Basic Health Access

Election outcomes may well be about demographic changes such as population migrations. The visible wealthiest may be Republican, but the highly educated and professionals have significant Democrat populations. Changes in demographics may work against the Democrats. In the previous election, major demographic changes in areas such as race/ethnicity were thought to contribute to Democrat gains. Since these were expected to continue, there were fewer worries about the future elections. There are, of course, many ways to look at demographics. State migration patterns have been changing - perhaps not enough to impact elections with larger margins of victory, but enough to impact close elections such as in 2016. Migrations For Jobs or for Lower Cost of Living   Young college educated persons tend to move to areas with concentrations of populations - Blue Cities and States. Blue people in need of less grueling winters can leave cold Blue States for the So...

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?...

About every 6 months another article will come out crying out for the need for more geriatricians to address the "the Silver Tsunami" or deluge of more elderly and oldest of the elderly. The following borrowed from The Music Man can be used as a guide to write your own media piece, or perhaps you can use it to see why media efforts often paralyze the needed response in ways that can prevent the restoration of basic access to care. Trouble in River City Due to Too Few Geriatricians and Lack of Geriatric Training A good opening for such an article ( Few Young Doctors NPR ) is to get quotes from small town people about their needs. Soon there is a Statement of Need indicating that there are only a few geriatricians in the state - a state with great and growing needs for geriatricians, nurses and therapists. There is often an implication that the need is for those who know how to care for this population, but there are many holes in the arguments: Geriatricians are t...

Thomas Paine MD has illustrated how to destroy clinical care in an emergency room setting. I used his subtopics to illustrate how CMS and others are doing much the same to clinical care in the area of primary care in the United States. 1. Ignore and undervalue clinical experience.       While attention is being paid to value-based, MIPS, and MACRA payments - there is not much change to lowly paid cognitive, office, and basic services. This may also be why experience is least rewarded in primary care as the youngest to oldest salary gap is smallest. In contrast, newer orthopedist are paid most similar to oldest. The payment design rewards the most subspecialized - where the most income can be generated. CMS physician payment design rewards longer training and more technology but ignores factors such as experience, continuity, and retention in a needed career - factors important in primary care and mental health delivery. Where the patients are...