Physicians writing on KevinMD about the rules they practice under: prior authorization and the algorithms now deciding it, gold card laws, scope of practice and who may practice without supervision, Medicare and Medicaid, the Affordable Care Act, drug pricing, rationing that is done and not named, and the policies that decide which patients get care. Four maintained records draw on this archive: Prior authorization: what physicians say, in their own words, Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words, Race and medicine: what physicians say, in their own words, and Medical ethics: what physicians say, in their own words.
If you think health care is expensive now, wait until you see what it costs when it’s free.
-P.J. O’Rourke
I distinctly remember that in first grade I had an idea of breathtaking wisdom and profundity. Candy should be free. You may have had a similar thought at the same age. This idea was supported by an incontrovertible rationale, namely that I really liked candy. Tragically, it only took a moment for …
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How will doctors handle the flood of newly insured patients?
Excessive health care spending is overwhelming America’s economy, but the subtler truth is that this excess has been largely facilitated by subjugating primary care. A wealth of evidence shows that empowered primary care results in better outcomes at lower cost. Other developed nations have heeded this truth. But US payment policy has undervalued primary care while favoring specialists. The result has been spotty health quality, with costs that are double …
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Diminishing primary care leads to excessive health spending
A staple of conservative critiques of universal coverage is that having health insurance doesn’t equal access. The corollary is that the uninsured already have access to care—from doctors and hospitals willing to take care of them on a charitable basis and from “safety-net” institutions.
This argument isn’t new, having been made years before the Affordable Care Act became law. In 2007, the Council for Affordable Health Insurance opined that universal coverage …
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An evidence based assessment of universal coverage
Us and Them
And after all we’re only ordinary men
The wanna-be congressman appeared with his neat hair and pressed suit, a competent yet compassionate expression on his face. ”The first thing I am going to do when I get to congress is to work to repeal Obamacare,” he said, expression growing subtly angry. ”I will do everything I can to give you back the care you need from those who think big …
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While politicians are fighting, patients are being ignored
Which of the candidates for President proposes to give people a defined amount of federal money (call it a voucher) to buy coverage from competing qualified private insurers (under federal benefit mandates) offered through a health insurance marketplace run by government?
The answer: Mr. Romney, and his new running mate, Paul Ryan. And President Obama.
How is that, you say? Isn’t the Romney/Ryan vision of how to reform health care diametrically opposed …
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What the Romney-Ryan and Obama Medicare plans have in common
Medicare has moved to the center of this year’s presidential campaign for a single overriding reason: shrinking the nation’s long-term government deficit demands dealing with health care costs. No one – left, center or right – disagrees with that analysis.
What they also agree on is that limiting health care’s inexorable growth will require cutting future payments to those who deliver care – the doctors and hospitals, the nursing homes and …
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Curbing Medicare costs: Are seniors or the government responsible?
I’m a big fan of the current Direct TV ads. One of my favorites involves a guy who goes to a self-help seminar, becomes overconfident, goes to Las Vegas and loses everything, and has to sell his hair to eat. The ads are all based around the theme of avoiding making mistakes by becoming something that you are not intended to become.
I think there is much for doctors to learn …
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Will physicians be caught in the ACO web?
They both are and they both aren’t.
I’ve never seen a week in health care policy like last week. The media reports have to be in the thousands, all trying to make sense of the furious debate between Obama and Romney over Medicare.
As someone who has studied this issue for more than 20 years, it has also been more than exasperating for me to watch each side trade claims and for …
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Will Obama or Romney save Medicare? And who’s telling the truth?
Basketball imposed my first patient experience in the American health care system. A loose ball and flying elbow saw me to an x-ray machine and a consult with a respected surgeon in New York City. The wait at the hospital was long. CNN blazed through the speakers and the only reading material was a sea of People magazine. For hours, I found myself in a blinking contest between Blitzer or Kardashian.
Once in …
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What can basketball teach us about health policy?
The decision is in – and it is likely to have a substantial impact on this year’s elections, the Congress, the Court, the healthcare industry, and all Americans.
Of all the commentary I’ve read in the wake of the recent Supreme Court decision, Time Magazine‘s “Special Report: The Health Care Decision” struck me as the most balanced and comprehensive.
In the lead article, “Roberts Rules,” author David Von Drehle skillfully dissected the …
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Chief Justice Roberts’ health reform ruling analysis: A win-win?
Our septic tank backed up recently. When I say backed up, I mean, into the basement. And when I say into the basement, I mean, out of the bathroom and onto the carpet. And under the walls. The stars were aligned, and I had to go to work. My wife borrowed a Shop-Vac and rented a steam cleaner. I was assigned to call the septic-tank guy. The kids helped clean …
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Why must medical care be provided for free?
Several years ago I had dinner with a woman who had served in the late 1990s as the national Chief Medical Officer of a major health plan. At the time, she said, she had developed a strategic initiative that called for abandoning the plan’s utilization review and medical management efforts, which had produced heartburn and a backlash among both physicians and patients. Instead, the idea was to retrospectively analyze utilization …
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Why medical management is critical to health reform
During my college years, we loved the album Bat Out of Hell by Meat Loaf. We would wail along with Meat Loaf as he screamed out his passionate interpretation of Paradise by the Dashboard Lights. Another memorable song on that album was Two out of Three Ain’t Bad, which offers an important lesson to those of us interested in health care reform.
No, Meat Loaf was not a medical policy wonk …
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Are ACOs merely repackaged HMOs?
Across the nation, the medical calendar starts in July, not January. Every July 1, hospitals are infused with new, eager interns who have just graduated from medical school. To get off to a good July start, I give a talk to the obstetrical and gynecology interns and residents about medical professionalism. It is mandated (and rightly so) by the ACGME (Accreditation Council for Graduate Medical Education) that we teach, mentor …
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Moral professionalism should include advocacy and duty
At academic medical centers (AMCs) all over the country, health care delivery and payment reform are becoming reality. AMCs need to think in a new way about the markets they serve. Timing for AMCs transforming care delivery is critical. We need to find the perfect middle ground, or what I like to call the “Goldilocks Factor.” AMCs need to transform delivery, definitely not too slowly, but not too fast for …
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Changing health care delivery at academic medical centers
Most doctors will tell you that Medicare payments to doctors haven’t increased in a decade, and that doctors are turning away Medicare patients in droves. But they would be mistaken on both counts.
An authoritative compilation of current data from the Medicare Payment Advisory Commission shows what is really happening with Medicare physician spending:
Medicare spending per beneficiary on physicians’ fee schedule services steadily increased from 2001 to 2011. In 2001, Medicare …
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The truth about Medicare physician spending
Most of the attention given to the nascent state health insurance exchanges has largely focused on their role in improving access to insurance for individuals and small employers, not on the role they can play in improving health care quality.
As envisioned by the Affordable Care Act, health insurance exchanges provide an opportunity to create more organized and competitive insurance markets by offering a choice of plans, establishing rules on the …
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How health insurance exchanges can improve quality
When I first got interested in medicine, I also got interested in health policy. I was already out of college and so I decided to educate myself – not a bad discussion topic for med school interviews, after all – and found it much, much harder than expected. There were so many topics, so many opinions, and so little that seemed to connect up to give me the big picture. …
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4 things every medical student should know about health policy
