Moving Health Care Beyond a Divided Congress

Universal coverage is half the battle. The sad fact is that so far the insurance expansions have expanded plans inadequate to supply sufficient workforce where most Americans most lack care. Expansions fail just as much with lower payments where workforce is most needed and payments not able to cover the cost 130 million people in 2621 counties have half enough generalists and general specialists and the managed care to micromanagement to value based bandwagon has made this worse. They never had great deficits of health insurance as this 40.2% had 40.6% of the uninsured in 2010. What they have is the worst public and private health insurance plans - the ones that fix deficits in workforce and access barriers in place. This is seen in primary care in 2621 counties lowest in health care workforce with 45% of complexity in this 40% of the population with only 25% of the primary care workforce supported by less than 20% of primary care spending. The fight for health equity as shaped by the health care financial design - has yet to be seen on the radar scope. And these populations are growing fastest while their health care is being declined by design.