Revisiting Basic Health Access in a Land of Smoke and Mirrors

Each day we see more fabulous solutions proposed for the various woes of health care in the United States. Truly we have a dizzying intellect and desire to try everything other than focusing on the right thing. The one thing that you can depend upon is that the innovative solutions are quite misguided. Decades ago we appear to have lost touch with the most important components of health care - the people that deliver the care. 

Basic Health Access Is a Major Example of Dysfunctional Design

Basic health care is about support for the team members that choose to invest their lives in a better life for others. Our nation has allowed its health designers to ignore the basic needs of over 100 million Americans by geography, with more tens of millions facing numerous other barriers. What they need to be able to change destructive behaviors, compromising situations, and adverse environments is denied them. Attempts to prevent these people factors from shaping poor health, education, economic, and societal outcomes have long been left behind. 


Suppression of Basic Health Access

With rising demand, the basic services should have increased in cost/payments. Instead, our nation has suppressed market forces by keeping payments too low where 100 million Americans are found. Where primary care and other services and workforce have been most concentrated, the supply is highest and payments would be lower by market forces. The designers have shaped health care for all Americans based on their awareness of situations and environments impacting a relative few. Meanwhile most Americans face the consequences of a distorted design.

The impact has been worst where mental health, primary care, MD, DO, NP, PA, and RN workforce is least concentrated - by national design. Even worse, it has long designed payments lowest where basic services are most needed. 

The new designs represent the worst discrimination of all. This is discrimination that hurts the most where care is attempted for those most complex with least resources and least health outcomes, for numerous reasons other than clinical intervention. Designers far away may intend improvements, but the reality is compromise specific to small practices and small hospitals and populations and health care that they do not understand.

Medicare, Medicaid, Metallic Discrimination

Places with concentrations of federal or 3 M patients (Medicaid, Medicare, Metallic) are the places with workforce deficits because of insurance coverage that has facilitated suppression of basic health care - by design. Medicaid and Medicare were created to address longstanding inequities, but they have become vehicles driving greater concentrations of dollars in the hands of few doing well and lesser dollars for services of most of us left behind. 

With new technologies and new types of services, higher payments were established. Demand for services resulted in higher costs and better payments. The gap between basic, office, cognitive services and procedural/technical/subspecialized services was created - thus distorting workforce toward higher concentrations in only 5% of the land area. Across 95% of the land area with 65% of Americans,  health care needs were left behind. The basic services that remained were left behind with lower payments. The payments will be stagnant or lower during a period of rapidly increasing demand, population, elderly, and complexity.

Our government has failed to understand that health care is
  • about people, not technology; 
  • about solid, dependable access to care, not rapid chaotic changes that complicate care, especially where care is most needed; 
  • about social determinants, not digital divisiveness; 
  • about changing people/patient behaviors, not distantly micromanaging physician/clinician behaviors; 
  • about higher team member productivity; not lower; 
  • about less administrative cost, not more; 
  • about less regulation impairment of productivity, not more; 
  • about less destruction of small practices and facilities, not more; 
  • about more dollars distributed where dollars are least concentrated, not more dollars shipped out (mail order pharmacy, software, hardware, change consultants)
Better Outcomes Are About People

Our nation has changed health care, education and other people interaction dominant areas for the worse - because it compromises the support of the people that can best interact. The team members to change behaviors, situations, environments, and other people factors should have the top priority in health care, and in education, and in public health...





No Positive Spin for the Innovator Tailspin - more claims for innovation successes are apparently attempts to hide failure
Stop the Promotion To Restore Mental Health Access - claims of mental health care reforms or improvements are a stark contrast from the reality of lowest payment, highest complexity of care, unreliable payment, and poor support other than lots of rhetoric


Primary care can be recovered and should be recovered, 
but cannot be recovered when moving the wrong directions

Robert C. Bowman, M.D.        Robert.Bowman@DignityHealth.org

The blogs represent the opinion of the blogger alone.
Copyright 2016

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