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.
Single payer health care is enjoying a boomlet in public opinion.
A Pew Research Center poll released in June 2017 found that, “Overall, 33 percent of the public now favors such a ‘single payer’ approach to health insurance, up 5 percentage points since January and 12 points since 2014.” 58 percent of those surveyed by Pew said that the government has a responsibility to ensure health for all, with a third …
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Are physicians ready for single-payer health care?
We live in an era of demonization. Political adversaries are not opponents; they are villains. Commentary that contrasts with our views is labeled”fake news.” Presumption of innocence? R.I.P. Civil discourse has become a quaint memory. Why would one debate respectfully when today’s tactic is to talk over and demean your adversary?
On the morning that I prepared this post, I read an article reporting that one of Ohio’s largest insurance companies, Anthem, is denying payment for non-emergency …
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Denying payment for emergency care: a physician defends insurers
For more than 100 years, Americans have searched for a cure for health care inequality. Instead, we’ve been prescribed placebos: watered-down poverty programs and party politics.
Despite attempts to ease the pain with reforms like Medicaid and the Affordable Care Act (ACA), we continue to rely on a market-driven health care system. After stitching together the remnants of various poverty programs, we are left with a system so dysfunctional and freakish …
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A case for national health insurance
It has been well publicized that premiums for Obamacare insurance plans have been rising at a disturbing rate. Local news is filled with reports of 21.5%, 36.3% and even higher price hikes. President Trump complained in February that Obamacare premiums “have increased by double and triple digits,” even remarking that premiums in Arizona “went up 116% last year alone.”
If the cost of buying insurance were really …
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Obamacare prices are rising. But not for the reasons you think.
Public health and poverty go hand in hand, the latter oftentimes affecting the former. While the root of poverty is complicated, political, and rarely based on an individual’s capacity to succeed, it has more profound, long term effects that go beyond the bank account.
Consider a reality where wage theft — that is, nonpayment of wages to which workers are entitled — greatly contributes to low income. But it goes beyond …
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Low income is a neglected public health issue
“Philadelphia is a sanctuary where we can live in peace,” said Mrs. Lopez, a patient at a local clinic caring for the undocumented. “It wasn’t always this way, and we lived in constant fear,” she added, referring to Philadelphia’s recent adoption of “sanctuary city” policies, adopted also by dozens of other cities and counties across the country. What exactly are these “sanctuaries”? Whom do they protect? And why should physicians …
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What physicians should know about sanctuary cities
There is an accepted storyline in American health care that is so ingrained in our culture that it is almost beyond question. It goes like this. The chief culprit underlying the high-cost, low-quality American health care system is the traditional fee-for-service payment model, which rewards physicians for the volume of services they provide with no consideration for the quality of care being delivered.
The answer, the story goes on to say, …
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The bureaucratic myth harming American health care
As part of the interview for my book, I asked about the role that mental health plays in healthcare. Responses were unequivocal: It plays a vital role. All of these doctors have patients who are depressed, anxious, traumatized, or otherwise in need of mental health services. My doctor interviewees frequently added comments about lack of access to mental health services and insurance interference.
Refusal to pay is a big problem, according …
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A consistent and clear picture of significant barriers to mental health care
Dr. Pramela Ganji had just finished her lunch when she was told that the appellate court had reversed and vacated her conviction. At first, she didn’t believe it.
After all, this whole experience had been surreal. Dr. Ganji, a 68-year-old well-respected medical doctor and married mother of 3 children, had practiced medicine for 40 years without incident. Her patients loved her, and she had dedicated her life to helping others. …
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The unjust prosecution of physicians is not unique
I have worked with some great nurse practitioners (NPs) who I consider to be friends. They play a vital role in team-based practice. This is not about NP bashing. Nor is it a turf war; now that I’m retired, I have no turf to protect. I am a member of Physicians for Patient Protection out of real concern for the future of medicine in this country.
I want there to be …
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Are diploma mills hurting the nursing profession?
The state of medicine in America is a highly discussed topic today. The reports are rarely positive. Politicians battle for control over their vision for health care and predict doom and gloom if the other side “wins.” The cost of health care continues to rise for employers and employees. Physician burnout and dissatisfaction are on the rise. We hear from politicians, media outlets, and others on how to fix the …
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The patient-physician relationship is in critical condition
On a recent trip to urgent care for my child, I began to clearly see how the changes in medicine are affecting our patients and who is benefiting from the bottom line of what is occurring in the U.S. health care system.
A minor injury to my two-year-old son had me waiting patiently to be seen at a local urgent care center. Eventually, a nurse practitioner evaluated, correctly diagnosed and successfully …
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Do patients pay less for less expensive care? Why the CVS/Aetna deal matters.
Lots of mergers have been announced lately, but there’s still one transformative merger that will define and reshape the U.S. health care market in 2018: the CVS/Aetna $69 billion deal announced last December.
CVS is best known for its 9700 retail pharmacies and 1100 walk-in clinics, but its most significant profit driver is its pharmacy benefits manager (PBM) enterprise — a middleman between pharmaceutical manufacturers and dispensers like drugstores. The company …
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The CVS-Aetna merger is still the one to watch in 2018
Anyone who has ever tried to buy health insurance in the open marketplace knows how difficult and expensive it can be. I spent years working at jobs that did not provide health insurance, and I remember the annual feeling of dread when I received notice of the new premium increase. The only way I could keep the cost affordable was by continually raising the deductible until eventually, I was paying …
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Here’s why health insurance is different from other insurance
Camille’s dark glasses disguised a black eye she suffered falling from bed, cowering to take cover. Someone fired shots near her bungalow’s back window again, a routine rhythm of her slice of Chicago that she has heard for years now.
The 82 year old walks with a cane but carries a brick in her purse. She’s not afraid to use it on a badly behaving neighbor.
Most would think she has more …
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Racial disparities are dividing us in death, too
The recent announcement that Berkshire Hathaway, Amazon, and JPMorgan have joined forces to pare down health care costs has sent ripple effects across the health care space. The announcement sent stocks tumbling due to the uncertainty of what influence these companies will have on a deeply complex, unruly and wasteful health care system.
Said Berkshire Hathaway chair and CEO Warren Buffett: “The ballooning costs of health care act as a hungry …
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Will Buffet, Bezos, and Dimon be able to control health care costs?
CNN recently posted an article online, asking this very question. It was posed in the guise of our leading mega-billionaires, Warren Buffet, Jeff Bezos, and Jamie Dimon, “fixing” our broken health care system. In actuality, these three industry giants announced plans to combine resources to create their own insurance system for their combined 850,000+ employees. A nice gesture, to be sure, but not really a panacea for a nation of …
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Why is health care so expensive in the United States?
