Sinking Health Care Design After Design

Those shaping health care have long deserted the top priority focus upon health care delivery. Their efforts from above make it much harder for those delivering care down below. Those delivering care are forced to bail out health care delivery - working harder and harder to keep US health care delivery afloat despite greater challenges from above and from outside of the boat. They are too busy and are too poorly organized to address those largest, most organized, and most distant from health care delivery who continue to shape designs that fit those at the top best while leaving the rest behind.
 
The designers have created more lines of revenue for health care in highest concentrations (training, schools, foundations, research related corporations, management groups). The designers send the highest payments in each line of revenue to highest concentration settings. The designers are selected by a process that involves highest concentration and most exclusive origins, schools, programs, corporations, institutions, foundations, and government associations. 

Divisions between highest and lowest concentrations continue to shape designers least aware of the consequences of their designs.
 
 
Note that the water level is higher inside the boat. The floods from above that are sinking the ship are about 
  • Increasing burdens trickle down from those riding high with highest cost services - services paid best consume more workforce and steal workforce from most Americans left behind and from basic services
  • Unaddressed 2 to 4 times overutilization of high cost services where physicians are more to most concentrated
  • Administration, management, CEO, VP, shareholder, and other non-delivery costs have registered astronomical increases since the 1990s
  • Micromanagement has mushroomed despite reports that demonstrate as much cost of micromanagement as can be saved (CBO Report)
  • Costly digitalization, innovation. regulation, certification, integration of regulation and digitalization (evidence based for no power to change outcomes, costly, worst for smaller providers)
  • Pay for performance, Readmission Penalty, Value Based costs (evidence based for no power to change outcomes, costly, discriminatory to smaller providers and those providing care for the most challenging populations abused by designs)
  • More corporations added and more new types of corporations added and their supporting media and political power added and more fake news added - allowing them to claim more of the health care pie that gets bigger in every way except with regard to the basics such as those delivering the care (software, hardware, technology, info tech, info security, consultants...)
  • More opportunities for waste, fraud, and abuse due to inflation of health care to the current bloated complexity, due to rapid change, and due to increased confusion
  • Fewer in health care are focused on delivery, more are focused upon the ways that they can most profit
More Millions of Americans Added to Compromise by Design Each Year
 
The designs result in compromise that proceeds in a steady direction, from lowest to ever higher concentrations of people impacted. The poorest, those least healthy, disabled, fixed in income, least organized, most distant, and those living in counties with lowest concentrations of health care dollars and health care workforce have been losing the most with movement over the decades steadily up the scale to higher concentrations of social determinants, situations, health care dollars, and health care workforce.

Housing collapse in higher concentration settings has been a great design for those in higher concentrations as more millions of the most costly, most medically vulnerable, and most financially vulnerable are forced to depart counties with higher to highest concentrations (physicians, dollars, people) to counties lowest. By 2040 half of the American people will reside in counties lowest in health workforce and social support as these are populations increasing fastest by birth, by inmigration, and by more counties falling to lowest concentrations via closures of small hospitals and small practices as well as declines in the generalists and general specialties that provide 90% of local services for these counties. Even more tens of millions left behind in pockets of higher concentration counties will indicate 60 - 65% left behind - by design.
 
Millions more Americans are added each year
to those submersed by the rising water levels with low or no access.
About 132 million in 2010 will rise to 200 million or half of Americans by 2040.
 
No Provisions for Basic Providers 
 
The health care designs leave them behind by compromising the providers responsible for 90% of local services where most Americans most need care. The designs have taken down generalists, general specialties, primary care, rural health, small health, small hospitals, mental health, women's health, and basic surgical services.

Triple Threat takes down health access with insufficient revenue, costs of delivery accelerated by designers, and increasing complexity of practice - often meaningless.

Those Who Think That They Shape Health Outcomes - Do Not
 
Americans leading health care under water are not even The health outcomes are not even being addressed in a positive way. Those at the top are so convinced of their ultimate importance that they have deserted their leadership role. 
 
Value Based Demands Reward the Least Valuable, Penalize the Most Valuable
 
Designers demand value in health care as they continue to send more dollars to those least valuable. Those most valuable practicing where half enough workforce exists in lowest concentration settings have toiled hard to keep same outcomes despite lesser pay for basic services. They have continued the battle to provide care despite 15% less paid for the same services where most Americans most need care. 
 
Same services delivered with the same outcomes accomplished at lower cost is clearly most valuable - but suffers from payment too small with cost of delivery too high as they face the greatest complexity in places with half enough workforce. The designers have also rewarded them with the highest costs resulting from digitalization and innovation as smaller has ended up paying more.

Most Valuable Leadership in America

Best America leaders focus on the needs of all Americans and work to avoid harm to most Americans. Red Counties are predominantly lowest physician concentration counties and now would seem to be a great opportunity to improve investments specific to these Red/lowest concentration counties. So far it appears that the worsening is being accelerated. It is likely that tens of billions of dollars more each year will not go to these counties or will be taken from them in costs of measurement, digitalization, certification, and regulation.
 
Best leadership would work to guide Americans away from the environments, situations, conditions, behaviors, and social determinants that matter most in health, education, and other areas. The ship called health care is adrift in the water. Steady declines in outcomes are most specific to the populations left behind. These are not specific in ways that allow individuals to be prevented from harm. You cannot prevent infant deaths or maternal deaths or premature deaths by clinical interventions in the last minutes or seconds of a life that has had years or decades of previous influences involving so many dimensions. l

At the Mercy of Conditions, Environments, Situations

The winds, currents, and tides are left unopposed to shape the outcomes. They are shaped worse and worse where the least investments are made in people from the earliest months and years of life. Children growing up in survival mode will consume education and health care but not benefit. Their lives are about the short term with little long term focus - for them or for their families.

Designing for Dollars Works for Designers
 
Those directing from above are so successfully focused on their needs that they have "stolen" dollars that could direct Americans to better health outcomes. Runaway health care costs consume more and more of federal, state, local, employer, and personal budgets leaving less and less for the true determinants of health - better investments in Americans from the earliest months and years of life, housing, education, police, fire, environments, situations, job development, and support for young families and seniors. 
 
Investing in Infants, Children, New Families, 
Human Infrastructure, and Physical Infrastructure

More support for the human infrastructure and the physical infrastructure can help steer more millions away from bad outcomes - but not if American leadership continues to focus on their own benefit across politics, health care, and more.

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