Health Policy and Public Health

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.

A meeting with Kathleen Sebelius about Obamacare

Manoj Jain, MD, MPH

Health Policy

November 12, 2013

Recently, I was among a dozen people who sat privately to talk about the Affordable Care Act (ACA), aka Obamacare, with the embattled Health and Human Services Secretary, Kathleen Sebelius. Dressed in a light green blazer, sitting alongside Memphis Mayor AC Wharton and Congressman Steve Cohen, who had nudged her to visit Memphis, Secretary Sebelius listened to our feedback and shared her insights.

First and foremost, addressing the issue of the …

Analyzing the bipartisan plan to repeal the SGR

Bob Doherty

Health Policy

November 11, 2013

Recently, the chairs and ranking members of the Senate Finance and House Ways and Means committees released a bipartisan, bicameral plan to repeal the Medicare SGR and reform physician payments. And this time, it looks like the effort could actually succeed: never before has there been agreement between the House and Senate, Republicans and Democrats, on a plan to repeal the SGR, never mind on what they would replace it …

Is it too soon to declare the Affordable Care Act a failure?

Naomi Freundlich

Health Policy

November 11, 2013

It is hardly an understatement to characterize the health insurance exchange rollout as a big disappointment. A botched website poses a serious problem and threatens to dampen enthusiasm for the new law — especially among the coveted “young invulnerables” who need to sign up for coverage to keep premiums affordable for all. In the short term, the website troubles put the Obama administration firmly back on the defensive, scrambling to …

Do we really need greater numbers of lesser trained physicians?

Hans Duvefelt, MD

Health Policy

November 10, 2013

My Swedish medical school curriculum was 5 1/2 years, but I remember during a third-year class trip to the Soviet Union hearing that some doctors over there had a much shorter education. My classmates and I were at first surprised to see physicians staffing ill equipped ambulances, riding the streets of Moscow with critically ill patients and no equipment to deliver care. We concluded that physician labor was cheap and …

Financial incentives are the wrong way to compensate physicians

Jeffrey V. Winston, MD

Health Policy

November 9, 2013

Everyone agrees that the US healthcare system is too costly. The challenge of public policy is deliver higher value by improving quality while reducing costs by eliminating waste and increasing efficiency. Historically physician compensation has been tied to productivity, which encourages procedures and over-utilization.

How can we motivate physicians to provide preventive, cost effective and quality care without incentive programs? Alfie Kohn in 1993 published ”Incentive Plans Cannot Work.” Clearly, poorly …

Doctor dinosaur: Physicians may not be exempt from extinction

Dennis Bethel, MD

Physician

November 9, 2013

I grew up in a solidly middle class family. Our home was safe, loving, and we never wanted for anything. My parents believed in hard work and instilled in me the importance of a college education. I was the first kid on the block to have a computer. That Radio Shack TRS-80 was a marvel of modern technology and made me the envy of my friends. Today, a TRS-80 is …

Physicians are the biggest driver of health costs

Kenneth Lin, MD

Health Policy

November 8, 2013

There are many reasons to be dismayed by the error-filled and managerially incompetent rollout of the federal health insurance exchanges that are in many ways the linchpin of President Obama’s Affordable Care Act. I sympathize with commentators who have called for the resignation of Department of Health and Human Services Secretary Kathleen Sebelius. It’s hard to imagine Franklin Roosevelt not firing someone in his cabinet had social security stumbled this …

5 recommendations to achieving a grand bargain in Medicare

Stephen C. Schimpff, MD

Health Policy

November 6, 2013

There are just a few key reasons why Medicare has become inordinately expensive. There is no end in sight for cost escalation. But there are some obvious solutions and they all begin with chronic illnesses.

Chronic illnesses — diabetes, heart failure, cancer, chronic lung disease, etc. — are increasing at exponential rates; are caused largely by lifestyle behaviors; and consume 70-85% of all claims paid. Medicare enrollees tend to have chronic …

Obamacare’s effect on small business: An unintended consequence?

Brad Wright, PhD

Health Policy

November 4, 2013

For employers, the Affordable Care Act takes two distinct approaches.

First, for small employers (those with 50 or fewer full-time employees), the ACA does not penalize, but rather incentives the purchase of insurance with subsidies available through the Small Business Health Options Program (SHOP). Second, for large employers (those with 51 or more full-time employees), the ACA does very little. Recognizing that the overwhelming majority of these large employers already offer …

Should smokers pay higher health insurance premiums?

Carol Duh-Leong

Health Policy

November 4, 2013

While the Affordable Care Act ends the era of denying people with pre-existing conditions access to health care, it allows insurance companies to charge tobacco users up to 50% more for their monthly premiums. Tobacco use for this purpose is defined as any self-reported tobacco use four or more times a week within the past six months. There are excellent intentions behind this policy — smoking is the number one …

Why insurance is the wrong model for health care

Paul Laband, MD

Health Policy

November 2, 2013

Insurance, in its traditional form, is the wrong model for health care financing. It is the wrong commodity to be bought and sold. We don’t need health insurance, and I will tell you why. I will also tell you what we do need.

Insurance is something you buy, and then hope you never have to use. It is a hedging of your bets against bad outcomes. Term life insurance is the …

Why health insurance for all obstructs lowering health care costs

David Mokotoff, MD

Health Policy

November 2, 2013

If you are like millions of Americans, at some point in your adult life, your doctor will order you to have a CT or MRI scan. Quick, easy, and painless, these invaluable imaging tests provide a vast amount and array of diagnostic information about illnesses, and direct treatment paths.

However, the real pain usually begins when you receive the bill. It is not uncommon for the charges, including radiological interpretation, to …

Is the death of the solo practitioner a bad thing?

Cedric Dark, MD, MPH

Health Policy

November 2, 2013

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In recent years, there has been a shift away from solo practice to group practice among physicians. The trend, which some say began in the early 2000s, appears to have accelerated with new incentives proscribed in legislation such as the Affordable Care Act. The push for accountable care organizations seems to be fostering the rapid reorganization of medicine from one based on …

Changing how doctors, patients and the media perceive prevention

Robert Pearl, MD

Physician

October 29, 2013

Imagine two men in their early 60s. A year from now, both men will be dead.

Changing how doctors, patients and the media perceive prevention could save lives and billions of health care dollars.

Today, each is scheduled for an initial consultation with an orthopedic surgeon and will undergo hip replacement surgery. Patient A will die on the operating table from a surgical complication. Patient B will undergo the procedure without incident. …

Should the health exchanges be shut down?

Robert Laszewski

Health Policy

October 29, 2013

My sense is that the biggest reason Obamacare is now in trouble is because of the top-secret way in which the administration has handled the rollout. If they had developed the computer system in a transparent way, the marketplace would have told them long ago this would not work.

No one outside the inner circle at the Department of Health and Human Services has any idea what’s really going on behind …

Why care must conform to patient values and cultural preferences

Margalit Gur-Arie

Health Policy

October 28, 2013

On his campaign trails, Harry Truman used to call on citizens to go out and vote for themselves, in their own selfish interests. It may sound shallow and divisive, but Harry Truman believed that the individual interests of the people should trump the special interests of the powerful few, and that’s how Democracy should work. Those were simpler times, but the logic still applies today, although it’s becoming increasingly difficult …

Should doctors encourage their patients to get health insurance?

Mara Gordon

Health Policy

October 26, 2013

She was a stressed-out mother of six, working a grueling job as a kitchen manager that required her to wake up at 4am every day. She came to her doctor for her headaches: searing, throbbing pain that made her vomit. She slept fewer than five hours a night. She had tried every over-the-counter pain medication I had heard of, and she had maxed out all of those doses. I met …

Obamacare covers screening colonoscopies, with a catch

Stephen C. Schimpff, MD

Conditions and Diseases

October 25, 2013

“An ounce of prevention” we all know is good medicine. An example is colonoscopy. It was time for mine so after some lengthy procrastination I called and set up an appointment which I soon found a perfectly good reason to postpone for a few weeks. A common occurrence. The government wants me (and you) to not procrastinate, at least not because of the cost. The Affordable Care Act (or Obamacare) …

David and Goliath lessons for doctors and our health system

Davis Liu, MD

Physician

October 24, 2013

October 1st was a special day. The Affordable Care Act (ACA) also commonly known as Obamacare became official. The federal government shut down because Republicans and Democrats disagreed around Obamacare funding. Most importantly, October 1st was when I could finally read Malcolm Gladwell’s new book David and Goliath.

Gladwell ponders why do underdogs succeed when we least expect them to? Is it possible that advantages a Goliath has can be a disadvantage? …

Finding out the price of health care should be a realistic expectation

Jessie Gruman, PhD

Patient

October 23, 2013

“Health care costs are sky-rocketing!” “The percentage of the U.S. GDP devoted to heath care costs is the highest in the world.” “The cost of Medicare is unsustainable.”

For most of us, the cost of health care (i.e., the dollars required by the system to produce and deliver care) isn’t what brings us the most anxiety.

It’s when we’re patients or helping a loved one find care that so many of us are deeply …