Dividing Rather than Supporting Better Health Outcomes

There are many ways to avoid improving US health outcomes and the United States seems to be best at avoiding.

The Past Contributions To Poor Outcomes

If you understand what was good about the US economy and reductions of disparities 1940s - 1960s, then you can understand what has been bad for health outcomes. Increased spending in a few areas results in decreased spending more specific to the determinants of health outcomes. The areas contributing to declines in outcomes include the contributions of

• runaway health care costs, 
• runaway defense spending, 
• runaway prison spending, 
• spending on the debt at high interest rates, 
• maldistributions of health and education by their spending designs that worsen disparities, 
• the consequences of Republican slash and burn (now by both parties Reps and Dems), 
• the consequences of costly Democratic regulation (now by Reps and Dems in health care), 
• autonomous divisions and agencies that can perform in a manner the opposite with regard to improving social determinants or outcomes (CMS for decades and recently Housing, Environment, and other Departments and Agencies) 
• reversals of international financing favoring the few (1970s reversals of equitable changes in the 1940s such as the Bretton Woods agreement), and 
• the US health care design favoring a few in few locations at high costs.

The above and other areas of overspending indicate the ways that federal state local employer family and personal budgets are depleted, leaving less for the long term investments that can make a difference in the human interactions most important for health, education, economic, and other outcomes.

Health care is poorly matched to improve health outcomes as so much goes to administrative and biomedical services with little investment in changing behavior, situations, conditions, or environments. Health care is so costly that it results in worsening socioeconomics - which can worsen outcomes.

The Present Impacts

At the macro level, too much for areas not important to the determinants of health can result in less ability to invest in parenting, children, students, infants, housing, nutrition, public health, public security, senior support to avoid costly care, other human infrastructure, and physical infrastructure.

Waves of runaway health care costs involve biomedical, administrative, micromanagement of cost, and micromanagement of quality areas. Obviously these areas still are going strong

You might even see why Red Counties are frustrated and why 60 Blue Rural Counties have had steadily worse for 60 years of failed, uncoordinated, costly, piecemeal interventions. You could see how these two sets defined by recent differences in voting are unified by the poor treatments of US designs.    Frying Pan to Fire for Red Counties

The Future Changes - Housing Shapes Inequities

When you start to look at the segregation of the United States at the macro (state, county) and micro level (zip code, census tract) you can also see how the housing design impacts the future. The continued collapse of affordable housing in higher concentration counties will result in more millions each year moving to places left behind via disparities. Dumped from their housing by failed finances or eviction they have few choices

• Homeless in shelters (ghastly as reviewed in LA Times), 
• Homeless on the street (almost as bad), 
• Crowding in with other family (stressful and unhealthy) or 
• Moving to counties with affordable housing but little public transportation as well as half enough basic health care, basic education, and basic social resources. 

In other words, the medically and financially and socially vulnerable continue to be segregated and most do not know it, but many sense it. Those mired in disparities cannot afford housing in higher concentration counties and are joined by those with similar issues departing higher concentration counties.

True Reforms Avoided and Assumptions Promoted

The true reforms in health care were avoided in the 2010s. True reforms would redistribute dollars (ia higher payments for cognitive, office, basic services.  

True reforms would support the team members delivering care - especially those delivering care to the half of Americans left behind. 

The failure of true reforms actually points to those who resist such reforms. These reforms have been resisted successfully by the few institutions, associations, and corporations doing well. Their attraction is so great that more are jumping on the bandwagon to grab more dollars as they work to shape the US health care design their way.

And with the rise of precision medicine, the true nature of American health care will be revealed - way too much for too few at costs far to high with benefits to few and to few locations - leaving most Americans behind already and with greater proportions to be added. Of course the subtle changes over the next three decades will be like a slippery slope with those safe at the top wondering what is going on as more Americans are mired at the bottom.

This American health care theme song has long been played in health access due to policies 1980 to 2010 and especially since 2010. Health access has suffered from the consequences of slash and burn plus regulation and innovation accelerating costs of delivery. This has adversely impact primary care spending for 40% of Americans in 2621 counties with half enough - with worse to come. These primary care practices had 38 billion to invest but now have only 30 billion remaining after the innovators, developers, regulators, digitizers, and certifiers extracted their unfair, ineffective, and inefficient share.

This should have been obvious as many of the discriminations and distractions were known. Unfortunately our guard is down. 

• Primary care associations compete to be the most innovative despite the consequences to members - especially family medicine with 36% of active physicians in these counties and also the most small practices.
• Primary care researchers are off wave hopping trying to add support to the innovations, regulations, and digitalizations - lured by 117 million research dollars pulled together by people who worship innovation. 

We have all been taught more about dividing rather than supporting - on both sides.

CMS Fails Rural Health

The Medical Mystery of Health Care Spending Increases since 1980 (with declining outcomes)

Why Salaries Are Downstream and Powerful vs Powerless Conflicts Dominate Determinants of Health

More Indications that More Americans Are Falling Further Behind - The ALICE study

Note the shift to the right or more orange in the Red Counties and the 60 Blue rural counties. Income, health, and economic disparities are concentrated in lower concentration counties.