Basic Health Access

JAMA has granted access to government officials for another publication. This time the author was President Obama. One portion of his publication stuck out. "We engaged with Congress to identify the combination of proven health reform ideas that could pass and have continued to adapt them since." Ideas should easily be recognized as not proven.  During an era where legislators are not willing to invest more dollars, there is a good probability of loser and a smaller probability of winner.   With government focused on cost cutting as a top priority since 1983, remaining dollars for meaningful use are more limited. With a for-profit health care design, winners are magnified and losers are further left behind. With strong lobbying by the largest and most organized corporations and associations, the probability of being a loser increases.   As we marginalize the local and the individual, those more organized and largest gain even more.  Ideas shoul...

Another innovation in the early stages is the geriatric emergency room or section of an ER. This will remain a great marketing tool, particularly where hospitals compete for the high end seniors and their dollars, but... Geriatric ERs will be Where Seniors Are Not The recent post about the mismatch between geriatricians and the locations of seniors should give a clue of what is to come. Emergency rooms are just as out of position for the elderly as we see for geriatricians. A geriatric ER would need the same supplementation to survive as is required for geriatric care - and because the care involves Medicare or Medicare plus Medicaid payments too low. The elderly with lower or fixed incomes tend to avoid high cost of living/high cost of housing areas where emergency rooms are found or were found. The real story regarding emergency rooms and elderly is that many EMs are closing because of concentrations of elderly, poor, Medicaid, Medicare, and other low paying plan patients. ...

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...

The folly of "quality studies" is the quality. One would think that there would be quality in studies published in the most prestigious journals or reported by the Institutes of Medicine. But you should be skeptical of any claim regarding quality. This is a basic requirement to understand what quality is and what it is not in application to health care.  The media constantly turns to the latest quality health care studies to attract attention and readership. Some are good reviews. Others do bashing of doctors, or certain types of providers. Some articles promote their favorites such as nurse practitioners or various innovations.  What stimulated my attention this time is July is a Dangerous Hospital Month on Vox . After the BMJ article about medical errors, it is likely that we will continue to see more in this area. Doctor bashing has become quite popular, especially when journalists experience health care in certain ways. What journalists and even quality experts t...