“Then you should say what you mean,” the March Hare went on.
“I do,” Alice hastily replied; “at least–at least I mean what I say–that’s the same thing, you know.”
“Not the same thing a bit!” said the Hatter. “You might just as well say that “I see what I eat” is the same thing as “I eat what I see!”
The brilliant Lewis Carroll had a field day with logical fallacies in …
The Affordable Care Act will face many more Halbigs
I am a long-time proponent of measuring provider performance and aligning it with payment as an effective means for improving the quality of care and with it, patient outcomes.
Because of this, I welcomed the value-based purchasing concepts and quality improvement initiatives that are fundamental to the Affordable Care Act (ACA).
But, as in so many things, the devil is in the details and, despite their best efforts, measure designers can’t always …
Quality measures benefit from quality improvement
A version of column was published in USA Today on July 2, 2014.
There are some who think that I’m overpaid as a physician, and that my salary fuels rising health costs. I can understand their point: A May 2014 survey released by the Medical Group Management Association found that internal medicine doctors like myself have a starting median annual salary of $190,000, …
Are American doctors paid too much or too little?
This is a simple plan that would empower patients, improve the lot of primary care physicians and likely hold down medical costs while improving quality in the health care system. I would first like to present the plan, then elaborate on how it could accomplish the above objectives.
The first part of the plan would set aside a portion of each person’s health care dollars (i.e., insurance premiums) and place it …
The 7% plan to fix primary care
For years, critics of Obamacare (Affordable Care Act), have predicted that it would turn out to be a “train wreck” — or something worse. But now we know that by every objective measure, the ACA is working out pretty darn well. Let’s run through the “train wreck” predictions, and what we now know to actually be the case:
Train wreck prediction #1: “Obamacare will lead to skyrocketing health care cost increases and …
Obamacare isn’t a train wreck. Here’s why.
After more than 40 attempts to pass legislation calling for repeal or significant changes to the health law, opponents of the Affordable Care Act have moved their focus from the House floor to the courthouse. Currently at least four lawsuits are working their way through state and district court — and one case awaits a nod from the Supreme Court — that would make it illegal for the federal government …
After Halbig: What’s next for Obamacare?
I am a solo, independent family physician and my practice is not a silo. It is not a cold, stagnant, immobile, potentially dangerous storage facility where data to be used by insurance companies and statisticians is held until it is finally purged. No, my office is a visually and emotionally comforting, innovative, healing environment where information is shared and confidence is enhanced. It is an oasis.
My practice is embedded in …
My oasis of care is being threatened
For a very long time, one of the most valuable business assets in New York City was a yellow cab taxi medallion. With recent value in the $1 million dollar range, ownership of the medallion was a virtual cash annuity, combined with equity growth (in 2004 medallion prices were in the mid $200,000 range and have increased in value 15% year over year in the 9 years since). As one …
What the Uber of health care will look like
There are few things more important than our health and our health care. Solving health care for everyone is critical to becoming a healthy, vibrant society. Because our government has controlled our health care for two generations, election realities and political rancor obscures our ability to collectively solve the problem. Allow me to use a fictitious government program, “Foodaid,” to defray the noise and illustrate how government-control of our health …
Why government cannot cure our health care
Health care costs far too much. We can do it better for half the cost. But if we did cut the cost in half, we would cut the jobs in half, wipe out 9% of the economy and plunge the country into a depression.
Really? It’s that simple? Half the cost equals half the jobs? So we’re doomed either way?
Actually, no. It’s not that simple. We cannot of course forecast with …
Health care at half the cost: What will that actually look like?
There is no doubt that Affordable Care Act has changed the landscape of medicine in the U.S. Now, private practice is becoming a thing of the past. Financial pressures, increasing regulatory requirements, electronic medical records and outrageously complex coding systems are forcing long time private physicians to enter into agreements with academic centers and large hospital systems in order to survive.
As a result, medicine today is more about increasing patient …
Correcting the physician shortage isn’t an easy solution
Whether you’ve praised or vilified Obamacare, see it as an amazing achievement or an existential threat, it is the law of the land. The price transparency created by online exchanges, a vital part of the law, stands to make cost the biggest driver of choice. This, along with cuts in government health spending, will disrupt the economics of health care in dramatic new ways.
Our first response to this brave new …
Health care efficiency can mean different things
The venerable University of Texas MD Anderson Cancer Center in Houston will accept patients with traditional Texas Medicaid health insurance, and some patients in Medicaid managed care plans. Memorial Hermann, another large health system in Houston, will accept traditional Medicaid patients and also those in Medicaid managed care plans. Neither institution will accept the Blue Cross Blue Shield HMO silver plan sold on the Affordable Care marketplace, according to Read more…
Hypoliquidemia has now come to health care
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The 2-1 decision by the DC Court of Appeals striking down federal premium subsidies, in at least the 27 states that opted for the feds to run their Obamacare insurance exchanges, has the potential to strike a devastating blow to the new health law.
The law says that individuals can get subsidies to buy health insurance in the states that set up insurance exchanges. That appears to exclude the states that do …
Why Republicans should worry about the Halbig ruling
Many hospitals rely on bond funding for their expansion and the purchase of new equipment. Revenue that is created by the hospital is then used to pay back the bondholders. The risk to bondholders is that they are generally paid after the hospital pays its operational expenses. Therefore, if the hospital is less profitable than expected (or not profitable at all), bondholders assume the financial risk.
Hospitals have historically been rated …
The effect of health care quality on hospital credit ratings
Luxury goods are items that people purchase in disproportionately greater amounts as their income increases. That’s how economists think of them anyway. But for the average American, a luxury good means something else. We tend to think of luxury goods being things like designer clothing, luxury cars, and high-end restaurants. Our minds fill with images of Gucci, Burberry, and Luis Vuitton, or Mercedes-Benz, Porsche, and Ferrari.
One thing is clear to …
Is higher cost health care perceived as being higher quality?
The Commonwealth Fund just published its fourth Mirror, Mirror on the Wall study comparing the U.S. health care system with other countries, and as in all previous studies, we ranked as the absolutely worst health care system in the developed world, bar none.
Yikes.
The Commonwealth Fund studied many health care domains, and we didn’t rank in first place for anything. The best we managed to do is place a lackluster third …
Digging deeper into the Commonwealth Fund health rankings
An excerpt from The Demise of Medicine.
The Dalai Lama has once been quoted as saying, “Our prime purpose in this life is to help others. And if you can’t help them, at least don’t hurt them.” In a nutshell, the Hippocratic Oath can be summarized in this one phrase: “Primum non …
Throwing the Hippocratic Oath in the trash
Michelle Obama recently wrote an opinion piece in the New York Times discussing her pet project of childhood obesity. Discussing the Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC, she criticized the House of Representatives for considering a bill that would allow white potatoes to be included in the list of foods that could be purchased with WIC funds.
One …
Obamacare and WIC: When others pay the bills
The administration issued a report recently that says individuals who selected plans in the federal health insurance exchanges have a post-credit premium that is on average 76% less than the full premium for the plans they selected. And, 69% are paying less than $100 after the subsidies — 46% are paying $50 or less.
The administration also pointed out that 65% of individuals selecting the silver plan in the federal exchange chose …
Obamacare plans aren’t attractive to the middle class
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