Public Health & Policy
Texas’ Medicaid expansion: a lifesaving solution ignored
Most Texas politicians balk at even discussing Medicaid expansion. They fear the wrath of state leadership and the threat of being primaried by someone further to the right.
The expansion of Medicaid to the full extent permitted by the Affordable Care Act (ACA) is both an ethical and financial imperative. From a moral standpoint, expansion would provide health care coverage to a significant number of low-income individuals who are currently unable …
America’s democracy is on the brink: Will leaders act before it’s too late?
At age 80, I’m an “old guy.” I’ve been an avid reader and writer on multiple subjects all of my life. Though I write primarily about U.S. health care, I maintain a lively interest in politics generally. Since election day, I’ve been hearing stories that express a profound sense of trauma in millions of us. Many feel themselves to be in mourning for their beloved country. Others feel vindicated and …
The answer is gratitude and it puts you in a good place
Regardless of how one might have voted in the election, the aftermath now includes a dizzying array of proposed cabinet and other health-related appointments and rumors about what they and the new administration might do. How do we in medicine navigate all of this? The answer may not be intuitive: gratitude. We’re not talking here about insincere gratitude, …
What the death of UnitedHealth CEO reveals about our broken health care system
The sudden death of UnitedHealth CEO Brian Thompson has pulled back the curtain on something we’ve all known deep down: America’s health care system is failing. Every day, we hear heartbreaking stories of people denied life-saving treatments like cancer care, not because those treatments don’t exist, but because someone decided they weren’t “cost-effective.” This isn’t just a health care problem—it’s a crisis of humanity.
We talk about “making America great …
The hidden truth about ghost networks: one mom’s fight for mental health care justice
Jane Doe – her real name being hidden to protect her young child – thought she knew how to help her eight-year-old son “”Baby Doe.” She was well-educated, employed in a professional role by a federal agency, and comfortable navigating bureaucracies and unresponsive gatekeepers. More importantly, she was a fierce advocate for her child, who had been diagnosed with an autism spectrum disorder and needed occupational and speech therapies, which …
Medicaid in non-expansion states: Explaining the indefensible
Over the years, as members of the Health and Public Policy Committee (HPPC) of the Texas chapter of the American College of Physicians (ACP), we have focused on advocacy for what we believe is the most important health policy issue in our state, Medicaid expansion under provisions of the Affordable Care Act (ACA). Our efforts, and the work of many others, have had no discernable impact on state policy.
In the …
Doctors at the forefront of health care reform [PODCAST]
Transforming public health: a physician’s innovative approach [PODCAST]
Is the Goldwater Rule hindering us?
Robert F. Kennedy Jr. will likely be the next Secretary of Health and Human Services. He has said things that are not true about vaccines, autism, raw milk, and more that we do not have to list here. Furthermore, I do not want to waste time with facts about his opinions. The health professionals who are reading this essay already know that RFK Jr.’s opinions are not supported by facts.
If …
Why prevention is the missing link in health care policy [PODCAST]
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We’re joined by Anand Parekh, internal medicine physician and author of Prevention First: Policymaking for a Healthier America. We dive into the lessons of the COVID-19 pandemic, exploring the pivotal role of prevention …
Toxic waste disaster: How Hughes Aircraft poisoned Tucson’s environment and people
An excerpt from Disabled Ecologies.
The multicolored poisonous waste disposed of by Hughes Aircraft Company was never just TCE, the most infamous ingredient. It was always a toxic soup: dozens of volatile organic compounds and heavy metals, contaminants with names like dichloroethylene, chromium, cadmium, and benzene. The chemicals were used in the early 1950s in the manufacture and cleaning of missiles that would travel thousands of miles overseas to …
Trust in American health care: What’s driving the decline?
Trust is vital to the provision of quality health care. Quality outcomes have shown a correlation with exceptional health care experiences, with patients associating higher trust in health care professionals with “more beneficial health behavior, fewer symptoms, and improved quality of life.” Sadly, trust in American health care is on the decline. Stress placed on the health care system by the COVID-19 pandemic amplified growing concerns, with forty-eight …
The long walk home to a better health care system
Like him or not, Bruce Springsteen’s albums have served as the soundtrack to our lives, writing songs that are a reflection of ourselves, challenging our assumptions, and helping us make sense of our messy, chaotic lives. People from all walks of life and from all over the world have found meaning in his music. So, it was no surprise that several months prior to the 2024 presidential election, while on …
How to fix our broken health care system from the inside [PODCAST]
A physician’s perspective on the crisis in Massachusetts health care
I am a surgeon from a family of surgeons, all based in Massachusetts. Throughout my career, I have faced many challenges, both in and outside of the operating room. Like most doctors, I am saddened by the current collapse of our system in general and my own hospital in particular, which is facing closure due to mounting debt owed to private equity. For the record, I have been warning my …
Voting from the hospital: How emergency ballots give patients a voice
Voting is one of the most fundamental rights in our democracy, and yet it can be incredibly challenging. Getting to your polling station, waiting in line, remembering to request your absentee ballot, checking your voter registration status—it is not a straightforward process. If you suffer from an unexpected illness or injury and find yourself hospitalized, it can feel impossible to make your voice heard and participate in an election. Fortunately, …
Why climate change threatens our children’s future: hurricanes, floods, and a call to act
As Valencia, Spain, reels from devastating flash floods and the U.S. Southeast recovers from hurricanes Helene and Milton, I, like many other parents, look at my own kids with increasing concern about the ailing world they will inherit.
If a climate haven like Asheville, North Carolina, lying 2,000 feet above and 300 miles away from the ocean, can be swept away by a single catastrophic storm, how can we possibly keep our children safe?
Scientists have shown that ocean warming due to …
The hidden $935 billion problem in U.S. health care no one is talking about—and how to solve it
“Waste is worse than loss. The time is coming when every person who lays claim to ability will keep the question of waste before him constantly.”
– Thomas Edison
The escalating challenge of waste in U.S. medicine
The U.S. health care system is struggling with inefficiencies and waste that weaken its effectiveness, thus reducing accessibility and sustainability as a whole. According to a study by JAMA, between $760 and $935 billion is wasted …
Health care reform requires better access and quality: dialysis as an example
Having spent two years in Oxford as a Marshall Scholar in the mid-1970s, I came back to medical school believing in a national health service—i.e., Medicare for all. But I learned firsthand that a monopoly can provide access without ensuring quality. When quality isn’t the priority, there’s no hope for lowering costs or alleviating suffering.
Medicare is already the single payer for dialysis and has failed patients miserably. As a result, …
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