Physicians writing on KevinMD about policy as it reaches the exam room: prior authorization and the state and federal rules now written for it, scope of practice laws state by state, the CDC opioid guideline and what forced tapers did to patients, and public health from vaccination to the pandemic. Four maintained records draw on this archive: Prior authorization: what physicians say, in their own words, Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words, Opioids: what physicians and pain patients say, in their own words, and Vaccines: what physicians say, in their own words.

Medicaid managed care and the case for mutual stewardship

Health Policy
September 23, 2026

Roughly half of American children receive their health care through Medicaid or CHIP. These programs were legislated to cover them, and the choice has been made (repeatedly, across decades and both parties) not to fund them at the level their aims require. Pediatricians did not make that choice and should not stop saying it is the wrong one.

However, that choice, and the confines it creates, defines the real-world conditions …

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Medicaid managed care and the case for mutual stewardship

The conflict of interest that discloses as nothing

Medications
September 23, 2026

With 66 percent of U.S. adults, some 131 million people, now taking prescription drugs, and with Medicare drug spending running into the hundreds of billions, it is worth asking how the pharmaceutical industry came to occupy so central a place in American health care. Several recent developments show how the relationship works.

The FDA announced this month that it is hiring more than 2,000 employees, rebuilding after reductions …

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The conflict of interest that discloses as nothing

Underage online gambling needs more than a checkbox

Conditions and Diseases
September 22, 2026

Gambling as a recreational activity continues to expand, driven by the constant availability of online platforms. Sports betting, casino-style games, and real-time micro-betting are now accessible on smartphones at any hour, turning what was once occasional into a continuous presence shaped by artificial intelligence, big data, and app designs that permit bets before, during, and after events.

Gambling disorder is recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth …

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Underage online gambling needs more than a checkbox

AI in prior authorization: 3 contract questions for 2027

Health Policy
September 22, 2026

Health systems are buying software that assembles a prior authorization packet from the chart, files it, and chases status. Health plans are buying software that reads the same packet, scores medical necessity against internal rules, and routes a yes or a request for more information. Vendors on both sides advertise essentially the same promise: Artificial intelligence will fix prior authorization.

That is only half true. What is arriving is a dual-use …

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AI in prior authorization: 3 contract questions for 2027

A poem about political division and the will to begin again

Conditions and Diseases
September 18, 2026

I watch the world spinning faster
than I can follow,
a wheel thrown down a hill
with no one reaching for the brake.

Decisions made in haste,
words fired like arrows,
people stepping over the rights of others
as though compassion
has become an inconvenience.

Where is the moral compass
we once carried inside our hearts?

Somewhere above us,
a man sits upon his golden throne,
surrounded by wealth
and power and influence,
and maybe he thinks he can
control the world.

The people below think,
“If he …

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A poem about political division and the will to begin again

Can physicians and organized labor stand together?

Physician
September 15, 2026

Our cultural ethos has revolved around the paragons of “hard work” and so much so that now our health leaders are suggesting that “healthy” Americans work longer to delay retirement to stimulate the economy. In the words of Dr. Oz, “If Americans could stay healthy enough to work just one additional year or start working earlier in their lives, it would increase the GDP of our nation by trillions …

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Can physicians and organized labor stand together?

Local news and public health: the segment viewers missed

Health Policy
September 9, 2026

Local news has always been a mirror: imperfect, sometimes distorted, but still a reflection of what a community believes matters. In Jacksonville, that mirror has become increasingly fogged. Last night, it reflected almost nothing of public value.

For nearly twenty minutes, English-speaking viewers watched the demolition of an empty indoor mall, a structure long abandoned except for a megachurch occupying the old Belk store. The anchors narrated the fall of drywall, …

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Local news and public health: the segment viewers missed

Why value-based care hasn’t lowered your medical bills [PODCAST]

Podcast
September 8, 2026
YouTube video

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Everyone agrees health care should reward better outcomes at lower cost. So why hasn’t it happened? The answer isn’t payment models or policy. It comes down to the everyday choices individual clinicians make, …

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Why value-based care hasn’t lowered your medical bills [PODCAST]

Why a broken health care system keeps getting worse

Health Policy
September 8, 2026

“We have to ask ourselves whether medicine is to remain a humanitarian and respected profession or a new but depersonalized science in the service of prolonging life rather than diminishing human suffering.” Elisabeth Kubler-Ross

Over the course of my career, I have witnessed an inexorable decline in the quality of medical care that we, as physicians, render to our patients. There is a myriad of reasons for this sad development, some …

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Why a broken health care system keeps getting worse

Physician advocacy is a duty, not a political choice

Health Policy
September 7, 2026

Christopher Nolan’s The Odyssey was more than just a tale about a man’s long journey home. It is ultimately a warning about what happens when society abandons its shared obligations. I found his modern interpretation helpful for framing a recent shift in attitudes toward public health and medicine.

In the film, the actions of the Greeks at Troy violated one of their wider society’s most foundational social norms: Zeus’ Law. It …

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Physician advocacy is a duty, not a political choice

Prior authorization automation has an arithmetic problem

Health Policy
September 6, 2026

Wael Khouli wrote here on July 26 that AI will not replace physician advisors, volume will. He is right, and his argument applies elsewhere in the clinic to the people who build prior authorizations. I build this kind of software and have seen automation rescue teams as much as I have seen careless implementations bury them. The difference comes down to the quality of existing data, workflows, and knowing when …

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Prior authorization automation has an arithmetic problem

Health insurance mergers are why your doctor is leaving [PODCAST]

Podcast
September 4, 2026
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

In a lot of towns there is only one health insurer left, and that is starting to show up in patient care. Rita Agarwal is a pediatric anesthesiologist who started asking why colleagues …

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Health insurance mergers are why your doctor is leaving [PODCAST]

Climate medicine deserves the seriousness we gave HIV

Health Policy
September 2, 2026

This summer has offered a compelling case study on why there’s a pressing need for the emerging field of climate medicine and what the medical system must prepare for in the years ahead as extreme heat waves, powerful storms, and out-of-control wildfires become the norm. While commonplace in the West, wildfire smoke has once again drifted in from Canada to reach the East Coast. Catastrophic flooding has devastated …

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Climate medicine deserves the seriousness we gave HIV

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Why employer-sponsored insurance fails your employees

Health Policy
September 1, 2026

Halfway through our dry run, we paused in the boardroom of a national health insurance company. Talking points refined. Slides polished. Empty chairs at empty tables, staring back at us. I didn’t linger on the silence then. Now, as a medical student, I cannot escape it. Because empty chairs look different here. Perhaps, they reflect the same fracture that plagues the reality of patients, providers, employers, and payors caught within …

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Why employer-sponsored insurance fails your employees

The case against for-profit health care on Wall Street

Health Policy
August 28, 2026

The American health care system, as I see it, is undergoing a quiet, clinical decapitation. At the root of this crisis is a fundamental, irreconcilable conflict of interest: the presence of health care companies on the public stock market. While we like to believe our medical institutions are guided by the Hippocratic Oath, the reality is that once a company goes public, the Oath is replaced by a fiduciary duty …

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The case against for-profit health care on Wall Street

How health insurance middlemen delay patient care

Health Policy
August 28, 2026

A friend I am calling “M” to protect her privacy was diagnosed with breast cancer two months ago. When we met in 6th grade science class, she had a bustling eBay business selling Beanie Babies.

Now she has three young boys, including a two-year-old, and has been a public-school teacher for 19 years. She receives health insurance coverage through her job, and until two months ago she said she loved her …

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How health insurance middlemen delay patient care

Chelsea Clinton on maternal mortality and moral optimism

Health Policy
August 22, 2026

Today’s world can often feel cruel, chaotic, and morally adrift. When you see millions at risk of losing health insurance for no justifiable reason, or watch women denied essential care because of political malfeasance, despair feels like a rational response. And yet, amid the noise and injustice, there are those who refuse to give in, people who continue, day after day, to build a more equitable, inclusive, and humane world. …

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Chelsea Clinton on maternal mortality and moral optimism

Social determinants of health start outside the clinic

Health Policy
August 17, 2026

What if one of the most effective health care interventions wasn’t a medical treatment at all, but a set of pots and pans?

That may sound surprising, but it captures an important lesson from New York’s Medicaid 1115 waiver, one of the country’s most ambitious efforts to address social needs as part of health care. In Staten Island, the results suggest that improving health sometimes starts far outside a doctor’s office.

Health …

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Social determinants of health start outside the clinic

How measuring physician shortages reveals hidden gaps

Health Policy
August 17, 2026

Physician shortage forecasts influence everything from residency expansion to rural workforce policy. But many of those forecasts begin with a deceptively simple question: How many physicians are practicing?

A physician with a full clinical schedule and a physician approaching retirement who sees patients only a few days each month may both appear as one physician in a workforce database. Yet their contributions to patient care differ dramatically. When workforce planning relies …

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How measuring physician shortages reveals hidden gaps

Medical device monopolies drive up health care costs

Health Policy
August 16, 2026

U.S. health care performs very poorly compared with health care in other developed countries. Held up against 10 nations that we usually compare ourselves with, we are dead last on overall performance.

Source: “Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System. Comparing Performance in 10 Nations,” The Commonwealth Fund.

And it is not because we don’t spend enough money on health …

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Medical device monopolies drive up health care costs

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