Peter Ubel, MD

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel. He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together.

Obamacare: What did Jonathan Gruber really say?

Peter Ubel, MD

Policy

December 11, 2014

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 …

Stop using food stamps to buy soda. But how?

Peter Ubel, MD

Policy

December 4, 2014

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 …

We waste a lot of dollars on unnecessary medical care

Peter Ubel, MD

Policy

November 26, 2014

It is well known that Medicare expenditures threaten the financial solvency of the U.S. government. And it is pretty well agreed upon that some of our Medicare spending goes towards wasteful medical care.

But which medical care is wasteful and how much is such care costing us? A study in JAMA Internal Medicine provides a sneak peek at answers to these important questions. The research, led by Aaron Schwartz, a graduate student …

Medicare punishes hospitals for taking care of poor people

Peter Ubel, MD

Policy

November 6, 2014

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Such a no-brainer: If patients who receive care at hospital A are more likely to get readmitted to the hospital 10, 20 or 30 days after discharge than patients in hospital B, then hospital A must be doing something wrong. Perhaps clinicians at that hospital are less adept at diagnosing and managing patients’ problems. Perhaps the follow-up care at hospital A …

How pay for performance leads to overdiagnosis and overtreatment

Peter Ubel, MD

Conditions

October 8, 2014

Not long ago, the Joint Commission established that patients with pneumonia should receive antibiotics within four hours of diagnosis. Timely diagnosis and treatment can be the difference between life and death in patients with this illness. In fact, some people believe this kind of quality measure should play a large role in how we pay for medical care. After all, doctors should not be paid solely on the basis of …

Doctors and patients deserve better than Medicaid

Peter Ubel, MD

Policy

October 2, 2014

I have written a couple of pieces documenting the high percentage of physicians who refuse to take Medicaid patients, and some of the reasons for their refusal. One of my pieces prompted a physician to email me with his take on this matter. I am going to quote from that email, but take out identifying information to protect his anonymity.

Here’s what he …

Our value judgments are often psychologically frail

Peter Ubel, MD

Policy

September 23, 2014

In health policy circles (yes, those exist!), experts often refer to three aims for a modern health care system: to offer 1) universal access to 2) high quality medical care at 3) an affordable cost. Access, quality, and cost: a possibly unachievable set of goals, certainly in the U.S., where the quality of our care is decent (but uneven), while access to care and the high cost of our care compare dismally to …

Who should be receiving therapeutic hypothermia?

Peter Ubel, MD

Conditions

September 17, 2014

Thanks to the popularity of medical television shows, most people have witnessed hundreds of fictional cardiac arrests in their lifetime. In most of these scenes, the patient loses consciousness, and the medical team rushes to the bedside:

“He’s in v-fib.”

“Get me the paddles.”

The team performs urgent chest compressions for a few seconds. Then they place the metal paddles on the victim’s chest:

“Clear!” Kathump.

The patient’s heart is back to normal again, tragedy …

Will lower prices for genomic tests raise medical costs?

Peter Ubel, MD

Conditions

September 3, 2014

The first time scientists sequenced a person’s entire genome, it took more than a decade and cost hundreds of millions of dollars. Currently, such sequencing takes less than twenty-four hours and costs less than $5,000.

To put that into perspective, Myriad Genetics charges $3,000 to test for mutations in just two genes associated with breast cancer. The days of affordable genomic sequencing are rapidly approaching. But will such testing bankrupt us?

In most consumer …

How listing side effects on TV ads can sell more drugs

Peter Ubel, MD

Meds

August 25, 2014

I must not be the only person to wonder how pharmaceutical companies succeed with direct to consumer advertisements when, stuck in the middle of all their TV ads, are those long lists of side effects. You know what I mean. After watching a smiling and attractive person running through a field after receiving some wonder pill, the narrator tucks his voice down an octave and intones that the medication “could …

Here’s why you can’t resist eating that dessert

Peter Ubel, MD

Conditions

July 23, 2014

It all comes down to willpower, right? Strength of purpose. Muster the resolve to skip dessert, and you have a shot at losing that spare tire hanging off your belly. Succumb to your temptations, however, and you are simply being weak.

But is it just weakness that causes us to overeat?

A study in Psychological Science suggests that our inability to resist that mouthwatering looking chocolate cake doesn’t arise simply because our …

Doctors must discuss the cost of care with their patients

Peter Ubel, MD

Policy

July 10, 2014

I have been writing a bit lately on the need for health care providers to talk with their patients about health care costs, if for no other reason than to enable patients to determine whether they can afford to pay for the healthcare that their doctors are recommending them to receive. I have been criticized for this position, on the grounds that I am rationing care from people with …

It is wrong to subsidize rich, European nations

Peter Ubel, MD

Policy

June 12, 2014

People have criticized the Affordable Care Act for amounting to a large transfer of wealth, from wealthy Americans to those not as well-off. But the real transfer of wealth has been from United States to other developed nations, whose health care costs we have subsidized for many years by paying so generously for many of our health care services. No better example of this comes to mind than the price …

Are safe harbors the answer to fixing medical malpractice?

Peter Ubel, MD

Physician

June 4, 2014

The U.S. medical malpractice system is broken. It frequently does not punish doctors who need punishing, while levying fines against doctors who did nothing wrong. And this dreadfully inaccurate system still manages to take almost five years, on average, to settle claims.

Experts have been promoting a type of reform known as safe harbor rules, which would shield physicians from lawsuits in cases where they were known to be following accepted …

Protocol-driven observational units can reduce ER crowding

Peter Ubel, MD

Policy

May 23, 2014

“If you insure them, they will come.”

Those words might as well be the mantra of hospitals across the country, because they can expect an onslaught of customers thanks to the expansion of health insurance under Obamacare. A recent study published in Science showed increased emergency room use among people in Oregon who became eligible for Medicaid, compared to others who, literally by the luck of the draw, were not chosen to …

Predicting Medicaid enrollment numbers under the Affordable Care Act

Peter Ubel, MD

Policy

May 19, 2014

The Affordable Care Act expanded Medicaid eligibility this year in those states which decided to follow its provisions. That means lots of people are now newly eligible for Medicaid. However, the number of people signing up for Medicaid in the states has been underwhelming. Which raises a question: How much can we expect enrollment numbers to increase over the next few years?

To begin to answer that question, a group of …

The Affordable Care Act has made restaurants more partisan

Peter Ubel, MD

Policy

April 24, 2014

Politics in the US is discouragingly partisan. National politics has become increasingly partisan since at least the late ’60s, when the passage of civil rights legislation influenced many conservative southern Democrats to join the Republican Party. Even state politics has become more partisan, where even famously nice people in Wisconsin have found themselves battling their neighbors across political divisions. Fortunately, most of life does not force us to confront our political differences, meaning …

Doctors often do not know the cost of treatment alternatives

Peter Ubel, MD

Physician

April 18, 2014

A new study asks orthopedic surgeons to guess the price of the devices they implant: “the amount your institution currently pays the vendor for the implant.” Despite a lenient grading system, in which the researchers counted as correct any guess within 20% of the actual price, surgeons estimated costs correctly only 1 in 5 times.

When I first glanced at this study, I wasn’t sure of its importance. But then I learned …

Do rural provider bonus payments do more good than harm?

Peter Ubel, MD

Policy

April 9, 2014

If you live in the rural U.S., you probably face relatively limited access to the wonders of American health care. There won’t be as many physicians per capita offering you their services. This paucity of health care professionals will be especially stark for subspecialty care. There are not many ENT specialists opening up shops in rural Texas when they can find jobs in Houston or San Antonio.

This undersupply of physicians …

Profits are not to blame for health care costs in the United States

Peter Ubel, MD

Policy

February 21, 2014

We all know that health care costs in the U.S. are too high. But why is American health care so expensive? Some experts blame the desire for profit. Russell Andrews, a neurosurgeon and author of Too Big To Succeed laments “the morphing of American medicine from a function of a humanitarian society into a revenue stream for health care profits, drug and medical device companies, hospitals, and insurance companies. In …

Peter Ubel, MD

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