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.
“Hey doc, I saw on an ad on the TV last night about this new asthma inhaler. Shouldn’t I give it a try?”
This type of question would occur several times a week. When I started practicing medicine it was considered unethical to advertise medical treatments. Now, we’re bombarded with enticements for tests and treatments. The inhaler the patient requested cost $264 a month — more than double what he was …
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The medical industrial complex and the surge of health costs
The Republicans have an alternative to Obamacare and they may have given the Democrats a big political gift.
The proposal was unveiled by Republican Senators Richard Burr (NC), Tom Coburn (OK), and Orrin Hatch (UT).
The Republican plan targets many of the most unpopular parts of the Affordable Care Act such as expensive mandated benefits and the resulting lack of choice, the individual mandate, the employer mandate, and age-rating disruptions.
My sense is …
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An analysis of the Republican alternative to Obamacare
1. Process vs. product. Computers are just machines. I repeat, they are just tools. Health information technology is a shell which houses knowledge and human ability. It is nothing more. Electronic medical records may either streamline our thought processes or make them more cluttered. They will not, however, lead to better or more perfect care. They haven’t yet, and they won’t in the future. And they are prone to be adulterated …
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10 reasons to feel pessimistic about health care
I recently asked if Obamacare was unraveling.
The Obama administration announced that they are delaying the employer mandate again.
In the announcement, they said that large employers, those with at least 100 workers, will only have to cover 70% of their otherwise eligible workforce in 2015 and 95% in 2016 and beyond.
The administration also said that employers with 50 to 100 workers will have their mandate to provide affordable health …
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Obamacare: What will the administration back off on next?
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 …
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Profits are not to blame for health care costs in the United States
There is a new report out from the Congressional Budget Office (CBO) titled “The Slow Recovery of the Labor Market,” and as its title implies, it predicts a slow recovery from a labor perspective. Among other things, the CBO report is now making headlines in the political game of Obamacare because it forecasts a 2.5 million job reduction by 2024 due to the effects of the health care …
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Don’t blame Obamacare for these 10 things
Even the best of families have skeletons: the uncle who had some shady business dealings, the cousin in drug rehab, brother with the messy divorce and custody fight, or the adult kids who are maxed out on their credit and behind in their mortgage payments but have to “keep up appearances” with their expensive suburban lifestyle. When these things happen, there is a tendency to “keep it all in the …
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Obamacare supporters shouldn’t cast a blind eye to its faults
As the patient-centered medical homes (PCMHs) train charges forward along with implementation of the Affordable Care Act, dollars are taken directly out of our health care system to certify providers in a method with no proven benefit. And, while there is a marked shortage of primary care providers nationwide, funds that could be used toward providing the direct provision of, or access to, health care are instead devoted to accreditation, …
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The data behind the medical home: High costs without a benefit?
Is Obamacare unraveling?
Rumors have been circulating in the marketplace all week that the administration was thinking of extending the individual health insurance policies that Obamacare was supposed to have cancelled for as much as three more years.
Those rumors have now come out into the open with Tom Murphy’s AP story that began running recently.
That the administration might extend these polices shouldn’t come as a shock. My sense has always been that at …
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Obamacare is considering extending individual health insurance policies
A little over a month ago, my family of five moved to a more spacious and modern house in the same neighborhood. I’m slowly getting adjusted to our new place — the locations of the light switches, how to operate the refrigerator’s automatic ice maker, which cycle to choose among the dozen different options displayed on our high-end washing machine. It still takes me a few minutes longer to get …
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Health reform: Forward progress or a temporary dislocation?
In describing why Cooper Union, a unique college that offers absolutely free education to students, would effectively die if it starts charging tuition, Kevin Slavin wrote:
For many of us, Cooper wasn’t even the cheapest way to go to school…So the question is: why did we go? We went not because of the financial value of free–that is, zero tuition–but rather, because of the academic value of free. At Cooper Union …
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Why monetary carrots and sticks are detrimental to health care
A primary criticism of the Affordable Care Act is that it creates incentives for employers to hire fewer full-time employees. One of the House’s attempts to repeal the ACA even referenced it as the “job-killing healthcare law.” It’s true that there are some provisions in the ACA that employers may exploit in order to minimize the cost of doing business.
At the same time, it’s also true that the ACA protects …
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Does Obamacare really kill jobs?
Trauma surgeons earn their patients’ respect every day, acting decisively in the face of calamity and uncertainty, heroically beating back death with steel blades and iron wills. Primary care physicians, however, have traditionally been at a relative disadvantage with regard to public opinion. After all, reconciling medication lists, reviewing lab results, and discussing health behaviors simply aren’t as exciting. In fairness, though, surgeons have always had one other advantage: anesthesia. …
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Fix primary care with technology and anesthesia
Patient-centered primary care medical homes (PCMHs) are all the rage. A frequently-touted part of the Affordable Care Act (ACA), they have received literally hundreds of millions of dollars in federal incentive and demonstration-project funding. They’ve been around for decades. In fact, the more you know about the intention behind the creation of a primary care patient-centered medical home (PCMH), the more you want to ask, “Well, of course – how …
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Is the medical home really worth it?
In addition to providing coverage to millions of uninsured Americans, one of the key attributes of the Affordable Care Act (aka Obamacare) is reforming the way that we finance health care in the U.S.
Since the rise of the health insurance industry (as a job benefit or under Medicare), we have operated under a system known as “fee-for-service,” in which every little nugget of health care provided (from an operation to …
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Accountable care organizations: Everything old is new again
While the Affordable Care Act, or Obamacare, has been criticized by its opposition as “socialized medicine,” it relies heavily on private health insurance. On the other end of the political spectrum is the idea that a government-run single payer system, similar to Canada’s, is the best way to deliver health care. (This is sometimes shorthanded in the U.S. as “Medicare for All.”) However, this system has been believed politically impossible …
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Vermont tests single payer and the country is watching
The primary debate in health care reform this past year centered on insurance coverage. The next great debate will focus on the cost of providing health care.
For decades, the way we’ve paid doctors and hospitals has driven up health care costs. And while the pace of health care spending has slowed the last four years, it continues to rise faster and more noticeably than improvements in U.S. health care outcomes.
The reason is not …
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The high cost of health care: Blame the financial model
The Affordable Care Act was enacted all the way back in 2010. But, even before then, critics were asserting that this new law would more or less destroy the American economy, insert Uncle Sam squarely between patients and providers, and initiate the end of freedom as it ushered in socialized medicine. That was nearly 4 years — and 40 repeal attempts — ago, and yet, the sky remains intact above …
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The Affordable Care Act is here and the sky has not fallen
