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.

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