Two Forces Shaping Declines in Outcomes in Health Education and More

Cries of victory may ring out today after the apparent defeat of the misguided Republican Replacement Plan, but the sand people will be back and in greater deception. The designs over past decades will continue to be shaped by those with their own agendas - agendas that are a poor fit with the needs of most Americans or true improvements in health outcomes.

The first realization that must be made is that the designers will be back with plans that work for them, but not for most Americans.

The second realization is that good intentions taken to excess have consequences as seen in austerity focus and in runaway health care costs.

Austerity Focus	Runaway Health Costs
Cuts or prevents or diverts investments in areas that shape local determinants of outcomes	Increase so rapidly that federal and state dollars are diverted to health care and away from the determinants of outcomes
The Determinants of Health, Education, Economic and Other Outcomes include housing, nutrition, senior resources, public servants, job development, child development, local education, public health, Social Security, disability spending.
Dollars distributed equitably help to reduce disparities as in SNAP, Social Security, disability, and child/education spending for the earliest age groups.
Over 30,000 health care dollars are spent per person in top concentrations and this
results in less than $3500 per person spent in lowest concentration settings.
Dollars, cash flow, jobs, social determinants, and local resources were needed are stolen, diverted, or compromised resulting in worsening outcomes.
Strategies - It is a great tactic to scapegoat dependent populations as the cause of our national problems. This paves the way to slash and burn.	Strategies -Health spending increases marginalize other spending. Health spending is designed to be concentrated where concentrations are already found, helping to shape disparities.
It also helps to trash government programs as ineffecient and ineffective - especially the programs that spend dollars where disparities exist. It is not a coincidence that the targeted programs are the ones that best distribute dollars - programs that are directly at odds with those who concentrate.	More lines of revenue are added to benefit the few with little change or decline for the basic services most important for most Americans most behind. Top reimbursements go to the concentrated with lowest payments for the distributed.
Blaming works well also - Blame schools and teachers rather than the situations and environments of age 0 - age 6 children in this nation - worst among the 23 developed nation and a key factors shaping worst health, education, and economic outcomes.	Grants, best practices, study panels, management consultation, certifications are other mechanisms. Study results designed to demonstrate benefit can be used to build the case for even more.
Confusion can be spread by promoting the studies that make your points, rather than more objective reviews. False news works well, or targeted injection of half-truths to influence opinions for some while avoiding upsetting others. Where you send information is very important.	Other strategies include measurement focus, managed care, managed cost, subspecialization focus, digitalization, larger health is better health, higher volume is better, profit focus, guaranteed annual payment increases for largest insurance and largest systems, research that results in very costly drugs, increasing costs of health professional education, marginalize physicians and nurses that might oppose profitable plans.

Austerity focus is another mechanism that takes away the investments that drive outcomes - investments in infrastructure, nutrition, housing, job development, and the support for team members in health, education, and public service.
Health care costs continue to rise because of the policy designs of the last few decades - and these cost increases in health care are what eat up other domestic discretionary spending at the state and federal levels.


Yesterday's failure is success for now but a nation great in health, education, economic, and other outcomes requires investments to be made starting with the earliest months and years of life and in those who most influence these years.

Pay for Performance has failed to deliver on promised outcomes, has driven up the cost of delivery, has added distractions for team members, has distorted health services research, and has contributed to two forms of discrimination with regard to most needed providers. It is time for something else such as returning the focus to support for the team members that deliver the care.