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.
Obamacare is working quite well, in some places, for quite a large number of people. But you wouldn’t know that from the constant media drumbeat about the problems with the healthcare.gov enrollment portal and the relatively small (fewer than 6%) of the population whose individual insurance policies have to be replaced because they don’t meet the law’s benefits and ratings standards.
Now, before I get a rash of comments about how I can …
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Where Obamacare is working well
What first comes to mind when you hear the word “hospital”?
Your reaction may depend on your past experiences. You may feel gratitude for the birth of a child or the treatment of acute appendicitis. You may feel sorrow, remembering a loved one who passed away on a hospital bed.
Regardless of our experiences, many of us assume the closer our hospital is to where we live, the safer and better off …
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Health reform will close hospitals: Why that may not be a bad idea
The most commonly heard comment in healthcare these days is that we have to move from paying for volume to paying for value. While it may sound trite, it also turns out to be pretty true. Right now, most healthcare services are paid for on a fee-for-service basis — with little regard for the quality of that service. We clearly need to move towards value-based payments (sometimes referred to as …
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Do safety net hospitals get penalized under new payment models?
The recent health care discussion in the media has centered around the implementation of the Affordable Care Act, now no longer a lengthy, inert document but rather a living, breathing manifestation of what should be a collective, unambiguous vision for the delivery of care in the United States. It is, however, anything but comprehensive in scope, and the coverage has primarily focused on crashing websites, politics, calls for resignations, and …
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Is health care a right or a business? It’s time to make a choice
Despite the current outcry over Healthcare.gov, Obamacare will soon bring 30 million Americans healthcare coverage. But if the website to signup may have lacked adequate planning, is our infrastructure for primary care ready? With some estimating a current shortage of 20,000 doctors, legions of new patients will add stress to an already crippled system. As a junior medical resident managing my own panel of outpatients at our local VA hospital, …
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The key to saving primary care
How do we keep the well people well while managing the devil out of the 1%?
This is one of our most complex and challenging questions, and there is no simple answer — but we needn’t look far to see that progress is being made.
Judging from the unprecedented groundswell of interest in health and wellness — and the corresponding emergence of a “wellbeing economy” — I think it’s fair to say …
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Health and wellness: We need to broaden our perspective
Some years ago, driving through an end of town where pawn shops and boarded up homes are common, I saw a small placard sign nailed on a telephone pole. “Buy Health Insurance,” it touted with premiums as low as $25 a month. I was tempted.
Health insurance, for me and for most Americans, is a necessary part of life, similar to home rent or mortgage, grocery bills and gasoline. Insurance is …
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The difficult transition from substandard to standardized coverage
For several weeks, the bumpy rollout of the federal health insurance marketplaces has overshadowed almost all other health care topics. But after reviewing the timely Health Affairs issue dedicated to the health care work force, it is clear we must maintain our focus on building a primary care system of the highest quality and value. Within that increasingly complex system, primary care physicians are the first, most critical line of …
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AAFP: The right care by the right provider is more important than ever
I was reading a blog about health policy and the failings of the ACA rollout posted on CNN. The author spends time talking about how much we want to change our health care system. And how, since change is hard, no one should be surprised by the pains accompanying this change, particularly in terms of individuals loosing their current insurance policies due to the rollout of the ACA …
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We really need 3 health care systems
As we mark significant milestones in our changing healthcare landscape, much of the dialogue continues to focus on the goals of payers and providers. Yet the goals of a third group are just as important. In order to truly transform care delivery in coming years, our efforts must include patients — their needs, interests, and engagement — at every step.
For the first time, the Affordable Care Act (ACA) will give …
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Bringing low income patients into the health care conversation
In an earlier post, I presented some data on which kind of physicians in the United States are most and least likely to see new patients who receive Medicaid, the state/federal program to pay healthcare costs for low income people. Now a recent study lays out some reasons why many physicians are so reluctant to see such patients.
Not surprisingly, it starts with low reimbursement rates. Medicaid pays about 61% …
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Why physicians are hesitant to take Medicaid patients
The president, by his own admission, did “fumble the ball” on the rollout of the major elements of health reform implementation. Not only is Healthcare.gov not functioning as it should, but people in the individual market are having their health insurance coverage cancelled–despite repeated assurances that if they liked their current coverage, they could keep it.
While that is absolutely a problem, it needs to be put into perspective. For …
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You can now keep your plan: What does this mean for you?
By now, the Obamacare insurance exchange debacle is old news. Our attention spans are so short, we’re on to the next disaster. So we sit before our TVs and enjoy the Humana ads with a smiling senior pointing to a whiteboards with their insurance plan name, or watch the news sponsored by UnitedHealthcare or Walmart’s pharmacy department. Everyone’s got a cheaper plan these days with more benefits than the other …
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What Healthcare.gov can learn from the Challenger shuttle disaster
Dr. Bob Centor, author of the always provocative and thoughtful DB’s Medical Rants, suggests that the deep divide over the Affordable Care Act is based on “a major philosophic disagreement” over the respective roles of government and of individuals in choosing what is best for them:
The administration and their supporters believe that government’s job is to protect citizens from their bad choices. They want to decide what the people need and …
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Is Obamacare paternalistic?
Covered California, the state-run Obamacare health insurance exchange, announced recently that 59,000 people have so far signed up for health insurance.
Given that California amounts to about 10% of the nation’s population, this would suggest a smooth running federal exchange might well have enabled the Obama administration to have met its national first month goal of 500,000 sign-ups.
But the California enrollment also points to the real challenge Obamacare faces.
In the first …
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California offers clues to the future of the Obamacare exchanges
From the point of view of the rational humble classical liberal, Obamacare sucks.
We rebel against the further intrusion of a narcissistic national government into our lives, as any sane person would who recognizes the value of liberty and the repeatedly proven harm of collectivism.
Given that the national government constantly takes away liberty, and given that even the Constitution has been unable to defend our liberty against the onslaught of the …
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The unintended beneficial consequences of Obamacare
A little known rule published by CMS to implement the Affordable Care Act (ACA) could pose a significant financial risk for doctors, hospitals and other healthcare providers. The rule requires health plans participating in the exchanges to provide individuals purchasing insurance through the exchanges a grace period before terminating the coverage for non payment of the premiums. Doctors and other healthcare providers will continue to provide care during the grace …
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A little known rule in the ACA could pose financial risk to doctors
The roll out of Healthcare.gov has given plenty of ammunition to opponents of health care reform, who style themselves as crusaders against incompetence. While many who oppose the program do so in good faith, some critics carry an ugly prejudice against sick and disabled people.
That prejudice is “just deserts” — the idea that people get what they deserve. Rich people deserve their luxury. Poor people deserve their poverty. Sick and …
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Do you believe sick and disabled people deserve care?
Over the last couple of years, we have been witnessing the start of a seismic shift in healthcare philosophy. For far too long, the system has been totally focused on rewarding quantity: The more patients seen, tests performed, procedures completed — the higher the incentives.
Now, instead of rewarding healthcare providers for quantity in the “fee-for-service” model, we are moving towards a system that rightly focuses on the quality of care …
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How can we judge the ideal health system of the future?
If you are a staunch conservative who believes that free markets should solve health care, or that poor people should work harder and have more skin in the game, or that governments should stick to building armies, you don’t need to read this post, unless of course you enjoy being aggravated by liberals.
If you are one of the talking heads posing as a progressive, while repeating the slogans of Obamacare …
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3 reasons to be against Obamacare
