Basic Health Access

For forty years Americans have been convinced that cancer can be fixed. It fits with our quite impossible dream of living forever. We have constantly been told that all that we need is more of each of the following highly specialized and costly research,  highly specialized and costly tests,  highly specialized and costly scans,  highly specialized and costly physicians/staff/systems... Can this be done without collapsing health care or the national economy? Is this a good expenditure of dollars? Can our bodies endure the treatments? In more recent times we have a call for a cancer moonshot. Is this a fit with what can be done, what science dictates, and at reasonable value? What is highest probability - is that we will not be able to afford it. President Kennedy understood this with his original moonshot claim and indicated that we could not do this, unless we focused on keeping costs reasonable. Science, innovation, and discovery costs in health care have...

About every 6 months another article will come out crying out for the need for more geriatricians to address the "the Silver Tsunami" or deluge of more elderly and oldest of the elderly. The following borrowed from The Music Man can be used as a guide to write your own media piece, or perhaps you can use it to see why media efforts often paralyze the needed response in ways that can prevent the restoration of basic access to care. Trouble in River City Due to Too Few Geriatricians and Lack of Geriatric Training A good opening for such an article ( Few Young Doctors NPR ) is to get quotes from small town people about their needs. Soon there is a Statement of Need indicating that there are only a few geriatricians in the state - a state with great and growing needs for geriatricians, nurses and therapists. There is often an implication that the need is for those who know how to care for this population, but there are many holes in the arguments: Geriatricians are t...

In the wake of another gun tragedy there have been many calls for change. Trauma experts have asked for better trauma response preparedness. The advocates for change are taking advantage of this narrow window of opportunity,  but their calls for changes will not do much.  How can I be so sure? First of all, c alls for greater preparedness for disasters or traumas have been made for decades. The calls have been made by those logical in their thinking as well as those passionate after disasters. But most importantly, there is no design to support change. The funding designs, training designs, and locations of health care would need to be changed in the opposite ways of the last 30 years. It only takes common sense to understand that responses have become more limited with ER closures, mergers, and movements. The personnel to respond to disaster are fewer and are less linked to ERs than ever. The on call systems that backed up emergency rooms and disaster responses h...

Thomas Paine MD has illustrated how to destroy clinical care in an emergency room setting. I used his subtopics to illustrate how CMS and others are doing much the same to clinical care in the area of primary care in the United States. 1. Ignore and undervalue clinical experience.       While attention is being paid to value-based, MIPS, and MACRA payments - there is not much change to lowly paid cognitive, office, and basic services. This may also be why experience is least rewarded in primary care as the youngest to oldest salary gap is smallest. In contrast, newer orthopedist are paid most similar to oldest. The payment design rewards the most subspecialized - where the most income can be generated. CMS physician payment design rewards longer training and more technology but ignores factors such as experience, continuity, and retention in a needed career - factors important in primary care and mental health delivery. Where the patients are...