Why Not Better Health Access for Most Veterans?

Most Veterans are located in counties distant from Veterans facilities. Veterans facilities are concentrated in major metro areas where highest concentrations of physicians are found. As a visual representation these are mostly Blue Counties. Most Veterans find it too expensive to live in places with highest concentrations of physicians as the housing is highest cost to buy or rent. Veterans clinic locations have extended to other sites, but the widespread distribution of veterans makes this a ridiculous and costly choice. The design for Veterans health care is a poor fit for health access for most Veterans.

Triple Threat Hurts Access to Veterans More

Veterans are most likely to arise from families, counties, and communities that are average to lower in concentrations. They are most often from lowest concentration counties and they tend to return, and they are joined by Veterans not from these counties. This has to do with housing.

Affordable housing is lacking in highest concentration counties and it is getting worse. Veterans tend to have a shift to lower income as shaped by origins, ages, disability, medical conditions, mental health issues, and limitations in benefits.

The most medically and financially vulnerable in the nation are shaped away from counties highest in concentrations of dollars, health care workforce, economics, and support services to counties lowest in concentrations. Veterans are not the only ones being concentrated and left behind in lowest concentration counties.

Veterans are 50% found in lowest physician concentration counties. These 2621 counties have 40% of the US population and half enough primary care.

Veteran health plans that allowed uses of local services for basic health access

  1. would be better for Veterans, 
  2. would be better for these local practices, and 
  3. would be better for efficient care.

The Myth of Veteran Specialized Physicians for Veterans

Veterans often do not need physicians that are specially skilled in veteran illnesses. Like all Americans, they need more basic care most of the time. 55% of services in the US are basic primary care services. It is hard to get basic services if there are too few supported in primary care with half enough in places where 50% of Veterans are found.

Boosting Primary Care Where Primary Care is Half Enough By Design

Reasonable payments for Veteran primary care services would also help these primary care practices struggling most to survive. Expansions of plans that force patients to avoid primary care (high deductible) and expansions of private and public plans paying the least are killing local primary care for most Americans. 

Counties lowest in physician concentrations have lowest concentrations of all health care workforce. Nurse practitioners and physician assistants are no more of a solution as they are also paid least and have highest cost of delivery increases in these counties. The NP and PA contributions to veterans care has worked well for NP and PA and veterans who can easily access facilities. It has worked in inefficient VA facilities where it is hard to see more than 2 patients per hour. More efficient and much better distributed care is not possible via the VA - but the nation's small and primary care practices

Triple Threat is killing off health access where needed
- revenue, cost of delivery, and complexity have been worsened by design.

Veteran care is perhaps one of the best examples 
of long term meaningless complexity, 
of highest costs of delivery, and of insufficient revenue

Insufficient revenue is by design and as eaten up by non-delivery costs.

Triple Threat is the consistent enemy of health access, primary care, and care for most Americans.

Cost cutting due to runaway health care costs have not helped

Cuts to Veterans benefits hurt these lowest concentration counties by reducing local dollars, social determinants, and health outcomes. Cuts to SNAP, Social Security, and Disability also hurt these counties most as 42 - 44% of these dollars go to these populations with 40%. If all applied that were eligible for SNAP and Disability and other programs, these counties would do better.

Housing Determinants of Health Access

Counties that have lowest concentrations of workforce, local support resources, and access to care are counties that have affordable housing. This is important in understanding why people stay in these counties and are joined by millions moving away from higher concentration counties. Those most likely to depart include the medically and financially vulnerable and this includes veterans. SNAP, Social Security, and Disability dollars are concentrated in these counties with higher levels of elderly, poor, and those with complex illnesses.

Politicians can make matters much worse for lowest concentration counties (essentially the Red Counties) by cuts in these areas. Also cutbacks in Medicare and in Medicaid will impact these counties to a greater degree. Those largest and most organized will deflect the bulk of the cost cutting and this will result in widening disparities as over the last 34 years of policy changes.

Improving Access for Veterans and for Most Americans

Universal Insurance Will Not Fix Health Access. Veterans are a good example with regard to the designs that prevent access. Health insurance expansions cannot fix access. Improvements in access require a move from 40 billion for primary care in these 2621 counties to a minimum of 70 billion but innovation, digitalization, and regulation have reduced this annual amount by 6 billion - the wrong way from greater primary care capacity.

Half of veterans in these counties need primary care to be built up for better access for them and their neighbors, friends, and family.

Veterans need plans that have available workforce - not distant promises and expensive solutions involving highest administrative costs or new clinic start ups - brick and mortar start ups that represent the most cost for the least access. In contrast the rural and lowest concentration county practices have been the most efficient - paid 15% less.

Supporting local practices where 50% of Americans will most lack local workforce is 2040 is necessary. Housing collapses and disasters could accelerate this movement. But the nation is going backwards for veterans and for most Americans - by design. Even with millions more a year added to lowest concentration counties, the dollars for care are the same or declining - by design.

Of course this does not stop workforce leaders from claiming to be the solution for workforce woes. Any logical consideration results in the conclusion that the Triple Threat financial design is the problem.


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