Why are there vending machines in hospitals? This seems like an odd question to ponder, and it certainly would seem to have nothing to do with the current state of medicine and health care in our country. But it is a question that I am having a hard time wrapping my brain around. Certainly, most hospitals do have vending machines that sell snacks and soda, and they are by no …
Why are there vending machines in hospitals?
It’s February 15, and our country has had yet another school shooting. Seventeen more kids are dead, despite multiple warnings that the perpetrator was high risk. No one wanted this to happen. Across the political spectrum, Americans are appropriately asking what they can do to prevent another shooting. Yesterday many asked for a day to mourn. They said, “tomorrow we take action.” Today is tomorrow.
My liberal friends are calling to …
5 things America can do today to reduce gun deaths
On September 5th, 2017, the Trump administration denounced the further implementation of Deferred Action for Childhood Arrivals (DACA) and called for its revocation in 6 months. Opponents quickly voiced their concerns towards the unjust decree. Now, the deadline is near and a heightened urgency to act is imperative. To encourage advocacy and help legislators understand the vitality of DACA-recipients, the following displays the power of the undocumented.
Days after news of …
The way doctors and hospitals are paid is undergoing a quick and quiet revolution in an attempt to control costs and improve health outcomes. Federal payers are driving this change from fee-for-service payments to reimbursements based on quality outcomes and measurements of clinical processes. This focus on clinical outcomes does not account for the deep inequities that drive poor health outcomes in the United States. Without measuring and paying for …
Health equity is the missing value in value-based payments
What happens when you place an entire nation’s health care in the hands of an overly-controlling, ineffective government bureaucracy and huge corporations whose mission it is to squeeze as much money from the system, no matter the cost, including people’s lives? You get the carnage that is the American health care system.
You get my week as a family doctor in the worst health care system in the world.
This week a diabetic patient who …
A week in the worst health care system in the world
The exploitation and bullying of medical students and residents can only be meaningfully understood in the broader historical context of the New Deal’s dismantling and the destruction of the middle class that has followed in its wake. Moreover, it is fallacious to look at this inhumane treatment as something that happens only within the confines of the medical profession. For these exploitative working conditions have in fact become the norm …
The way we treat young doctors is barbaric
With over 300,000 opioid-related deaths reported since 2000 and two million patients battling addiction today, it’s evident that more qualified medical providers are needed to care for substance abuse patients. Psychiatrists and addiction specialists are struggling to meet the demands of this high need population. The good news amid this national health care epidemic is that more than 1,200 certified PAs practicing in psychiatry work hard to help fill these …
Fight the opioid crisis with physician assistants
The most profound health care legislation enacted since the Affordable Care Act, The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a huge mistake. It adds another vast layer of bureaucracy to a health care system already overburdened by such things, and penalizes physicians who take care of the most complicated patients. The head of the Centers for Medicare and Medicaid Services (CMS), who administer the program, admits …
Doctors must take a stand and force the government to cancel MACRA
“Of all forms of inequality, injustice in health care is the most shocking and inhumane.”
– Martin Luther King, Jr.
I am very strongly of the opinion that equal access to quality health care should not be regarded as a privilege but rather ought to be viewed as one of the most basic right afforded to all. Much of the industrialized world agrees with this notion based on the infrastructure of health …
Exploring 2 roads to universal health coverage
In early September, the New York Times Upshot published a bold piece titled “The Best Healthcare System in the World.” The article brought together prominent health economists and physician experts to judge the health systems of the world in a head-to-head tourney to determine which health system deserved the prestigious title. The article, published at a time of intense policy debate concerning the U.S. health care system, …
Health care debates could use a healthy dose of ideal theory
I finally finished reading the many journals piled up on my dining room table, which have been shunted to other flat surfaces for projects or the visits of friends. I didn’t read them all well, but I touched them all and read what interested me.
The early October edition of the Annals of Internal Medicine particularly caught my eye. There were two major articles that looked at determinants of health in …
Health suffers when ground down by poverty
In a research article published in Annals of Internal Medicine, investigators studied performance in Medicare’s Value-Based Payment Modifier program (VM) — a prominent pay-for-performance (P4P) program that adjusts providers’ Part B payment rates on the basis of their performance on a set of quality and cost measures. The authors were interested in 2 questions: Is engagement in VM associated with changes in provider performance on quality or cost measures? Does …
Pay for performance: Have we gotten what we’ve paid for?
In the early 1960s, President John F. Kennedy said, “The time to repair the roof is when the sun is shining.” It was a clarion call, a full-throated warning against national complacency in an era of great prosperity.
It was during this same period that community hospitals stood as the dominant force in American health care. By the mid-20th century, some 6,000 inpatient facilities had spread throughout the country, often serving …
Why hospital mergers are destined to fail
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Isn’t getting cancer bad enough?
That’s the frustrated thought that goes through my mind when I see patients with cancer suffering — not from their cancer, but from the failure of the health care system.
Take Nancy,* a 60-year-old woman with hormone-positive breast cancer. When she came to the emergency room with a fungating breast mass, we knew …
Obstruction of medical justice: How health care fails patients with cancer
Americans witnessed the many failed attempts of our elected officials to reform our broken health care system over the past year. Some call for repealing and replacing the Affordable Care Act (ACA) while others think it is the cure-all for what ails our system. The simple fact that politicians fail to consider is the fact that having health care coverage does equate to actually receiving health care services.
In fact, the …
If politicians really want to address the problems in health care, this is what they should do
Newborns born in 29 other countries of the world have life expectancies exceeding 80 years; yet, an infant born in the U.S. in 2016 is expected to live only 78.6 years according to recently released statistics. While death rates fell for 7 of the 10 biggest killers, such as cancer and heart disease, they climbed for the under-65 crowd. The irrefutable culprit is the unrelenting opioid epidemic.
Last year, life expectancy …
Can the dwindling numbers of primary care physicians explain decreased life expectancy?
Many medical schools don’t encourage political thought in their students, far less nurture it. That’s a shame because it squanders an opportunity to equip future thought leaders to deal with serious concerns facing the U.S. population, many of which have their tentacles in politics.
In “Experiencing Politics,” a memoir about his 12-year stint in the …
Should medical school encourage political thought?
Ever wonder what health care really means and why it’s even used? When you’re sick, do you need health care or a doctor? Maybe as physicians, we need to ask the same about the words “health care provider.”
On April 11, 1993, The New York Times editor William Safire commented on the attempt at the time to label physicians as providers:
As a physician, I am somewhat distressed …
Why health care replaced physician care
Recently, pharmacy giant CVS agreed to purchase Aetna for an astounding $69 billion dollar sum. The company allegedly plans to reduce health spending by developing an integrated system touted as “a new front door for health care in America.” This merger is actually an acquisition, entailing transfer of ownership. The central aim of an acquisition is to increase market share, expand the scope of services provided, and improve financial …
The CVS-Aetna merger: millions of lives hang in the balance
There are many apt comparisons to be made between aviation and health care. As a (lapsed) instrument-rated pilot, I may have some insight about the system in which planes function on a daily basis in the United States. It is truly an impressive system which is (to paraphrase Don Berwick) well-designed to achieve the safety results that it does. However, the kind of statement that some health care safety leaders …
Health care and the airline industry have a lot in common
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