This is a remarkable entry.

Chris, you appear to be

1. very moved by the Commonwealth Fund

2. really thinking these days.

I too have been thinking about the cost of health care from a different perspective.

Health care is leading to a spiral of poverty for many people who simply cannot afford it. It is not just about health insurance.

1 out of 2 bankruptcies is health care related and the laws have changed so when someone files bankruptcy they are not protected on health care bills and then lose their homes which is now going to complicate the homeless problem.

There is also an issue of "how much care and decisions related to that."

On a recent showing of Extreme Home Makeover, the crew built a home for a homeless family with a daughter that has a rare disease that cost $500K annually in medical bills.

Recently somewhere in the media hype of the web, I think it was reported that a family was refused further care by Cigna for a dying child with health insurance for another surgery or procedure.

In this country that is so rich (a bit humorous to say today after a day at the Stock Market)---there is so much resource and access and capacity is now a challenging issue of people who use to be members of the now non-existent middle class.

In other countries people at the bottom of the pyramid are seeing a method of solution for them through microlending. However people in the BoP are least likely to be healthy so how do they get healthy enough to be entrepreneurs.

I am going to the UN on Friday. I am taking my questions with me to a meeting on poverty. According to Monica Sharma, M.D. over 3 Billion people globally managed to eek out existence to have a basis for health.

In this country, we have a growing number of people who still do not have health insurance, however we have a growing population of 100M people chronically ill who can't keep up with the expense of being chronically ill.
By 2020 there will be 50M Diabetics, what is the role of hospitals in tackling that figure to decrease it?

So I know we can assure quality care and that hospitals can do excellent work.

The question in my mind is how do we insure access for people to care in hospital and keep them out or prevent them from going to the hospital with resources that may be insurance dependent or not.

I think that is where we now need to look outside the hospital to shape the hospitals of the future we need.

Does anyone know if in the United States someone or some group has taken a look through this kind of filter? I would like to know as I shape my global inquiry on poverty and health.

The internet will play a large role in providing access to health care to all people with and without insurance.

Insurers will be on board because it will save them money. Doctors will be much more accessible online and provide medical advice to their patients over the internet.