How to change the US healthcare system: some thoughts.

how to change the health care system in the US. Here are some of the ideas I have thought of:

Keep your first efforts local. What is happening in your immediate community? How is your practice or agency or organization managed? What are it's values? What is the quality of care being offered? How accessible is it for all community members?

As Social Workers we are especially skilled, hopefully, in helping people navigate the local service system. Where are the cracks in the system? We Social Workers have been taught how to do "case" and "class" advocacy which leads to the question of what are the skills and activities of advocacy at both the case and the class levels?

I have found that people increasingly are opting out of the commercial system and have gone without care or explored resources that are "off-grid." I, myself, practice what I preach and have become very skeptical about participating in what constiutes current practices which Cory Doctorow has called "enshitification."

Also, I notice that boycotts have occured by various unions of health care workers and in some cases institutions who have dropped off of panels and refused to cooperate with various health care insurers.

In the extreme, some resistance and objections to the current health system has become violent as in the case of Louis Mangione killed United Healthcare excutive Brian Thompson in December of 2024 in NYC.

I don't support violence or condone it but I do understand the dynamics contributing to such violent behavior. I favor "bypass" as a strategy because I don't think the current health care system can be changed. We have to create and implement alternative systems which we have had in the past through nonprofit organizations often staffed by religious organizations, and govenmental entities such as the VA and City and County hospitals paid for my tax and charitable dollars.

What ideas does anyone have about creating and implementing alternative nonprofit service health care systems?

Does not reading books make Americans more illiterate?

 From The Atlantic, August 2026, The End Of Reading Is Over, by Rose Horowatch.

Americans, once members of a proudly literate society, read much less than they used to. According to the National Endowment for the Arts, which conducts the most comprehensive survey of the nation’s reading habits, fewer than half of all adults reported having read a book of any kind in 2022. Only 38 percent read a novel or short story. A study analyzing 236,000 responses to the American Time Use Survey found that the proportion of Americans who read for pleasure on any given day fell from 28 percent in 2004 to 16 percent in 2023. (The study looked at people who had read a book, magazine, or newspaper; listened to an audiobook; or read an e-book.) Gambling has become a more common leisure activity than reading a book: Last year, 57 percent of Americans placed a bet.

What does it mean that the majority of Americans don't read books for pleasure? Are Americans increasingly becoming illiterate distracted by sound bites and sensationalized headlines to attact their attention? What does this phenomenon mean for the future of democracy?

When a society shifts from widespread long-form reading to a state where only a small minority regularly engages with books, the consequences ripple across cultural, political, economic, and psychological domains. Data from the American Time Use Survey and recent studies out of the University of Florida and University College London confirm that daily reading for pleasure has dropped to roughly 16% of the population.

While digital media provides a constant stream of "textual fragments"—captions, news bites, and social posts—the loss of sustained, deep reading alters how a society processes information and relates to one another.

Have you read a book in the last year? Are reading a book now? Do prefer fiction or nonfiction? If you read books, what's the best book you have read in the last five years and what made it the best for you?

GOP policies makes American health care system even worse.

 From Public Health Watch, 08/01/26

Recent federal policy changes will stress U.S. hospital and health systems, making it harder for them to provide care, a new Urban Institute report predicts.

New limits on Medicaid financing, work requirements for Medicaid users, the end of health insurance tax credits and other recent health-related policies put into place by Congress and the Trump administration will have a negative impact across the country, according to the July 29 report.

Together, the policies are expected to increase the number of uninsured people, reduce hospital revenue and overburden the healthcare workforce. Financial strain could force some hospitals to reduce services, cut staff or close, especially in already struggling rural and low-income communities. As of 2025, about 40% of hospitals were already operating with negative margins, the report noted.

Growing numbers of uninsured and underinsured patients are expected to increase uncompensated care, leaving hospitals with more unpaid bills. An additional 5.3 million people are expected to become uninsured under the new Medicaid work requirements alone, according to estimates from the Congressional Budget Office.

New limits on state Medicaid financing could also reduce payments to hospitals, making it harder for them to stay financially stable. Safety net, rural, academic and children's hospitals are expected to face greater financial challenges because of their reliance on Medicaid funding.

Changes to immigration policies also are expected to worsen existing workforce shortages by making it harder to recruit and retain healthcare staff. Foreign-born workers accounted for 18% of the U.S. healthcare workforce and 27% of hospital physicians in 2023. New Trump administration restrictions on who can enter and stay in the U.S. are expected to squeeze the workforce supply.

Lowest quality of life states in America are Republican governed

 From Jess Piper on 07/23/26

I just found out that I live in one of the worst ranked states in the country.

Well, I already knew that instinctively, but my thoughts were confirmed when I came across a CNBC study of the worst ranked states in the country. Here is the ranking:

Tennessee
Texas
Indiana
Louisiana
Georgia
Utah
Missouri
Alabama
Oklahoma
Arkansas

States ranked at the bottom of the list were penalized for high crime rates, low health care access, a lack of livable wage policies, a lack of worker protections, and laws that restrict civil and reproductive rights.

......................

I bet you noticed something else immediately, though. Each of the states listed is dominated by the Republican Party. They all have a GOP-dominated government and many of the states listed, like mine, have had a GOP supermajority for decades and also have a Republican trifecta holding the Governor’s office and the Statehouse and State Senate.

This is where I state the obvious: Republicans can’t govern. And they don’t want to. It was never about governance. It was always about consolidating power.

For more click here.

Standard time is much better than Daylight Savings Time if the US is to stabilize its clock.

From the Local Epidemiologist on 07/22/26

Congress has gotten as far as it ever has in ending twice-a-year clock changes. The House passed the Sunshine Protection Act, which would make daylight saving time (DST) permanent. It now heads to the Senate. If that passes, your mornings will stay darker for longer. But if it doesn’t go through, another bill is coming right behind it that would stabilize clock time in the opposite direction, enacting permanent standard time.

Ending the clock switch is extremely popular, and science agrees stopping this madness is what’s best for our health. But nearly every major sleep-medicine and circadian-biology organization recommends permanent standard time, not permanent daylight saving time (DST), which the House just approved.

The science about why the direction of the clock switch matters starts with your body.

For more click here.

The proposal coming from the US House of Representatives to make Daylight Savings Time permanent and people in the US would no longer be changing their clocks twice per year is bad for the nation's health and is not based on science.

To do away with the time changes is a good idea and seems to be popular with the American people, but it would be better if the permanent time change was to Standard Time not Daylight Savings Time based on the circadian rythms of homo sapiens.

If you can't win fair and square: cheat

From The Conversation on July 17, 2026

 US President Donald Trump has used a rare nationwide prime-time address to again claim the 2020 presidential election was stolen, US voting machines cannot be trusted, and a “deep state” conspiracy has covered it all up.

However, the declassified documents the White House released alongside the speech do not support those claims.

As such, Trump’s speech may matter less for what it says about the 2020 election than what it portends for November’s Congressional midterm elections, which could result in huge losses for his Republican Party.

Critics say Trump is clearly setting the stage to delegitimise the vote, so he can contest the result if it doesn’t go his way.

For more click here

Will you affirm and promote the right of conscience and the use of democratic processes in the US? Will you pledge to tell the truth and to be fair in your interactions with others?

How it works: The Replacement Theory

How does authoritarianism work? One dynamic is the replacement theory.

The Catholic birth rate in Northern Ireland was approximately double the Protestant birth rate—yet during the three decades prior to the march on Derry, the Catholic population had remained virtually static, because so many people had no choice but to leave.

Keefe, Patrick Radden. Say Nothing: A True Story of Murder and Memory in Northern Ireland (p. 14). Knopf Doubleday Publishing Group. Kindle Edition. 

With Catholic birth rates higher than Protestant, the “replacement theory” raised its ugly head fueling subjugation and discrimination in Northern Ireland as it had in Nazi Germany, in the United States, and today, once again in the United States with White Supremacism having been reawakened with the MAGA movement. The threatened dominant class practices rejection, exclusion, and exile.

This dynamic occurs repeatedly in human history as one group attempts to maintain control over perceived threatening others. Failing societies favor exclusion while thriving successful societies favor inclusion. The replacement theory is fanned by would be authoritarians to gain political power. It only temporarily works as the society they would govern becomes increasingly rigid, brittle, and then breaks down.

How it works: We are the product

 

I have gone off grid. I don't want to be a commodity that's sold to the higest bidder. 

The Netflix documentary, The Social Dilemma is a must watch for everyon about how people are manipulated by algorythms. This documentary as made in 2020 and AI has become even more powerful in the last 6 years.

The US poor performing healthcare system.

 

Today, everybody in Taiwan is fully covered for doctor and hospital services. Everybody has a driver’s-license-like healthcare card, which accesses their entire medical history. They can book a doctor’s appointment on any computer terminal in the country, and the entire cost of the system is a bit more than 6 percent of Taiwan’s GDP (in the United States, healthcare consumes 24 percent of our GDP) because there are no insurance company intermediaries sucking profits off the system.

Hartmann, Thom. The Hidden History of American Healthcare: Why Sickness Bankrupts You and Makes Others Insanely Rich (pp. 2-3). Berrett-Koehler Publishers. Kindle Edition. 

In his book The Hidden History Of American Healthcare by Thom Hartman, he opens  with a description of how different countries, specifically Taiwan and the US dealt with the Covid 19 pandemic. Taiwan and the US are very different countries so it could be argued that you can’t compare their health care systems because of different circumstances, but it is worthy of note that Taiwan covers healthcare for all its citizens at the cost of 6% of their GDP while the US cost is 24% of its GDP and it not only doesn’t cover all its citizens and even the ones who have healthcare coverage are covered poorly with co-pays and deductibles and needs for cost containing authorizations before care can be delivered.

When you reflect on how the US healthcare system operates compared to other first world countries the American system performs at substandard levels in spite of its high cost. This observation leads to the question of why Americans not only tolerate this low performing system but support political representatives who design, and support it?

People or profit in the US health care system?

The U.S. healthcare system stands apart from those of other high-income nations. While nearly all other developed countries utilize some form of universal healthcare to ensure every citizen has coverage, the U.S. relies on a complex, fragmented hybrid system dominated by private, employer-sponsored insurance alongside targeted public programs.

Despite spending nearly twice as much per capita on healthcare as the average wealthy nation, the U.S. frequently sees lower life expectancy and higher rates of chronic illness compared to its peers.

Why is the US health care system the worst in the first world nations? Because it is profit making and the primary incentives for the system is to make a profit not serve the health needs of Americans. 

Why is the system set up this way to maximize profit rather than to provide service? Because the health care corporations spend inordinate sums of money on lobbying and campaign donations to legislators and government executives who support their corporate interests rather than the interests of the people they represent and supposedly are working for.

The primary social policy undermining the US healthcare system is the Citizens United ruling of the US Supreme Court which claims that corporations are persons who have free speech and therefore can spend any amount of money they choose to sponsor and support elected officials at all levels of government.

If you want to change the health care system in the US to better serve people, elect legislators and executive officials who want what’s best for their constituents and not the corporations. We need politicians who support people not profit.