had lost income, retirement benefits, jobs, houses, and access to health care while the richest, especially corporate executives, got richer.  The less fortunate's anger was not directed indiscriminately at the successful or the rich, but those who got wealthy by gaming the system, or flaunting the rules that lesser mortals had to obey.  Perhaps not surprisingly, some of those most vulnerable to such criticism have responded with contempt. 

Anonymous or Indirect Defenses of the One Percent

The initial defense of the plutocrats came from some of their political supporters, who denounced their "demonization" (see this opinion piece by Barbara Ehrenreich in September, 2011) or decried the rise of "mob rule" (see this by Paul Krugman in October).  Then several articles documented the anonymous complaints of finance insiders about:
a bunch of whiny people who are lazy and incompetent and have nothing to do with their time
from a Reuters article in October.

a ragtag group looking for sex, drugs and rock 'n' roll
from a NY Times article in October.

The Plutocrats Strike Back

However, increasingly those in the one percent are willing to be open. In late December a Bloomberg article documented the sentiments of a number of finance and other corporate leaders.

- Jamie Dimon, CEO of JP Morgan Chase, complained:
Acting like everyone who's been successful is bad and because you're rich you're bad, I don't understand it.

- Bernard Marcus, founder of Home Depot:
Who gives a crap about some imbecile? Are you kidding me?

- John A Allison IV, Chairman of BB&T:
'Instead of an attack on the 1 percent, let’s call it an attack on the very productive,' Allison said. 'This attack is destructive.'

- Stephen Schwarzman, CEO of the Blackstone Group:
'You have to have skin in the game,' said Schwarzman, 64. 'I’m not saying how much people should do. But we should all be part of the system.'

- John Paulson, President of hedge fund Paulson & Co:
has also said the rich benefit society.

'The top 1 percent of New Yorkers pay over 40 percent of all income taxes,...'

- Tom Galisano, founder of Paychex Inc:
If I hear a politician use the term ‘paying your fair share’ one more time, I’m going to vomit

- Ken Langone, founder of Home Depot:
I am a fat cat, I’m not ashamed

Considering how Paul Krugman explained the generation of the global financial collapse by
people who got rich by peddling complex financial schemes that, far from delivering clear benefits to the American people, helped push us into a crisis whose aftereffects continue to blight the lives of tens of millions of their fellow citizens.

Yet they have paid no price. Their institutions were bailed out by taxpayers, with few strings attached. They continue to benefit from explicit and implicit federal guarantees — basically, they’re still in a game of heads they win, tails taxpayers lose. And they benefit from tax loopholes that in many cases have people with multimillion-dollar incomes paying lower rates than middle-class families.
Thus the responses by the very rich above only represent some or more arrogance.

The Plutocrats as Health Care Leaders

One wonders how much this arrogance carried over into health care. We have noted previously how the leadership of finance has increasingly overlapped the leadership of health care, and how top executives increasingly seem to identify more with each other than with their employees, customers, or other stakeholders. Therefore, it should be no surprise that all but one of the group above also had or have leadership roles in health care organizations.

- Jamie Dimon is on the board of trustees of the New York University Langone Medical Center

- Bernard Marcus formerly served as the chair of the board of the CDC Foundation.

- John A Allison IV is a member of the board of visitors of Wake Forest University Baptist Medical Center, per his BB&T Corp official biography.

- Stephen Schwarzman's Blackstone Group includes the Blackstone Healthcare Group, which invests in various health care corporations (as of 2010, Nycomed, Gerresheimer, Stiefel Laboratories, and Catalant per this press release), and all of whose members serve on one or more boards of directors of health care corporations (per the press  release, Arthur Higgins serves on the boards of Zimmer, Eco Labs, and Resverlogix Corp; Lodewijk J R de Vink serves on the board of Roche; Doug Rogers serves on the boards of Codevax, Charles River Laboratories, and Computerized Medical Systems.)

- John Paulson is on the board of trustees of New York University,

- Kenneth G Langone, is vice chair again of the board of trustees of New York University, and chair of the board of trustees of the NYU Langone Medical Center.

I submit that linking their sentiments above to their leadership roles in health care should be highly disconcerting.  Do we want people running medical centers who are proud to be "fat cats?"  Do we want people running medical centers who do not understand why people who have lost income, retirement funds, jobs or their homes might be upset?  Do we want people running health care corporations who do not think the poor and middle-class have any skin in the economic game?   Do we want people running health care foundations who think that those who complain about the current economic situation are "imbeciles?"


The problems of health care increasingly seem to be a part of the larger problems with the global political economy.  The problems we have been discussing that affect health care leadership seem to have come out of the culture of what now many are calling the larger plutocracy. 

So it now seems that true health care reform will require a larger reform of the political economy.  However, we still need leaders who understand the health care context, uphold health care professionals' values, and put patients first.  We do not need leaders who are ill-informed, incompetent, self-interested, conflicted, or corrupt.  We need governance that is accountable, honest, transparent, ethical, and again puts patients first. 


Anonymous said...

They are imbeciles indeed, but higly conflicted, financially. Patients suffer.

Afraid said...

If the measurement is based on results, we citizens are truly imbecilic.

And the answer is pretty straightforward and achievable --- leave the Republican and Democratic parties and join a new political movement.

APeticola said...

Wonderful post! You tie together so much -- appreciate it!

Someday the tide just has to turn, and your laying out the current miserable situation so clearly is a real contribution. Thanks & happy new year!

Anonymous said...

I was taught that if I complain about a problem, I should be prepared to offer a solution. Your specific solution is...?

Roy M. Poses MD said...

Anonymous of Jan 1, 2012 -

Note that as long as most of the problems we discuss on this blog remain "anechoic," that is, almost never discussed within medical, health care research, and health care policy circles, it may be premature to talk about their solutions.

I would hope that what we write on this blog does inspire some people to think about solutions.

Nonetheless, for my take on some general soluations, see the final paragraphs above.

In particular, in my humble opinionn, we need a new way to pick the members of boards of trustees of non-profit health care organizations. They ideally should be chosen because of their knowledge of, sympathy with, and support of the mission. Organizations that mainly provide care to patients should benefit from the stewardship of people who can represent the interests of such patients. Although it is appropriate to recognize those willing to make big financial donations, people should not be allowed to "buy" board seats with big contributions. Finally, people of questionable character, or with major questions about their ethics should not sit on such boards.

Afraid said...

I disagree with you Roy. I don't think that the citizens are unaware of the problems. Indeed we are quite well aware.

If you think we are falling for all their proclamations of piety, look at any poll that asks questions about trusting institutions of any sort.

Its the world of appearances - the government appears to be fair, healthcare organizations appear to care, etc. Boards of Directors/Trustees appear to be community leaders.

It is clear we don't believe in the appearances they put on, but there simply isn't something we can do.

I think it will take things getting a lot worse before enough people act to make things better later.

Roy M. Poses MD said...


I did not say that the citizenry are unaware of the larger problems with the leadership of finance, and of government. In fact, their awareness, as embodied by the OWS movement, has lead to at least some public discussion of issues that the plutocrats PR spin doctors have been trying very hard to bury.

I did say, however, that there has been little discussion of the issues we address on HCR in medical, health research, and health policy venues. For example, I don't know if anyone other than a few bloggers, including yours truly, have been publicly discussing the overlap between leaders of (often failed) finance firms and health care leadership and governance.

As long as we in health care cannot even discuss these issues, it will be hard to address them.

By the way, I think the general public is much more aware about problems in leadership of finance, and of government, but often still think of health care institutions, like the local hospital, as being unaffected by such problems.

Gene Dorio, M.D. said...

In response to the comment from “Anonymous” rightly asking for solutions:

John Adams once said of Thomas Paine “he was a man to tear a house down, but who lacked the skills to rebuild it.” The internet “Health Care Renewal” pages certainly help to inspire, and hopefully ignite, a fire of solutions to rebuild “our house”.... that we did not tear down.

Healthcare decision-making was hijacked by the profit-seeking insurance and hospital industries decades ago, with the hands of physicians being put into financial shackles. Doctors and their organizations stood by and allowed this to happen. There are solutions, but they must go to the core of the problem:

Lobbyist: True “debate” has been removed from our legislative jargon with laws made by money-influenced politicians tweaked for corporate benefit. Solution: Public financing of election campaigns with strict rules on money and access (good luck with this one as Congress has demonstrated their inability to self-regulate).

Backbone: Physicians must create their own stage away from their local and national organizations informing and educating the public concerning illicit profits, nullifying money from healthcare industry lobbyists, and demonstrating minimized care and access because of those profits. Solution: Not only use the web to interact, but organize internet and local meetings to bring our voice back to the community.

Preservation: Not allow the loss of Medicare to be used to politically instill fear in our senior population. Solution: Saving this healthcare safety net is paramount, but can be easily approached by better cost-saving measures of tort reform, fraud, and end-of-life care.

Reality: The understanding our nation can never compete in the world marketplace if we do not have healthcare. Every country we vie with has healthcare. In this country, instead of focusing on making a good product, we are forced to worry about loss of our job, foreclosure, bankruptcy, divorce, moving, and catastrophic illness. Solution: blanket Medicare to cover all Americans, raise taxes, regulate carefully, don’t try to “reinvent the wheel” when there are several efficient and effective national plans used throughout the world (Taiwan and the Netherlands), and remove the outrageous profiteering businesspeople from medical decision-making.

Statistically, this country contributes a higher percentage of GDP monies toward healthcare than any nation in the world, yet our ability to provide this care to the people is rated low, just ahead of Cuba. We need more solutions to combat this business takeover, but then these solutions will need to be carried on the shoulders of those, who like the revolutionaries, are willing to fight against greed and self-interest.

Gene Dorio, M.D.

obesity surgery in india said...

Even I wonder on how much this arrogance will carried over no health care. it will be of no surprise that all but one of the group above also had or have leadership roles in health care organizations.