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.
As Republicans in the Senate are working diligently on the destruction of Obamacare, progressives in California are doggedly pursuing a distinctly opposite approach. The California single-payer bill (SB562), aims to expand health insurance coverage to all state residents regardless of income or immigration status. Just as Republicans at the federal level have tried to jam through their health care package without debate or adequate analysis of the downstream financial impact …
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The terrible execution of California’s single-payer attempt
Our national useless dialogue on the future of health care in the U.S. continues. Trumpcare has a long way to go before it potentially becomes law, so no one knows what it will finally look like. Obamacare is in a death spiral anyway. So the existing financing system will change no matter what.
But once again the two-party scream-at-each-other system is only talking about changes in health care financing. On one side, …
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This is why the dialogue on the future of health care is useless
Despite campaign promises from then candidate Donald Trump as well as from incumbent and new members of Congress to repeal and replace Obamacare, now almost six months into the Trump presidency, Obamacare is still the law of the land. Progress, albeit slow, was apparent this week as the Senate debated their version of a replacement, following the House doing the same two months ago.
Are either if these bills a true …
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A two-tier solution to the current health care quagmire
California’s state senate’s unipartisan passing of a sweeping single-payer health care bill, the Healthy California Act, has drawn attention to single payer as a solution to the decaying Affordable Care Act. The ACA decreased competition and plan availability in health insurance and leaves patients holding the bag of unaffordable premiums, deductibles, and copays. It’s no surprise that a majority of state residents Read more…
Single payer is not a cure for a broken system
Darlin Kpangbah receives free health insurance through Medicaid and is grateful for the coverage in case of accidents, such as when she tore a ligament in her leg a few years ago. “I feel like I’m injury-prone,” said Kpangbah, 20, who lives in Sacramento, Calif. Without insurance, she said, the injury “would’ve been huge to pay for.”
Young adults like Kpangbah were among the biggest beneficiaries of Obamacare, which helped reduce …
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There’s good and bad news for millennials in the Senate’s GOP health bill
“You’re a doctor. You’re a doctor. Goddammit, you’re a doctor, man! You’re a doctor, so say so, and that’s the message, and we’ll follow you,” Jon Lovett shouted to an audience member on Pod Save America. The listener was an internal medicine resident who, in early May, asked how young physicians could better advocate for their patients. I heard this before the House of Representatives voted on the American Health …
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Overcoming trainee mistreatment to advocate for our patients
As a physician, I often forget how much I know. But there are things that remind me just how different our own experience as doctors is from those who don’t spend their days and nights taking care of the ill.
I do a lot of work for television, helping writers and directors to create medically plausible stories and scenes. I used to get worried that I might get the dose of …
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It’s time to advocate for our patients to politicians
The Senate version of the Republican health care bill lays bare the priorities of America’s current political leadership. It is not pretty. The new bill demonstrates the Republicans’ entirely unbalanced view of government and fiscal policy, where monetary value trumps all other values, and where only the wealthy are worthy of a helping hand.
These are the new values of the Republican leadership as evidenced by the new bill. We once …
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What the Better Care Reconciliation Act says about America
President Trump told a group of Republican Senators that the House-based American Health Care Act is “mean” — and on this he surely called it right!
How else would one describe a bill that would take health insurance away from 23 million people, allow states to waive rules requiring insurers to cover people with preexisting conditions at no extra charge, and raise premiums and deductibles to the oldest and …
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The ACP leads the charge against the Better Care Reconciliation Act
Dear Senators,
I know that the plan is to meet soon to pass the latest GOP health plan. The Affordable Care Act (ACA), also known as Obamacare, failed with a price tag of over a trillion dollars. Yes, this faulty plan is not sustainable as is. Yet, your proposed plan is just a rehashing of the failed elements.
While you look at the economics and short-fallings, I look patients in the eye …
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If you want to truly fix a broken system, look at the patients
Any physician who firmly believes in the ethical principles of beneficence and justice will recognize the legislation recently passed by the United States Congress known as the American Healthcare Act (AHCA) as a moral travesty. The bill’s provisions to shift costs from the wealthy to the impoverished, diminish protections for individuals with pre-existing conditions, and strip away essential health benefits for patients are cruel measures that run directly counter to …
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Residency programs and medical schools must prioritize advocacy training
President Trump campaigned on repealing and replacing Obamacare. Congress, when campaigning for reelection every two years, promised the same. Yet Congress can’t seem to get the job done. First, they needed the House, then the Senate, finally the White House. All delivered to GOP control by the voters. With the reasonable expectation of repeal and replace.
Yet nothing from Congress but a dial tone. The House passed an Obamacare-lite bill, tweaking …
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The progressive argument for repealing Obamacare
Medicaid is the largest single health insurance program in the nation, spending more than $500 billion to serve the most vulnerable people with some of the highest need, including children, pregnant mothers, people with disabilities, the poor and the elderly living in nursing homes. Recent proposals to repeal and replace Obamacare – such as the American Health Care Act (AHCA) – would fundamentally change the Medicaid program. …
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Why Medicaid block grants won’t work
For years, health care reform has pursued the holy grail of higher quality at lower cost. I’ve always believed it’s achievable, and now it’s needed more than ever.
The U.S. health care system is failing. Costs continue to increase faster than our nation’s ability to pay, and the quality of our outcomes lag those of most other industrialized nations. People increasingly ask me what concrete steps could make a difference. The …
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Achieving health care’s holy grail: Improved quality at lower costs
While Thomas Jefferson may have written that “All men are created equal” in our Declaration of Independence, nothing could be further from the truth when it comes to health care in the United States. As a physician, I have pledged to ease suffering and heal those who are sick. However, I find that my job has become increasingly difficult over the last several years. The Affordable Care Act (ACA) has …
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A physician’s 4-point plan to fix health care
During my salad days, I — like a lot of physicians — thought I could take on the world. Despite working in a smaller, community hospital, our ER saw a lot of the same type of orthopedic trauma I saw during residency. And my young partners and I took virtually every case that came in except spinal trauma. We did this whether we were on unassigned ER call or not …
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Think you can do anything you set your mind to? Think again.
I once participated in a discussion about a research study that was drawing data from charges submitted to Medicare and patient outcomes. The head of the project was referring to the financial data as costs, and I simply asked, “Isn’t this really charges, what Medicare is being charged by the hospital?” The response was a sort of non-answer, and then the person concluded, “It probably doesn’t really matter whether we …
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Charges and costs aren’t the same thing
Single-payer health care remains the holy grail for Democrats seeking the ultimate in command and control government. Wealth redistribution on a previously unimaginable scale. The nanny state government controlling all aspects of everyone’s life, as few human activities don’t influence health in some way.
Congressional Democrats are locked and loaded with federal legislation expanding Medicare to everyone. Specifically, this bill would provide, “all individuals residing in the United States and U.S. territories …
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Will California be the third strike against single payer?
“Choose your battles carefully,” goes the old saying. My physician colleagues would do well to heed that advice. For the past several years, physicians in many states have been engaged in battles with nurse practitioners in their respective states who are seeking to remove antiquated regulations. These regulations preclude nurse practitioners from practicing to the full extent of their education, as recommended by the Institute Medicine report: Read more…
Doctors and nurse practitioners have to stop fighting
