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.
Before I went to medical school, I had little interest in politics. It wasn’t that I didn’t care about my country; I spent seven years serving in the United States Navy and have always taken pride in being an American. I suppose the reason for my political apathy was because things had always gone pretty well for me.
I grew up in a conservative, upper-middle-class family with two working parents. I …
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Patients made this doctor care about politics
The most common dividing lines in the national discourse on health care reform simply miss the mark. If one looks beyond the partisan posturing, each side has valid points, but also glaring weaknesses. We may need to work together to get health care right.
I was recently invited to a political gathering to discuss health care reform. The room quickly divided along traditional lines.
From left of the political spectrum, there were …
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Both markets and the government are needed to fix health care
178 measures.
This is what we’re up to — the collected compilation of quality and performance metrics for our ambulatory care network, across all the different divisions.
Where did these come from, who decided this is what we should measure, does anyone really have any idea if measuring these things reflects the true quality of the care our patients receive?
That’s a lot of questions all at once, and I’m not sure we’re …
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Do quality metrics really improve patient care?
When interviewing for my book, I asked about insurance, but the topic came up even when I didn’t specifically ask about it. It was never positive in relation to practice.
A doctor said, “I expected to be around tough and hard cases. I expected it to be hard. I did not expect to have to think if the insurance company will not pay for it.”Another one said, “This completely changes the …
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Insurance and the destruction of our health care system
It was nearing the end of my day at the mobile health clinic where I work as a nurse practitioner, providing free, comprehensive primary care to uninsured patients in central Florida. Clinic was officially over, and we were no longer taking patients; I was signing notes and finishing up some teaching points with a PA student when a woman walked up and asked me if she could “talk to me …
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The hidden work of primary care
If all politics is local, then Washington’s health care debacle has brought politics to the front stoop of every health care provider in America. There is no escaping it – debates taking place on Capitol Hill are set to affect the very survival of our patients. Irrespective of political leanings, doctors, nurses and providers of all stripes have ethical and professional obligations to speak up and become engaged in order …
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Doctors ignore politics? Not so fast.
Yet another round of attempted health care reform has come and gone, and once again, failed. And so, the traditional open enrollment season for health insurance is upon us, and as usual, many Americans are facing outlandish increases in premiums, skyrocketing deductible amounts, and shrinking coverage. Americans are increasingly enslaved and endangered by the rising costs and the growing dysfunction. Fixing things is, to put things in the proper perspective, …
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Fixing health care requires putting patients and their health teams on top
As a trainee at a large private health system (residency) followed by a NCI-designed comprehensive cancer (fellowship) in two large metropolitan areas in the United States, I was not prepared to face the challenges of working at a university setting affiliated with a county (public) hospital in more rural west-Texas. After one and a half years of experience as a practicing urologic oncologist, these are the five challenges I have …
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5 challenges of working in a county hospital
Eat what you kill.
Sounds like a mantra from a survival reality show, right? Akin to “eat or be eaten,” “kill or be killed.” It’s also a common reference to the prevailing business model in our American scarcity-minded, competition-driven, fee-for-service health care culture. How ironic, the application of these words to this profession. It was explained to me essentially as: “Every man for himself, and you’re a minion. You are expected …
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Can universal health care and capitalism coexist? Yes, here’s how.
When Aneurin Bevan was asked how he convinced doctors to come on board the National Health Service (NHS) he allegedly replied, “I stuffed their mouths full of gold.” Bevan recognized that to conscript doctors to the largest socialist experiment in health care in the world he had to appeal not so much to their morals, but their pockets.
There is much piety about the NHS. It is the envy of the …
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The real reason why the National Health Service survives
On September 30th of this year, the Children’s Health Insurance Program (CHIP) ran out of federal funding. While CHIP has not received as much publicity as the Affordable Care Act (ACA), it has had a major impact on the American population: providing health insurance for 9 million children who would otherwise not be insured. Despite its success, there is currently a debate about the funding of CHIP.
CHIP, which was passed …
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There shouldn’t be a debate about funding CHIP
The truth about change in health care was never more perfectly captured than in an episode of Sex and the City, when Carrie Bradshaw lamented that we keep “should-ing all over ourselves.”
In the past decade, those of us on the front lines of health care have seen the passage of nine major pieces of federal legislation that, combined, have profoundly affected how they work. We’ve seen the number of people …
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5 shifts to move health care in the right direction
Baseball, like medicine, is deeply imbued with a sense of tradition, and no team more so than the New York Yankees, disdainful of innovations like placing players’ names on the backs of their jerseys and resistant to eroding strict standards related to haircuts and beards.
It’s why doctors and patients alike should pay special attention to why the Yankees parted ways with their old manager and what they now seek instead. In …
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What baseball can teach doctors
Over the past several years there have been numerous reports on the rates of death and injury in children with firearms. In fact, a 2-year-old child recently accidentally took his own life in Philadelphia recently. Although the studies don’t entirely agree, two things are certain; 1 death is one too many and children don’t need to exercise their second amendment rights.
The United States has by far the highest rate of …
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Do children need to exercise their Second Amendment rights?
Following a relatively routine doctor appointment, I received my bill for over $1,000. I rubbed my eyes, hoping to find an overlooked decimal point. I didn’t.
My experience is not unique. We have a problem in the U.S. We pay over $3 trillion annually for health care — about 18 percent of our GDP. No other developed nation spends more than Read more…
3 reasons why health care costs are rising
Growing up Republican, I have long believed in personal responsibility. In junior high school, when I observed close relatives who struggled with obesity, I vowed to never let myself get out of shape. (“Junior high” is what we called middle school back in the day.) When hip surgery gone wrong dramatically reduced my level of physical activity two and a half years ago, I cut back on what I ate …
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Who’s really to blame for the obesity epidemic?
A strange thing happened last year in some the nation’s most established hospitals and health systems. Hundreds of millions of dollars in income suddenly disappeared.
This article, part two of a series that began with a look at primary care disruption, examines the economic struggles of inpatient facilities, the even harsher realities in front of them, and why hospitals are likely to aggravate, not address, health care’s rising …
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Hospitals are struggling and the future is grim
