There are two camps in America: those who think that health care is a right and those who think that it’s a privilege. Well, perhaps that’s a bit of an oversimplification, but bear with me. Given these two respective positions, what are we to make of the health inequalities that are well documented in the United States? First, we must acknowledge that health is the product of multiple factors …
Imagine you have severe depression and go to a Boston emergency room for treatment. You are told to follow up with a psychiatrist within two weeks. You have good health insurance, so this shouldn’t be a problem, right?
Wrong. In a new study just published in the Annals of Emergency Medicine, we found quite the opposite. Access to outpatient psychiatric care in the greater Boston area is severely limited, even for those with …
Health care changes should be made in small increments, easily understood by the People.
Any changes that are made should be made in small increments and they should be cost effective and easily accepted by the public. It is clear at this juncture that we cannot afford the breadth and the scope of “reform” that is being currently proposed; to …
So I have a Droid. I purchased it in July, not long after taking my old flip-phone for an oceanic bath at Hilton Head, SC. I waffled for a long time. In fact, I almost purchased a Casio phone that was marketed as water and impact resistant. “Mil-spec,” was the phrase used … a phrase which appeals to me as a one-time Air-Guard flight surgeon. What it meant to me …
Despite the slight upward tick in medical students opting for careers in family medicine over the last two years, efforts aimed at solving the primary care physician shortage are often thwarted by state and federal policy decisions.
There is reason for hope, however: The number of medical school applications in California is extraordinarily high. A higher proportion of …
In 1990 I made a quantum leap from practicing in the Navy’s single-payer, universal-coverage health care system into civilian pediatrics. Having been insulated from …
Recently, we marked the 66th birthday of Medicaid, the jointly funded but State-run program that supports health care for the poor. Medicaid plays a huge role in selected populations: 70% of nursing home inhabitants, 56% of low-income children and 42% of adults, and 44% of people living with HIV/AIDS all have their health care paid for by Medicaid. Medicaid is much talked about these days, and the reason is of course …
One of the great myths of healthcare is that there is an actual “system” in the United States. If such a system exists, I have yet to become familiarized with it. What we have are mountains of paper that slavishly tie the patient, doctor, hospital and insurance carrier alike to a system of coding interpreted by individuals with no sense of what the codes mean or the labor and …
Not only is Social Security on the chopping block in order to respond to Republican extortion. So is Medicare.
But Medicare isn’t the nation’s budgetary problems. It’s the solution. The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.
Medicare offers a means of reducing these costs — if Washington would let …
A few weeks ago a patient came into my office referred for evaluation regarding surgery on her carotid artery. Although she had no symptoms, her primary physician had performed carotid ultrasound and found a severe narrowing on one side. She presented the results of this examination, and several additional diagnostic studies that had been performed recently. As it turned out, the doppler was inaccurate and she did not have any narrowing. …
37 years ago, at the very tail of the civil rights movement, my community health center (CHC) was established in Oakland to fill an unmet and urgent need. A growing population of immigrants were settling in downtown Oakland and had few choices for health care. Community surveys conducted by local leaders confirmed that residents received significantly less health care than the rest of the population largely due to a …
How to slow Medicare’s escalating costs has been the big health care policy issue recently, with Republicans and Democrats offering competing proposals, each part of broader plans for reducing the federal deficit—projected to be $1.5 trillion this year, with the government borrowing 40 cents for every dollar it spends.
Unfortunately, neither the Medicare proposal of Representative Paul Ryan’s House Budget Committee, nor that offered in response by President Obama, can …
Danielle and Robb Deaver are living proof of the awful reality of Nebraska’s ill-conceived “fetal pain” law. The law, which took effect last October and is the only one of its kind in America, prohibits abortions in the state after the 20th week of pregnancy. It is based on the discredited notion that a fetus may feel pain at that stage of development. Physicians who break the law face …
Health care leaders are busy talking to attorneys and consultants about how to set up Accountable Care Organizations (ACOs). A recent Advisory Board survey found that 73 per cent of hospital finance executives said that creating such an organization was a top priority for their health system.
Last year my most popular keynote topic was patient-centered medical home creation; this year everyone wants a presentation on ACOs.
There is no “right” answer to the healthcare reform issue. There are facts, opinions, myths, politics and reality, all in no particular order of magnitude. Unfortunately, thus far and likely in the future, the reform will be political and thus costly and painful and will not address the core issues involved in fixing the inherent systemic problems.
There have been many things written with regard to this topic and I …
Republican budget guru Paul Ryan had a plan to end Medicare as we know it to be replaced with a series of less-generous vouchers. The House of Representatives has voted to implement this plan. The political side of this has been written about a lot, and I am not going to rehash what has been better covered elsewhere. I do want to address what seems to be a persistent …
The revelations about the huge golden parachute given the outgoing CEO of ostensibly non-profit Massachusetts Blue Cross Blue Shield induced some public discussion about the disconnect between executive compensation and the mission of health care organizations.
First, new proxy statements revealed the compensation of executives of two large for-profit health care insurers/managed care companies.
Cigna
As reported by the AP, via ABC News, the CEO got a big raise:
Sometimes you just don’t want to be right. Over the past 5 years, I have seen an alarming pattern arise in my profession. Many of my patients have heard me talk about Soylent Green, an old Charleton Heston movie. The premise of the movie seems absurd. Can you imagine the government of the United States providing for all the needs of its people including healthcare, food, clothing, and even death?
Medical malpractice reform is one of the few health care policy issues where there is a real possibility of agreement between the White House and Congress. A common refrain is that the fear of lawsuits leads physicians to practice defensive medicine, ordering too many tests just to cover their behinds in case of a lawsuit. It drives up costs without creating benefits. There’s some truth to this argument, …
Washington has been touting Accountable Care Organizations (ACOs) as the end-all solution to health care’s woes. Designed to reduce Medicare spending and increase care coordination across a large number of patients, members of an ACO – hospitals, primary care physicians, specialists – would be paid if and when their patient population received outstanding quality of care. However, as the Centers for Medicare and Medicaid Services (CMS) finalize their ACO …
