The janitor approached my office manager with a very worried expression. “Uh, Brenda …” he said, hesitantly.
“Yes?” she replied, wondering what janitorial emergency was looming in her near future.
“Uh …well … I was cleaning Dr. Lamberts’ office yesterday and I noticed on his computer …” He cleared his throat nervously, “Uh … his computer had something on it.”
“Something on his computer? You mean on top of the computer, or on …
The fatal error in health care
Whenever a discussion of health care policy is initiated, the importance of health insurance, of extending coverage, takes center stage. The need for insurance quickly becomes an undeniable truth, a universal imperative. And no one ever seems to question this subtle premise before getting more patients fitted with shiny, new policies. This was precisely the case with the Affordable Care Act.
My question, however, is simple. Where is the evidence that …
Why more health insurance isn’t necessarily better
With the rollout of Obamacare, we are living in a moment in which there is no dearth of heated debates among friends, family, and co-workers.
And often times, these debates degrade to become emotion vs. emotion, or even ad hominem, and so these initially well-meaning conversations morph into heated arguments that lead nowhere. (Even Immanuel Kant advised debaters to out-shout opponents when more civil methods of discourse had failed.)
It is far …
A framework for evidence-based debate of contentious health issues
A version of column was published on March 5, 2014 in the New York Times’ Room for Debate blog.
To remedy our fragmented health system, reformers want to consolidate health care. President Obama, for instance, has praised integrated health systems like the Mayo Clinic as a model for national reform. To that end, the Affordable Care Act drives more hospitals to become more Mayo-like by purchasing physician practices. Today, about 39% …
Growing hospital networks create a tension for health reformers
American consumers value the freedom to comparison shop. We like to survey a variety of options and select “the one” that what we really want. If we want triple-ply, select-a-size paper towels with a blue shepherdess imprinted on them, then we expect to be able to find them in aisle 9. Deny us options and we’ll take our business elsewhere.
When it comes to health care, though, endless options may not …
Can narrow networks increase health care quality?
I first heard about the ICD-10 when I was working at a small start-up, trying to develop an EMR for a string of dialysis clinics. It was always spoken of with a certain gravity, like the ominous visit from an aunt that nobody in the family likes, but feels obligated to see. Practical (read: business) people hate ICD-10. It’s giant and unwieldy. Doctors think it’ll be an excuse to bilk …
ICD-10 and the problem of interobserver variability
Health insurance reform was long overdue. But did it need to be done the way the architects of the Affordable Care Act did it?
Obamacare was enacted, and the private health insurance market fundamentally changed, so that we could cover millions of people who previously couldn’t get coverage.
Are enough people getting coverage who didn’t have it before to justify the sacrifices the people who were already covered — in the individual, …
Measuring Obamacare’s success: Are enough people getting coverage?
We believe integrated will triumph fragmented every time.
-Steve Jobs
Two articles recently got my attention. The first was an interview by Dr. Robert Pearl, CEO of the Permanente Medical Group with my favorite author and thinker Malcolm Gladwell. On Pearl’s blog, he answered Gladwell’s request to tell people what is was like to be a doctor.
The second was a NPR article, “When Facts Are Scarce, ER Doctor Turns …
Why are doctors crazy enough to accept health care’s status quo?
The worst news in health care is not antibiotic resistance, drug-drug interactions, hospital acquired infections, lack of communication between systems of medical records, and certainly not the alarming rate of obesity in our youth.
The worst news is the increasing number of dissatisfied physicians.
The physician, also known in the system as a “provider,” has been the direct target of assault by the government. The logic has been that if the physician …
Dissatisfied doctors can’t provide good patient care
There’s a bit of buzz in the news recently over President Obama’s nominee for surgeon general, Dr. Vivek Murthy.
It’s worth pausing here to note the last truly consequential surgeon general: Dr. C Everett Koop single-handedly carried out the entirety of the Reagan Administration’s AIDS response (to be clear — this is true because of how little the Reagan administration did, not because of how much Koop did); fought hard …
The surgeon general nominee: Both the NRA and Vivek Murthy are wrong
In a recent article, Malcolm Gladwell dissected and diagnosed American health care.
Throughout our interview, he tackled controversial topics from the Affordable Care Act and medical malpractice to the contrasting Canadian health care system and much more. I expected him to dive deep below the surface and provide new and intriguing perspectives. He didn’t disappoint.
But it was his closing comment that caught me off guard. When I asked Gladwell …
Help people understand what it is really like to be a physician
Legislative bodies are moving with unprecedented swiftness to ensure we lead healthier lives. From bans on soda to bans on fast food, from mandates on health insurance coverage to mandates on EMR use, from bans on trans fats to mandates on care delivery models, our governments (federal, state, and local) are supposedly helping us live well. But our current approach to health care is about as scientific as our approach to fashion — skinny jeans, …
We must restrain our penchant for bans and mandates in health care
His is the story of which American dreams are made: a first-generation immigrant who grew up in South Florida, where he worked on weekends to support his father’s small business. After winning a spot at Harvard at 16, he set his sights on medicine and leadership. He founded an international non-profit focused on HIV/AIDS youth education while at Yale for medical school — and threw on an MBA for good …
Vivek Murthy: A surgeon general nominee hijacked by special interests
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Frontline caregivers across the United States — and in many other countries, no doubt — are bombarded by multiple quality improvement (QI) projects. A clinical unit might simultaneously be engaged in efforts to reduce readmissions, eliminate hospital-acquired infections and other complications, increase hand-hygiene compliance, improve performance on core measures, and enhance the patient experience. The demands brought by participating in all of these efforts risk overwhelming health care professionals, who …
How do we avoid initiative fatigue?
Most people, regardless of their political leaning, can agree that the market for health care in the United States isn’t really working well. Take one step further, though, and disagreement rapidly ensues.
On the left, the common understanding is that a market failure has occurred, and that the proper thing to do is have government intervene to correct that failure — usually by expanding public insurance programs, subsidizing private insurance, and …
Can transparency in health care happen in the United States?
Malcolm Gladwell hasn’t written much about American health care. But that doesn’t mean he hasn’t been thinking about it. And it sure hasn’t stopped many of his powerful ideas like “tipping point,” “outlier” and “blink” from gaining entry into the national health care debate.
In his most recent book, “David and Goliath,” Gladwell reshaped our perspectives on the underdog and highlighted our tendency to over-value certain strengths. In the health care …
Malcolm Gladwell on our health care system
Recently JAMA published a special theme issue on critical issues in U.S. health care. Among the contributors was Dr. Ezekiel Emanuel, the oncologist, bioethicist and former White House adviser on health policy.
In his article, “Going to the Moon in Health Care: Medicine’s Big Hairy Audacious Goal (BHAG),” Emanuel argues that contemporary medicine is in need of vision, an overarching, aspirational goal “like going to the moon that can make …
Universal coverage remains a big deal
Physicians in Congress are on the rise. From 1960 to 2004, only 25 of the 2196 members of Congress were physicians. During an era that brought such fundamental changes to health policy as the creation of Medicare and Medicaid, physicians were disproportionately less likely to hold congressional office than their counterparts in law (979) and in business (298). In recent years, the ranks of physician-representatives have swelled — twenty physicians …
The surge of physician membership in Congress
Safety net emergency departments are frequently blamed for being the source of rising health care costs. After all, they care for the millions of underserved and un-insured Americans forced by a variety of circumstances to visit ERs for their primary care and low-acuity concerns.
With the Affordable Care Act (ACA) reforms initiated in January, demand for emergency services will rise significantly. Medicaid already covers over 50 million individuals – most of …
How safety net ERs can save health care reform
The administration has confirmed that the individual policies that were supposed to be cancelled because of Obamacare can now remain in force another two years.
For months I have been saying millions of individual health insurance policies will be cancelled by year-end — most deferred until December because of the carriers’ early renewal programs and because of President Obama’s request the policies be extended in the states that have allowed it.
The …
Even supporters need to realize that Obamacare needs a fundamental fix
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