Basic Health Access

Another micromanagement has demonstrated costs of micromanagement as much as what might be saved. This is of course what CBO indicated a decade ago about such interventions. This time the CMS Comprehensive Primary Care Initiative failed to demonstrate much - in the practices that survive in the US.  "The initiative slowed growth in emergency department visits by 2 percent in CPC practices, relative to comparison practices. However, it did not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures." Higher costs without changes in outcomes - this is not value-based. Once again it appears that the personnel used up in micromanagements of costs and of quality could have better been used to address care delivery. Oregon PCMH Saved 240 million but spent over 250 million Words like comprehensive and continuity...

Innovation is good. Innovation worship is not good. Innovation application without scientific testing or clinical trials is unethical regarding clinical interventions and should be just as prohibited with regard to health policy. Clinical trials can harm hundreds or thousands. Innovative policies can harm millions. It takes a reasonable understanding of health care, health care outcomes, social determinants, and the investments that most improve social determinants to understand the consequences arising from the innovative nightmares past, present, and future. If you review the information sources with a critical eye, you too may find that the innovative policy designs have been disruptive to care, have hurt health care where health care is most needed, have reduced access to care, and have resulted in distortions in the literature. Indeed what is accepted and published in journals seriously lacks consideration of alternative hypothesis, lacks inclusion of many pages of limitatio...

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...

Once again Americans are rallied to fight against the result (high prices) rather than what caused the high prices. More money is thrown at the diagnosis leaving less remaining for prevention of high health care costs and prices. The process is great for those who write the articles, capture the attention, and enrich themselves. It is also the easy choice. Exposing high health care prices as evil takes no effort at all. The real harm is done by those who promote what seems to be popular as they distract Americans from the real causes of high health care costs. The Biomedical and Micromanagement Waves that have long shaped runaway health care costs are the result of the same influences that shape higher prices and less for more Americans - by design. Higher costs are the result of advantages of designs that favor those bigger, those most organized, those who prepare to profit from the newest designs or implement them to their advantage, and those in the right locations serv...

Discussions of state or federal budgets draw much attention, but it is the American people who make America work, fill in the gaps, and accomplish far more than the dollars expended.  Ideally the designs for dollars, people, and services all align for best result. A divided nation will accomplish far less, and this will often result in a widening gap impacting most people.  M Scott Peck wrote a book on "community" and noted that you knew community existed when it happened. Happening worth having is togetherness. We are not together. Our inefficiency rocks the core of our nation, what we hope to accomplish, and how we can accomplish it. Infrastructure is a popular word. Embedded in infrastructure is the ability to facilitate more efficient and effective function. There are multiple types of infrastructure in a nation. America is made up of physical infrastructure, spiritual infrastructure, and human infrastructure. Rarely have these all aligned except for major wars and...