An excerpt from So Long, Marcus Welby, M.D.: How Today’s Health Care Is Suffocating Independent Physicians – and How Some Changed to Thrive.
Ripley Hollister has been president of his county’s medical society in Colorado Springs, Colo., and a director of the Colorado Medical Society. He has been a unit commander …
The doctor who has to do the laundry
After more than 40 attempts to pass legislation calling for repeal or significant changes to the health law, opponents of the Affordable Care Act have moved their focus from the House floor to the courthouse. Currently at least four lawsuits are working their way through state and district court — and one case awaits a nod from the Supreme Court — that would make it illegal for the federal government …
After Halbig: What’s next for Obamacare?
Part of a series.
Primary care need not be expensive and until the past few decades it was paid for out of pocket. Heretical perhaps, but it would be very useful to go back again to paying the PCP out of pocket directly by the patient, preferably with a tax-advantaged health savings account (HSA).
A County Doctor wrote on his blog:
I can freeze a couple of warts in less than a …
Primary care should be paid for directly by the patient
Anyone from outer space reading the news and watching TV would think that the U.S. has some of the worst health care possible. The negativity appears to be pervasive. Controversy over this, outrage over that. Whether it’s inadequate health outcomes, policy debate, or scandals with patient care, the stories and discussion abound.
As someone who grew up and went to medical school overseas and then came to the U.S. for medical residency (along …
5 things that make U.S. health care great
For a very long time, one of the most valuable business assets in New York City was a yellow cab taxi medallion. With recent value in the $1 million dollar range, ownership of the medallion was a virtual cash annuity, combined with equity growth (in 2004 medallion prices were in the mid $200,000 range and have increased in value 15% year over year in the 9 years since). As one …
What the Uber of health care will look like
There are few things more important than our health and our health care. Solving health care for everyone is critical to becoming a healthy, vibrant society. Because our government has controlled our health care for two generations, election realities and political rancor obscures our ability to collectively solve the problem. Allow me to use a fictitious government program, “Foodaid,” to defray the noise and illustrate how government-control of our health …
Why government cannot cure our health care
Health care costs far too much. We can do it better for half the cost. But if we did cut the cost in half, we would cut the jobs in half, wipe out 9% of the economy and plunge the country into a depression.
Really? It’s that simple? Half the cost equals half the jobs? So we’re doomed either way?
Actually, no. It’s not that simple. We cannot of course forecast with …
Health care at half the cost: What will that actually look like?
There is no doubt that Affordable Care Act has changed the landscape of medicine in the U.S. Now, private practice is becoming a thing of the past. Financial pressures, increasing regulatory requirements, electronic medical records and outrageously complex coding systems are forcing long time private physicians to enter into agreements with academic centers and large hospital systems in order to survive.
As a result, medicine today is more about increasing patient …
Correcting the physician shortage isn’t an easy solution
Whether you’ve praised or vilified Obamacare, see it as an amazing achievement or an existential threat, it is the law of the land. The price transparency created by online exchanges, a vital part of the law, stands to make cost the biggest driver of choice. This, along with cuts in government health spending, will disrupt the economics of health care in dramatic new ways.
Our first response to this brave new …
Health care efficiency can mean different things
At a crowded townhall meeting in 1959, an elderly woman stepped up to the microphone and spoke to a panel of senators. “I am not worried for my son’s time,” she began. “He is 35, and I am sure he will face a better future when his time comes to retire. But what is to be done for those of us who need help right now?”
This was one of a …
Medicare’s 49th birthday: What is to be done?
The venerable University of Texas MD Anderson Cancer Center in Houston will accept patients with traditional Texas Medicaid health insurance, and some patients in Medicaid managed care plans. Memorial Hermann, another large health system in Houston, will accept traditional Medicaid patients and also those in Medicaid managed care plans. Neither institution will accept the Blue Cross Blue Shield HMO silver plan sold on the Affordable Care marketplace, according to Read more…
Hypoliquidemia has now come to health care
The 2-1 decision by the DC Court of Appeals striking down federal premium subsidies, in at least the 27 states that opted for the feds to run their Obamacare insurance exchanges, has the potential to strike a devastating blow to the new health law.
The law says that individuals can get subsidies to buy health insurance in the states that set up insurance exchanges. That appears to exclude the states that do …
Why Republicans should worry about the Halbig ruling
Many hospitals rely on bond funding for their expansion and the purchase of new equipment. Revenue that is created by the hospital is then used to pay back the bondholders. The risk to bondholders is that they are generally paid after the hospital pays its operational expenses. Therefore, if the hospital is less profitable than expected (or not profitable at all), bondholders assume the financial risk.
Hospitals have historically been rated …
The effect of health care quality on hospital credit ratings
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Luxury goods are items that people purchase in disproportionately greater amounts as their income increases. That’s how economists think of them anyway. But for the average American, a luxury good means something else. We tend to think of luxury goods being things like designer clothing, luxury cars, and high-end restaurants. Our minds fill with images of Gucci, Burberry, and Luis Vuitton, or Mercedes-Benz, Porsche, and Ferrari.
One thing is clear to …
Is higher cost health care perceived as being higher quality?
Having just retired on July 1st, my medical group’s commercial health insurance policy is no longer available to me. However, being past 65, I started a year ago applying for Medicare benefits. Despite my knowledge in this field, I had assumed this would be a snap.
I also had assumed that my Medicare patients who enrolled in a Medicare HMO (Medicare Advantage) did so for purely economic reasons. My experience has …
Do patients choose Medicare Advantage for convenience?
When Uncle Will needed a hip replacement, he chose an orthopedic surgeon, Jason Brockman, and Mountain Memorial Hospital because of their excellent reputations for low complication rates and satisfied patients. The process reminded him of when he bought his first brand new truck.
Norm and Clara Anderson chose Dr. Wheeler as their family doctor once they had made the decision to relocate to Maine and raise their family away from the …
Don’t turn primary care into General Motors
We believe in data. We are scientists after all. And yet in this new era of big data is it possible we are measuring the wrong things?
Most measures of physician performance are process or intermediate outcome measures aimed at a production line model of care. Was an A1c done, did the physician use a computer to send an order to the laboratory, were antibiotics given within two hours of presentation.
Yet …
Big data in health care: Are we measuring the wrong things?
The Commonwealth Fund just published its fourth Mirror, Mirror on the Wall study comparing the U.S. health care system with other countries, and as in all previous studies, we ranked as the absolutely worst health care system in the developed world, bar none.
Yikes.
The Commonwealth Fund studied many health care domains, and we didn’t rank in first place for anything. The best we managed to do is place a lackluster third …
Digging deeper into the Commonwealth Fund health rankings
Adverse events — when bad things happen to patients because of what we as medical professionals do — are a leading cause of suffering and death in the U.S. and globally. Indeed, as I have written before, patient safety is a major issue in American health care, and one that has gotten far too little attention. Tens of thousands of Americans die needlessly because of preventable infections, medication errors, surgical …
The difficulty of moving the needle on patient safety
There is an old gag about an intensely optimistic child whose bright outlook on life is so irrepressible that when he is presented with a room full of manure for Christmas, he screams with delight, convinced that there “must be pony in there someplace.”
I was reminded of that when I read the recent research report and the accompanying …
The suspect quality improvements of the medical home
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