Retarget Ten Teams to Be On Track for a Better America

Dr. Berwick has a JAMA publication listing ten teams that he would support such that we can get serious about producing health. There is obviously some difference in Dr. Berwick over time as he sees health outcomes as predominantly not shaped by health care delivery, but he still sees health care as responsible. Dr. Berwick has been at the top levels of health care leadership. It is not surprising that his opinions differ from my view from the bottom involving most abused health care delivery and their health care team members.

As President Obama’s choice to implement much of ACA, he still supports health insurance expansions.

My opinion is that quantity is not the solution for health insurance. Expansions of the worst quality plans are not helping in key areas such as basic health access for most Americans. They need major improvements in health care insurance quality. This quality must be very specific to the support of more and better delivery team members where most Americans are most behind.

It is the low quality that shapes deficits of workforce and access barriers. Expansions of the worst plans will not help. A minimum of 40 billion more must go to primary care in 2621 counties with half enough primary care to double the funding levels. This is a minimum requirement to bring primary care levels to average and required levels. This will be a start but toward team members more and better that are less than half enough due to the financial design.

Once you grasp the basic health access situation you can see how health insurance expansions and more micromanagement are punishing – not promising.

The focus on health insurance expansion is the incorrect treatment because the main insurance problem in the US is the quality of health care insurance.?

·????????Studies document low standards of insurance company performance. Medicaid is one of the worst across many private contracted plans. Audits of Blue Cross Plans involving Veterans indicates problem and the excuse that industry standards were met – is no excuse at all. Lack of response to the Office of Inspector General is most alarming.

·????????Worst quality health insurance shapes deficits of workforce that training cannot address. Where our nation has concentrations of the worst health insurance plans, it has deficits of workforce. The 2621 counties lowest in health care insurance are in the 30 worst states and have concentrations of elderly, poor, disabled, and worst employers – shaping concentrations of the worst Medicare, Medicaid, and private health insurance plans. These counties did not lack for insurance coverage more than other Americans as this 40% had about 40 – 41% of the uninsured in 2010. They also do not lack for employment more than others. What they have always had is the worst quality employers and health insurance plans. When plans fail to support providers and pay too little for the basic office services and pay less where most Americans have the lowest workforce levels, expansions of the worst plans is not going to help. Also the worst plans do not provide financial security from sudden high costs or prolonged expensive care. America uniquely abuses Americans as they grow older and sicker and poorer – by design.

Funding for food and housing is needed

More funding is needed, but I disagree that this should be addressed by health care dollars, especially underfunded Medicaid dollars. Inevitably this would worsen the duties and lessen the supports of delivery team members already shaped fewer and lesser where concentrations of Medicaid patients are found.

What we most need is a small army of teens and young people who work with those who serve locally – helping to expand what they can do across health, education, housing, food, and other supports.

Generation after generation the outcomes are worsening for most Americans most behind. It will take much more than what we have done for decades to change our course. And it will take generation after generation of such efforts to begin to see outcomes changes.

Immigrant needs.

I try not to single out any racial or ethnic or geographic group to be addressed because I see most Americans as behind by health, education, economic, and other designs.

Corrections and prison health.

We spend twice too much on prisons, military, health care, and debt. This is killing America generation after generation as so little is left in federal, state, local, employer, and personal budgets to invest in people development. Federal and state budgets document the changes over time. And those most vulnerable and least organized continue to fall further behind.

Climate and decarbonization and voting rights ?

These are important, but they pales compared to most Americans denied reasonable access to care. And if we do not address generation upon generation of Americans worsening by design, they will not matter.

Education and early childhood supports

Up until age 10 and stacked as early as possible we must change the life course of our children. Environments of homes, schools, and day care must be addressed. This has to have the top priority and this will require decreases in military, prison, debt, and health care spending to accomplish them. These investments are also best distributed as are food and other basic dollars. Health care, military, prison, and debt spending favor the few doing well.

Elderly and loneliness.

Once again a small army of dedicated teens and young adults is needed to address the development, parenting, education, job training, social support, loneliness, fall prevention, and other community determined activities to help them to better health. This includes a major improvement in health literacy, too far behind for most Americans.

Community connections projects, readmissions projects, fall prevention projects, and many more indicate the value of such efforts.

A CCC Civilian Conservation Corps small army is needed working throughout our communities. This should also be the early preparation for physician, nurse, teacher, social worker, police, and fire careers Those demonstrating empathy, service orientation, communication skills, teamwork, and change agent ability should be selected to progress with local training to become official servants of these communities.

The tasks are indeed overwhelming, which is why we need a small army working with existing human infrastructure to expand what they can do. Communities need to work on priorities important for them. COPC and asset based approaches can be helpful.

My perspective remains true to basic health access and to delivery team members. There is no way to divert dollars within budgets and not impact delivery personnel, as they are the largest component of health care budgets. For decades we have had outstanding examples of those in the community, often connected with hospitals, who set up access to care, medications, food, and much more.