Saving Lives and Losing Them


After watching Michael Moore virtually melt down on CNN a few minutes ago, I had some thoughts…

As I wrote about before, there are two problems with healthcare:

  1. Access to care
  2. Quality of care once it's provided

The Lean work that I do is focused on quality of care, so I'm somewhat biased to focus on issue #2. Moore, in SiCKO, focused exclusively on issue #1, which I thought was a real wasted opportunity to focus on a bigger killer.

Michael Moore keeps screaming that 18,000 Americans without insurance die each year. That's awful, don't get me wrong. If you take the number as approximately 47,000,000 Americans who don't have insurance, that's a “death rate” of 0.000383.

The U.S. population, per Google, is approximately 301,000,000. That gives us 254,000,000 WITH insurance. If you believe the oft-cited Institute of Medicine numbers, 98,000 Americans die each year because of preventable medical mistakes. Also a tragedy. That's a rate of 0.000386.

Basically the same rates. I was stunned when I did the math in Excel. Is it fair to say that IF you were able to get coverage for those 47,000,000, that just as many (116,000) would die because of medical mistakes instead of today's total from 1) lack of insurance and 2) medical mistakes?

OK, that's not exactly right, because the 47,000,000 without insurance DO get treatment, usually through the Emergency Room. That's not the best treatment always, but we won't have two exclusive sample sets to compare.

But, I think my overall point is valid — if we're going to get everybody coverage, we have an obligation to eliminate preventable medical mistakes the same way we've pretty much (knock on wood, I fly tomorrow) eliminated preventable airline disasters. Lean methods — process focus, standardized work, root cause problem solving to name a few — can help solve our quality crisis. Our goal needs to be ZERO preventable deaths, absolutely.

Instead of JUST focusing on the access crisis, let's also spent some time discussing the quality crisis. I, for one, am more confident in fixing the quality crisis. I'll put more faith in Lean methods than our politicians anyday. Has anyone heard a Presidential candidate talk about preventable medical errors??


Two somewhat unrelated points that I can't resist commenting on:

1) At the end of the interview, CNN's Wolf Blitzer asked Moore to continue taping a 2nd half of the interview that would air tomorrow. Ironically enough, Moore complained that he would probably be edited and parts of the interview would be left on the cutting room floor to make him look bad. I guess he's familiar with the method…

2) Moore made a huge assertion that doctors would rather see a Medicare patient because they know they'll get a check sent right out instead of fighting “an hour on the phone to get a $15 office visit paid” (with insurance). I've seen medical claims billers fight both private insurance AND the federal government, fighting to get rejected payments overturned. To say the government easily and efficiently ships checks out seems to be another example of fairy-tale land (along with “free” healthcare). As this article points out:

In a recent poll conducted by the Washington State Medical Association, 57% of physicians surveyed were either limiting Medicare patients or dropping all of their Medicare patients.

“Increasingly, physicians are being forced to choose between keeping their medical practices financially viable and treating all of the Medicare patients that need their services,” the report said.

Medicare keeps slashing payments, which is, in a different way, limiting access to care. But, I don't recall Moore addressing that problem either.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. That guy has to be about the biggest waste this great land of ours has ever produced. I just cannot find the words to explain it properly. I wish he would just leave… move to Canada, Cuba, anywhere. Just leave and quit giving Democrats a bad name. They have enough issues as it is. Sorry… couldn’t resist.

  2. Great post, again, on something I’ve stayed away from. One item I was fascinated by is that Moore points to France as “the perfect model.” They do have lower mortality, higher access, an interesting concept of the sicker you are the less you pay. Guess what… they’re also running increasingly high healthcare deficits and are looking to… get this… adopt private U.S. HMO models. Of course Moore conveniently left that on the cutting room floor!

  3. Great job focusing on the problem. It pains me to see the amount of people who think this guy is the gospel. If only we could all refocus on solving the problem and not who’s right or wrong. The uninsured would just be another bar in our Pareto chart.

  4. Standardized procedures (quality) in the medical field is coming, though it’s a slow movement–at least that’s what the healthcare professionals we’ve talked to say. Visual work instructions have worked so well in manufacturing and aerospace, it seems like healthcare could benefit, too. Nurses love our standardized procedures, but we still meet with resistance from hospitals. As I understand it, they can only use these types of documents as “guidelines.” That’s because any procedure has to be done within the context of the patient’s condition. In simplistic terms, that means you can’t do step 3 of a procedure that requires an injection in the arm if you’re dealing with a patient who has no arm. Of course, that leaves me wondering about the role common sense plays . . . Thanks for pressing on with the battle for quality care AND access to care.

  5. Hi Renee – thanks for your comment. Standardized work *is* a great way of improving quality in healthcare. Michael Moore wasn’t highlighting anything close to that issue, of how variation or failure to follow standard practices leads to many patient injuries and deaths.

    I believe that standard work DOES absolutely require common sense and thinking. I view standard work as a set of guidelines and a playbook. Sometimes, you have a good reason for deviated from the playbook. But, if you’re always deviating from the playbook or doing so without a good reason, that’s a problem.

    Standard Work requires that employees have their thinking caps on, this isn’t a “be a robot and leave your brain at the door” system.

    It’s important to consider WHAT to standardize, not to standardize for the sake of standardizing. If it’s important, for infection prevention, to insert a central line using a certain procedure, then the process should be standardized — people need to follow that standard. They also need to understand WHY to follow the standard, it’s not just “because managers said so.” It’s for the patient, it’s for the employee’s safety, etc.

  6. Ron Pereira said…
    That guy has to be about the biggest waste this great land of ours has ever produced. I just cannot find the words to explain it properly. I wish he would just leave… move to Canada, Cuba, anywhere. Just leave and quit giving Democrats a bad name. They have enough issues as it is. Sorry… couldn’t resist.

    Poor impluse control is a sure sign of immaturity. When our nation finds the courage to act as adults perhaps we’ll solve some really important problems.

  7. Hi Andrew,

    I will grant you I probably should have followed the 24 hour rule before posting my thoughts.

    But let me ask you something. Do you think Michael Moore practices this “impulse control” rule? Perhaps you may want to watch the video before answering.


  8. Never forget 2 things about Michael moore: a) Like other feature film makers, he deals with fantasy, and b) the real reason he is against the American medical system is he is sick and tired of American medical professionals telling him he is not the picture of health (overweight and most likely with high BP) that should be projected to the American public.


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