Basic Health Access

There are more indications of the punishment of health care costs upon our nation. A recent article in Forbes indicates that GoFundMe accounts are increasingly used to help with overwhelming costs.  There are numerous indicators of worsening facing most Americans - the ones that health care designers fail to understand most. Generally the article is a good review of the increasing costs as out of pocket expenses go up, employers and health insurers move to lesser coverage, and high deductible plans hit hard. Those who have lower income are often forced to go to lower cost high deductible plans - but of course the $10,000 that they have to pay is overwhelming. The answer to this issue is we need to fix the healthcare system. There is enough spending at over 3 trillion. How the dollars are spent actually makes the situation worse.  There are many solutions that can lower healthcare costs. The author lists some We spend 10% to 20% more in overhead than ot...

There are certain people who pay attention to salaries and benefits as shaping physician specialty choice. There is a correlation, but correlation is not causation. I look at these are great distractions. What's behind the salaries and benefits is more important. And what drives this from upstream is even more important. The real force, the major influence, is the financial design - revenue, cost of delivery, complexity. Behind this is powerful vs powerless. There are more than salary and benefit factors at work in career choice. And beyond the areas obvious to medical students and residents, are the upstream forces. This should be quite obvious in health care where the largest and most organized have the greatest influence regarding the payment design. They design themselves the most lines of revenue, including lines of revenue such as graduate medical education, research, patents, corporate ventures,  and foundation support that others do not rece...

I loved my career in rural medical education. Only rural practice was better. As a rural medical educator I felt very comfortable with the fact that there were many ways to improve the preparation for rural practice. Over time I grew uncomfortable as I recognized more and more that training was not going to overcome workforce deficits. The sad fact is that special training works for those associated with special training. Special training does not reduce the problem of inadequate access to care. The proof is in the concentrations of primary care where needed. These concentrations of primary care have remained the same - about half enough. Yes it is true that a special training program or school can have higher proportions serving in locations of need - but their success only results in displacement of others - FM for what was IM, and NP/PA for previous IM or FM. The specially trained replace the traditionally trained. This is a rearrangement of the deck chairs rather than an increas...