The number of kids less than 6 years of age who experienced skull fractures in this country, since 2000.  Skull fractures in young children symbolize the results of many social problems that exist, ranging from lack of attentiveness to your young child, to unnecessary accident or injury, to neglect, to abuse.  With multiple causes. they may be unpreventable, but they can at least be reduced in number.  This social problem is one that health insurance can help to improve, but requires considerable change on behalf of society itself.  Most importantly however, is the fact that more than likely not one insurance company has reviewed the distribution of this problem in large areas, such as the state or regional level.  Too much time is spent bickering on thousands of unneccessary public health problems, like this one, due to in adequate care and service provided at the health insurance industry level.

How is it that the White House, congress, HMOs planners, and the bulk of the health insurance industry can lead us in circles?  With the establishment of the HMP concept in 1971, by Pres. Richard Nixon, the plans were to improve the health insurance for everyone in the United States.  However, health insurance coverage has always been a product made available mostly to the employed, in particular those who earn more and work for large companies.

Health insurance for small companies has never experienced an advantage over the past 45 years.  Nor have better programs evolved due to this initial development of Health Maintenance Organizations or HMOs.  Similar failures exist in nearly every one of the programs for health insurance that was approved and managed.  The programs with the least failures illustrate how we assign value to a new plan.  The plans with the least non-compliant insurance companies demonstrate a “win” for this system; the the plans with the greatest number of successes.

The inadequacies of government and health insurance industries are directly responsible for the societal dissatisfactions that current exist, and are one of the major contributing factors leading to the violence and life threatening behavioral problems that currently exist.  The Columbine incident serves as a primary example of this.  At first, we cannot clearly see how such a localized event may relate to this nation’s “personality.”  Poor health insurance is one of numerous triggers that impact how people behave and “feel” about life in general.  Differentiation of kids into the “rich and poor”, “have and have nots”  leads to psychological unrest, which in turn feed into whatever other social failures exist in a community setting.  This does not imply that insurance companies are the direct cause for these tragedies; but the lack of attention insurance companies pay to dealing with these kinds of social disruptions, and developing programs to treat them or tack action against them which is well targeted, is a consequence of their inability to spatially evaluate these important social/societal problems.

In the recent changes taking place in the nation’s health insurance “plans”, while a consider number of previously uninsured were subsequently enrolled, a large number of previously enrolled recipients lost their coverage.  Its like trading pewter for tin; one is more highly favored than the other–for now.

A major problem that persists due to this bickering and changing of plans is the customers–the “members” according to insurance companies, and “patients” according the health care providers–suffer as the consequence of governmental-corporate arguments.  When much of the time is spent by congress trying to develop yet another “new plan”, little or no time is spent repairing the damages that already exist.  In this case, these “damages” are the increasingly ill-health that the American people are demonstrating, to nearby health facilities and to insurance companies less and less willing to sponsor them, and facilitate a transition to a stabler, perhaps even healthier, state of living.

Adult sexual abuse is a major problem in this country, which can be directly related to the unwillingness of insurance companies to develop productive programs.  Their unwillingness to be required to cover individuals with chronic disease opens the door for refusing coverage to people with other medical problems, that appear to be “unphysical” at first.  But if the many socially defined conditions and behaviors have underlying genomic, physiological, endocrine, genetic, or epigenomic (impact of environment on our genetics expression), this makes it possible for these companies to refuse care to families with significant biologically, drug-abuse induced misbehaviors, including child and spouse abuse, or LGBTI-related health risks.   Is society ready for the gene argument to be used to explain why the insurance companies can refuse to cover anyone’s health care, for any given medical diagnosis reason?

This current decision being made about health care will delay the development of the overall health care system itself, due to the “control” and “power” insurance companies have on Congress, and White House politics and Congress have upon the development of governmentally funded healthcare coverage.  Remember, the issues currently at hand with the new Trump Health Insurance plan pertain to those who are in need of coverage, many in desperate need.  Illegal immigrants get disqualified for never having paid into the system, nor legally tried to become a part of the system.  (Its like joining a club without paying the dues–should other paying “members” let this continue?).  But the less engaged “innocent bystanders”, who are “victims of their health”, get punished the worst by this.

An abused child, malnourished by neglectful parents, may never receive the care required to reach his or her 18th year.  I produced this may “one generation of pre-school children ago” an applied a formula that emphasized the cities where this form of abuse was the greatest.  As noted earlier, the fact that insurance companies are unaware of this can be blamed on their disrespect for the public and their focus on increasing earnings, instead of health.  But the fact that the government too is engaged in this lack of respect or interest in public health enables these initial niduses for this new social epidemic to continue and spread into other communities.  It would be very easy to study these “hot spots” for malnutrition, study comparable areas without as much abuse, and determine the causes for this social problem. But the current system remains too focused on financial aspects to enable this part of the healthcare system to be improved.

The next steps taken by congress to disqualify people from health insurance coverage, or demand increase financial contributions on behalf of those that want it or need it, will ultimately reduced a system with lesser customers. (Obamacare disqualified the borderline poor who were disabled, impacting enrollment in Medicaid Medicare and Handicapped Disability programs by 8 to 10 percent in November 2015.)  The cost for care will become a deterrent to even the most commonly sick.

Back in 1970, my mother had to deal with the refusal of Blue Cross-Blue Shield (BCBS) to manage my epilepsy needs, which included an annual visit with the neurologist, coverage of the cost for my prescription drugs, my annual EEG, my CAT scan (then a new technology), my meetings with social workers and counselors, my occasional emergency or critical care visits.  When compared with the cost for my annual physical for school, BCBS covered less than 10% of my healthcare needs.  So why even enroll?

Imagine for a moment a society where those eligible for treatment due to drug abuse are only the employed, able to afford health insurance.  The amount of opioid abuse in this country could mean that 50% or more of those experiencing this problem will not be fully managed unless effective programs are put in place.  This means that insurance companies unwilling to cover you for this past history, also set the stage for your future demise, should such a habit become hard to break.  This also mean, the only surviving opioid abusers (with that inherited genome), could become the middle to upper class workers, able to afford insurance, able to afford the care for their abuse provided by the insurers.  The lower class (other genome bearers) may ultimately die off, allowing social Darwinism to become the deciding factor for how addicted the future generations of kids, produced by these workers, will influence society and its healthcare needs.

Another unfortunate set of conditions influenced by the transition of care that appears to be happening is the enhanced neglect of care provided to certain victims of human behavioral conditions.  Over the years, child abandonment has developed small hot spots or niduses within large urban settings.  The statistics I used to analyze this, for the most part, came from the pre-Detroit Failure, pre-BLM social disruption years. The impacts of poverty now may be accentuated in regions where poverty was already having an impact on the health of specific communities.  Interestingly, the Obamacare and Trumpcare systems both failed to address this growing problem in certain urban settings.  They perpetuated bad practices already developed just before the passage of PPACA, and initiated in pieces by the everchanging HMO plans since 1971.

This map again depicts the core spots where abuse and neglect lead to the abandonment of newborns by placing them in predefined spots (hospitals, police stations, firehouses) where they may be transferred to a reputable care facility.  These are the 2000 to 2010 stats on this newly evolved “diagnosis” entered into the medical records.  It would be interesting to see how much these cases have increased, and what new niduses were developed since 2010.

It is possible that the currently change in healthcare insurance program will, like the failures before it, also be short lived, assuming it is passed.  Theoretically, it is important to remember that congress is the cause for its passage, but Insurance Companies themselves the cause for its evolution into this state of failure that it is experiencing.

Insurance companies do have an unwritten social obligation, which they don’t recognize, to provide coverage for healthcare in as many ways possible, so as to reduce the rates of sickness and death that result from poor personal and professional health care management.  But when insurance programs direct their attention primarily to their investors and selves, as financial officers looking for success, they engage in a unique form of evolutionary selection, akin to an offshoot of the “Soylent Green” scenario.  You need to “feed” your consumers enough to keep them engaged, but prevent them from dying off completely — otherwise, you lose your need for existence.

Children abusing children–peak areas in this country.  Are there are programs devoted to this cause in these given areas?  Probably not.  I doubt anyone in the insurance business is familiar with this above 2010/2012 finding.

Like other social “diseases” or misbehaviors, insurance companies have spent minimal time trying to deal with behavioral health.  Their focus is on physical health, or conditions that can be successfully treated by basic physical means.  Like what was said earlier, society has given rise to a new form of physical disease due to the genomic and epigenomic philosophies.  Genetics somehow relates to our health, knowledge of the genome will allow for these relationships to be “uncovered” (or so they think), and by understanding human genetics makeup and gene expression, we can turn any social or psychological condition into a physical condition with potential “physical treatments”.

Other examples of Social Disease and the inability of insurance companies to manage their patient populations follow.

Homelessness in 2010 (V and E codes derived); new niduses have no doubt been developed.

Congenital Tuberculosis – peak areas influences through immigration and the lack of adequate testing and screening; kids are born with TB due to inadequate plans.  These are all cases, not just newborns (when they are diagnosed) or kids <18 yo, and so may represent some young adults as well, who were born here and had TB.

Beri beri – a disease of malnutrition and another sign of regional mismanagement by health insurance companies and governments.

Rickets – another disease malnutrition — this time CHRONIC!

Insurance companies and the past plans have done little to properly manage suicide.  In the last ten years, suicide by children and especially teens has become a priority according to many suicide programs.  Yet, it is likely none of these programs have reviewed the distributions of age-group related cases at the small area level.

Pedestrian accidents, which involve being hit by a car

 Based on V-codes, E-codes; another overlooked preventable status of care and life style.

Mapping all of the ICDs, V-codes and E-Codes requires an accelerated mapping program.  This program was actually developed between 2005 and 2010, tested, and used to produce these national maps.  Some studies were performed as well on multiple age-groups and cultural backgrounds.

In spite of the possibility of developing such a system, none of the major providers of EMR data use and integration have designed a program equivalent to this version that I developed.  To date, these companies include all of those engaged in EMR utilization, even the largest ones providing numerous agencies with EMR related BI and ERP support devoted the healthcare and Population Health.

An early test of my modeling algorithm.  In the first months, I developed the “Three-Tier” model for overlaying one set of conditions or features over another.  This was used to compare the distribution of two similar ICDs, one culturally-related, the other culturally-linked (genetically linked, but not culturally bound; I covered these types of diseases and their classification on several other pages).  

The goal of such programs should be to produce 1000s of map per day and design focused reporting tools on place, race, ethnicity, religion, language, culture, age range, country of origin, in-migration patterns, land use patterns, SES, genomics, epigenomics, etc.  The current system of health insurance is extremely inadequate for managing the complex health of an increasing complex US population.

The value of Medical GIS is the answer these problems, assuming it is properly employed.  Current products, because they require stepwise development and data development and process, are still inadequate for meeting these needs.  The government and health insurance programs, and their healthcare reform antics, are the primary cause for this delay in technological advancements.  We are repeatedly sidetracked by arguments focused on eligibility for health insurance coverage, not on population, community, family and personal health related needs.