Basic Health Access

Those shaping health care have long deserted the top priority focus upon health care delivery. Their efforts from above make it much harder for those delivering care down below. Those delivering care are forced to bail out health care delivery - working harder and harder to keep US health care delivery afloat despite greater challenges from above and from outside of the boat. They are too busy and are too poorly organized to address those largest, most organized, and most distant from health care delivery who continue to shape designs that fit those at the top best while leaving the rest behind.   The designers have created more lines of revenue for health care in highest concentrations (training, schools, foundations, research related corporations, management groups). The designers send the highest payments in each line of revenue to highest concentration settings. The designers are selected by a process that involves highest concentration and most exclusive origins, schools...

The recent Beyond Flexner postings and social mission articles have revived interest in Academic Medicine's Season of Accountability and Social Responsibility  by William T. Butler, M.D. Dr. Butler gave this address to AAMC in 1990 and expected a response - one that never came. The following are predominantly Dr. Butler's words with an update regarding the lack of progress regarding his calls to action. Public Concerns About the Overall Health Care System Dr. Butler declared that academic medicine had entered a new and stormy "season" of accountability and social responsibility, due to public concerns about the overall health care system. His recommendations are followed by comments regarding academic medicine addressing these concerns or not. Public concerns have continued. There has been no progress in this area. The political arena has been a distraction, but the concerns continue. The same types of headlines listed not only are seen in the media headl...

Periodically there are calls for Academic Medicine to be accountable for health care in areas such as health care workforce. This accountability includes the larger dimension of people with substantial limitations in their health care such as rural populations or underserved urban populations. The access situations are worsening across primary care, mental health, and general specialties - those who provide 90% of care for half of the population most in need of care. The lack of any significant improvement for decades indicates barriers not easily addressed. In fact it may well be that the top priorities for academic and largest systems are such that true reforms are prevented -  reforms that would address the primary care, mental health, and basic services payments that are essential for distributions of services and broadening of health access. A social mission or accountability would require academic and other health care leaders to stand up for higher payments for basic se...