It’s been a rough past couple of months not only for millions of Americans whose health care futures depend on decisions to be made by the new Congress and the Trump administration but for those of us who teach about the U.S. health system for a living. As one health policy expert I follow tweeted only half-facetiously, on election night: “Dear students: all that stuff I taught you about the …
What are the ethics of health care reform?
Three men walk into a deli for lunch, take a number, and sit quietly until called. There are no prices on display, nor is the food visible. The first man, Ron, is called to the counter and states that he is hungry when asked what brings him in. He presents his food insurance credentials, and five minutes later, he walks out the door with a 12-inch gourmet sandwich, a side …
Our convoluted health care payment system
The call came at 4:30 a.m. I answered when she called the second time, as I was too late to answer the first. “Dr. Harper. I think I need to go to the hospital. I just feel so weak.”
It was Bessie, a patient I have known for over 15 years. She’s been struggling for a few week, and while we are working through this struggle, we are clearly not doing …
Changes in the Affordable Care Act need to put patients first
An excerpt from Flatlining: How Healthcare Could Kill the U.S. Economy.
In recent history, the U.S. economy has experienced the near catastrophic failure of two major market segments. The first was the auto industry and the second was the housing industry. While each of these reached their breaking point for different reasons, they both required a significant government bailout to keep them from completely melting down.
What is also true about both …
How health care could crash the U.S. economy
The concept of sickness insurance began in Germany in 1883. Chancellor Otto Von Bismarck initiated insurance for the poor. A decision about how these services were to be delivered is critical to understanding the contentious debates around health care. Could Bismarck have given vouchers for care as needed? Alternatively, should the government control the needed health care facilities?
Perhaps thinking the poor did not have the capability to manage their own health, he chose …
A solution to fix the chaos in Medicare
Republicans have been waiting a long time for this moment. After sixty previous attempts to repeal the Affordable Care Act, commonly known as Obamacare, their moment has arrived. President-elect Trump and Speaker Ryan believe that they can repeal Obamacare and roll back the clock. It won’t happen. Here’s why.
1. Millions will lose health insurance. Pre-Obamacare, nearly 20 percent of Americans went uninsured, and this disproportionately affected lower-income levels. Those are …
Repealing Obamacare faces these 7 challenges
If you understand statistics and possess the intestinal fortitude to examine a ranking methodology, you will recognize that it involves ingredients that have to be recombined, repackaged and renamed. It’s messy, like sausage-making.
This is not to say that the end product — hospital rankings — are distasteful. Patients deserve valid, transparent and timely information about quality of care so they can make informed decisions about whether and where to receive …
We need more science in hospital quality measures
The Republican congressional leadership appears to be determined to move forward with a high-risk “repeal, delay and replace” plan, very early in the new 115th Congress to repeal (at least on paper) the Affordable Care Act’s key coverage provisions—Medicaid expansion, subsidies to make private insurance sold through the exchanges affordable, the individual and employer mandates, and the taxes to pay for coverage—by a simple majority vote, while delaying when the …
50 ways to lose your coverage if Obamacare is repealed
President Barack Obama, whether wittingly or not, invested his entire political capital in reforming health care in America. He gambled and lost. Not because he had nefarious intentions, but because he left the gory details to a corrupt Congress and a shady cadre of lying and conniving technocrats, ending up with something vastly different from what he campaigned on. From everything I’m reading now, President-elect Donald Trump is about to …
Obama gambled on health care and lost. Will Trump lose too?
The Affordable Care Act is perhaps the biggest overhaul of the U.S. health care system in many decades. Enacted by President Barack Obama in 2010, it made health care attainable and affordable to millions of Americans. Individuals with pre-existing medical conditions cannot be denied health care coverage; insurance companies have to cover essential health care needs including mental health and preventive services, children can be covered under their parents’ plans …
How should the Affordable Care Act be modified?
President-elect Donald Trump has repeatedly vowed to “repeal and replace Obamacare.” A logical question is: With what? The announcement of Rep. Tom Price (R-Ga) as Trump’s nominee for secretary of health and human services provides some answers.
Unlike other Republican critics of the Affordable Care Act (ACA), Price, an orthopedic surgeon, has offered many replacement plans of unmatched detail. His Empowering Patients First Act was 242 pages …
The potential costs of Tom Price as HHS secretary
It used to be that hospitals billed Medicare for the services they provided, and Medicare — I know this is crazy! – simply paid the bills.
Those days are rapidly receding into history. Soon, a significant chunk of hospital revenue will be at risk, under a series of Medicare pay-for-performance programs. The idea behind P4P (as the cool kids call it) is simple. Third-party payers, like insurance companies or the Medicare …
Pay-for-performance is here to stay. Hospitals better pay attention.
A guest column by the American College of Physicians, exclusive to KevinMD.com.
When the Trump Administration takes office, health reform as we now know it will not go away, but it will take a different form. I don’t think the changes will be as easy as opponents of the Affordable Care Act make them appear to be. …
Will repeal and replace of the ACA move us forward or set us back?
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The Affordable Care Act (ACA), often called Obamacare, has come under sharp criticism. Now, with the nomination of Rep. Tom Price (R-Ga.) for secretary of health and human services, there are concerns about whether it will be repealed or changed. Price, a physician, has been a long-time critic of the law and has devised proposals of his own to replace it.
While Price may have alternative proposals that may be easier …
Why it’s wrong to blame Obamacare for health care ills
Dear President-elect Trump,
You have stated that one of the first things you will do in office is to overturn Obamacare. You state that you will keep coverage for pre-existing conditions and children to age 26 but beyond that is unclear. Speaker Ryan said it would be “patient centered” but what that means remains to be seen. You now have a former surgeon as head of HHS. If I may, I would …
This physician gives Trump some health care advice
The AMA supports the nomination of Dr. Tom Price based on decades of interactions with him as a member of the AMA House of Delegates, Georgia state senator and as a member of the House of Representatives since 2005. Over these years, there have been important policy issues on which we agreed (medical liability reform) and others on which we …
Why the AMA supports Dr. Price to lead HHS
According to many conservative pundits, Obamacare is a job killer. Five days before Obama signed the law, in fact, speaker John Boehner declared that the president was pushing “his job-killing government takeover of health care that will hurt small businesses.” Years after the law was passed, critics continued trumpeting this theme, Ted Cruz calling Obamacare “the biggest job-killer in this country,” and even claiming …
Tom is a forty-three-year-old self-employed painter and father of two.
He’s currently in remission from lung cancer, having been first diagnosed five years ago. At the time of his diagnosis, he did not have health insurance. Thankfully, for him, American law had finally made it illegal for health insurance companies to discriminate against individuals with preexisting conditions.
Tom had to be offered insurance at community rates. And, this was a good thing …
No matter what Trump does to health care, we must accept an imperfect reality
Supporters of the health care status quo are outraged, predictably, over what they see as Donald Trump’s search-and-destroy mission on Obamacare. They cite all of the newly insured people under the Affordable Care Act — then turn to gloom-and-doom scenarios, insisting everyone will lose insurance, especially those who are low-income and on Medicaid.
Change is never easy, and it can sometimes be scary when facts aren’t known. So will millions of …
Repealing the Affordable Care Act won’t be a big deal. Here’s why.
We are at a watershed moment for health care, both nationally and in Massachusetts.
Massachusetts, the state that first piloted the model, “Romneycare” in 2006, that was disseminated to the nation as “Obamacare” is now going full steam ahead with ACO models under the newly approved 1115 waiver, that received the CMS green light in early November. Having expanded to near universal coverage in 2006, now, at the end of 2016, we are taking on …
10 questions to frame the health care debate
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