A “Crowd-Sourced” Textbook Creation Project

Power Flipping the Wisdom of Crowds for Public Health Good!

The system only changes if we empower the one person who cares about their health the most – the patient. Over the next decade, I believe people will become the CEOs of their own health.

-Vinod Khosla [Venture Capitalist]


Ultimately, any informed choice comes down to transparency and changing human behavior!


Exposing what’s behind the curtain of the medical industrial complex


 The U.S. healthcare crisis has reached a tipping point!

There’s widespread dissatisfaction with a health system that focuses on profit over health. At the same time patients, payers, providers and public health policymakers are beginning to understand the value of investing in wellness, rather than paying only for treatment. Technology connects us through social media. Knowledge is power and daily we are influenced by its ability to disrupt inefficient industries. The power in this book  will educate us all and help disrupt the medical industrial complex for the public good. 

-David Edward Marcinko [Editor]



For those unfamiliar with this economics expression … it means ‘no choice at all’.

Now, this is very different than transparent decision-making science that offers a real choice. In other words: this choice or that one –OR the either/or fallacy whereby the arguer characterizes a complex problem with many possible solutions, as having only two outcomes: one desirable and one not. But, with a true Thomas Hobson’s choice dilemma; there is NO real choice at all!

Our Raison d’ Etre

Behavioral Economists study and question why people do … what they do! That’s where our research is focused, and why this book is titled: HOBSON’S CHOICE IN MEDICINE [Crowd-Sourced Reflections on Decision Making, Health Economics, Rationing and Free Enterprise]. 

In fact, with your help, we seek to illustrate the many false choices that participants in the US Healthcare System Quartet [patient – payers – providers – public policymakers] face … and often unwittingly make each day.

For example:

Patients: “This health plan covers all drug costs” … As long as they are in our generic formulary.

Payers: “The government does not force anyone to buy health insurance” … The choice is to buy insurance or pay a higher tax bill [“fee” or “penalty”].

Providers: “You don’t have to sign an insurance Hold Harmless Contract Clause to indemnify us for a malpractice claim” … But, you may be de-selected from our medical panel if you don’t.

Public Policymakers: “You can keep your doctor” … As long as s/he is in a narrow PP-ACA network of physicians and hospitals.

So, always think, be skeptical, read the fine print; and help us expose the many false healthcare choices that we face. And, participate in this R&D effort so we can offer a frank “insider’s look” behind the metaphorical curtain of the late Arnold “Bud” Relman MD.

Relman called this secret curtain the “medical-industrial complex”

Dr. Relman was  Editor-in-Chief of the New England Journal of Medicine, who issued a clarion call in 1980 that would resound through his career, assailing the American health care system as caring more about making money than curing the sick.


Our book is dedicated to Kenneth Joseph “Ken” Arrow PhD, the youngest winner of the Nobel Prize in Economics in 1972; at age 51. His work combined disparate topics like mathematics, game theory and information technology; utility, scarcity and consumption; finance and economics; insurance and risk management; and cognitive behavioral economics … into a diverse singularity called Health Economics.

 Arrow is known today as the “father” of Health Economics

Dr. Arrow remains  internationally active through the non-profit Health Impact Fund, a proposed Pay-for-Performance [P4P] mechanism that provides market based and free enterprise solutions for the development and distribution of drugs and medicines globally.  


“Wisdom of Crowds”


Please comment or submit personal patient stories, professional experiences, payer conundrums or public health policy anecdotes about your own Hobsonian Choices in the healthcare industrial complex; right here.

Upon receipt, they may be redacted, peer-reviewed and placed into one of four categories: [1] provider, [2] patient, [3] payer, or [4] public policymaker; respectively. 




The Sharing Economy is Bringing People Together … Become a Data Point … Participate in Collaborative Research and Public Good Education, Today!

-Bertalan Mesko MD PhD [Medical Futurist]

Note: E-mail submissions may be named, or anonymous. OR; you may use the survey form below. Submissions become property of the HCM project and do not guarantee text book or website inclusion. 



2 thoughts on “

  1. Why Customer-Centricity Doesn’t Matter As Much As You Think It Does

    According to Jeremy Wallman, a consultant based in Connecticut, customer centricity in the form of patient choice has been a mantra of managed care organizations for well over a decade. If you listen closely, you can hear plaintive cries of our care providers, lamenting the labyrinthine, almost Kafka-esque system of prior authorization, reimbursement, meaningful use, and near-real-time obsolescence of medical technology. The crushing weight of reform, the perverted incentives created by volume-based reimbursement, and the soaring costs of doing business have created a situation — much like public education – where our system is fueled primarily by the power of a dedicated and passionate community whose members are motivated by their desire to care for other human beings.

    “How can we possibly think about self-service websites when we are holding back an imploding healthcare delivery system”. Maybe we need to ask a more basic question…..is the U.S. healthcare system viable in the long-term? That question might simply be too hard to answer. So instead, we try to convince ourselves that delivering medical care should be treated as a business. Innovation and value are fueled by financial incentives and healthcare is no different.

    But it is different …. It is very different.

    In some particularly competitive/ wealthy markets, providers are offering differentiated services….delivery rooms with hotel-style amenities, upgraded menus, concierge services, etc., usually available for an extra charge. But these services are not adding to anyone’s bottom line…they are just attracting those few patients who have the luxury of choice. Where is the value here?

    So perhaps it is time to acknowledge what the policy wonks have been saying all along……the challenges of our healthcare system will be addressed by creating value for all the stakeholders in the value chain, not just patient-customers, and instead of working to delight patients, we should be working to remove the barriers to achieving efficiency and sustainability. At that point, patients and care providers can focus on what is most important – making human beings healthier.

    More: http://thehealthcareblog.com/blog/2016/08/12/why-customer-centricity-doesnt-matter-as-much-as-you-think-it-does/

    Hope Hetico RN MHA


  2. What a Mess!

    To say that the healthcare ecosystem in the United States is a complex situation is an understatement. I mean, just think about it. In what other situation is a customer (a patient) told by one party (their doctor) what product they will be buying (from pharma), and told by another (their insurance) how much they will pay for it? OR, from [public] policymakers who decree they MUST buy a health insurance plan; and then help them pay for it?

    While a simplification, the proliferation of these tangled stakeholders [4 Ps] in the healthcare environment have grown to epic proportions – and so have the problems they present to the system. As a result, our healthcare system is commonly viewed as broken – out of touch with reality, greedy, and driven by shareholder value over patient outcomes.

    So, I trust this book will be beneficial … and fulfill its promise … to us all!



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