Policy

The political selectivity of medical freedom: a double standard

Policy
December 22, 2025

I’ve been thinking about “choice” a lot lately, not the rich, ethically grounded version we teach in medical school, rooted in autonomy, informed consent, and shared decision-making, but a thinner, more selective version now circulating in political and legal discourse. The kind that sounds principled until you read the fine print.

The message goes like this: You may choose, just make sure you choose correctly.

It’s the literary equivalent of Animal Farm: …

Read more…

Understanding alternative drug funding programs

Policy
December 20, 2025

As elected officials and citizens brace for the possible expiration of federal subsidies for health insurance premiums, many wonder if there are alternatives to the confusing rebate/copay/deductible/premium drug coverage word salad (see: PSAOs, GPOs, NADACs, ASOs, MLRs, AWPs, WACs, U&Cs, MACs, BERs, GERs, DFERs, GDRs, NDCs, DIRs, and ERISAs).

Just because patients don’t understand the opaque layers/players behind the drug procurement affordability crisis, doesn’t mean that lawmakers do, say experts (which …

Read more…

The impact of policy cuts on ableism in health care

Policy
December 19, 2025

I am a disabled doctor. Being in residency, where many of my peers are young and able-bodied, I entered medicine with extensive experience on the other side of the examination table. I also entered medicine wanting to emulate the best of the care I received, and minimize the worst.

Over time, I have met more and more doctors like me who struggle with temporary or permanent disability. I see how systems …

Read more…

Accountable care cooperatives: a community-owned health care fix

Policy
December 13, 2025

After the longest government shutdown in U.S. history (one triggered by battles over health care funding) the core issue remains unresolved. Neither political party has produced a durable solution. The Centers for Medicare and Medicaid Services (CMS) projects U.S. health care spending will reach nearly $9 trillion by 2035, consuming 20 percent to 22 percent of GDP. The Congressional Budget Office projects that without significant changes in policy, …

Read more…

Why U.S. health care costs so much

Policy
December 12, 2025

The U.S. has the lowest health care quality ranking compared to other high-income countries. According to the Centers for Medicare and Medicaid Services (CMS), the U.S. spent approximately $4.9 trillion on health care in 2023. This means that almost one out of every five dollars spent in the U.S. goes towards health services. Despite this high spending, the U.S. consistently has a lower life expectancy compared …

Read more…

Why the expiration of ACA enhanced subsidies threatens health care access

Policy
December 12, 2025

Just over 40 days into the longest government shutdown in American history, the rope snapped. The enhanced premium tax credits that kept 22 million Americans insured will expire on December 31, 2025. Premiums are soaring, protections are vanishing, and the safety net is unraveling. Americans are already reeling from gutted SNAP benefits. Now they’re losing health care coverage too. The Congress has made it clear that the most vulnerable are …

Read more…

Why extending ACA subsidies is crucial for health care access

Policy
December 11, 2025

When Americans decide something is right, political inertia does not prevent us from acting, and now is the time for health care. Before the Affordable Care Act (ACA), 60 percent of Americans had employer-sponsored coverage, 20 percent relied on public programs, and the remaining 20 percent had to obtain insurance on their own, a difficult task because the individual market was unsustainable. But the ACA stabilized these issues by expanding …

Read more…

Medicare payment is failing rural health

Policy
December 5, 2025

Ten years ago, I quit my job and started a solo office-based practice in rural Washington. I serve patients like Mr. G, an elderly gentleman who drove over 70 miles through mountain passes and rural highways to receive care for gangrene of his foot, as nearby hospitals were either too full or too far away. But Medicare’s broken payment system is endangering practices like mine, quietly dismantling access to affordable …

Read more…

Did the CDC just dismantle vaccine safety clarity?

Policy
November 22, 2025

“Vaccines do not cause autism.” That statement once anchored public health. The CDC just dismantled it, quietly, strategically, and dangerously.

Presumption reversed, justice subverted

Attorney Lindsey Halligan didn’t misspeak when she claimed James Comey must prove his innocence beyond a reasonable doubt to a Virginia grand jury. She exposed the new doctrine: guilt by accusation, innocence by loyalty. Then she staged a procedural ambush. She bypassed the full grand jury entirely. She …

Read more…

Direct primary care in low-income markets

Policy
November 22, 2025

Even the most “affordable” DPC models struggle in lower-income markets because the behavioral economics of these populations create high churn and unstable revenue. Practices that succeed in underserved areas nearly always diversify into employer partnerships, institutional contracts, or expansion into higher-income neighborhoods. Without understanding these behavioral and economic realities, physicians risk building a model the community cannot sustain long-term.

I previously argued that physicians must answer five market questions before …

Read more…

Why medical organizations must end their silence

Policy
November 14, 2025

Professional medical organizations, such as the American Medical Association (AMA), American Hospital Association (AHA), and American College of Physicians (ACP), do more than set policy. They are custodians of medicine’s ethical core, defenders of science, and guardians of public trust. Yet, at critical moments, these organizations too often fall back on a strategy of silence. That silence is not neutral. It carries real consequences.

Mixed messages, missed voices

Consider a recent example. …

Read more…

The flaw in the ACA’s physician ownership ban

Policy
November 14, 2025

“The most expensive piece of medical equipment is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.” Dr. Atul Gawande, an endocrine surgeon practicing at Brigham’s Women and Children Hospital in Boston, Massachusetts, wrote those words in the June 1, 2009, edition of the New Yorker in an article entitled, “The Cost Conundrum.” In that article, Dr. Gawande compared health care expenditures …

Read more…

The paradox of primary care and value-based reform

Policy
November 13, 2025

An excerpt from Wonderful and Broken: The Complex Reality of Primary Care in the United States.

In a health care system full of paradoxes, this is perhaps the most striking. Primary care delivering value-based care is seen by many as the solution for an inefficient, inequitable, and poorly-performing health care system. Yet it is a shocking mess of burnout and depletion. With all the radical intention of Lenin, we must …

Read more…

ADVERTISEMENT

Deaths in custody highlight crisis in Philly prisons

Policy
November 12, 2025

The Kensington community is still reeling after the deaths of Amanda Cahill and Joey Gabor, who both died in custody shortly after being arrested during the area’s controversial narcotics sweeps at the end of 2024. While we don’t know the details behind these deaths, they are alarming and depict the vulnerability of those incarcerated with substance use disorder. We as physicians working to curtail the opioid epidemic must advocate for …

Read more…

South Carolina’s CON repeal: an opportunity for doctors

Policy
November 11, 2025

Imagine having to ask your competitors for permission to open a new business: a corner café, a diagnostic clinic, or a surgical center. For decades, that was the reality in South Carolina health care. Certificate of Need (CON) laws gave entrenched hospital systems the power to contest new outpatient facilities, imaging centers, and physician-led ventures. It stifled competition, raised costs, and preserved the status quo.

That era is ending. In 2023, …

Read more…

Why ACA subsidies aren’t the main issue

Policy
November 10, 2025

As a physician with decades of experience, I have watched health care in this country change from a patient-centered calling into a profit-driven corporate enterprise. Much of the current political rhetoric surrounding the Affordable Care Act (ACA) conveniently ignores the real structural issues that drive up premiums and reduce access for ordinary Americans.

The recent claim that, if Republicans “get their way” and ACA tax credits expire, insurance costs will skyrocket …

Read more…

The physician mental health crisis in the ER

Policy
October 24, 2025

The numbers are staggering. Americans made 139.8 million emergency department visits in 2024, that is 42.7 visits per 100 people, with behavioral health issues driving an unprecedented surge. Behind these statistics lies a harsh reality: depression, a leading cause of ill health and disability worldwide, is overwhelming our emergency departments with cases they were never designed to handle. This tsunami of mental health crises creates a vicious cycle. …

Read more…

Why the MAHA plan is the wrong cure

Policy
October 22, 2025

“Make America Healthy Again (MAHA).” Finally, something we can all agree on.

The new MAHA report with its pages of promises taps into something real, something we see daily in primary care practice: Many Americans feel unwell, unheard, and unprotected by the very institutions meant to support them. Compared to our peer countries, we live shorter, sicker lives, suicide rates are rising, and even our children are …

Read more…

How AI on social media fuels body dysmorphia

Policy
October 18, 2025

The alarming relationship between artificial intelligence and adolescent body dysmorphia

That is what the American Health Law Association called the global increase in social media usage: an epidemic.

Indeed, social media usage and reliance, especially by youth, is becoming a mental health phenomenon quickly escalating out of control.

Nearly 25 percent of youth report spending over four hours on social media daily, with 46 percent of adolescents claiming that social media …

Read more…

Why direct primary care (DPC) models fail

Policy
October 13, 2025

I’m going to say something controversial: the DPC community’s obsession with “purity” is missing the point. After two decades designing health care financial models, negotiating payer & vendor contracts, and building compliance frameworks, I’ve learned that most alternative payment models don’t fail because they’re impure. They fail because someone forgot to do the math.

When $1 million can’t save a bad idea

The University of Houston medical school launched a direct primary …

Read more…

37
pages