Basic Health Access

An article by Andrew Weil indicates how "The Biomedical Model is Failing Us." Despite lofty claims, the drugs promoted have not done much for mental health. Not surprisingly the biomedical model may have failed most when applied to mental health where so much is about behaviors, relationships, and other people factors. Weil points out, "In 1977, the journal Science published a provocative article titled “The Need for a New Medical Model: A Challenge for Biomedicine.” I consider it a landmark in medical philosophy and the intellectual foundation of today’s integrative medicine. The author, George L. Engel, M.D., was a professor of psychiatry at the University of Rochester (New York) School of Medicine. Determined to overcome the limiting influence of Cartesian dualism, which assigns mind and body to separate realms, Engel envisioned medical students of the future learning that health and illness result from an interaction of biological, psychological, soci...

Articles illustrating the problems of minorities in areas such as mental health care access are quite popular. The authors and editors often chose such comparisons to gain attention, readers, and advertising as seen in black vs white, male vs female, physician vs nurse practitioner, and comparisons of good vs bad quality. Such studies illustrate disparities, but a major question must be asked? Is a focus on race or ethnicity the best way to actually help America address mental health disparities? From the Kaiser Health News Article - "Young people in general aren’t likely to see mental health specialists. But the numbers fell further when racial and ethnic backgrounds were factored in. About 5.7 percent of white children and young adults were likely to see a mental health specialist in a given year, compared with about 2.3 percent for black or Hispanic young people." Analysis Issues But is this difference or disparity about one specific area such as race/ethnicity?...

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...

Critical attention is needed to address claims of "value" for any number of recent health innovations. Enough is enough. It is about time to turn from distraction to needed action. Rapid Change Is Costly and Distracting In this health policy period of incredibly rapid change, it should be apparent that change comes with high cost and often accomplishes nothing at all. Half of ACOs have fallen by the wayside. Meaningful Use is being left behind. Medicaid expansion was held hostage and even with expansion it still fails for primary care and mental health due to payments too low. Medical homes have finally gained the close examination required of such a costly endeavor at $105,000 per primary care physician more in cost of delivery per year. Physicians now spend hundreds more hours a years on EHRs leaving less time for patient care and for generating revenue to support care delivery. A narrow focus upon "quality" can be very costly - especially when...