Basic Health Access

Pessimists include politicians, micromanagers, insurance payers - those that devalue those who deliver the health care or any that try to hold them accountable. Optimists sit at home optimizing care on spreadsheets and have difficulty separating assumption from reality but that does not stop their abusive policies and regulations. Realists are those out there delivering care, constantly adjusting in one on one interactions with patients as always, but they must now adjust to the resource deficits from the pessimists and to the innovative regulatory distractions of the optimists. For us realists, health care is our life. And we are tired of the abuses of the pessimists and the optimists. Let our people and our patients go.   Via Timeline Photos   Triple Threat is the enemy of health access.  Pessimistic revenue kept too low.  Optimistic tinkering accelerating costs of delivery.  Challenging patient complexity made worse b...

A popular video on social media lists 20 areas of improvement around the planet. It lists a 50% decrease in homeless veteran numbers. The rapid declines in Veteran homeless counts in metro areas are not necessarily a positive result. The media has a hard time understanding demographics and this makes it difficult when attempting to report on positive and negative areas. Another popular poster notes that homeless veterans need attention before refugees. The fact of the matter is that many Americans are treated like refugees - as those who do well plan ways to do even better. Their designs continue to leave most Americans behind. The relevant areas to consider for Veteran situations are not immigrants. The relevant areas are declines of veteran benefits, deteriorations involving lower income, disabled, fixed income, and less healthy populations of which Veterans are part. Most important is the consideration of available and affordable housing. Factors Regarding Veteran Homeles...

Family physicians are the most likely to encounter vulnerable populations. Addressing the needs of these populations requires more team members with better support. The team members are the ones most compromised in the past three decades of payments too low and cost of delivery too high made worse by rapid chaotic change. Family medicine leaders have set up a series of meetings. The track record of these large gatherings is not stellar.  The first of these meetings addressed access. The second of these meetings focused upon vulnerable populations. There is a third planned to address primary care workforce. The result will be more panels, reports, centers, and initiatives. But this will not address access, vulnerable populations, or primary care workforce. When a single area is important to all of the core missions of family medicine associations, this should be the dominant if not the only focus. Reports, Panels, Centers, and Grants are what CMS does when it cannot t...

Journalists and researchers find common ground in dramatic presentations that illustrate the extremes of those doing best or those doing worst. What works to gain publication or to reap advertising revenue does not help in understanding disparities - especially those shaped by the health care design.   Choosing the worst county is a poor choice because these counties are so few and so atypical. Rural counties are also atypical as the counties have lowest concentrations of people, but not necessarily other demographics. A measure more consistent in health representation can be helpful in understanding disparities in outcomes. Categorizations that compare counties by concentrations of physicians illustrate important concepts regarding health workforce, outcomes, insurance, and demographics.    Few Ahead and Many Behind   There are only about 5 - 10 counties in most states - that have higher to highest concentrations of  physicians and health spen...

Cries of victory may ring out today after the apparent defeat of the misguided Republican Replacement Plan, but the sand people will be back and in greater deception. The designs over past decades will continue to be shaped by those with their own agendas - agendas that are a poor fit with the needs of most Americans or true improvements in health outcomes. The first realization that must be made is that the designers will be back with plans that work for them, but not for most Americans. The second realization is that good intentions taken to excess have consequences as seen in austerity focus and in runaway health care costs. Austerity Focus Runaway Health Costs Cuts or prevents or diverts investments in areas that shape local determinants of outcomes Increase so rapidly that federal and state dollars are diverted to health care and away from the determinants of outcomes The Determinants of Health, Education, Economic and Other Outc...

Our nation should not waste time and energy on the past. Numerous protests to attempt to preserve ACA may or may not have impact. What is most important is shaping a better future - really shaping a better future. A better future begins with better children - children healthier and more developed mentally and physically and emotionally. Better health outcomes and better outcomes in education, economics, and other areas are about better children. Children are also the key to returning sanity and accountability to the new leadership. Children's health insurance known as CHIP has enjoyed bipartisan political support for many years. The current movement away from this support is the mistake that should cost current leaders their leadership or force them to be accountable. The politicians that support slashing CHIP have declared against children, have declared against key needs in Red Counties, have declared against people working their way out of poverty, and have declared ag...

Many articles have focused upon different perspectives regarding the reasons for the election results. The red counties have been identified as having lower education levels. There are many more differences in demographics and other characteristics. Perhaps the most common ground is that these are counties that have been left behind by a number of designs or that feel that they have been left behind or likely both. The 2700+ red counties are the same or similar to the 2621 lowest physician concentration counties that I have studied. While it is true that education statistical differences exist such as only 27% of bachelors degrees found in these counties with 40% of the population, there are a number of other demographic, policy, political, and other differences. These are important to understand regarding why voters saw red and voted red. The bigger question is whether the red party will address the needs  of those who turned the tide. Newer articles (Economist) have...