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.
American doctors are unhappy about a lot of things. Americans, in general, are unhappy about a lot of things. In many ways, both groups share similar concerns. But the road back to happiness may follow a similar path for both, as well.
American doctors once felt part of something special. American health care, by reputation at least, was the best in the world, and we were its proud emissaries. We functioned …
Read more…
How to unite doctors in these divided times
The two biggest sources of frustration for the majority of physicians are the EMR systems and bureaucracy within the work environment that physicians are forced to deal with daily. EMRs are a ship that has sailed, unfortunately, and our only option currently is to try and improve this situation.
However, the bureaucracy and administrative burdens that physicians encounter are issues that we should challenge, and I feel single payer is a …
Read more…
Here’s why this doctor came around to single-payer insurance
At this time in history, it may serve us well to reflect on the tortuous past, the harrowing present and the unpredictable future of health care in America.
First and foremost we must recognize we do not have “a health care system” — rather our health care is delivered in an uncoordinated, misaligned and exorbitantly expensive fashion. For example, 1 in 5 Medicare patients are readmitted to the hospital within 30 days of discharge, …
Read more…
Health care in American is on life support, and the future is uncharted
As a physician, I am often discouraged when I turn on the news and read about the state of health care in our country. I can see all 397 sides of the debate and some truth in all sides. The enormous cost of medicine is overwhelming to comprehend for patients and families and even to those of us in medicine.
I think it is important to know all that goes into …
Read more…
This is what to remember in health reform: We are all one patient
As is customary for every administration in recent history, the Trump administration chose to impale itself on the national spear known as health care in America. The consequences so far are precisely as I expected, but one intriguing phenomenon is surprisingly beginning to emerge. People are starting to talk about single payer. People who are not avowed socialists, people who benefit handsomely from the health care status quo seem to …
Read more…
A single-payer system is the American way
I told you so. I also told the POTUS in my open letter, but he did not read it.
Who could honestly believe the nation would support dumping coverage for 22 million people? As David Leonhard wrote recently op-ed in the New York Times: “They [Republicans and President Trump] had only one big weakness, in fact: They weren’t dealing in reality.” When faced with reality, it is interesting what a few good …
Read more…
Health reform is stalled. Here’s how to do it right.
Two seemingly unrelated national policy debates are afoot, and we can’t adequately address one unless we address the other.
Health care reform has been the hottest topic. What to do about America’s aging infrastructure has been less animated but may be more pressing.
Yet even as cracks in America’s health system and infrastructure expand, political divides between parties and within parties have stalled efforts to develop policies and implement solutions. Problematically, debates …
Read more…
Bridges and roads are also important to your health
When I began my career as a physician in the late 1990s, I was relatively apolitical. Since then, as our health care system has crumbled, and as its demise (and our repeated failure to fix things) has increasingly affected my patients and my practice, I have become very political. In 2008, I began giving lectures in the community in support of a single-payer health reform model. My political leanings tend …
Read more…
Would single payer work? The real devil is in the details.
Health – /helTH/ – The state of being free from illness or injury
Care – /ker/ – The provision of what is necessary for the health, welfare, and protection of someone or something.
System – /’sistəm/ – A set of things working together as parts of a mechanism or an interconnecting network.
It’s not keeping us Healthy, it doesn’t seem to Care, and it’s certainly no kind of System. What we’re got is …
Read more…
Health reform: It’s time for Congress to grow up and do their jobs
We are a nation divided. Our two major political parties agree on essentially nothing. Republicans cannot agree even amongst themselves how to proceed on health care reform. It is demoralizing that even though U.S. health care has sunken to last among developed nations, our elected leaders are unable to envision or agree upon any effective solutions. We could all use a win. When it comes to health care reform, administrative …
Read more…
Health reform should simplify our health system. Here are some ideas.
Much has been written in recent weeks about the failure of direct primary care giant and pioneer Qliance. Much of the conversation has examined the reasons for their closing and the negative impact it will have on the direct primary care movement. Questions have been raised about the longevity of the movement, with many exclaiming that “If they can’t sustain it, no one can.”
While I don’t pretend to know all …
Read more…
Forget what you’ve heard. Direct primary care is here to stay.
Any backpacker traveling on a shoestring in Thailand knows not to blow their entire budget on premium whiskey in a premium hotel on the first night in Bangkok. Rather, you need to skip the occasional meal, stay in a cheap dorm with random strangers and drink cheap beer on Khao San Road if you wish to see the country and return home without having to wash dishes in a restaurant …
Read more…
The chargemaster is health care’s most evil component
The need for what we are calling medical “quality” is acute, yet the strategies employed to obtain it are destroying medicine. Patient outcomes are inconsistent, care varies depending on many factors outside of disease state, and the cost of our medical system is not sustainable. But to fix this, most health systems employ non-clinicians to audit charts while checking boxes such as “A1C<8%?” and “DVT prophylaxis ordered within 24 hours?” …
Read more…
5 steps to create medical quality without trying
Can politicians fix our health care system? Sure, but they and everyone else trying will have to realize what our political leaders have voiced, but not seen that the system is complex and the truth behind Einstein’s statement that we cannot fix a broken system using the same thinking that created it. The lack of those elements is why we are still stuck. Rather than repeating the arguments of the …
Read more…
Less mechanical and more complex thinking equals a health care fix
As our new president has said, health care is complicated. Republicans call for Obamacare’s repeal, but are hard-pressed to come up with a workable alternative. Democrats recommend improving Obamacare, but are largely silent as to how they would do that. Americans are caught in the middle of this apparent health care quagmire. But for America to flourish as a nation, a solution must be found.
To start, we must frame the …
Read more…
Health reform everybody could love
This week at each of our hospitals, a woman gave birth to a baby with a severe heart defect. Twenty years ago, these babies may not have lived. Today, after complex surgery and specialist care, each will go to school, live a normal life. The “medical miracles” that saved these infants — and that could save the child of someone you love — were perfected with support from Medicaid. New …
Read more…
All children need Medicaid
I was thinking of giving politics a break for my next column, instead focusing on some interesting news in the medical world. But alas, politics has permeated all aspects of life, whether professional sports or the latest TV series.
Few television shows don’t have a same-sex couple or transgendered individual. Sports news can’t avoid discussions of race, climate change or gun control. What about the medical world? Is that too overrun …
Read more…
Politics distracts physicians from taking care of their patients
I already know I sound like a broken record. Yet, I can’t fathom why I seem to be the only person talking about this. There have been numerous articles in both syndicated journals and the blogosphere about the many things wrong with the American health care system, including the overspecialization which we know leads to higher costs (but not necessarily better outcomes). Just as I feared, the New York Times …
Read more…
#Medicare4All won’t fix the problem
As our elected officials consider to weigh the future of our nation’s health care, I thought I would take the opportunity to share a few vignettes of patients that I’ve encountered this year who exemplify the way that access to health care can make the difference between life and death.
The undocumented immigrant with seizures. We recently met a young undocumented Californian in his twenties in the emergency department, who came after …
Read more…
This is why access to health care matters
