In the current healthcare system, the people who most need help are the least likely to get it.

Think they need an annual physical, some vaccinations, antibiotics when they get an infection, a scolding when they get too fat, and a lecture when they smoke?  Think again.

How do you deal with an individual who comes into an emergency room (or in the era of Obamacare, the office of a primary health provider) and is “sick.” Is it because they are homeless or abusing drugs or never had regular healthcare before or struggle with a psychiatric diagnosis perhaps developed as a survivor of rape, incest, or alcoholic parents?

Who do you think is in the current publicly-supported healthcare system of last resort? If that panhandler at the stop sign comes to see a doctor, the patient will typically be hungry, a chain smoker, unable to tell a coherent story or provide a medical history, and prepared to blame a doctor for not being able to fix all of the problems the person has encountered through life. Can you separate a life of living on the street while using drugs and eating fast food with lots of fat and cholesterol from what is found in a simple annual blood panel? Can you tell the medical patient to start eating in a healthy way (when the patient is homeless, has no job, has no money for Whole Foods Market)? Can you expect these patients to adhere to a doctor recommended treatment-intervention which might include lots of pills for an unhealthy lifestyle or because of HIV/AIDS?

High need patient-clients in the healthcare system have many needs and difficulties. Fix one and you see three more problems.

We need a system that can deal with patients-clients that have many of the problems shown in the mind map below. Concurrently. Simultaneously.

or alternately (same model, different way of viewing it) …

PS. I know that effective and cost-effective healthcare/socialcare agencies can be built because the US government has created dozens, if not hundreds, of these programs as “demonstrations” that the concept works. The program is then funded for about five years at a “fair” level and after five years receives no further federal funding (the program is then supposed to have a rich aunt or a “corporate” fund raising department). We KNOW that comprehensive service systems can be built, be effective, use resources appropriately and frugally.

It just takes a village.

Oprah, where are you?