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.

A poem for everyone fighting the health care system

Health Policy
July 21, 2026

The steel cage door slams shut.
Its metallic echo reverberates through the arena,
a warning bell for a contest already decided by those selling tickets.
Under the harsh lights stands the patient.
Thin, weary, clutching a stack of medical records
instead of weapons.
Across the cage wait towering opponents.
Corporate health systems, their muscles swollen
with profits and policies.
Government regulations, thick rulebooks
wrapped around their fists.
Pharmaceutical giants, draped in sponsorship banners,
their pockets heavy with the cost of survival.

The crowd …

Read more…

A poem for everyone fighting the health care system

Kentucky’s abortion ban has no rape and incest exceptions

Health Policy
July 21, 2026

In 2019, Kentucky lawmakers passed the Human Life Protection Act (2019 HB 148), a law designed to take effect if Roe v. Wade were overturned. On June 24, 2022, following the decision in Dobbs v. Jackson Women’s Health Organization, that law went into effect, banning abortion in nearly all circumstances. Today, the only exception permitted is for serious medical risk to the pregnant patient. There are no exceptions for rape …

Read more…

Kentucky’s abortion ban has no rape and incest exceptions

Physician moral injury, not burnout, is the real wound

Health Policy
July 20, 2026

“Have you seen The Pitt?”

This question has become commonplace; patients want to know if it is realistic, colleagues want to compare reactions, and many of us find ourselves dissecting the commentary on an imperfect health care system captured in weekly, one-hour installments that mirror physicians’ everyday reality.

The show does many things well: It is medically accurate, faithfully depicts interdisciplinary teamwork, and reveals the humanity and vulnerability of health care workers. …

Read more…

Physician moral injury, not burnout, is the real wound

The measure of medicine is outcomes, not prestige

Health Policy
July 18, 2026

Institutional credibility and clinical excellence are not synonymous. One is conferred by reputation; the other is earned through knowledge, compassion, judgment, and the trust of patients.

Hospitals, academic centers, and large physician groups have earned tremendous respect, and rightly so. But excellent medicine is also practiced every day in independent clinics, private practices, and community-based settings that exist outside traditional health care systems.

My own journey through medicine has given me a …

Read more…

The measure of medicine is outcomes, not prestige

Why medical malpractice claims cost more than ever

Health Policy
July 18, 2026

Medical malpractice claims are becoming more expensive, more volatile, and more consequential, even as overall claim frequency has decreased, driving up malpractice costs and rate pressure.

Actual medical malpractice claims frequency has declined from historic levels. In 2025, claims frequency was approximately 4.6 percent, down from 7.5 percent in 2016 and well below the roughly 17 percent average observed between 1991 and 2005. While physicians report fewer lawsuits than in the …

Read more…

Why medical malpractice claims cost more than ever

Why physician advocacy matters more than ever

Health Policy
July 17, 2026

When I started medical school, I pledged to take care of anyone who would walk through the door. I pledged not to discriminate between my patients and to advocate for them both inside and outside the clinic. Like many first-year medical students, I entered medicine with a certain idealism. I believed medicine was fundamentally about serving those who needed care most, and I assumed everyone around me would agree with …

Read more…

Why physician advocacy matters more than ever

How to fix health care without Medicare for All [PODCAST]

Health Policy
July 15, 2026
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Medicare for All keeps dying in Congress. So what would actually get the major players to agree on universal coverage? Health care journalist Ken Terry returns to lay out a different model, one …

Read more…

How to fix health care without Medicare for All [PODCAST]

Why change fails in health care organizations

Health Policy
July 15, 2026

The committee had met six times. The quality data was clear. The care pathway was evidence-based. The physicians in the room nodded. Six months later, nothing had changed.

Not because the initiative was wrong. Not because the physicians were resistant. Because the environment it landed in was never built to hold it.

This is the diagnosis most physician leaders never make, not about their patients, but about their organizations. They identify the …

Read more…

Why change fails in health care organizations

The question to ask after a hospital says it’s accredited

Health Policy
July 14, 2026

China now has more than 100 JCI-accredited hospitals, the same Joint Commission International standard many U.S. patients recognize from conversations about hospital quality. That number surprises people. It also invites a dangerous shortcut: “JCI-accredited” becomes shorthand for “safe,” “excellent,” or “the best place for my operation.”

Patients deserve a more careful answer.

JCI accreditation matters. I do not dismiss it. But it is not a guarantee of outcomes, technical skill, complication management, …

Read more…

The question to ask after a hospital says it’s accredited

Canada’s primary care investment is missing a North Star

Health Policy
July 12, 2026

Something remarkable is happening in Canadian health policy right now. After decades of incremental change, provinces and territories are making serious, sustained investments in primary care. These bilateral health agreements represent a genuine federal-provincial commitment, billions of dollars directed toward the kind of team-based, patient-centered care that Canadians have been asking for.

The people designing these investments care deeply. The intent is right. But when the accountability reviews come, how will …

Read more…

Canada’s primary care investment is missing a North Star

The corporatization of medicine, in salaries and beds

Health Policy
July 11, 2026

In the 1970s, the American hospital was, in the industry’s own language, an “open workshop.” A physician kept an office down the street, admitted patients to the hospital when they needed a bed or an operating room, and worked largely independent of whoever managed the building. The doctor made the medical decisions; the administrator kept the lights on and the ledgers balanced. It was an arrangement with obvious flaws (fragmentation, …

Read more…

The corporatization of medicine, in salaries and beds

How California can stop underage online gambling

Health Policy
July 5, 2026

As California voters decide between Xavier Becerra and Steve Hilton for governor, one growing public health concern needs more focus from both: the surge in underage online gambling. Easy access through phones and apps creates risks that could spiral if left unchecked. AB 2617, the Protecting Kids from Online Gambling Act, provides a practical starting point. Advancing, refining, and enforcing solid measures here should be a priority regardless of …

Read more…

How California can stop underage online gambling

How the happiest countries protect mental health

Health Policy
July 5, 2026

Mental health policy has gained increasingly earned attention in the last decade, and policy solutions are needed now more than ever. According to the 2016 Commonwealth Fund International Health Policy Survey, the United States has the second-highest rate of self-reported emotional distress among high-income nations. Among high-earning adults in these countries, those in the U.S. were the most likely to have been diagnosed with depression, anxiety, or other mental health …

Read more…

How the happiest countries protect mental health

ADVERTISEMENT

Private equity is reshaping concierge medicine

Health Policy
July 1, 2026

Nobody is asking this out loud. They should be.

Consider any mid-sized American city. A physician shortage that predates the pandemic. A growing population. Enough employer density to attract outside capital. A physician opens an independent concierge or DPC practice. The panel fills. The model works. The relationship medicine covenant holds.

Then the room changes.

Around 63 percent of physician transactions in 2023 were attributable to a PE firm or their portfolio …

Read more…

Private equity is reshaping concierge medicine

What’s missing from the tobacco harm reduction debate

Health Policy
June 30, 2026

Anyone who uses social media is likely to encounter messages about tobacco harm reduction. This information comes from multiple sources with varying and overlapping agendas. At one end of the spectrum, the World Health Organization and most public health authorities emphasize the risks associated with nicotine in all forms. Their primary concern is preventing nicotine initiation among adolescents and young adults, thereby reducing future tobacco-related disease. At the other end …

Read more…

What’s missing from the tobacco harm reduction debate

The pediatric oncology workforce shortage is widening

Health Policy
June 27, 2026

The U.S. health care system is facing a serious workforce shortage. In pediatric oncology, the stakes are especially high. But the issue is not simply a lack of available positions. Increasingly, it is a recruitment and retention challenge.

Recent pediatric hematology-oncology fellowship data shows that while training positions increased by 36.6 percent between 2009 and 2025, applicants increased by only 8.3 percent. During that same period, the applicant-to-position ratio declined …

Read more…

The pediatric oncology workforce shortage is widening

Hospital overcrowding makes safe care impossible

Health Policy
June 26, 2026

Twenty-five years ago, 15-year-old Lewis Blackman died following elective surgery at a respected South Carolina hospital. Since he was placed in a suboptimal ward that was inadequate for his condition, his health worsened from a perforated ulcer and overwhelming infection, warning signs were missed, family concerns were not adequately escalated, and life-saving treatment came too late. His death became one of the most influential patient safety cases in American …

Read more…

Hospital overcrowding makes safe care impossible

Why clinicians leave and why they used to stay

Health Policy
June 25, 2026

Health care keeps asking how to recruit more clinicians.

That question matters. But it is not the only one. We should also be asking why fewer clinicians are staying.

Across the country, health care leaders are sounding alarms about workforce shortages, access challenges, burnout, and turnover. The proposed solutions are familiar: increase reimbursement, recruit more clinicians, expand training programs, and improve efficiency.

All of those efforts matter. But much of the conversation still …

Read more…

Why clinicians leave and why they used to stay

Rural health equity starts outside the clinic walls

Health Policy
June 25, 2026

Health care is fundamentally broken when the patient has to choose between a day’s wages and a basic clinical checkup. In the rural landscape of California’s Imperial Valley, this is not a hypothetical dilemma. It is a daily reality for thousands of frontline agricultural workers and underserved families.

As a primary care physician operating independent clinics along the California-Mexico border, I have watched the conventional, centralized health care delivery system repeatedly …

Read more…

Rural health equity starts outside the clinic walls

Why health care leaders keep blaming the system

Health Policy
June 25, 2026

Every day in medicine, we hear a familiar refrain: “I want to do the right thing for my patients, but my hands are tied by the system.”

It is a comforting narrative. It casts doctors, administrators, and clinical leaders as helpless victims of an invisible and rigid machine. It positions them as casualties of a vast medical-industrial complex driven by insurance mandates, regulatory compliance, and predatory billing cycles. We shrug our …

Read more…

Why health care leaders keep blaming the system

157
pages