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America Is Where Majorities Face Discrimination By Design?Majority rule is valued in America as are protections for minorities. But America is a land where majorities are treated poorly and small numbers benefit most. Health care is a great example of reversals of American values and value based care may be one of the worst examples.

https://www.dhirubhai.net/pulse/america-where-majorities-face-discrimination-design-robert-bowman/


It is a welcome sign that some health care leaders propose Primary Care for All. But having a card to access primary care is meaningless unless there is a change in values. A change in values must proceed before a major change. Otherwise another major reform attempt will still result in payments too low and costs to high with additional failure of primary care and care where most Americans most need care.

https://www.dhirubhai.net/pulse/primary-care-all-nice-d-robert-bowman/


The AHRQ social media posts often involve articles that are not high quality scientific work. Dear AHRQ, Please look at these article more critically. I can understand the desire to promote more mental health treatment or more primary care or greater "value," but this should not justify the publication and promotion of articles that should be rejected or rewritten.

https://www.dhirubhai.net/pulse/ahrq-other-research-experts-need-demand-more-robert-bowman/


Basic Health Access Can Only Be Recovered By Local Efforts - SERPA/RCCN Lead the Way The obvious question after reading this will be – why are we not doing this? Why are misguided efforts thrust upon us by national, state, or corporation experts? Why not focus local and from the inside out?

https://www.dhirubhai.net/pulse/basic-health-access-can-only-recovered-local-efforts-robert-bowman/?



For Walmart and VillageMD to make a difference in the truly underserved parts of the nation where 40 - 50% of the US population is most impacted they would need to be willing to do much more work while receiving lesser revenue and serving patients with higher complexity that have half enough local social support resources and the worst public and private health insurance plans.

https://www.dhirubhai.net/pulse/walmart-village-md-focus-primary-care-truly-likely-robert-bowman/


Red County/Lowest Health Care Workforce Counties are not valued. Sadly many are deceived. Many of the programs that help Red Counties are being attacked and many in Red Counties attack these programs. This is how sad the situation has become. ACA has clearly been one of the worst health policies making situations in lowest health care concentration counties worse. There are 2621 Counties in the US with 40% of the population and about 22 – 26% of generalists and general specialists – and not much else. These counties are essentially the Red Counties in the last election plus rural counties predominantly Black, Hispanic/Border, and Native American. They are all left behind by design. Red County Lives Matter also – even if they fight against what helps them.

https://www.dhirubhai.net/pulse/red-county-lowest-health-care-workforce-counties-matter-robert-bowman/

This began as a discussion of the difficulty of being an expert. An expert understands much about a particular area but they may have little awareness of the overall impact of their "advance." Context and meaning can be lost with singular focus. This is very apparent in health care where a focus on better outcomes is likely to be shaping adverse consequences across practices, hospitals, and outcomes where most of the American population is already most behind.

Given the exclusive origins, exclusive training, most urban backgrounds, science and policy focus, and immersions in academic and managed care dogma, it may be difficult for them to understand the populations most distant from them in so many dimensions.


https://www.dhirubhai.net/pulse/should-we-trust-health-care-designs-designers-who-do-most-bowman/

There are a number of other reasons for the changes in health care workforce. To understand why it appears that nurse practitioner and physician assistant numbers are increasing relative to physicians, you would need to understand the massive and unprecedented changes in health care professional workforce that are ongoing. https://www.dhirubhai.net/pulse/see-through-promotions-understand-why-np-pa-robert-bowman/

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Over and over we see medical education and nursing and physician assistant leaders promoting the need for more of their kind. This promotional material continues despite their massive overexpansions. A recent AAMC promotion states simply that We Need More Doctors.


Where are we spending more - info tech, management, drugs, administration, insurance. Flat lined are the population, primary care spending, spending on general specialists, spending in 2621 counties lowest in health care workforce.

Controlling COVID transmission is like controlling nuclear fission. https://www.dhirubhai.net/pulse/human-control-rods-vs-nuclear-fission-covid-robert-bowman/

If you understand social determinants, they you should fight value based designs that worsen social determinants and likely outcomes. Follow the dollars to see who wins and who loses. https://www.dhirubhai.net/pulse/social-determinant-focus-argues-against-value-based-designs-bowman/

Pipelines to primary care or underserved practices continue to fail to work to resolve deficits of health care workforce because the financial design has not resulted in increased dollars for the increase in that workforce. Specific training can improve the suitability of training, but is incapable of addressing the deficits. Those focused on addressing shortages need our nation to value most Americans and those few who remain to serve them despite half enough dollars and team members. https://www.dhirubhai.net/pulse/rural-primary-care-underserved-pipelines-still-work-resolve-bowman/

Health insurance promotions make a stab and looking good – when in fact they pay too little for primary care and require too much cost to get any improvement. https://www.dhirubhai.net/pulse/health-insurance-heroes-hardly-robert-bowman/

https://www.dhirubhai.net/pulse/myths-physician-ages-shortages-robert-bowman/


https://www.dhirubhai.net/pulse/myths-physician-shortages-robert-bowman/

There are many reasons why we should not measure and the arguments against measurement including discrimination, disruption, poor logic, financial costs, and worsening of outcomes by measurement impacts.

Please consider why we should not measure

https://www.dhirubhai.net/pulse/why-we-should-measure-let-me-count-ways-robert-bowman/

The media is filled with what bad has been done and is being done. It is important to remember what has happened so that we do not repeat the past mistakes. But we are also not DOING. We are talking. And we are not replicating and enhancing the investments that have been done to address disparities. Even worse our innovations and regulations in areas such as education and health care design - are causing disparities.

https://www.dhirubhai.net/pulse/day-after-juneteenth-robert-bowman/


Much background work is needed until a Medicare for All would be meaningful in key areas such as redistribution of health care dollar to the places and populations most behind and those who serve them, who are half enough by past and present designs.

https://www.dhirubhai.net/pulse/medicare-all-premature-until-groundwork-laid-robert-bowman/



https://www.dhirubhai.net/pulse/top-down-policy-designs-abuse-grassroots-coalitions-needed-bowman/



To see how health care policy designs can hurt most Americans, you must understand the Americans most behind and those who deliver health care to them.

https://www.dhirubhai.net/pulse/counties-lowest-health-care-workforce-40-population-get-robert-bowman/


Almost daily new studies come out regarding some micromanagement of health care that shapes better outcomes. Many if not most of these studies should not be published or should have major limitations indicated. The relationship between Primary Care and Outcomes is a good example.

https://www.dhirubhai.net/pulse/why-outcomes-studies-flawed-primary-care-example-robert-bowman/



https://www.dhirubhai.net/pulse/primary-care-cannot-fix-health-outcomes-robert-bowman/


https://www.dhirubhai.net/pulse/designers-lie-when-promote-primary-care-recovery-plans-robert-bowman/



https://www.dhirubhai.net/pulse/should-health-care-leaders-discuss-disparities-fix-designs-bowman/


https://www.dhirubhai.net/pulse/does-medical-education-fight-disparities-help-cause-them-bowman/


https://www.dhirubhai.net/pulse/care-coordination-prevented-health-designs-robert-bowman/



https://www.dhirubhai.net/pulse/acute-abuse-those-behind-vs-chronic-valued-robert-bowman/


https://www.dhirubhai.net/pulse/primary-care-gets-caught-physician-pay-crossfire-reprint-bowman/



https://www.dhirubhai.net/pulse/primary-care-collapse-impacts-more-than-rural-robert-bowman/


https://www.dhirubhai.net/pulse/please-focus-social-determinants-situations-more-race-robert-bowman/



https://www.dhirubhai.net/pulse/declines-primary-care-spending-only-tip-iceberg-robert-bowman/


https://www.dhirubhai.net/pulse/what-can-rural-medical-educators-do-ivory-towers-robert-bowman/

COVID will expose the massive overexpansions of annual graduates across nurse practitioners, physician assistants, US osteopathic, and US MD. The bubble was set to burst in the future, but COVID has accelerated it. The experts are still pushing more graduates and more types of health professionals with expanded activities.

https://www.dhirubhai.net/pulse/expanded-workforce-removed-restrictions-even-glut-robert-bowman/


https://www.dhirubhai.net/pulse/characteristics-2621-counties-lowest-health-care-workforce-bowman/


https://www.dhirubhai.net/pulse/covid-burst-bubble-too-many-np-pa-do-md-graduates-robert-bowman/


https://www.dhirubhai.net/pulse/death-basic-health-access-robert-bowman/


https://www.dhirubhai.net/pulse/view-primary-care-pipelines-from-bottom-grassroots-robert-bowman/



https://www.dhirubhai.net/pulse/why-admissions-more-native-americans-resolve-deficits-robert-bowman/


ACA has not reigned in costs or improved quality. It has burdened those who deliver the care and has diverted their support funding to pay for software, hardware, and regulatory changes. Even worse, the various changes have widened disparities of access, workforce, economics, and more - by design.

https://www.dhirubhai.net/pulse/why-most-americans-should-celebrate-10-years-obamacare-robert-bowman/


https://www.dhirubhai.net/pulse/stop-measurement-madness-now-more-than-ever-robert-bowman/


https://www.dhirubhai.net/pulse/think-twice-medicine-career-keep-your-eyes-wide-open-robert-bowman/

Current levels of expansion in recent decades are many times the annual population growth and far exceed the increases in health care spending (and the health professional spending category is stagnant).

https://www.dhirubhai.net/pulse/stop-expanding-md-do-np-pa-graduates-robert-bowman/

https://www.dhirubhai.net/pulse/primary-care-worsened-design-robert-bowmanOlder/

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