Basic Health Access

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...

Teaching Community Health Center sites are a new innovation in graduate medical education (GME). Teaching CHCs have been set up to address failures in traditional GME in important health access areas - primary care needs, rural training, and the needs of states with fewer physicians. In general the states with highest concentrations of physicians have the most GME, the most specialized GME, the most clinicians of all types, and the highest spending on medical education and health care. Teaching CHCs have been announced and it is possible to assess 65 sites with regard to future health access workforce impact.  Will Teaching CHC Sites Deliver on their Promise of Needed Health Access Result? Yes, but limited - The best answer is that the Teaching CHCs will have some small impact, but the full potential will not be realized. Changes should be specific to better site choices and greater focus upon graduates that will deliver health access where needed. Local access impro...

Major journals have slipped in another article that apparently was designed for controversy and for widespread distribution to media outlets. The title of this Health Affairs article is not original or easily misunderstood - "Higher Fees Paid to US Physicians Drive Higher Spending for Physician Services as Compared to Other Countries." Health Affairs published the bait. Media outlets such as the NY Times were hooked. Controversy will once again divert the nation from addressing real problems such as deficits in primary care. The American Medical Association has chimed in for a defense. Once again too much focus on physicians with the most highly specialized services will defeat basic health access. What is common to major journals, media outlets, and the past 30 years of political administrations is a poor understanding of primary care. Errors of perspective and analysis are far too common. It is not a surprise that one of the Health Affairs authors is a member of ...

Primary care workforce is substantially less than annual graduate numbers depict due to departures from primary care during primary care training, at graduation, and each year after graduation. The Health Resources and Services Administration projection of 2020 physician primary care was last posted in 2010. This document indicates increases in primary care that are impossible for internal medicine and family practice. To properly guide the nation, HRSA must not wait for new data or studies. It should remove the erroneous projections. This major document represents much good work tainted by the primary care projections. Family Medicine Internal Medicine Pediatrics Annual Graduates since 1980 3000 and steady for zero growth for 30 yrs About 1% annual growth to 7200 About 2% annual growth to 3200 % Primary Care Entry 85% - surveys, office based retention, COGME 91% 20 - 25% for senior resident surveys and COGME 44% for senior resident surveys and CO...