More for Few and Less for Most

When you pay so much more for health care costs as seen in Massachusetts - you deplete child development, early education, mental health public health, higher education, environmental changes, housing, nutrition, and public security. The US is among the worst toward the right.

A few people benefit from the health care design. A few locations benefit from health care spending - particularly in just a few zip codes in the state of Massachusetts.

State budgets are also depleted by prison spending. Federal budgets are depleted by military cost increases and prison costs - also about twice the level of spending as compared to other nations, just like runaway health care costs.

In many ways too much for too little result in health, in prison, and in military spending results in greater divisions, worsening disparities, and declining outcomes.

These increasing costs deplete the human infrastructure investments needed and the physical infrastructure investments needed - worsening the spiritual infrastructure. How we perceive our nation, its people, and its government has much to do with investments for few with most left behind.

The US overspends relative to other nations where it matters least, and underspends in critical areas such as investments in children.

Diabetes, obesity, and other factors considered important in worsening the human condition are themselves shaped upstream - by factors related to income and other social determinants. It is not likely that chronic diseases can be reduced or prevented - unless the human condition changes.

As a side note, only spending upon family practice is distributed equitably. The MD DO NP and PA positions in family practice have population based distribution. In the case of family medicine, this is about 26 to 32 family physicians per 100,000. Other specialties are 3 to 6 times more likely to concentrate where higher concentrations of physicians, specialists, and health care dollars are found. Only family practice distributes, but more training in family practice cannot reduce deficits. This is because family practice depends upon the financial design. Family practices have the worst finances shaped by being small, basic, cognitive, and where needed. They experience patients with the worst public and private plans - just like their patients.

Family practice has done well during only one period of recent US history - 1965 to 1978. Only this period of time did Medicare and Medicaid increase the dollars invested most specifically in primary care where most Americans most need primary care - via increased spending on the elderly and poor. Family medicine had a one time major expansion from a few hundred to 3000 by 1980 - and then stagnation along with most of the nation, primary care, and care where needed.

Numerous designs favor the few while the many fall behind as seen since the 1980s.

When health, education, and economic designs favor the few, most will fall behind steadily.

Bob Bowman
Basic Health Access Blogspot