In the Washington DC area, housing that was used for special purposes such
as drug rehab, shelters, etc. Was also sold. It became too valuable for the
typical not-for-profit uses and the not for profits sold out
Big issues involve the conversion of public housing of multiple blocks,
turned into much higher property value with real estate deals.
Those who know the right people, zoning laws, grant funding, and future
development are always in a position to make substantial income.
Those who are less socially organized are moved around a lot, and not
always in the right directions or locations.
Disruptions in existing health care and other connections are rampant.
In Nebraska the state has been tracking primary care in rural and in urban
areas
Primary care physicians per 100,000 have been moving steadily up from the
50s to 61 per 100,000 in the rural areas, many decades of effort involving
birth to admissions to training changes and a host of people involved.
Primary care physicians per 100,000 in urban areas have declined
substantially , cut in half from 148 to 75 per 100,000 from 1994 to 2007
Medicaid cut 55,000 people, mostly from urban poverty locations. 10 - 15%
of the population in these areas lost all health care coverage.
Primary care physician production for the nation also reached an all time
high in the mid 1990s. Production was not the problem. Support for primary
care is the problem.
Same with support for lower and middle income children in nurturing and
development, in teaching and education, in public servants and public
security. Just sad to see it happen on those that I care for.
In my studies on physician concentrations, the super center zip codes with
200 physicians have 1100 physicians per 100000, the typical centers with 75
- 199 physicians have 400 physicians per 100k, all other locations in
urban served, urban underserved, rural served, and rural underserved have
less than 150 physicians per 100k. In the urban underserved areas, the
levels are particularly suppressed and primary care levels are lower in
locations near major medical centers.
Major medical center employers can get government funding due to primary
care shortages, which they can actually help create by not hiring primary
care physicians or by converting nurse practitioners or physician
assistants to specialty care. The government funding does not help as
primary care levels go even lower and will not change until primary care
receives a much better share.
When public housing, public transportation, public security, public health,
public education, and public support for primary care are at lowest levels
or even lower due to misuse, the situation for lower and middle income
people is worse. Sadly those who most lose in the process are those of
higher status who forget the most important reason about how to maintain
higher status - greater stability. Most important in this focus on
stability is the prospect that each child, regardless of origins, could do
well and therefore should personally invest in a future. With fewer
learning this basic important lesson, security will be difficult for all.
Promotion and spread of the disease of fatalism is the enemy of us all.
Robert C. Bowman, M.D.
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