Peter Ubel, MD
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Latest articles
Health policy
It has always been financially rewarding for doctors to take care of rich patients. People with more money … well, they have more money to spend on health care. But shouldn't this more money/higher payment relationship go away in Medicare?…
It has always been financially rewarding for doctors to take care of rich patients. People with more money … well, they have more money to spend on health care. But shouldn’t this more money/higher payment relationship go away in Medicare?
It doesn’t, and some recent payment reforms may be making matters worse.
Medicare is a federal program to reimburse medical costs in people who are disabled, have kidney failure, or are …
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Clinicians shouldn’t be punished for taking care of needy populations
Health policy
After three months of physical therapy, her doctor told her that it was time to get an MRI. She had already paid off her annual deductible, meaning the imaging test would “only” cost her the $150 co-pay. An imaging center…
After three months of physical therapy, her doctor told her that it was time to get an MRI. She had already paid off her annual deductible, meaning the imaging test would “only” cost her the $150 co-pay. An imaging center near where she worked charged $1,500 for the test. Just two miles away, another facility would have just charged only $900 for the same test. She arranged to go to …
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Patients alone cannot combat high health care prices
Conditions and diseases
The FDA plays a critical role in our nation’s response to the COVID-19 pandemic. It helps decide which medicines are safe and effective to treat the disease. It evaluates the accuracy and reliability of laboratory tests. And it will play…
The FDA plays a critical role in our nation’s response to the COVID-19 pandemic. It helps decide which medicines are safe and effective to treat the disease. It evaluates the accuracy and reliability of laboratory tests. And it will play a central role in assessing potential vaccines.
But will the FDA bureaucracy move with the kind of speed necessary to deal with such a crisis? Some critics are concerned it will …
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Is the FDA too slow to handle the pandemic?
Health policy
Physician reimbursement increasingly depends upon measures of health care quality. Physicians who fall short on quality measures now face financial penalties. But it might be quality measures, themselves, that are falling short, according to a study conducted by the American…
Physician reimbursement increasingly depends upon measures of health care quality. Physicians who fall short on quality measures now face financial penalties.
The study involved a panel of people with expertise in evidence-based medicine. Panelists were asked to evaluate the validity of quality measures being used by either …
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Quality measures have gotten ahead of the science of quality measurement
Conditions and diseases
Happiness doesn’t always come easily. Some people seem naturally happy, like they inherited the right gene or were born into the right circumstances. Many other people struggle to find happiness. Perhaps even more people hope to become happier than they…
Happiness doesn’t always come easily. Some people seem naturally happy, like they inherited the right gene or were born into the right circumstances. Many other people struggle to find happiness. Perhaps even more people hope to become happier than they already are. But what kind of plan should people follow if they are hoping to become happier? Or will any kind of plan merely make it harder to thrive?
It …
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The key to happiness is not a mystery
Conditions and diseases
High blood pressure is the silent killer. It puts people at risk for heart attacks, strokes, vascular disease, kidney failure. It is basically really bad to have longstanding, undertreated high blood pressure. But it is also harmful to be told…
High blood pressure is the silent killer. It puts people at risk for heart attacks, strokes, vascular disease, kidney failure. It is basically really bad to have longstanding, undertreated high blood pressure.
But it is also harmful to be told you have high blood pressure when you don’t, and to be treated for high blood pressure when that treatment won’t benefit you. So when your doctor diagnoses you with high blood …
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How do you know if you have hypertension and need medication?
Health policy
Americans are not fans of socialized medicine. Sure, some people want socialized health care payment, including many people who are fans of Medicare for all. But even most Bernie Sanders supporters probably aren't in favor of socializing the entire U.S.…
Americans are not fans of socialized medicine. Sure, some people want socialized health care payment, including many people who are fans of Medicare for all. But even most Bernie Sanders supporters probably aren’t in favor of socializing the entire U.S. health care system, thereby making hospitals and medical clinics into government property. Americans are proud of the high quality of care offered by non-government providers, from their local community
…
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Does socialized medical care provide higher quality than private care?
Health policy
One of my elderly relatives was in line at the grocery store one day and saw the person ahead of him, charging what looked like a cart full of junk food to her food assistance card. My relative was incensed:…
One of my elderly relatives was in line at the grocery store one day and saw the person ahead of him, charging what looked like a cart full of junk food to her food assistance card. My relative was incensed: Why, should his hard-earned tax dollars be used to pay for someone’s Cheetos?
Currently, one in seven Americans receives some kind of government assistance to pay for food. The largest …
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What if people were only allowed to use food assistance dollars to buy healthy food?
Health policy
Over half of Medicare spending is concentrated in 10 percent of patients. With Medicare expenditures rising at an unsustainable clip, reigning in the costs of those patients is key to controlling health care spending. So who are those patients and…
So who are those patients and what expenses are they racking up?
It’s not who or what I expected. When I think of high-cost patients, I envision people with drawn-out hospital stays, or imagine people …
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Expensive Medicare patients aren’t who you think
Health policy
U.S. health care spending is maddeningly high. As in fifty percent higher than what other wealthy countries spend, with no evidence we’re getting any bang for all those additional health care bucks. In 2014, the state of Maryland took direct…
U.S. health care spending is maddeningly high. As in fifty percent higher than what other wealthy countries spend, with no evidence we’re getting any bang for all those additional health care bucks.
In 2014, the state of Maryland took direct aim at this profitless profligacy, enacting a bold (dare I say European?) approach: It gave hospitals fixed budgets to cover the costs not only of inpatient hospital care, but also outpatient care …
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If you build a budget, hospitals will adapt
Health policy
The day of solo practitioners is coming to an end. In its place will be gaggles of gastroenterologists and flocks of physicians. Mega practices are becoming the norm in American medical care. Here’s a few pictures of this trend, somewhat…
Here’s a few pictures of this trend, somewhat dated (they only go through 2015) but still quite revealing.
The figure below illustrates the distribution of primary care physicians in the U.S., from June 2013 …
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Welcome to the new normal: practices of 500 physicians or more
Health policy
Health care reimbursement in the U.S. is frighteningly complex. We have federal payers, like Medicare; state/federal payers, like Medicaid; private, for-profit insurance companies, like Aetna; private, not for profit insurers, like many local Blue Cross Blue Shield networks. Oh yes,…
Health care reimbursement in the U.S. is frighteningly complex. We have federal payers, like Medicare; state/federal payers, like Medicaid; private, for-profit insurance companies, like Aetna; private, not for profit insurers, like many local Blue Cross Blue Shield networks. Oh yes, and we have private insurance companies managing reimbursement for many Medicare and Medicaid recipients.
This complexity comes with costs. Doctors and hospitals need to hire armies of people to process bills …
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American physicians deserve timely payment
Health policy
Jill Ladkin was already having a terrible autumn. It began with a seizure that put her in the hospital with what seemed like scores of unfamiliar physicians attending to her state of health. The brain scan revealed a mass in…
Jill Ladkin was already having a terrible autumn. It began with a seizure that put her in the hospital with what seemed like scores of unfamiliar physicians attending to her state of health. The brain scan revealed a mass in the lining of her brain, a location usually signifying a benign tumor; but, given her seizure, the tumor was hardly what you would call a harmless growth. The surgeon had a theory of what …
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Why is it so difficult for Americans to make doctors’ appointments?
Drugs and prescribing
The HPV vaccine saves lives. It does so by reducing a person’s chance of being infected by the human papilloma virus, a virus that causes a whole range of cancers including, most importantly, cervical cancer. Vaccinate your teenage daughter against…
The HPV vaccine saves lives. It does so by reducing a person’s chance of being infected by the human papilloma virus, a virus that causes a whole range of cancers including, most importantly, cervical cancer. Vaccinate your teenage daughter against HPV, and you will increase the chance she will live to old age. Simple as that.
Yet currently, the majority of American teenagers, boys and girls, are reaching adulthood without the full …
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If we don’t pay now to vaccinate our children, they will pay later
Drugs and prescribing
In recent years, it feels like we’ve been inundated by stories of greedy pharmaceutical companies jacking up the price of important generic medications. In 2015, “Pharma Bro” Martin Shkreli, recognized that no other generic companies were manufacturing Daraprim, a drug…
In recent years, it feels like we’ve been inundated by stories of greedy pharmaceutical companies jacking up the price of important generic medications. In 2015, “Pharma Bro” Martin Shkreli, recognized that no other generic companies were manufacturing Daraprim, a drug used to treat infections common among people with AIDS, from $13.50 a pill to $750, confident that no generic competitor was around to cut into his market …
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Are generic drug price hikes media hype?
Conditions and diseases
Most men diagnosed with prostate cancer don’t die of the disease. Between 2011 and 2015, 112.6 per 100,000 men per year were diagnosed with prostate cancer in the U.S., but only 19.5 per 100,000 men per year died of the…
Most men diagnosed with prostate cancer don’t die of the disease. Between 2011 and 2015, 112.6 per 100,000 men per year were diagnosed with prostate cancer in the U.S., but only 19.5 per 100,000 men per year died of the disease over that same period of time. That is still far too many deaths. But the huge disparity between deaths and diagnoses arises in large part from overdiagnosis of prostate …
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Screening elderly men for prostate cancer: More harm than good?
Conditions and diseases
Here’s what most medical experts agree on: People 50 and older should be screened for colon cancer. Here’s what is more controversial: Whether that screening should start, routinely, at age 45. Recently, the American Cancer Society (ACS) recommended that colon…
Here’s what most medical experts agree on: People 50 and older should be screened for colon cancer.
Here’s what is more controversial: Whether that screening should start, routinely, at age 45.
Recently, the American Cancer Society (ACS) recommended that colon cancer screenings start at age 45. Their recommendation was based in large part on an uptick in the number of people 45 to 50 years old who are being diagnosed with colon cancer …
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Should we start screening for colon cancer at age 45?
Drugs and prescribing
Chemotherapy drugs have become ridiculously expensive. Many new drugs come to market costing more than $100,000 per patient for a full course of treatment. Often, patients have to pay a significant portion of these costs. For example, a 20% co-insurance…
Chemotherapy drugs have become ridiculously expensive. Many new drugs come to market costing more than $100,000 per patient for a full course of treatment. Often, patients have to pay a significant portion of these costs. For example, a 20% co-insurance rate, typical for basic Medicare coverage, leaves patients responsible for more than $20,000 of chemotherapy costs, an often crippling burden.
Fortunately, many expensive cancer drugs are going …
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Generics aren’t going to help the cost of chemotherapy drugs
Drugs and prescribing
Sometimes it is hard for hospitals to provide expensive care to poor patients. When a low-income patient needs $20,000 of chemotherapy, a hospital loses money if that patient cannot pay for the medicine, or pays through Medicaid, with its relatively…
Sometimes it is hard for hospitals to provide expensive care to poor patients. When a low-income patient needs $20,000 of chemotherapy, a hospital loses money if that patient cannot pay for the medicine, or pays through Medicaid, with its relatively stingy reimbursement. Fortunately, the federal government created a program for hospitals that care for a disproportionate share of low-income patients, whereby they can purchase those medicines at a discount. The program …
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How hospitals are taking advantage of the 340B Drug Pricing Program
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