Health Policy

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.

How to take money out of health care, and is a single-payer system inevitable?

Kevin

Health Policy

October 22, 2009

by Bruce Douglas, MD

I’ve been practicing my health care specialty for sixty years and have enjoyed almost every minute of it. The minutes I have not enjoyed all have to do with “money.”

Financial transactions in doctors’ offices are the root of most evils in the relationship between doctor and patient. Along with that evil goes an additional detraction from good, humane health care called the fee-for-service system, which …

What health reform can learn from Regina Holliday

Rahul K. Parikh, MD

Health Policy

October 19, 2009

If you want to get insights into the problems of our health care system, look at a mural by Washington DC resident Regina Holliday.

Holliday is a 37-year old mother of two and an art teacher. Last summer, her husband, Fred, died from kidney cancer at the age of 39. The Hollidays’ experience is a case study in …

Doctors need to fix the health care system that they had a hand in breaking

Kevin

Health Policy

October 16, 2009

by Daniel A. Graubert, MD

Medicine has changed so dramatically since I graduated medical school in the 1980’s, that it is hardly recognizable.

Certainly, there has been an enormous growth in knowledge which is often beneficial, but has often led us down the wrong path. For example, when advanced imaging techniques such as CT scans and MRIs became available, we were able to see the inside of large numbers of patients …

Embracing the change coming to our health care system

Donald Tex Bryant

Health Policy

October 15, 2009

As Bob Dylan sang so long ago, The Times They Are A-Changin’. Some like change; some do not.

Consider these change scenarios:

* One of the important scenes of change for health care providers is the national debate on health care coverage currently playing out in Washington D.C. Some are very vocal in their support. The media covers many of the vocal opponents. Certainly some sort of change will come out of …

How health care reform can improve public health

Kevin

Health Policy

October 13, 2009

by Paula Hartman Cohen

Have we overlooked the public health aspect of health care reform?

In the health care reform debate, we’ve heard and read how health care reform will or will not work, what it will or will not cost, and how it will or will not impact each one of us as individuals.

We’ve also heard from those who have great faith in our current system, and sincerely believe we should …

Does the Max Baucus health reform plan do enough for doctors?

Glenn Laffel, MD, PhD

Health Policy

October 10, 2009

Max Baucus’ decision to release his solo album—subtitled the Senate Finance Committee’s proposal on health reform—was timed with the precision of a 4th grade marching band.

Physicians could live with that, but the bill contained gornisht on tort reform and not much more than that on Medicare reimbursement. Upon seeing that, the Long White Coats reacted as if they’d seen earwax on their stethoscopes.

“The feeling of most doctors is that …

AMA: Permanent repeal of the Medicare physician payment formula must be part of health reform

Kevin

Health Policy

October 8, 2009

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

All eyes are on the Senate Finance Committee this week as they prepare to vote to move health reform legislation forward. The AMA is committed to health reform, and as the process moves to the Senate floor, it’s crucial that the Senate include permanent repeal of the current Medicare …

CBO cost analysis of the Baucus health reform plan

Kevin

Health Policy

October 7, 2009

Originally posted in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

In its much-anticipated cost estimate, the Congressional Budget Office (CBO) said the Senate Finance Committee’s healthcare reform bill would cost $829 billion over 10 years and begin to drive down the federal deficit after that first decade.

The price tag is lower than Sen. Max Baucus’ (D-Mont.) previous …

When political discourse is like borderline personality disorder

Marya Zilberberg, MD, MPH

Health Policy

October 7, 2009

When I was a kid in Odessa my Dad and I went to see The Sound of Music at least 17 times in the span of 3 months. Remember that song sung by the nuns when Maria is late for the vespers, “How do you solve the problem like Maria?” One nun says “She’s an angel”, another one counters “She’s a demon”, when the voice of reason from Mother Superior …

Is incident reporting effective in reducing medical errors and increasing patient safety?

Robert Wachter, MD

Health Policy

October 6, 2009

When the patient safety field began a decade ago with the publication of the IOM report on medical errors, one of its first thrusts was to import lessons from “safer” industries, particularly aviation. Most of these lessons – a focus on bad systems more than bad people, the importance of teamwork, the use of checklists, the value of simulation training – have served us well.

But one lesson from …

Analysis of the Senate Finance Committee health care reform bill

Kevin

Health Policy

October 3, 2009

Originally posted in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

The Senate Finance Committee finished work on its healthcare reform bill in the wee hours of Friday morning, paving the way for a committee vote next week.

After considering hundreds of amendments, the committee is now waiting for a cost-estimate from the Congressional Budget Office (CBO) before it …

Health care reform analysis from a former insurance and hospital executive

Kevin

Health Policy

October 3, 2009

by Marie Cooper

I have been in senior executive management in both managed care and a major hospital system. I find the hysteria over “reform” bitterly amusing because it is so misdirected.

The real problem with health care in America? Greed, indifference and incompetence, pure and simple. But not in the places everyone is pointing.

Insurer side

Insurance companies have to maximize their revenue because they answer to their boards. They …

What the United States health care system can learn from Mexico

Kevin

Health Policy

October 2, 2009

by Esther Buddenhagen, MSW

I write as a lay person concerned about the gap between what many people should receive and what they actually receive. The question of good medical care for ordinary people is being buried not only by insurance issues but by failure to come to terms with what primary care should be about.

Even Atul Gawande, who is particularly good at making distinctions between good and …

A formula to help Congress with health care costs

Kevin

Health Policy

September 30, 2009

by Gary R. Gibson, MD, FACP

In his 2007 book Critical, Tom Daschle said lawmakers were “flummoxed” when attempting to craft specific reform legislation. They seem flummoxed again as they fail to recognize the primacy of the patient-physician covenant and try to analyze a complex problem without a suitable conceptual model.

The formula below represents a valid conceptual model describing health care costs.

“E” is expressed in monetary units …

What doctors can learn from patients in the health care reform debate

Wendy S. Harpham, MD

Health Policy

September 30, 2009

Two things are missing from the bustling conversations on health care reform jamming the Internet highway. First, where among the finger-pointing anecdotes and critical analyses of our “broken” American medical system are the stories and discussions of all that is right? Second, where is our sense of hope?

I’ve experienced American health care from an unusual, yet useful, vantage: that of a physician with chronically recurring cancer. From both sides of …

Will there really be an impending shortage of cardiologists?

Larry Husten, PhD

Health Policy

September 28, 2009

There can be little doubt that the lethal combination of aging baby boomers, the obesity epidemic, and the growing success of medical and interventional therapies for CV disease (resulting in more and more survivors of major events) is going to produce a flood of cardiovascular disease in the coming decades, and cardiologists in great numbers will be needed to care for these people.

However, that doesn’t mean that the message conveyed …

What does socialism have to do with the health care reform debate?

Kevin

Health Policy

September 24, 2009

by David Alway, MD

In thinking about socialism and medicine in the United States let’s adopt socialist point of view and ponder some logical conclusions.

Injustice Exists

The socialist notices that some people are starving, don’t have adequate shelter, or are relatively uneducated. He also observes that others are very well off, having access to the finest meals, enough money to buy grand homes and are well-educated. This state of affairs, …

Should soft drinks be taxed and be called a public health hazard?

Kevin

Health Policy

September 24, 2009

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Soft drinks and other beverages loaded with sugar should be taxed as a public health hazard, much as cigarettes are, a group of prominent medical researchers says.

Since extensive evidence ties sugary drinks to an epidemic of obesity and related health problems, such as heart disease and diabetes, they …

Health care reform protests and how fears and beliefs are exploited

Kevin

Health Policy

September 21, 2009

by Abraham Verghese, MD

The unfortunate politicians who have braved town hall meetings to talk about health reform seem to have been taken by surprise by the vitriol and volume of the push back. Yes, I know the audiences were marshaled and recruited to shout down the speakers but still the passion on display was genuine and not in the least surprising to me. What the President and our politicians should …

Is the public plan option supported by doctors?

Emily P. Walker

Health Policy

September 18, 2009

by Emily P. Walker, Washington Correspondent, MedPage Today

A solid majority of physicians favor creating a new public insurance option that would operate alongside existing private plans, according to a survey published online in the New England Journal of Medicine.

About 63% of doctors, across a smattering of specialties and in various geographic regions, support a public insurance option. That …