The Giant Preschool in Health Equity Zones

It sounds benign, even charitable, enough:

State officials will head to South Kingstown on Friday to ceremonially launch one of a handful of new community-based programs aimed at reducing disparities in health among different racial, ethnic and socioeconomic groups.

Instead of focusing only on health care and insurance, Rhode Island is using $2.7 million in federal money to create 11 “health equity zones” to target the root causes of poor health, including poverty, homelessness and lack of affordable nutritious food.

For now, the boundaries of each “zone” appear to designate the area in which a particular agency will be responsible for handing out taxpayer dollars and delivering subsidized services.  As the language becomes less strange in Rhode Islanders’ ears, however, we can expect the concept to begin changing, first to indicate a zone in which there is “equity” (i.e., a leveling of services) and then to a mechanism to expand that “equity” across the state.

The lines are easy to read between.  “Health equity zones” are part of a strategy pursued by former director of health Michael Fine that will eventually translate into “patient-centered medical homes” (PCMHs):

The Rhode Island Department of Health is developing a mechanism for a network of Neighborhood Health Stations (or Stations) that will build on current PCMH initiatives in Rhode Island and improve how primary care is delivered.

Every Rhode Island community of 10,000 will have a Station to provide 90% of the health services communities need—including medical care, behavioral health, oral health, physical therapy, home health, chronic disease self-management, and emergency medical services—so that 90% of Rhode Islanders use their community’s Station.

In this way, the state government will take over almost all healthcare activity for people in the state (with the state government’s usual corruption, incompetence, and habit of telling people how they have to live their lives).  But wait, there’s more!  As the funding for this initiative, the state will set up the Rhode Island Primary Care Trust:

The Primary Care Trust will consolidate the funds that every health insurance provider in Rhode Island uses to pay for primary care services. Through this pool of funds, Neighborhood Health Stations will receive a standard amount per patient each month, creating significant savings over the administrative costs of the current fee-for-service billing and payment methods used in most medical practices. The Primary Care Trust will also provide tiered incentives when Neighborhood Health Stations achieve specific health outcomes and serve patients in their local communities.

The state will take all money that currently goes toward healthcare for Rhode Islanders and put it in this “trust.”  Then, the stations will receive a set amount per patient.  If one patient requires more-expensive care, the difference will have to come out of the amount paid for other patients, who will receive less care.  The trust will likely layer in incentives and/or requirements for outcomes, meaning that the statistical results for some groups will have to match those of other groups, whether or not there’s some factor making their care more challenging and whether or not it requires more money to be taken from the per-patient payments for others.  This is “equity.”

And that’s not all.  The trust will also offer the stations more money to undertake “active management of community population health” — translation: to find ways to change behavior in the community if it might affect health in some way.  But…

… [the] benefits for population health don’t stop there. The savings generated by reductions in costly and unnecessary hospital and emergency department visits, and by increased access to robust primary care, can be redirected to impact the major determinants of health—almost all of which are social. Spending our public health and healthcare dollars more wisely includes supporting promising interventions not only in primary care, but also in education, housing, public safety, and the environment.

Using money that people and organizations initially intended for healthcare, and leveraging community stations with control over almost everybody’s healthcare, the state will then go after social engineering, forcing new mandates in our schools, new redistribution in our housing, new regulations on public safety (read, “gun control”), and new dictates on any activity that might affect the environment.

When all is said and done, a “health equity zone” will be a sort of giant preschool room in which our overseers in the government bureaucracy ensure that we live like they say we should, staying away from hurtful ideas and the sharp edges of life.

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