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.
A month into Donald Trump’s presidency, it is clear we are in for a wild and dizzying ride. As is typical in matters of opinion, post-mortem analyses on how we got here are frequent and varied.
However, I believe the Affordable Care Act was the iceberg which sunk Hillary Clinton’s ship. Sure, there were both real and fabricated scandals which dampened enthusiasm among potential Clinton voters. There were the emails. There …
Read more…
Obamacare cost Hillary the presidency
It won’t work.
Obamacare works for the poorest that have affordable health insurance because all of the program’s subsidies tilt in their favor.
Obamacare doesn’t work well for the working and middle class who get much less support — particularly those who earn more than 400 percent of the federal poverty level, who constitute 40 percent of the population and don’t get any help.
Because so many don’t do well under the law, …
Read more…
Obamacare was poorly constructed. The Republican plan is worse.
Rationing of health care services according to an individual’s ability to pay — or, as the case may be, the inability to do so — is becoming more prevalent in the United States, both in the public and private insurance spheres. Commercial payers, for example, increasingly require doctors to follow a complex and time-consuming authorization process. Recent surveys show that 75 percent of doctors complain about this often unnecessary step.
Insurance …
Read more…
Is health care rationing our only hope?
One of the popular critiques of the American health care system is that it is high-volume, low-quality, and that this is a direct result of the traditional fee-for-service approach to paying doctors for medical care. In the past, doctors and hospitals have been paid much the same way that we pay for other goods and services. When they provide a service, such as an appointment or a procedure, they are …
Read more…
Value-based pay is doomed to fail. Here’s why.
I can envision a comprehensive design for health care in the United States that will expand access and control costs while conforming to our shared national values of personal responsibility, care for thy neighbor and free enterprise.
After dozens of attempts to repeal, defund, delay or restrict Obamacare, the Republicans now have the opportunity to do all of the above. The problem is that it is not clear what should be …
Read more…
A comprehensive health care redesign for the United States
Imagine a smoking ban in the privacy of your own home? For over 2.3 million residents of public housing, this will be their reality. On November 12, 2015, former Secretary of Housing and Urban Development (HUD), Julian Castro, announced HUD’s policy for “smoke-free” federally funded public housing. The policy requires that residents refrain from “using tobacco products in their units, common areas, and within 25 feet of public housing and …
Read more…
How a smoking ban is regressive policy
Knee replacements are booming. Between 2005 and 2015, the number of knee replacement procedures in the United States doubled, to more than one million. Experts think the figure might rise sixfold more in the next couple decades, because of our aging population. Since many people receiving knee replacements are elderly, Medicare picks up most of the cost of such procedures. In response to this huge rise in expenditures, …
Read more…
The unintended consequences of bundled payments
I’m a member of the 25,000-strong medical school graduating class of Obamacare.
We were pre-med college students during the debate over the Affordable Care Act (ACA) and began medical school during its implementation. We put ourselves into deep debt and studied late into the night with the promise that we would practice medicine in a system that promoted insurance coverage, reduced medical bankruptcy, and incentivized high-quality care.
Increasingly, we see that promise …
Read more…
The Obamacare generation of physicians is ready to fight for patients
America’s health care system is broken and no longer works. Many practicing physicians are unhappy with the way insurance companies control medicine. Most patients are unsatisfied with the benefits they receive from the health insurance companies and with the lack of choice they have in who cares for them. Patients are frustrated with the exorbitant cost of prescription medicine. They wonder why this system often doesn’t allow them to receive …
Read more…
12 steps to make America’s health care great again
Health care costs are out-of-control, and many patients can no longer afford medical treatment. The system is broken, but no real fixes are visible on the horizon. Sure, politicians debate the road health care should take and act like they are very concerned about the health of Americans. Truthfully, however, they are driven by political agendas corporate influence. Little discussion is given to what it would take to fix the …
Read more…
Politicians can’t fix our health care system
It has come to pass: President Donald J. Trump. Are you scared? Are you planning to “resist” the policies you imagine President Trump will pursue by tweeting furiously with clever hashtags galore? Would you prefer to move my fastidious quotation marks from “resist” to “President”? This is, after all, the first President in a very long time to take office without the blessings and financial support of established “world order” …
Read more…
Here’s what’s really scary about Trump’s health care
Whether rejoicing or mourning, millions of Americans awoke on January 21st feeling suddenly at the threshold of a new and uncertain era. However, in public safety-net emergency departments across the nation — like Harborview Medical Center in Seattle, where we work — the service of healing continued seamlessly, paying no heed to the national drama that has unfolded for the past several months.
That day and into the night, there were …
Read more…
Don’t repeal the ACA without a replacement
It was 3 a.m. and 3 degrees outside, and I was about to discharge Mike from our emergency department for the third time in less than 24 hours.
“Doc, let me finish this episode,” he said, his eyes glued to the TV in the ER waiting room.
Mike was homeless, and this was our routine all winter last year, when it was too cold to sleep in shop doorways or the bridge under …
Read more…
We must be committed to putting patients over politics
Eight years ago when the tumultuous health care reform journey began, we couldn’t have imagined the roller-coaster ride it would take. The Affordable Care Act passing without a single Republican vote, surviving the Supreme Court ruling by the vote of a Republican-appointed judge, a disastrous roll-out of HealthCare.gov, thriving for four years with Obama’s re-election, and now its inevitable repeal with Donald Trump’s win.
So it may help to look back …
Read more…
What the ACA replacement must have
In hospitals today, administrators are eager to impose guidelines and metrics onto any facet of patient care they can measure. The sentiment that business people and clinical people are at odds flares with each new initiative. Clinicians feel ignored. Patients complain about how little attention they receive. Administrators try to distill complex pieces of information into smooth line items. We all spend as much time with computers as we do …
Read more…
Health care is teaching to the test
For much of her adult life, Cassie (not real name) struggled to get out of bed. Taking her kids to school, let alone showering or preparing meals was often more than she could handle. Cassie has bipolar disorder, and while she had health insurance through her employer, it did not offer mental or behavioral health benefits. The therapy and prescriptions she needed were too expensive. She was desperate, barely holding …
Read more…
Moving mental and behavioral health beyond parity
The problem with health care and drug prices in America isn’t that we spend too much money. The real problem is that we believe we are spending “other people’s money.”
Yes, I was raised in Sweden, but no, I’m not a Socialist. The irony is that “free” health care there is more clearly understood to be directly financed by local(!) taxes that can go up if people in that region consume …
Read more…
Health care needs a moral wake-up call
Cancer. The ominous word instantaneously triggers fear and anxiety. According to the American Cancer Society, cancer is the second most common cause of death in the United States, accounting for one in four deaths. Despite the attention cancer has garnered, an inequality exists. Patients without Internet access may not learn about possible therapeutic interventions. As we proceed with the “Moonshot” to better control cancer, we must assure that all patients …
Read more…
The Cancer Moonshot should not occur on class lines
The market for medical tourism grows as Americans increasingly seek medical care outside of the United States and pay cash for services. Patients know they can obtain adequate quality care in Mexico for out of pocket costs far lower than their insurance plans with high deductibles would cover. Posting basic outpatient visit and simple procedure prices could benefit our independent practices in the same way. The only thing worse than …
Read more…
Can independent practices stay viable using price transparency?
