Health Care Delivery Is No Laughing Matter

The Myth of Coverage Equals Care

Political cartoons lampoon one side or the other with ACA a common topic. A popular cartoon from Being Liberal depicts the Elephant in therapy after realizing the lack of failure of Obamacare, resulting in treatment for depression - a mental health condition which is covered under ACA. While intended for humor, the cartoon fails to raise the most important awareness:

More than coverage is required for needed care delivery.

The elements of the carton: 
  • Realizing - Those not able to gain awareness, will have a difficult time with therapy. Awareness of basic care needs has failed for Republics and Democrats for some time.
  • ACA isn't a failure, but it is not a success - especially in needed care areas
  • Depression may be "covered," but just try to find mental health care providers and services, or get approval for same from your "insurance" coverage.

Pay remains insufficient for primary care, for mental health, and for basic services (general surgical services) for the past three decades of payment designs

An entire generation of poor support has led to an entire generation of class years of MD, DO, NP, and PA graduates making other choices guided by highest health spending and better support for more specialized care, resulting in the current deficits where basic care is needed.

This is why the primary care delivery capacity, mental health delivery capacity, and basic service delivery capacity remains low - with shrinkage of the workforce despite rapidly increasing demand.

Stagnant health spending is bad enough. A pittance of funding increases go to pay for CEOs, administrators, management, innovations, consultants, billing personnel, health insurance companies, software companies, and technology - but not for more clinicians and teams to deliver the care. Shrinkage of care with higher or same cost is the opposite of value-based.

Disruptive innovation is a most appropriate term for what is going on, as basic services are being disrupted with innovation focus a reason. Distractive innovation is an appropriate term. Other common distractions are claims of being a solution, when no solution is possible because of designs for training and designs for payment. 

Returning Health and Life and Purpose to Health Care 

Health care delivery is mostly about people delivering health care to people - something that was taken out of health care design 3 decades ago. Poor awareness on the part of Republicans and Democrats and those who design health care will continue to prevent care where needed.


Cartoons are a good way to raise awareness, but the awareness that needs to be addressed is about failure in basic foundation types of care over decades of designs. 

Even the small proportion of spending for primary care in the United States would likely be enough, based on spending in other nations. However, the spending needs to be specific to the support of those that actually deliver the care - something avoided for decades.

Recent Works

Overcoming Barriers to Health Access Including ACA

Will Teaching CHC Sites Deliver on the Promise of Health Access

How Bad Medicine is Sweeping The Country.

Preventing Rural Workforce By Design

Best of Basic Health Access

Blogs indicate that primary care can be recovered and should be recovered, but it will take 30 consistent class years of improvement for actual recovery. We have to have at least one to begin.


Dr. Bowman is the North American Co-Editor of Rural and Remote Health. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association and the long term chair of the STFM Group on Rural Health.

Comments

Post a Comment

Popular posts from this blog

Another Fine CMS You Have Gotten Us Into

Perhaps we are indeed back to the time of Another Fine Mess (Laurel and Hardy). In a mad rush to implement innovation and to save all possible costs, CMS is creating complications for people that it is most responsible to protect. As PBS and Ken Burns celebrate the legacy of The Roosevelts, it is tragic to see what has become of over a century of effort involving Social Security, Medicare, Medicaid, and health care equity. The United States has one of the most complex health designs and clearly the various designers often know not what they are doing to others. More cartoons and comedians would find this a ripe area for material if not for the suffering involved. Health and Human Services has a huge role across Social Security and US health care. CMS or the Centers for Medicare and Medicaid Services has a dominant role to play in the design of health care in the United States.  CMS can be progressive or regressive. Interestingly CMS has chosen to appear to be progressive and in
Read more

The Essential True Reform Restores Primary Care and Much More

The list of distractions from True Reform are impressive. For decades True Reform has been specifically avoided as primary care worsens within practices and from outside. The demise is most specifically about the financial design. Unless there is a focus on True Reform, there is little hope for Basic Health Access. This may not make as much sense to those outside of family medicine. Family physicians not familiar with AAFP may also be clueless. If you think that you can fix primary care with more technology, more rearrangements, more types of health professional graduates, or more expansions of training - think again. None of these have any hope of working without financial design changes - major changes. The following are various concepts that dominate the discussions at AAFP and primary care meetings and media releases of associations and foundations and institutions. Members, staff, media releases, programs, and personnel have been reviewed.  There is little about Tru
Read more

Why not inside out empowerment rather than outside in abuse?

Just in from Annals of Family Medicine (Miller, Rubenstein, Howard, Crabtree) Shifting Implementation Science Theory to Empower Primary Care Practices Hope for primary care, generalists, rural health, and care where needed requires a very different perspective after decades of failed designs. Not surprisingly this will need to come from inside of these practices and places. Not surprisingly policies and practices dictated from outside have been not only a poor fit - but have been abusive to the populations most in need of care and the practices that serve them. There is hope from the primary care research community. The perspective must be inside of practice looking out - instead of outsiders forcing changes. Qualitative research explores and discovers and reflects as Ben, Will, and others taught me along with the various rural family physicians interviewed and researched in the 1990s in Nebraska. The current focus on quantitative research has demonstrated little to
Read more