More for Few and Less for Most

When you pay so much more for health care costs as seen in Massachusetts - you deplete child development, early education, mental health public health, higher education, environmental changes, housing, nutrition, and public security. The US is among the worst toward the right.



A few people benefit from the health care design. A few locations benefit from health care spending - particularly in just a few zip codes in the state of Massachusetts.

State budgets are also depleted by prison spending. Federal budgets are depleted by military cost increases and prison costs - also about twice the level of spending as compared to other nations, just like runaway health care costs.

In many ways too much for too little result in health, in prison, and in military spending results in greater divisions, worsening disparities, and declining outcomes.




These increasing costs deplete the human infrastructure investments needed and the physical infrastructure investments needed - worsening the spiritual infrastructure. How we perceive our nation, its people, and its government has much to do with investments for few with most left behind.

The US overspends relative to other nations where it matters least, and underspends in critical areas such as investments in children.

Diabetes, obesity, and other factors considered important in worsening the human condition are themselves shaped upstream - by factors related to income and other social determinants. It is not likely that chronic diseases can be reduced or prevented - unless the human condition changes.
As a side note, only spending upon family practice is distributed equitably. The MD DO NP and PA positions in family practice have population based distribution. In the case of family medicine, this is about 26 to 32 family physicians per 100,000. Other specialties are 3 to 6 times more likely to concentrate where higher concentrations of physicians, specialists, and health care dollars are found. Only family practice distributes, but more training in family practice cannot reduce deficits. This is because family practice depends upon the financial design. Family practices have the worst finances shaped by being small, basic, cognitive, and where needed. They experience patients with the worst public and private plans - just like their patients.

Family practice has done well during only one period of recent US history - 1965 to 1978. Only this period of time did Medicare and Medicaid increase the dollars invested most specifically in primary care where most Americans most need primary care - via increased spending on the elderly and poor. Family medicine had a one time major expansion from a few hundred to 3000 by 1980 - and then stagnation along with most of the nation, primary care, and care where needed.

Numerous designs favor the few while the many fall behind as seen since the 1980s.


When health, education, and economic designs favor the few, most will fall behind steadily.

Bob Bowman
Basic Health Access Blogspot

Comments

Post a Comment

Popular posts from this blog

Another Fine CMS You Have Gotten Us Into

Perhaps we are indeed back to the time of Another Fine Mess (Laurel and Hardy). In a mad rush to implement innovation and to save all possible costs, CMS is creating complications for people that it is most responsible to protect. As PBS and Ken Burns celebrate the legacy of The Roosevelts, it is tragic to see what has become of over a century of effort involving Social Security, Medicare, Medicaid, and health care equity. The United States has one of the most complex health designs and clearly the various designers often know not what they are doing to others. More cartoons and comedians would find this a ripe area for material if not for the suffering involved. Health and Human Services has a huge role across Social Security and US health care. CMS or the Centers for Medicare and Medicaid Services has a dominant role to play in the design of health care in the United States.  CMS can be progressive or regressive. Interestingly CMS has chosen to appear to be progressi...
Read more

The Essential True Reform Restores Primary Care and Much More

The list of distractions from True Reform are impressive. For decades True Reform has been specifically avoided as primary care worsens within practices and from outside. The demise is most specifically about the financial design. Unless there is a focus on True Reform, there is little hope for Basic Health Access. This may not make as much sense to those outside of family medicine. Family physicians not familiar with AAFP may also be clueless. If you think that you can fix primary care with more technology, more rearrangements, more types of health professional graduates, or more expansions of training - think again. None of these have any hope of working without financial design changes - major changes. The following are various concepts that dominate the discussions at AAFP and primary care meetings and media releases of associations and foundations and institutions. Members, staff, media releases, programs, and personnel have been reviewed.  There is little about...
Read more

Stop Killing Primary Care

Image
Primary care services have decreased in number steadily, year after year. Payments for primary care services overall have been stagnant as with other basic services taken for granted. Population, demand for care, and complexity are all increasing in ways that should have resulted in much more primary care for anyone who cares about primary care - but there is steadily less primary care. The financial design is broken by stagnant revenue and accelerating costs of delivery. The digital revolution has actually caused regression of primary care via worsening burnout, productivity, and meaningless complexity. The costs of delivering primary care have been increased across multiple dimensions by those who think that they are improving care when actually they are killing small health, primary care, generalists, general specialties, and basic access to care. This little death steadily, slowly over time is also specific to primary care physicians who appropriately describe it as trauma si...
Read more