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.
Because I wrote my book, I was recently asked to summarize the health care crisis. I have focused almost 25 years of research and writing about health care on what is happening on the ground, every day, with doctors and patients. I’m not an economist or financing expert or technology geek, so I can’t offer anything there. I am a practicing psychologist with advanced training in health care research …
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Those who try to solve health care don’t know the reality on the ground
In the long weeks since Valentine’s Day 2018, when those 17 students were killed in a mass shooting at Marjory Stoneman Douglas High School, justified outrage has flowed from all corners of society. In New York, high school students have marched through Manhattan streets. On Capitol Hill, others have protested for tighter gun legislation. Recently, at Stanford University, our medical community held a community health panel, titled “Gun Violence and …
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Let’s talk about guns as a health crisis
The Affordable Care Act (ACA), widely known as “Obamacare,” has survived several repeal attempts by Congress. Storm clouds, however, are still on the horizon.
The ACA’s individual mandate obligates every American to be covered by comprehensive health insurance. This requirement has been the most unpopular feature of the law. That’s because healthy people, especially those who are self-employed or between jobs, have found the ACA premiums too expensive.
They are not alone. Health …
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The skinny on skinny health insurance
The tragic case of Alfie Evans has roiled Great Britain and the world. Alfie was a two-year-old child in the United Kingdom with an unknown degenerative brain disease who eventually deteriorated to the point that he required life support. His brain had become mostly liquid, and he could not see, speak, or hear. Alder Hey Hospital decided his condition was terminal and irreversible and wanted to stop …
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The dangerous precedent of Alfie Evans
In the days after Hurricane Maria made landfall on Puerto Rico, four Yale physicians began an ambitious effort to send thousands of pounds of medical supplies to the storm-ravaged island. Despite having had no prior experience with disaster response, these doctors worked with contacts in Puerto Rico to generate a detailed needs-assessment, determining exactly which medical supplies were needed on the island. Using social media, traditional media, and professional connections, …
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Medical education in the era of climate change
I’m sitting in the waiting area across the endoscopy room of a major hospital. Mindless talk show TV runs in the background. Patients are waiting patiently. They anxiously look up every now and then from their phones towards the reception desk.
It’s a scene I’ve experienced for years while working in health care while waiting for doctors.
But there’s something different in the air now.
Patients, like those around me, will encounter a …
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Why some physicians thrive and some struggle to survive
Recently there was an article in the Washington Post titled, “Uber and Lyft think they can solve one of medicine’s biggest problems,” in which these two companies are angling to provide better, safer more reliable transportation for patients. While I applaud this mission, given the depth and reach of both companies, I think they may be underselling their abilities to improve health care delivery and reduce cost.
Recently, one of my …
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A better way of using Lyft and Uber in health care
As we continue to attempt to restructure how health care is measured, reimbursed and organized, we must hold true to the idea that health care is simply not a service commodity.
“A commodity is any good or service (“products” or “activities”) produced by human labor and offered as a product for general sale on the market.” Our health care delivery model continues to evolve as we move away from the fee-for-service (FFS) model …
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Health care is not a service commodity
Last fall, my nine-year-old daughter asked me to buy some extra lunch items at the grocery store because she and a friend of hers were going to take turns bringing in food for a classmate who couldn’t afford to purchase lunch at school. I was reminded of this conversation last week, when the school committee in my city voted to no longer deny middle- and high-school students lunch if they …
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Children shouldn’t worry about being hungry in school
Proponents of universal health care believe that health care is a universal human right, but is it a constitutionally-protected right, and if so, how does the U.S. Constitution compel the government to protect that right?
We can make the argument that the right to health care is indeed protected under the Ninth Amendment, which states, “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage …
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Does federal law violate our right to health care?
She said her insurance wouldn’t cover her oxygen.
I didn’t believe her. She needed it. She had an irreversible lung disease that made walking a block feel like a hundred-yard sprint. It was no trouble showing she needed it– her blood oxygen levels would drop below 85 percent with any activity (normal levels are between 95 to 100 percent). Surely this was a minor administrative hurdle. I told her I was …
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We can no longer tolerate an inhumane health care system
Why don’t doctors advocate for themselves? Or young doctors, at least. Maybe it’s because we’re bombarded with patient care, never ending-educational opportunities or the mountain of electronic medical records that still need signed.
Maybe it’s because it’s too overwhelming. Understanding and conquering the health care behemoth that organizations, third-party payers, and the government have created seems nearly impossible if you’re not already on your way to adding a master of health …
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5 ways young physicians can advocate for themselves
About 30 miles east of LA, on the quiet tree-lined campus of Claremont Graduate University, sunlight pierces the ornately covered windows of a lower-level classroom in Harper Hall. A glow is cast upon the 25 students of Dr. Debbie Freund’s health policy course; PhD candidates and practicing physicians among them.
Many of these bright young scholars will go on to take leadership roles in health policy, public health, IT and medical research. I …
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Stranger Things are happening in health care
Given the current state of health care, I have imagined the following hypothetical conversation between a patient and a doctor:
Patient: “Doctor, I’ve come to learn from reading somewhere that the current overarching goal in my care is for the signs and symptoms of my various conditions to be treated, but not the conditions or diseases themselves. Is this true?”
Doctor: “Well, you know, I would love to treat those conditions and …
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Is the physician-patient relationship becoming a provider-client one?
On March 24th, one of the largest demonstrations for gun control in U.S. history took place across the nation. Represented at the March for Our Lives were a diverse group of organizations and people, including young people affected by school shootings across the country, parents who have lost children to gun violence, members of law enforcement, teachers and educators and people exposed to community violence in urban neighborhoods.
I participated in …
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Why should health care professionals care about gun control?
Physicians are the building blocks of value-based care, yet the cumulative human and financial cost of our decisions are mostly hidden from us. Instead, our reality is analogous to being on a diet and a budget at a restaurant that doesn’t put prices or calorie counts on the menu.
We need and want cost transparency. A survey from Deloitte University discovered cost is a part of …
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A call for cost transparency
Let me warn you — I own guns. I love to shoot. And I’m a strong supporter of the Second Amendment. This may seem hypocritical coming from a doctor, but don’t shoot me figuratively speaking, of course — before I make my case. Any mass killing is a horrifying event. Any senseless death is riveting. Obviously, this goes without saying, but as a doctor whose purpose is to save lives, …
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Gun violence in America is a multifactorial problem
