It’s an end of the year thing. What happened in healthcare in the last year that is most important to you as a consumer? It is not good news. Our healthcare system in the United States is a dumpster fire and it did not get better this year. It costs twice as much and outcomes are much worse compared with all other developed countries. Consider these facts from
Very good year's summary, Bill. I think you are correct in that the forces of regression and corporate greed gained ground in 2023, not lost ground. We are moving further and further from a public health-based system of medical care, not closer. In the terms of addiction, we have not yet "hit bottom." We know what to do, why to do it, and what is likely to happen if we don't. But we remain as a society in the grip of denial and avoidance of reality. And, I'm afraid that history shows that people without scruples usually win over those with scruples. Things could get much, much worse than they are now. If I could hope for one thing in 2024 it would be for women's health care to improve significantly. This is key to children's health, primary care for the elderly, and public health in general to turn back the tide of repression and profit-based health care. Best wishes in the New Year, David
There are two great models where potential patients decide on priorities. One is the Southcentral Foundation and Vestra Health community owned model. The other is the German model where 90% are insured by their employers. Their governing board is elected from employees and employer representatives. The people served must govern, have access to the data, and decide on the priorities.
I think i agree though on one point which is the availability, clarity, comparability and honesty of timely data is vitally important and if any entity seeks to prevent or impair any of the above then they deserve to be avoided,
Which is another reason for the state to be as far away from healthcare as possible because single provider = zero choice.
The only thing worse that state healthcare is predatory corporate healthcare like we have in the United States. Everything they do, including the data is secret.
Primary care is the most valuable care and the patients who need it most in the US cannot obtain it. Deductibles. copays, transportation, and other massive barriers interfere. Most of this can be done remotely by nurse practitioners at a fraction of the cost.
Oh I totally agree that costs of care are massively inflated by regulatory barriers creating a shortage of allowed care providers and thus care provision!
I'd say you should never meet a specialist directly, you should see a nurse first, gather data, look up history, look at any change, they then talk to the doctor in Dr talk, Dr may chat to you, then the nurse checks the "prescription" and makes sure you're good to go.
The Dr could probably see 3 times more people this way,
I still consider employer funded schemes wrong as they take no account of individual employee health risks
If the model was the healthiest cohort was "free" and less healthy cohorts had to personally fund based on their additional risk then that would go some way to mitigating the problems.
Price is a useful feedback mechanism. lumping everyone in the same single cohort punishes those who go to efforts to maintain their own health and subsidizes & thus encourages and rewards those who do not.
Patients who are disadvangtaged, poor, and racial minorities have the highest incidence of obesity and chronic disease. The other systems in the world are based on primary care for everyone. I have met very few people who want to be sick and fat. by providing primary care which is cheap, we avoid massively expensive complications. The data is in. This is a proven concerpt.
Again: The solution to this siren call for arms may be this:
"Stop paying into a greedy, crony, state-controlled corporation-sponsored failed system that will end the corrupt Washington DC “public-private partnership” revolving doors. Cut out the corruption and the greedy big corporate go-betweens and start a grassroots organizational governing structure with independent unbiased oversight that allows individually owned and monetized data networks to enable trusted, high-quality, independent operators to perform good faith verifiable validation research to find the best solution for the best possible outcome for the lowest possible cost to enable trusted local healthcare delivery systems to manage and deliver early detection and effective preventative care is where the future is. Politicians and big governments and their cronies have failed all of us"
This good news is that When we digitize this new information infrastructure, the world will be a better place to live. I welcome everyone to Join our journey which we started two generations ago!
Stop paying into a greedy, crony, state-controlled corporate corporation-sponsored, failed system that will end the corrupt Washington DC “public-private partnership” revolving doors. Cut out the corruption and the greedy big corporate go-betweens and start a grassroots organizational governing structure with independent unbiased oversight that allows individually owned and monetized data networks to enable trusted, high-quality, independent operators to perform good faith verifiable validation research to find the best solution for the best possible outcome for the lowest possible cost to enable trusted local healthcare delivery systems to manage and deliver early detection and effective preventative care is where the future is. Politicians and big governments have failed all of us, Bill.
When we digitize this new information infrastructure, the world will be a better place to live. Happy New Year, Bill! Join us; we started this journey two generations ago, and our work continues!
Very good year's summary, Bill. I think you are correct in that the forces of regression and corporate greed gained ground in 2023, not lost ground. We are moving further and further from a public health-based system of medical care, not closer. In the terms of addiction, we have not yet "hit bottom." We know what to do, why to do it, and what is likely to happen if we don't. But we remain as a society in the grip of denial and avoidance of reality. And, I'm afraid that history shows that people without scruples usually win over those with scruples. Things could get much, much worse than they are now. If I could hope for one thing in 2024 it would be for women's health care to improve significantly. This is key to children's health, primary care for the elderly, and public health in general to turn back the tide of repression and profit-based health care. Best wishes in the New Year, David
I always appreciate your thoughtful comments. I am afraid you are correct. If we are going to be saved, we must save ourselves.
My system, the UK NHS is dismal it's dominated by bureaucrats and is run for their convenience.
The problem seems to me we want to design a health reward system(s) but we've got illness reward systems.
There are two great models where potential patients decide on priorities. One is the Southcentral Foundation and Vestra Health community owned model. The other is the German model where 90% are insured by their employers. Their governing board is elected from employees and employer representatives. The people served must govern, have access to the data, and decide on the priorities.
I think i agree though on one point which is the availability, clarity, comparability and honesty of timely data is vitally important and if any entity seeks to prevent or impair any of the above then they deserve to be avoided,
Which is another reason for the state to be as far away from healthcare as possible because single provider = zero choice.
The only thing worse that state healthcare is predatory corporate healthcare like we have in the United States. Everything they do, including the data is secret.
It's not much different from the NHS data which is often a lie
There's been stats on waiting times, but there's been secret queues to get onto the official queue. (which the waiting time stat is based on)
I can only compare the vast improvement in choice based dental and eye-care compared to the NHS monolith "options"
I can only say that Milton Friedman's 4 Ways to spend money should always be kept in mind.
Primary care is the most valuable care and the patients who need it most in the US cannot obtain it. Deductibles. copays, transportation, and other massive barriers interfere. Most of this can be done remotely by nurse practitioners at a fraction of the cost.
Oh I totally agree that costs of care are massively inflated by regulatory barriers creating a shortage of allowed care providers and thus care provision!
I'd say you should never meet a specialist directly, you should see a nurse first, gather data, look up history, look at any change, they then talk to the doctor in Dr talk, Dr may chat to you, then the nurse checks the "prescription" and makes sure you're good to go.
The Dr could probably see 3 times more people this way,
I still consider employer funded schemes wrong as they take no account of individual employee health risks
If the model was the healthiest cohort was "free" and less healthy cohorts had to personally fund based on their additional risk then that would go some way to mitigating the problems.
Price is a useful feedback mechanism. lumping everyone in the same single cohort punishes those who go to efforts to maintain their own health and subsidizes & thus encourages and rewards those who do not.
Patients who are disadvangtaged, poor, and racial minorities have the highest incidence of obesity and chronic disease. The other systems in the world are based on primary care for everyone. I have met very few people who want to be sick and fat. by providing primary care which is cheap, we avoid massively expensive complications. The data is in. This is a proven concerpt.
I've met even fewer people who want to reward people for being sick and fat.
If you advocate for a system make sure it does not do that.
Again: The solution to this siren call for arms may be this:
"Stop paying into a greedy, crony, state-controlled corporation-sponsored failed system that will end the corrupt Washington DC “public-private partnership” revolving doors. Cut out the corruption and the greedy big corporate go-betweens and start a grassroots organizational governing structure with independent unbiased oversight that allows individually owned and monetized data networks to enable trusted, high-quality, independent operators to perform good faith verifiable validation research to find the best solution for the best possible outcome for the lowest possible cost to enable trusted local healthcare delivery systems to manage and deliver early detection and effective preventative care is where the future is. Politicians and big governments and their cronies have failed all of us"
This good news is that When we digitize this new information infrastructure, the world will be a better place to live. I welcome everyone to Join our journey which we started two generations ago!
Stop paying into a greedy, crony, state-controlled corporate corporation-sponsored, failed system that will end the corrupt Washington DC “public-private partnership” revolving doors. Cut out the corruption and the greedy big corporate go-betweens and start a grassroots organizational governing structure with independent unbiased oversight that allows individually owned and monetized data networks to enable trusted, high-quality, independent operators to perform good faith verifiable validation research to find the best solution for the best possible outcome for the lowest possible cost to enable trusted local healthcare delivery systems to manage and deliver early detection and effective preventative care is where the future is. Politicians and big governments have failed all of us, Bill.
When we digitize this new information infrastructure, the world will be a better place to live. Happy New Year, Bill! Join us; we started this journey two generations ago, and our work continues!