Basic Health Access

There are many ways to avoid improving US health outcomes and the United States seems to be best at avoiding. The Past Contributions To Poor Outcomes If you understand what was good about the US economy and reductions of disparities 1940s - 1960s, then you can understand what has been bad for health outcomes. Increased spending in a few areas results in decreased spending more specific to the determinants of health outcomes. The areas contributing to declines in outcomes include the contributions of runaway health care costs,  runaway defense spending,  runaway prison spending,  spending on the debt at high interest rates,  maldistributions of health and education by their spending designs that worsen disparities,  the consequences of Republican slash and burn (now by both parties Reps and Dems),  the consequences of costly Democratic regulation (now by Reps and Dems in health care),  autonomous divisions and agencies that can perform ...

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 - w...

The debates over health care have continued to draw the attention of the entire nation. It is a time of difficulty understanding the truth or the consequences. Even those who promote reform may not understand the truth or the consequences impacting most Americans that most lack access. This is how the "experts" can point to 153 studies that indicate improvements when most Americans are falling further behind by design. Most apparent should be that access is not improved by insurance expansion where access to local workforce is the dominant reason for access barriers. Who would think that expansions of plans with neutral or negative margins would help increase primary care, mental health, and basic services - services that are 90% of local services where most Americans most lack care. Slash and burn involving insurance or Medicaid is not likely to help, but neither are costly regulations. Designs resulting in the worst of both are designs that impact basic care fo...

Health care in the United States is notable for being the worst when comparing health care among wealthy nations. A Commonwealth article was published in NEJM highlighting four areas that need to improve. Interestingly an improvement in primary care finances would address all four areas, but this discussion was avoided. Fitz Mullan had another article promoting the social mission just published in JAMA. Once again addressing bankrupt primary care finances would contribute to the social mission. Lofty ideals are easy to discuss, but the hard work is missing when it comes to addressing access barriers, disparities, and most Americans falling farther behind. You cannot get from last to first by failing to address areas that must be reformed - areas that actually shape insufficient access, insufficient primary care, insufficient team member support, and disparities.  Goals, Aims, and Missions must be replaced with specific actions. True Reform Is the Beginning The foundati...

In family medicine we most need change agents and least need those who remain stagnant and unable to change the course of health access, of primary care, and of health outcomes for most Americans. We fail in training and in family medicine workforce because we fail in selection and preparation in ways that training cannot address. The STFM blog highlighted the quality improvement potential of family medicine residents. There is so much more potential for those that begin efforts much earlier and work throughout their lives as change agents. The Social Beginning Is the Beginning of Change Agents Potential medical students and others preparing for health and education careers should spend age 14 to 30 years working in their communities improving health, education, and local resources in their communities. These important interactive life experiences should be the most important determinants for selection as nurses, public health officers, or family physicians. Selectio...

Recent meetings of family physicians brought up the age old question of expanded scope. Some raised concerns about threats to this scope. As is the usual, what is most important is the context. Where half of Americans are found, there is not a reason to be concerned about scope.    Only in highest concentration settings are family physicians limited - since all specialties other than family medicine concentrate in higher concentration settings.   The competition is less and less of a problem regarding broad scope for family physicians in lowest physician concentration counties. Few of the other specialties remain and many are in decline.    This places more burdens upon the remaining family practice workforce. This comes at a bad time as the practices require more time for documentation and there is less time for expanded scope such as hospital and procedural activities.   As discussed previously in recent blogs, the payment designs ...