There is a new report out from the Congressional Budget Office (CBO) titled “The Slow Recovery of the Labor Market,” and as its title implies, it predicts a slow recovery from a labor perspective. Among other things, the CBO report is now making headlines in the political game of Obamacare because it forecasts a 2.5 million job reduction by 2024 due to the effects of the health care …
Don’t blame Obamacare for these 10 things
Even the best of families have skeletons: the uncle who had some shady business dealings, the cousin in drug rehab, brother with the messy divorce and custody fight, or the adult kids who are maxed out on their credit and behind in their mortgage payments but have to “keep up appearances” with their expensive suburban lifestyle. When these things happen, there is a tendency to “keep it all in the …
Obamacare supporters shouldn’t cast a blind eye to its faults
The goal of the Affordable Care Act is to make affordable, quality health care coverage available to more Americans. But how many physicians will America need to satisfy this new demand?
The debate over doctor supply rages on with very little conclusive evidence to prove one case or the other.
Those experts who see a shortage point to America’s aging population — and their growing medical needs — as evidence of a …
Do we really need more physicians?
Next in a series.
Primary care physicians (PCPs) are becoming extinct. It’s true. Not many medical students choose primary care as their career path. Older PCPs are retiring early. Many others are closing their practices or seeking employment at the local hospital. And there has always been a shortage of primary care physicians in rural and urban poor areas. Today only 30% of all physicians practice primary care (compared to …
Why is there a shortage of primary care physicians?
As the patient-centered medical homes (PCMHs) train charges forward along with implementation of the Affordable Care Act, dollars are taken directly out of our health care system to certify providers in a method with no proven benefit. And, while there is a marked shortage of primary care providers nationwide, funds that could be used toward providing the direct provision of, or access to, health care are instead devoted to accreditation, …
The data behind the medical home: High costs without a benefit?
Is Obamacare unraveling?
Rumors have been circulating in the marketplace all week that the administration was thinking of extending the individual health insurance policies that Obamacare was supposed to have cancelled for as much as three more years.
Those rumors have now come out into the open with Tom Murphy’s AP story that began running recently.
That the administration might extend these polices shouldn’t come as a shock. My sense has always been that at …
Obamacare is considering extending individual health insurance policies
A little over a month ago, my family of five moved to a more spacious and modern house in the same neighborhood. I’m slowly getting adjusted to our new place — the locations of the light switches, how to operate the refrigerator’s automatic ice maker, which cycle to choose among the dozen different options displayed on our high-end washing machine. It still takes me a few minutes longer to get …
Health reform: Forward progress or a temporary dislocation?
A primary criticism of the Affordable Care Act is that it creates incentives for employers to hire fewer full-time employees. One of the House’s attempts to repeal the ACA even referenced it as the “job-killing healthcare law.” It’s true that there are some provisions in the ACA that employers may exploit in order to minimize the cost of doing business.
At the same time, it’s also true that the ACA protects …
Does Obamacare really kill jobs?
Trauma surgeons earn their patients’ respect every day, acting decisively in the face of calamity and uncertainty, heroically beating back death with steel blades and iron wills. Primary care physicians, however, have traditionally been at a relative disadvantage with regard to public opinion. After all, reconciling medication lists, reviewing lab results, and discussing health behaviors simply aren’t as exciting. In fairness, though, surgeons have always had one other advantage: anesthesia. …
Fix primary care with technology and anesthesia
Next in a series.
Primary care physicians (PCPs) have too little time per patient which means too many referrals to specialists, too little time listening and thinking, no time to delve into the stress or emotional causes of many symptoms and substantial frustration by PCP and patient alike.
Previously in this continuing series on primary care, I described a patient with a straight forward if unusual symptom who was bounced …
What is the main cause of the primary care crisis?
Hospitals need to overhaul their processes so they can help the un- and under-insured stay healthy.
Many people running health care institutions tell me that they have been fighting the fight, learning to be nimble, transforming their cultures, making big changes as the landscape rearranges itself like a really bad day along the San Andreas Fault.
But in comparison with the actual scale of the problems, most of the business models and …
Many will not survive the millions of new Medicaid recipients
Inappropriate use of emergency departments (EDs) → congested EDs → over-worked staff members → frustrated staff members → speculation of more non-emergent ED usage → expectation to provide high customer satisfaction scores → decreased actual customer satisfaction → decreased reimbursement → higher costs of ED → budget cuts → decreased staffing → return to beginning.
Whose idea was any of this? None of it makes sense to me. The idea of providing reimbursement to healthcare agencies based on customer satisfaction scores is …
The vicious cycle of emergency department use
Patient-centered primary care medical homes (PCMHs) are all the rage. A frequently-touted part of the Affordable Care Act (ACA), they have received literally hundreds of millions of dollars in federal incentive and demonstration-project funding. They’ve been around for decades. In fact, the more you know about the intention behind the creation of a primary care patient-centered medical home (PCMH), the more you want to ask, “Well, of course – how …
Is the medical home really worth it?
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In addition to providing coverage to millions of uninsured Americans, one of the key attributes of the Affordable Care Act (aka Obamacare) is reforming the way that we finance health care in the U.S.
Since the rise of the health insurance industry (as a job benefit or under Medicare), we have operated under a system known as “fee-for-service,” in which every little nugget of health care provided (from an operation to …
Accountable care organizations: Everything old is new again
First in a series.
The primary care physician (PCP) should be the backbone of the American healthcare system. But primary care is in crisis — a very serious crisis. The first statement is my considered opinion and I will attempt to convince you of its truth. The second sentence is a simple fact.
Accounting for only 5% of all health care expenses, the PCP can largely control the “if and …
The meaning and depth of the primary care crisis
It saddens me to proclaim that the American Medical Association (AMA), the once-venerable organization that has advocated for the interests of physicians and patients alike since its founding in 1847, is on the precipice of irrelevancy. Membership has dwindled such that only 1/4 of physicians now belong to its ranks.
The attendant decrease in social and political influence that accompanies this decrease in membership arguably compromises the ability of the AMA …
Address the primary care shortage and make the AMA more relevant
Recently, another installment was published from the research team of the Oregon Health Insurance Experiment. The major finding — Medicaid coverage results in a 40% increase in emergency department (ER) use. Many of the health care pundits quickly sifted through the scientific results to support their opinions.
You can read some of them here:
Sarah Kliff reports the facts: Expanding Medicaid doesn’t reduce ER trips. It increases them. Scott Gottlieb claims that Read more…
What the Oregon Health Study has told us so far
Recently, I attended a dinner and lecture at the local dining venue where they served huge hunks of prime rib and sauteed snow peas from some far away place where it’s spring, and chocolate mousse and wild rice. Global warming increased just slightly due to our excess consumption, but my portion would have been wasted had I stayed home. Beside the food, I was curious to see what the health care …
A health care lobbyist discusses population health
While the Affordable Care Act, or Obamacare, has been criticized by its opposition as “socialized medicine,” it relies heavily on private health insurance. On the other end of the political spectrum is the idea that a government-run single payer system, similar to Canada’s, is the best way to deliver health care. (This is sometimes shorthanded in the U.S. as “Medicare for All.”) However, this system has been believed politically impossible …
Vermont tests single payer and the country is watching
The primary debate in health care reform this past year centered on insurance coverage. The next great debate will focus on the cost of providing health care.
For decades, the way we’ve paid doctors and hospitals has driven up health care costs. And while the pace of health care spending has slowed the last four years, it continues to rise faster and more noticeably than improvements in U.S. health care outcomes.
The reason is not …
The high cost of health care: Blame the financial model
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