I’m not a big fan of bargaining and my half-hearted attempts to get a better price for a used car, garage sale find or contractor’s service have been mostly unsuccessful. There’s always that nagging feeling that the seller is laughing with delight once I’m gone, thinking, “I really pulled one over on that rube!”
And so it has come as somewhat of a shock to me that medical care has become …
Turning health care into a giant used car lot
A good recipe is one that combines high-quality ingredients in appropriate quantities to produce a savory main course or a decadent dessert.
It strikes me that, in order to answer the Affordable Care Act’s call for us to aggressively pursue population health, we must first understand what the recipe calls for.
Dichotomous as it may seem, the primary ingredient for population health is accurate, comprehensive data on the individuals who comprise the …
How to aggressively pursue population health
I advocated for the Affordable Care Act, and celebrated when it was passed.
It’s good to have everyone covered, I thought.
Insurance for everyone is the first step to health care for all.
Alas, access to health insurance isn’t the same as access to health care.
First there is the niggling detail of providers. We already have a primary care provider shortage. Internists, pediatricians, family physicians are already working at full capacity in caring for …
Reform creates new incentives in health care
If there’s anything that liberals hate it’s inequality – unless it’s the Federal tax code – and health care is a prime offender. The liberal mantra is that everyone should have the same access to basic health care. But this doesn’t just involve improving health care access and affordability for millions of uninsured Americans. It also involves limiting or impairing (through taxes) those health care plans liberals have decided are …
Are Cadillac plans responsible for rising health costs?
One could easily make a case that health care is today’s biggest consumer problem—not unlike those that sparked the consumer movement of the 1960s and 70s. Back then, consumer issues centered on problems with using credit, buying cars and home improvement services, and obtaining the best price for food, appliances, and just about every other new-fangled and expensive product that sprang from the post-war economy.
Like many old consumer problems, health …
Navigating the shopping troubles with insurance exchanges
The massive confusion about Obamacare (the Affordable Care Act) is much worse than I thought. The Kaiser Family Foundation came out with a poll that shows 42% of Americans don’t even know that Obamacare is the law. Seven percent of people think the Supreme Court struck it down and 12% think Congress repealed it.
I understand that there is confusion about the way it will work and who will be affected. …
Why Obamacare is a marketing fail
Unplanned readmissions to the hospital have been the focus of much attention in recent years for obvious reasons. First, they are relatively easy to measure using administrative claims data. Second, like all inpatient hospitalizations, they cost a lot of money–and are therefore a target for reducing spending. Third, they are a proxy for quality of care, as at least some portion of them are likely avoidable if the hospital does …
Is the hospital readmission rate a measure of quality?
Hi.
I’m Rob and I am a recovering doctor. Yeah, I am recovering … doing a lot better, actually. Things are tough, but they are a lot better since I left my destructive relationship with Medicare, Medicaid, and insurance companies. I’ve had to learn how to manage my own money (now that I can’t count on them to bail me out any more), but things are looking a lot better. I …
Confessions of a recovering doctor
Decisions in medicine are supposed to rest on concrete observations and hard evidence.
Often, hard evidence does not exist or when it does, it isn’t used. Why is this?
Concrete observations, too, are increasingly missed as we stare at computer screens longer and patients less. Yet we persist. Why?
This is our reality now, our evolving medical world.
But if we stop and think about it, medicine, by definition, is a world of technological …
How big data is affecting medical judgment
If a mosquito lands on someone’s head and you hit the mosquito with a shovel, is the death of the guy under the mosquito considered an unintended consequence?
So now we know that the government of the United States of America is spying on its own citizens, not specifically on any one in particular, but massively and indiscriminately collecting troves of data on all American people. All perfectly legal, …
Protecting us from the terrors of unhealthy lifestyles
Most Republicans hate Obamacare for what they consider to be government over-reach, most Democrats support it because they believe only a strong policy of government intervention can extend coverage to the millions of uninsured—and there are no signs that their ideological battle will abate anytime soon. But there may be one sweet spot that both parties could agree on: providing consumers (or patients, if you prefer) information on the prices …
Health care price transparency should receive bipartisan support
It is clear that healthcare in the US is more costly than in any other place in the world. We spend 18% of the gross domestic product on healthcare and our outcomes are no different than those of other industrialized nations who spend less than half that amount. How did we get here and what are we to do about it?
Recently, an article appeared in the Read more…
American’s health cost problem has no easy fixes
Many ask of our profession, “Are you knight or knave?”
The supposition, that there exists a dichotomy of options for the current physician, is a false one. Likely we are a little bit of both, and many shades in between. The maddening belief that the future of our healthcare system depends on this delineation is preposterous. I would more aptly characterize us as pawns.
The time for change has come.
After patiently listening to my …
Physicians need to speak with a unified voice
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As my head reels at the implications of the IRS scandal mushrooming in Washington, the IRS’s recently disclosed ability to access emails without warrant, the intricacy of the NSA PRISM wiretap techniques that includes their ability to acquire tech firms’ digital data, and even the Justice Department’s ability to secretly acquire telephone toll records from the Associated Press, I wonder (as a doctor) what all this means for the privacy protections afforded …
Does HIPAA really protect our privacy?
In 2009 I wrote a post titled “Quality or Conformity,” where I pointed out that many of the quality measures in primary care have more to do with whether doctors follow guidelines than if they deliver care that helps patients live long and well. There is a tendency to focus quality efforts on measuring what is easy to measure, rather than what matters the most.
That phenomenon is called …
Quality is a word that lacks universal meaning
Ralph Cramden was the quintessential sucker. I suppose only people of a certain age — my age, for instance — will remember Ralph. If you have fewer gray hairs than that, perhaps you will remember the next incarnation of Ralph, Fred Flintstone. The Honeymooners character, brought indelibly to life by Jackie Gleason, was the inspiration for Fred, just …
Either we are suckers, or we think health sucks
The following column was published on May 29th, 2013 in the New York Times’ Room for Debate blog, which asked the question, “Is Obamacare too complicated to succeed?”
Is the Affordable Care Act complicated? Of course it is. Even one of its architects concedes that it is phenomenally complex. Why? To pass, it had to be contorted to satisfy a number of special interest groups.
As its major reforms are implemented …
Complicated Obamacare clears a very low bar
Medical care in the U.S. over-promises and under delivers. It costs about twice as much as in most other developed countries, but compared to them manages to produce only mediocre health outcomes. The profit motive has resulted in badly misallocated resources — too much testing and treatment for people who don’t need it and lousy access for many who do.
The impact of advances in medical science on the delivery of …
Confronting the reality of uncertainty in medicine
Medscape published an article titled, 4 Top Complaints of Employed Doctors, and it was a very interesting read. Turns out the things employed physicians complain about are basically that they are employees.
Let me lay out these employed physicians gripes for you with a little detail so you will see what I mean. I will finish this article with a solid way to address all of them. These …
4 complaints of physician employees and 1 solution to fix them
Our culture — at least the movie-going part of it — seems to have embraced the adage: With great power comes great responsibility. Somehow, at the same time, it seems to have ignored the inevitable, underlying principle: Power and responsibility are conjoined. This, in turn, implies a corollary our culture also neglects routinely, if not universally: Before anyone can reasonably be expected to take responsibility, they must be suitably empowered.
After …
The power of culture in health care
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