Basic Health Access

The 3138 US Counties can be coded by physicians, by types of physicians such as active family physicians seen here, by population and by other demographics, including those age 65 that are increasing rapidly and even more in health care demand. As previously noted, the locations with top concentrations of physicians have lowest proportions of family physicians and primary care.  Numerous forces interact to shape higher proportions of family physicians where care is most needed and where higher proportions of elderly are found. These are counties most behind in education, employment, and poverty in addition to health spending, health facilities, and health care workforce. Slowest population growth is seen in counties most concentrated in health workforce. Highest cost of living and health care may shape most Americans elsewhere, especially the elderly and those on fixed or lower incomes.  Designs for health, education, and economics fail where neede...

The following is a 2004 prediction specific to the year 2014 made by US Health Experts as captured by US News and World Report: In 10 years, the increasing use of online medical resources will yield substantial improvement in many of the pervasive problems now facing healthcare—including rising healthcare costs, poor customer service, the high prevalence of medical mistakes, malpractice concerns, and lack of access to medical care for many Americans. Ten Years After By assumtion and belief backed by the creation of programs and expenditures, the US has actually helped to distract spending toward administrative costs and away from direct spending on those who deliver care - failing to meet increasing needs for workforce and services. Experts failed to understand the limitations of various designs. Care management, even using the most promising designs, did not result in appreciable savings. The cost of doing the management often ate up any savings as investigated b...

Spending Designs Discriminate Designs for spending send less to counties in most need of care that have populations with multiple dimensions of "left behind." This can be tracked by measuring distributions of Medicare dollars or by measuring workforce distributions. Counties with lower to lowest concentrations of workforce not only have fewer services, they have higher proportions of primary care and basic services. In other words they have less of the services and providers that generate the most revenue under US design. Thirty or more states, 2600 counties, and 40,000 zip codes geographically map discrimination. Discrimination can also be mapped by economics, race, ethnicity, age, income, education, and other measures. Decades of inaction indicate continued Discrimination by Design. American health spending, like workforce, is concentrated in 6 states, 250 counties, and 1100 zip codes. Spending design favors those doing well across a wide range of social determinant ...

The Politifact Lie of the Year in 2010 was awarded to the term "Government Takeover." Government Takeover or Government Control in various forms emerged from Republicans, health insurance association consultants, and certain media outlets. A brief attempt at naming the new health design as "public option" lost out. The spin doctors succeeded beyond their wildest dreams. The first Democratic agenda moved on the defensive and in many ways never recovered. The best interventions are the simple ones. The Government Control card played well from start to end. It will be interesting to see if Republicans are going to be perceived as in control and if Democrats can return the favor. This is, of course, a reason why America is difficult to govern. The Government Control card has indeed been played by both sides dating back many political campaigns. The latest and most successful example paved the way for a simplistic and powerful campaign 2010 to 2014 with the results a...

America's teachers reached the cover of Time Magazine recently, but not in a favorable light. The response of teachers is recorded: America’s teachers are not rotten apples, as Time’s cover suggests, that need to be smashed by Silicon Valley millionaires with no experience in education…. Yes, there is a real problem facing America’s teaching profession, but it has nothing to do with tenure. The problem is in recruiting, retaining, and supporting our teachers, especially at the hardest to staff schools. Randi Weingarten American Federation of Teachers The blame game has been most popular, but Rotten Apple branding is often a distraction from the real situations and relationships crippling education, the teacher-student relationship, and the learning of the child.  The same basic defensive statement can be made regarding any number of basic serving professionals that are under fire, facing declining support, increasing responsibility, increasing complexity, more regula...

When given a chance to operate the entire payment package, what do Health Insurance Companies (HICs) do? For the past 8 years HICs have been given the freedom to operate Medicare Advantage - the high prestige seniors plan from CMS. HICs helped design the complex payment formulas for MA HICs found a way to upcode higher patient complexity for MA patients HICs shoveled in the profits using the design that they helped to shape their way The  Center for Public Integrity  indicated, "For instance, audits of six plans found that health plans couldn’t justify payments from the government for 40 percent or more of their patients. The resulting overpayments were pegged at nearly $650 million for 2007 alone — just for those six plans." When is it "gaming the system" and when is the line crossed to fraud? The inconsistencies in HIC, GAO, and CMS efforts span the range of health care delivery. There is a pattern to the result. Some payment formulas benefit those with ...

This headline is amazing in numerous dimensions - Bipartisan, 33 Senators together, showing concern for rural health! But why have these 33 Senators not done more. More importantly, why have 70 Senators from 35 states not stood up for health care in their states - states left behind by the US health care design. The health care design developed over recent decades clearly favors 6 states.  What have Senators in 30 - 35 states been doing all of this time? The Senate may well hold the key to addressing needed health care reform. The reform that is needed is not about insurance reform or penalizing more providers for meaningless reasons. The reform that is needed is to redirect spending from few states, providers, and locations to many states, providers, and locations - all who are in greater need of care.  Like it or not, the design of the Senate favors numbers of states, even when the states have low levels of population. Senators could do more for thei...