Tuesday night, March 29 into March 30, I started to feel that sensation I associate with the start of a cold. It was a feeling in the back of my throat that’s almost hard to describe. I haven’t had that sensation in years. Because I have been wearing an N95 mask every time I come into contact with people outside of my inner circle, I hadn’t had any sort of …
This doctor got COVID. Here’s what it taught him.
We constantly argue about how to fix the U.S. health care system. But what we must understand is that the most important issue isn’t how to fix health care. The issue is how to get our Congress, the President, and the health care industry to allow anything of importance to change at all. The problem is that all three have a vested interest in the current system. The health care …
These leaders will not fix health care
Of late, doctor/friends on social media have taken to reposting news articles detailing the horrors taking place in other nations because of the evil scourge known as socialized medicine. In fact, the two words, alone or together, just don’t carry anything near the weight of the pain and suffering they imply, so I have taken to adding this exclamation point, in parentheses, to make it absolutely clear how terrible a …
The demonization of socialized medicine
It is wildly popular to say that the chief culprit in the U.S. health care system is the traditional fee-for-service payment system, which rewards physicians for volume but not quality, leading to high-cost, low-quality health care. It supposedly follows that the fix is a system of “value-based” payments.
Despite the popularity of these arguments, both aspects have been shown to be wrong. Studies show that the rising cost of American health …
What is the perfect fee-for-service system?
There is an accepted storyline in American health care that is so ingrained in our culture that it is almost beyond question. It goes like this. The chief culprit underlying the high-cost, low-quality American health care system is the traditional fee-for-service payment model, which rewards physicians for the volume of services they provide with no consideration for the quality of care being delivered.
The answer, the story goes on to say, …
The bureaucratic myth harming American health care
There is growing recognition that the broken American health care system is taking a toll, not just on patients and their families, but on health care professionals as well. Nearly half of all physicians in various surveys now report that they are burned out. Inevitably, the experts are lining up to further study the issue and to teach doctors better coping skills.
In terms of the need for further study, I am but a simple country doctor, but I think the …
Therapy and self-help strategies aren’t the answer to solving physician burnout
What happens when you place an entire nation’s health care in the hands of an overly-controlling, ineffective government bureaucracy and huge corporations whose mission it is to squeeze as much money from the system, no matter the cost, including people’s lives? You get the carnage that is the American health care system.
You get my week as a family doctor in the worst health care system in the world.
This week a diabetic patient who …
A week in the worst health care system in the world
The most profound health care legislation enacted since the Affordable Care Act, The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a huge mistake. It adds another vast layer of bureaucracy to a health care system already overburdened by such things, and penalizes physicians who take care of the most complicated patients. The head of the Centers for Medicare and Medicaid Services (CMS), who administer the program, admits …
Doctors must take a stand and force the government to cancel MACRA
Results of a study released JAMA Cardiology demonstrated that lower readmission rates among hospitalized heart failure patients, a key focus of recent Medicare value-based payment efforts, were associated with increased patient mortality. In other words, patients admitted to the hospital for heart failure are being re-admitted less frequently, but dying at higher numbers. Value-based pay, as it turns out, where monetary incentives and penalties are tied …
How value-based pay can worsen patient outcomes
The most common dividing lines in the national discourse on health care reform simply miss the mark. If one looks beyond the partisan posturing, each side has valid points, but also glaring weaknesses. We may need to work together to get health care right.
I was recently invited to a political gathering to discuss health care reform. The room quickly divided along traditional lines.
From left of the political spectrum, there were …
Both markets and the government are needed to fix health care
Yet another round of attempted health care reform has come and gone, and once again, failed. And so, the traditional open enrollment season for health insurance is upon us, and as usual, many Americans are facing outlandish increases in premiums, skyrocketing deductible amounts, and shrinking coverage. Americans are increasingly enslaved and endangered by the rising costs and the growing dysfunction. Fixing things is, to put things in the proper perspective, …
Fixing health care requires putting patients and their health teams on top
From the CMS website, October 30, 2017, “Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed the agency’s efforts to streamline quality measures, reduce regulatory burden, and promote innovation … We need to move from fee-for-service to a system that pays for value and quality — but how we define value and quality today is a problem. We all know it: Clinicians and hospitals have to report …
If Medicare wants value, it should cancel MACRA
If we listen to the president, fixing the American health care system is too complicated. It is not actually that complicated. The number one issue is cost. Even with many millions of people unable to access care, we already spend close to twenty percent of every dollar in the U.S. on health care. If we hope to include everyone in the health care system, then we need to lower health …
Fixing the American health care system is simple. Here’s how to do it.
We were once a nation noted for its achievements. We are now a nation that gets nothing done, unable to make even the slightest movement forward despite multiple national crises — a desperately broken health care system, a horrifying opioid epidemic, sickening gun-related mass murders, the threat of nuclear war, and massive storms resulting from man-made climate change. In the face of such monumental challenges, when bold action is needed, …
The most far-reaching effects of our failed leadership
One of the most popular narratives in American public discourse, especially as it pertains to health care, is that government is bad, and the free market, meaning private industry, is good. And the natural extension of this line of reasoning is that the government cannot, and therefore should not be part of any health care reform solution. Further, only the free market is capable of fixing things, and it was …
In health care reform, what’s the ideal role of government?
The current conversation regarding health care reform in the U.S. is essentially pointless. It can be boiled down into four statements: Obamacare stinks, so we need to get rid of it; Obamacare doesn’t stink, so we just need to improve upon it; the insurance companies are to blame, so a government single-payer system is the best idea; the government is to blame, and only the free market can fix health …
A health care solution to rival single payer
After being out of the news for a few weeks, health care reform came back with a bang this week when Senator Bernie Sanders unleashed his Medicare for all, single-payer reform plan, now backed by sixteen Democratic senators. More than anything, to make progress on reform of our dying health care system, the nation needs to get to a place where it can engage in serious conversations about such proposals.
I …
Bernie Sanders and the single-payer dream: Why we must take it seriously
The other day, rather than being at the office, I was sitting in the waiting room of our favorite gastroenterologist’s endoscopy suite. I had dutifully accompanied my wife, who was getting her colonoscopy. My cell phone buzzed. It was my nurse calling from the office. I had seen a patient late the previous day who was complaining of right leg pain.
I had ordered a D-dimer, hoping the test would be …
Here’s what it looks like when our health system actually works
I was browsing the latest issue of the Journal of the American Medical Association, as I often do, and an article by one Andy Slavitt, MBA, and Gail Wilensky, PhD, titled “Reforming Medicaid,” caught my eye. From 2015 to 2017, Mr. Slavitt served as the Acting Administrator for the Centers for Medicare & Medicaid Services (CMS). In that role, he oversaw the government’s awful Meaningful Use EHR program, and helped …
Administrators who don’t see patients often make the most important decisions
American doctors are unhappy about a lot of things. Americans, in general, are unhappy about a lot of things. In many ways, both groups share similar concerns. But the road back to happiness may follow a similar path for both, as well.
American doctors once felt part of something special. American health care, by reputation at least, was the best in the world, and we were its proud emissaries. We functioned …
How to unite doctors in these divided times
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