Basic Health Access

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...

Each new day brings more promotions of health care influence by ACA or CMS or various institutions or foundations supportive of innovation focus. Despite numerous claims of patient centered focus, there is more movement away from the support of the people to address people and patient factors.   A phone survey (goodness) is promoted in the New York Times with claims that Obamacare Appears to Be Making People Healthier . Even the worst of study designs about changes with the least potential to change health manages to find publication and promotion. Meanwhile most Americans await meaningful change because of health care design. DRG to ACA for Better or for Worse? A better case can be made for past decades of DRG to ACA designs making people less healthy. When designs slash the team members to address people factors and slash the cash needed to address social determinants to really influence health, lesser health is far more likely for more Amer...

Imagine 100% of Americans covered by insurance across private insurance and Medicare and an expanded Medicaid across all US locations. Would this be a great boost to health care in the US or not? Many would jump for joy at 100% insurance coverage. But the reality for health policy always remains the same. There are always winners and losers. Rather than a blatant promotion of expansion, more important is to understand who would win and who would lose? The current situation in Medicaid makes the answer quite obvious. Those providing the lowest paid services at the current time would remain the lowest paid - primary care, geriatric primary care, mental health care, basic services, cognitive services, office services. Despite 100% insurance coverage, the payments for these services would be insufficient to hire the team members and support the care needed, because payments are below the cost of delivery. Expansion Requires Expansion and Subtraction Is Contraction A decent busin...

A few hundred million more dollars for primary care is small change compared to 8 billion dollar annual increases in the cost of delivery. The various ACA and CMS proponents have been feasting on JAMA articles by CMS and President Obama. Primary care advocates hoping for any good news also pass around these pieces despite what the real message is about. It is important to read the fine print. Rather than the promotion of the new math, we need more who can calculate the damage being done to access and to primary care delivery capacity year after year for decades. Primary care is about people taking care of people. The main cost of delivery of primary care should always be the cost of the employees that deliver the care. The design of primary care should add more support for the team members that deliver primary care. The innovative designs have found ways to subtract from care delivery. Primary care delivery capacity is about the magnitude of support specific to primary care team ...

In 1983 after a very short period of testing on a very atypical state (New Jersey) and because there were no other existing options for cost cutting, the hospital payment method known as DRG or Diagnosis Related Groups was implemented. Bundling under a disease or condition or treatment remains a very popular method of cutting costs and is now being implemented with physician payments. What are the benefits and what are the consequences? Should we implement methods that have long term consequences when we fail to consider or study these issues? If there is any consolation for President Obama and CMS,  ...it may well be that Readmission Penalties took away some of the "poor quality" result of the Bundling Bungling that preceded it (DRGs). This may be the only evidence for Accountable Care working. Of course Readmissions focus has consequences also. Is the Change in Readmission Rates an Indication of Poor Quality from DRGs? This is an interesting question. As noted pre...