I started my medical career late. Really late. By that time, I’d lived a few lives. I’d earned a boatload of initials. I’d changed husbands, languages, and continents. I’d written a useless novel, and I’d been a Mary Kay lady.
One day over lunch as I was looking for something to do with myself, my husband suggested medicine. I spent the next nine years immersed in my medical training, feeling guilty …
Why are we hemorrhaging emergency nurses?
With the 2020 election cycle already moving into high gear, we are hearing a lot about Medicare for all. But is it a serious campaign promise, a catchy bumper sticker or a viable national program?
Supporters suggest it will be a panacea for our nation’s health insurance needs. Others are less sure. And some are downright opposed. So where do we go? As a starting point, there are things we can …
Medicare for all: a campaign promise, catchy bumper sticker, or viable program?
One of the most popular topics in health care is the idea of universal health care coverage. You know the soundbites: “Medicare for all.” “Single-payer system.”
While universal coverage sounds desirable to many, some factors must be considered. In this post, I’m going to provide an aerial view of this complicated topic. My goal is to translate this issue into patient-friendly language that all of us can understand. This topic isn’t …
A framework to understand universal health care
Say you want to know which baseball players provide the most value for the big dollars they’re being paid. A Google search quickly yields analytics. But suppose your primary care physician just diagnosed you with cancer. What will a search for a “high value” cancer doctor tell you?
Not much.
Public concern over bloated and …
Want to find the best doctor? Don’t rely on price tags.
Jimmy McMillan might have been right. Mr. McMillan ran for mayor of New York City as the founder and candidate of the “Rent Is Too Damn High” Party. And while he was talking about real estate rent, he might have made a similar complaint about health care’s rent — payments made for costs over what is needed to produce a good or product.
Rent is not …
The rent is too high in health care
Rudolf Virchow, a pioneering physician of the 1800s, once wrote that “politics is nothing but medicine on a large scale”. Over a century later, this nexus is as apparent as ever, and many doctors engage as practitioners of both.
Twitter erupted this past fall with photos of soiled scrubs, resuscitation room floors and surgically-removed bullets — all crimson with …
For future physician-activists: This is our lane
My wife and I once canoed across a glacial lake. There were twelve people in our 30-foot canoe. To reach the shore of the Mendenhall Glacier, we had to paddle two miles across a lake. All twelve of us had to paddle together to reach the shore. But what if we had different goals? What if the right side of the canoe wanted to paddle east and the left side …
Health care workers and administrators aren’t rowing in the same direction
The evolving politics of single-payer health care conflate the concepts of universal coverage, health care on demand and free health care. To the indiscriminate progressive mind, all three are part of the holy grail. The fly in the ointment is that highly attractive and altruistic politics runs into the brick wall of reality. As Thomas Sowell — a noted Stanford economist — wrote: “The first lesson of economics is scarcity: …
Medicare for all and the problem of health care on demand
Pay for performance (P4P) is all the rage in health care. Big Pharma led the way, and the popular press would have you believe that one can “incentivize” physicians and their clinical colleagues with as little as a sandwich and a bag of chips. Corporations have used bonuses, stock options, and commissions for years as motivators. And the government and insurance companies, although late to the party, are all in …
This article is sponsored by Careers by KevinMD.com.
The #MeToo movement exploded into the national spotlight in October 2017 with The New York Times exposé of sexual abuse allegations against Hollywood media mogul Harvey Weinstein. It has since encouraged thousands (if not hundreds of thousands) of people to come forward and share their stories of sexual harassment, sexual assault …
#MeToo: A culture change is needed in health care
Medicare for all is one of the leading campaign issues among the Democratic presidential candidates.
Michigan Rep. John Conyers first introduced the idea in Congress in 2003. It went nowhere, but as the one-time party of JFK morphed into something much further left, Medicare for all rose from the dead.
Medicare for all promises universal coverage, so that no one is without insurance. Unfortunately, it is cost prohibitive, costing as much as …
Instead of Medicare for all, how about Medicare for more?
This past June, California’s Department of Healthcare Services went live with the implementation of its non-medical transportation (NMT) benefit. NMT is described by the National Health Law Program as “transportation provided to access medically necessary services, which is provided by ordinary forms of transportation (public transportation, taxi, or any other forms of public or private transportation).” While transportation as a benefit has long existed under California’s Medicaid program as …
Non-medical transportation for postpartum moms is a necessity
According to the NASEM report, half of women medical students experience sexual harassment before they start their careers as physicians. The numbers are even higher for people belonging to minority groups. This harassment is generally overlooked and tolerated, and as injurious as it can be, these women often have to suck it up, keep it moving, and accept it as “part of …
A student doctor says, “Time’s Up”
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Thirteen years ago, as a student in New York City, I marched across the Brooklyn Bridge to implore my colleagues to fight for universal health care. That day, I enunciated what has become my personal mission by saying, “We need universal coverage that is portable. We need universal coverage that is comprehensive. We need universal coverage that ensures equal access to care. Most importantly, we need you — to lead …
A path to universal health coverage in America
Older surgeons are coming under increasing scrutiny as their competence and ability to practice medicine are called into question especially since many continue to work in their 60s and 70s. The New York Times addressed this in a recent article entitled, “When is the surgeon too old to operate?”
They described an 80-year-old chief of vascular surgery at a New Jersey hospital who was the first doctor evaluated by a …
Why is age only a concern regarding surgeons, and not government officials?
Over the past year, multiple mega-mergers were announced in health care. The four largest ones being:
1. On March 18, 2018, Cigna announced that it was acquiring Express Scripts for $68 billion in cash and stocks. The deal was closed on December 20, 2018.
2. On December 3, 2017, CVS announced that they were acquiring Aetna for $69 billion in cash and stocks. The deal was officially closed on November 28. …
Doctors and patients should be wary of health care mega-mergers
Children are relatively healthy overall. Although 25% of the American population is under the age of 19, only 2% of annual deaths occur in this age group. There was a time when the contributions of diseases to pediatric death rates were much higher. Declines in deaths from infectious disease or cancer, the result of early diagnosis, vaccinations, antibiotics, and medical and surgical treatment, have given way to increases in deaths from …
A disturbing study about children and guns
Imagine you’re a CEO in charge of a health care organization with thousands of physicians and 19 hospitals.
Overall, the quality of care delivered is good. Prices and costs are low. But there is a problem: Patients rate your service below average. Making matters worse, a swarm of low-priced competitors have moved in, challenging your market share. You’re going to need to improve patient satisfaction to survive. What do you do?
About …
The folly of using money to improve health care quality
Diagnostic errors (missed, delayed, incorrect diagnoses) are increasingly being recognized as a prevalent cause of harm to patients. At the same time, physicians are simultaneously under pressure to deliver high-quality, low-cost health care. How do physicians come to a balance between the competing demands of addressing underuse versus overuse, and consequently a balance between underdiagnosis from inadequate investigations versus overdiagnosis and resource waste? Can physicians learn from hearing about their …
How should physicians hear back about their diagnostic errors?
Like many accountable care organizations, Austin Regional Clinic (ARC) in Texas is building a record of success on the Medicare Shared Savings Program’s (MSSP) so-called “Track One.” Now looming, however, is an automatic transfer of ARC to the MSSP’s riskier “second track” after years of hard work implementing our value-based, population health treatment model.
On the first track, ARC and other ACOs assume “upside risk,” getting rewarded for taking on overall …
CMS risks ACO success by forcing move to another track
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