You couldn’t invent a worse health care system than the nightmare we have created in the U.S. Our medical costs are almost twice as high per person as they are in most other similar countries but produce only mediocre outcomes.
There is massive overtreatment of people who don’t need it, while many who desperately do have no coverage at all.
The payment incentives …
Fixing our broken health care system: Sometimes David wins
Whatever happened to “first, do no harm?”
One of the findings included in a Senate investigative committee’s report on the U.S. government’s post-9/11 torture program was that it was designed by two psychologists. They were paid “$80 million to develop torture tactics that were used against suspected terrorists in the wake of the September 11 attacks on the Pentagon and the World Trade Center” — including “waterboarding and mock burial on some of the …
Will the psychologists involved in torture be held accountable?
Last year, hospitals and health systems underwent 98 consolidations, a 51 percent increase from 2010. Many of these mergers and acquisitions arose in response to declining government reimbursement and the Affordable Care Act. Smaller hospitals are having increasing difficulties maintaining a margin and many face high debt burdens, bankruptcy or even closure.
But is consolidation the clear-cut answer?
Here are 4 reasons bigger actually may not be better for all hospitals:
1. Disparate …
Hospital consolidation: 4 reasons why bigger isn’t better
In the giddy days after the passage of ACA, I was chatting with a PhD student in health economics. He was in love with the ACA. He kept repeating that it would reduce costs, increase quality and increase access. Nothing original. You know the sort of stuff you heard at keynotes of medical meetings; “Healthcare post-Obamacare” or “Radiology in the new era.” Talks warning us that we were exiting the …
Health reform and Gruber: We want simple solutions to complex problems
I think I will become a neurosurgeon. Tomorrow.
It shouldn’t be too hard, right? I’m a breast cancer surgeon, and that is kind of like being a neurosurgeon, isn’t it? I wear scrubs and know how to tie knots really well. OK, maybe I don’t know much about the brain, and the last time I was on a neurosurgical team was during …
Why hospitals have to dramatically change their missions
An excerpt from The Myths of Modern Medicine: The Alarming Truth about American Health Care (Rowman & Littlefield).
Myth 1: “The United States boasts the best health care in the world.”
Betsy Lehman trusted her life to the American health care system. An award-winning journalist, Lehman was a rising star at the …
Physicians must be the architects of health care change
There is controversy about whether or not there will be a doctor shortage in the near future. I wonder why there is so much speculation. The Association of American Medical Colleges estimates that we will be short 90,000 physicians by 2020 and 130,000 physicians by 2025. If things stay as they are now, of course there will be a shortage. The …
Is there really a doctor shortage, and what can we do about it?
In the midst of multiple public health crises, the NIH budget is in an unprecedented period of stagnation. So why the growing chorus of voices calling to slash more science?
Senator Rand Paul recently slammed the NIH, specifically calling out a study of “origami condoms” which he says are “designed with Japanese folding paper in mind.” In fact, this research is …
Science bashing: The latest threat to research in America
So there is this guy from MIT or Harvard, or some other place where they teach our leaders how to lead, and his name is Jonathan Gruber. Mr. Gruber, it seems, was hired to consult with the Obama administration during the time the Affordable Care Act (ACA) was created because of his extensive expertise in designing the Massachusetts health care system. In recent weeks, people who don’t particularly like our …
Jonathan Gruber: What if he’s right?
Jonathan Gruber went from unknown to infamous in the last few weeks, a result of disparaging comments he made about the Affordable Care Act (Obamacare) and even more disparaging ones he made about the American people. According to Gruber, the Obama administration counted on “the stupidity of the American voter” to pass the bill. In fact, the Obama team’s “lack of transparency” was deliberate, because they believed the law would …
Obamacare: What did Jonathan Gruber really say?
Not long ago I interviewed Dr. Todd Sorensen, the CEO of Regional West Medical Center, a 184-bed facility serving a large swath of rural western Nebraska. I’ve known Dr. Sorensen since junior high school, and we’ve kept in touch over the years to discuss the health care system from his perspective as a physician and administrator and mine as a health …
Health care’s future: An interview with a hospital CEO
In the pediatrics playroom, the medical team and I, a medical student, hunkered down in child-sized chairs to review patient progress notes. A television screen nearby diverted my attention. On CNN, video of protesters alternated with Eric Garner’s final moments. The television was mute, but I could hear Garner say, “I can’t breathe …I can’t breathe …” One moment, he is …
Why you should protest the deaths of Eric Garner and Michael Brown
Any health care provider can tell you that clinical knowledge isn’t the only thing that determines how well you care for your patients. We’ve all seen — many times — the patient that can’t afford the correct antibiotic, doesn’t get preauthorization for the necessary CT scan, and can’t find a specialist who will take his or her insurance. Making the correct diagnosis is only the first step in helping a …
Medical schools fail to teach students about the health care system
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While millions of Americans are re-enrolling in Obamacare, signing up for health insurance for the first time, or double-checking the plans their employer offers, many will undoubtedly ask what’s affordable for them.
Good luck defining affordability. Like beauty, it’s in the eye of the beholder.
To better understand what affordability in health care means from the vantage point of the ‘kitchen table,’ the National Quality Forum, with support from the Robert Wood …
5 questions to ask before buying health insurance
The food stamp program helps over 40 million Americans pay for groceries. Unlike other forms of economic assistance, this program, called SNAP (the Supplemental Nutrition Assistance Program), only pays for food, thereby constraining how recipients make use of the aid. But are food stamps constrained enough?
SNAP recipients experience higher rates of obesity and diabetes than the general population. Experts estimate that SNAP recipients consume almost twice as many calories …
Stop using food stamps to buy soda. But how?
A few months ago I assessed a patient with dementia. I dutifully ordered the appropriate blood testing and MRI. As I delved further into the history, I was concerned that there may be a component of depression. Pseudodementia (memory disturbance and dementia like symptoms caused by depression) can often mimic classic Alzheimer’s disease, but resolves with proper treatment. The best way to differentiate these two syndromes is neuropsychological testing. I decided to send my patient to a colleague …
Why does the government fail to bend the cost curve?
My husband and I both like to run. I run about 3 miles once or twice a week — if the weather’s not too bad, and if I don’t have something else going on. Keith, on the other hand, runs half marathons. He goes for long runs on the weekend for 3 to 4 hours at a time, and shorter runs during the week. He runs in the heat, rain …
Quality improvement is a marathon, not a sprint
In the post-Affordable Care Act health care landscape, sweeping hospital closures have created new barriers to access in a system already criticized for its fragmentation and saturation. Looking back over the past 20 years, urban hospitals, and urban trauma centers in particular, bore the brunt of this impact, closing at the highest rates in the country. Now, evidence suggests the impact of urban hospital closures may disproportionately affect those …
Hospital closures affect the safety net. Here’s how.
One of the most subtle deceptions hidden inside the cracks of our sick care system is the lie told to doctors: that health is our primary goal for our patients.
I began to understand this paradox clearly when I listened to my friend’s anguish.
She’s been working as a full-time medical assistant in a busy nephrology practice, supporting two sometimes three full-time sub-specialty doctors. The practice is located in a small town …
Medicare’s perverse incentive to keep patients on dialysis
CMS recently announced it would begin next January to pay physicians for care coordination activities. It’s about time. As physicians have been saying for some time, any payment system that hopes to encourage value (better patient outcomes) has to start by paying physicians to coordinate the care of their patients. When physicians follow up on referrals or communicate with patients outside of the office, healthoutcomes improve, costs shrink and the patient …
Medicare will pay for care coordination. Should doctors take the money?
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