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.

The climbing rates of maternal mortality in Black women

Shani R. Scott, MD

Health Policy

December 9, 2019

To put it simply, I’m scared by news headlines and conversations about the climbing rates of maternal mortality among Black women. I’m not surprised, however. As an internist, I regularly marvel at the advances that have been made in Western medicine, yet I pause and wonder why, in our profession, we continually get this mortality issue wrong.

The conversation about the state of Black women’s health has reached a …

The gender imbalance in nursing

Cole Edmonson, DNP and Paulette Anest, RN

Health Policy

December 9, 2019

The gender imbalance in nursing, our nation’s largest profession, is a slow-to-change and complex problem steeped in stereotypes, economics, unconscious bias, power, and privilege in health care and society. Along with other diversity gaps in the nursing workforce, gender imbalance is another missing piece to achieving the highest quality patient care. Solving the gender imbalance could accelerate the profession in reaching its full potential.

Diversity improves quality

Addressing the gender gap represents …

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The gender imbalance in nursing

Gun violence is a public health crisis

Ton La, Jr., MD, JD

Health Policy

December 8, 2019

Every day, 100 Americans are killed with guns. Forty-four percent of American adults report knowing someone who has been shot.

As a society, we have come to accept gun violence as commonplace and not something to take immediate action on. We hear about a new mass shooting on the television, on social media, on the radio or from a friend. We shake our heads in disbelief, ponder on how this is …

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Gun violence is a public health crisis

Why are we failing to solve burnout?

Baird Brightman, PhD

Health Policy

December 7, 2019

How would you make sense of the following vignette:

Over a 40-plus-year period, a disease (“X”) is diagnosed, its causes are defined, and effective treatments are prescribed
30-50+ percent of people working in your organization are currently suffering from X and cry out for relief
The stakeholders in your organization not only fail to apply best practices for preventing/curing X; they actually enable the drivers/vectors of the epidemic to intensify

As …

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Why are we failing to solve burnout?

A perk of Medicare for all: More time for doctors and patients

Rani Marx, PhD, MPH and James G. Kahn, PhD

Health Policy

December 6, 2019

Health care reform dominated the past three democratic presidential debates: twice as much time was spent as on foreign policy or climate change. Yet discussions of health care financing miss one critical issue that patients and providers desperately care about: sufficient time to communicate with each other.

Presidential candidates focus on cost, policies, and logistics of implementation. But no one talks about how proposed plans will fix …

What would an optimal government-run health care system look like?

Taylor J. Christensen, MD

Health Policy

December 5, 2019

Next in a series.

The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating the five jobs we expect a health care system to do for us and then identifies which parties in the health care system (providers or insurers) have a natural incentive to fulfill each of those jobs. Those incentives arise naturally, but the big challenge …

There is a profound lack of self-esteem in the medical profession

Vincent M. Proctor, PA-C

Health Policy

December 4, 2019

I have noticed a profound lack of self-esteem in our profession. I am concerned. Concerned for us, and for our patients.

We are the most noble of professions. However, we have compromised our morals, values, ethics, and virtues. We are now living, operating, and existing in a constant state of contradiction. It is tearing us apart from within.

We continue to work for less, with fewer resources and ancillary staff, all while …

What would an optimal single-payer health care system look like?

Taylor J. Christensen, MD

Health Policy

November 29, 2019

Next in a series.

Is it finally time for wage insurance?

Kunal Sindhu, MD

Health Policy

November 28, 2019

America sits at the precipice of a crisis.

Automation has resulted in significant job losses — 47 perent of existing American jobs remain at high risk of being lost in the future. And at least some voters may have been reacting to automation in casting their ballots for Donald Trump in 2016. Yet, with the American politerati fixated on …

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Is it finally time for wage insurance?

What would an optimal libertarian health care system look like?

Taylor J. Christensen, MD

Health Policy

November 21, 2019

Next in a series.

In prior posts, I described my Healthcare Incentives Framework. If you haven’t read those, I recommend you check them out first to have the full context for this post. But here’s a refresher of the main points of the framework without re-explaining all the rationale:

The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating …

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What would an optimal libertarian health care system look like?

Where have all the doctors gone?

Valerie A. Jones, MD

Health Policy

November 17, 2019

As my husband passed the milestone birthday of 40, he thought it would be a good idea to get a physical exam as it had been several years since he saw a physician. Easy task, right? We soon came to find that the landscape of health care had been changing even faster than we thought.

We had just moved and needed to establish care in a new area. Multiple phone calls …

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Where have all the doctors gone?

The health effects of structural racism

Niran S. Al-Agba, MD

Health Policy

November 15, 2019

In the United States, the health of African-Americans lags behind most other racial minority groups. Compared to whites, black men and women face higher risks of chronic illness, infection, and injuries. Taken altogether, the average life span for African Americans is six years less compared to whites. If we can begin to acknowledge that health outcomes are often dependent on factors outside of the control of individual patients, their physicians, or their health …

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The health effects of structural racism

The cure to our malignant health system

Deane Waldman, MD, MBA

Health Policy

November 15, 2019

An excerpt from Curing the Cancer in U. S. Healthcare: StatesCare and Market-Based Medicine.

Clinical doctors can readily understand the continuing failure of the U.S. health care system. The attending physicians for Patient Healthcare–Washington, both legislative and executive branches–keep …

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The cure to our malignant health system

Why physicians should start thinking about climate change

Janice Boughton, MD

Health Policy

November 14, 2019

Climate change. Global warming. The greenhouse effect. Devastating wildfires, dangerous air quality. Catastrophic weather events and mass human migration. It all sounds like post-apocalyptic fiction except that it’s real. Inside our air-conditioned offices and homes, it can still be possible to be optimistic. Maybe it’s nothing out of the ordinary. Maybe it isn’t our fault and would have happened without human activity. Maybe we don’t know what will happen and …

The biggest addiction problem in the U.S.? Health insurance.

Jeffrey Gold, MD

Health Policy

November 11, 2019

Whenever I give a talk about health care, I ask the audience, “What is the worst addiction problem we have in the United States?”

The answers are typically the same, and all are good guesses — alcohol, tobacco, opiates, and sugar are most frequently cited. I agree these are all terrible addictions that need to be addressed, but, in my opinion, the worst addiction in America right now is health insurance.

That …

How we can help our veterans die in peace

Diane D. Blier, DNP

Health Policy

November 11, 2019

The World War II veteran, now in his 90s and receiving hospice for end-of-life care, was playing military anthems on his harmonica for fellow veterans. But the next minute, reliving the horrors of combat, he grew agitated and started to cry. “Oh, all those bodies!” he suddenly called out. “Terrible, terrible! Oh, the bodies.” He finally blurted out what he had kept to himself for decades. Two days later, he …

The barriers to patients choosing higher-value providers and insurers

Taylor J. Christensen, MD

Health Policy

November 10, 2019

Next in a series.

I have developed a framework, which I call the Healthcare Incentives Framework, that helps me understand health care systems. It outlines the jobs we expect a health care system to do for us and identifies which parties in the health care system have the primary incentive to fulfill each of those jobs. This is helpful because, if we are unsatisfied with how …

Health coverage really isn’t covering much

Todd Rice, MD, MBA

Health Policy

November 7, 2019

I’m a healthy 48-year old, ASA physical class I anesthesiologist. At least I was healthy until an unintentional 20-pound weight loss over the summer, accompanied by an unquenchable thirst, insatiable appetite, blurry vision, and the bathroom frequency of an elderly prostatic.

My lab workup would reveal a fasting blood sugar of 310 mg/dL, an A1C >14, positive urine ketones, low C-peptide, and glutamic acid decarboxylase antibody (GAD-65) level that was off …

How to structure financial incentives in our health care system

Taylor J. Christensen, MD

Health Policy

November 2, 2019

Next in a series.

In my previous post, I explained the basics of my Healthcare Incentives Framework, which enumerates the jobs we want a health care system to do for us and links them to the parties in the health care system that have the greatest incentive to fulfill those jobs. If you haven’t read that post, I recommend you read it first. For those …

Parallel thinking won’t solve problems in health care

Paul Pender, MD

Health Policy

November 1, 2019

A lot of media attention, including television, print, and online sources, is focused on various plans to revolutionize the delivery of health care in America. Critics point to medical errors, waste of resources, and lack of access among the numerous factors requiring the replacement of our health care system. To many politicians and think tank experts, the combination of government support programs (including Medicare, Medicaid, and Social Security disability) plus …

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