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Health policy and public health

4,357 articles · Since 2004

Articles, page 131

Health policy

What Lincoln can teach us about health reform

2

“Passed by corruption, aided and abetted by the purest man in America” is how anti-slavery Congressman Thaddeus Stevens described President Lincoln’s successful effort to enact the 13th amendment, banning slavery. This historically accurate quote, which runs counter to the public…

“Passed by corruption, aided and abetted by the purest man in America” is how anti-slavery Congressman Thaddeus Stevens described President Lincoln’s successful effort to enact the 13th amendment, banning slavery.   This historically accurate quote, which runs counter to the public image of “Honest Abe” Lincoln, is among the many  fascinating  stories recounted in the Steven Spielberg’s masterpiece  “Lincoln” playing  …

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What Lincoln can teach us about health reform

Physician voices

Don’t devalue physicians to mere employees

4

A buddy of mine sent along an interesting link by a physician named Ben Brown that makes an argument that doctors actually aren't all that well off. Salaries are down. Education costs can exceed $300,000 over the course of college,…

A buddy of mine sent along an interesting link by a physician named Ben Brown that makes an argument that doctors actually aren’t all that well off.   Salaries are down.  Education costs can exceed $300,000 over the course of college, medical school, and residency.  By the time you take that first job, you’re on the wrong side of 30 and Wells Fargo is demanding $1800 a month for all your student loans.  It’s a topic …

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Don’t devalue physicians to mere employees

Physician voices

Common criticisms of concierge medicine that deserve to be answered

25

The idea that patients are better off paying their doctor directly and using their insurance only for unaffordable catastrophes is gaining some traction. With implementation of the Affordable Care Act looming in 2014 many patients are looking at their doctor’s…

The idea that patients are better off paying their doctor directly and using their insurance only for unaffordable catastrophes is gaining some traction. With implementation of the Affordable Care Act looming in 2014 many patients are looking at their doctor’s already crowded waiting room and wondering how their care will be impacted when their doctor is responsible for even more patients. And doctors who even now are swamped and frustrated …

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Common criticisms of concierge medicine that deserve to be answered

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Health policy

Does health reform require doctors to stray from their ethical code?

6

The difference between a job and a profession is a matter of ownership. Anyone who is applying for employment understands that the job they seek actually belongs to someone else. It is typically offered by an individual or a corporation…

The difference between a job and a profession is a matter of ownership. Anyone who is applying for employment understands that the job they seek actually belongs to someone else. It is typically offered by an individual or a corporation who defines the job and determines who is qualified to perform it. If the job holder is unable or unwilling to do the work, the owner takes the job back …

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Does health reform require doctors to stray from their ethical code?

Health policy

Fix our health system: Be like Switzerland

42

I was working in the ER this weekend when one of my nurses asked me a simple question: “How would you fix the health care system?” Obviously, this is a complex problem requiring complex solutions, but in an environment where…

I was working in the ER this weekend when one of my nurses asked me a simple question: “How would you fix the health care system?” Obviously, this is a complex problem requiring complex solutions, but in an environment where at any minute a heart attack or a stroke could disrupt a conversation I prepared a sound bite for an answer.

“Do …

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Fix our health system: Be like Switzerland

Health policy

We have inherited a health system that is broken beyond repair

18

I can truly say logging on to the National Commission on Certification of Physician Assistants website and seeing I’ve passed the boards was one of the happiest moments of my life. All of the hours invested learning to take great…

I can truly say logging on to the National Commission on Certification of Physician Assistants website and seeing I’ve passed the boards was one of the happiest moments of my life. All of the hours invested learning to take great care of patients was worth that feeling. Like an entire generation of young new MD/DO/PA/NP graduates looking to make a positive …

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We have inherited a health system that is broken beyond repair

Health policy

One doctor’s holiday wish list

4

Many years ago, I wrote this essay in which I wondered why I receive so few gifts from my patients in the holiday season. I was prompted to write the essay by the memory of my father, an orthopedic surgeon…

Many years ago, I wrote this essay in which I wondered why I receive so few gifts from my patients in the holiday season. I was prompted to write the essay by the memory of my father, an orthopedic surgeon in solo practice, whose patients showered him every December with foil-wrapped bottles of booze, tins of cookies, and all manner of goodies, including a “World’s Greatest Doctor Figurine.”

I speculated …

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One doctor’s holiday wish list

Health policy

The deep professional rift between nursing and medicine

13

I recently attended Primary Care Progress’s Gregg Stracks Leadership Summit. The summit brought together chapter leaders from around the country to get coaching in how to lead our chapters to accomplish our individual goals. I went to the summit knowing…

I recently attended Primary Care Progress’s Gregg Stracks Leadership Summit. The summit brought together chapter leaders from around the country to get coaching in how to lead our chapters to accomplish our individual goals.

I went to the summit knowing that PCP values teams – the team-based model of organizing to improve the primary care profession and the team-based model of primary care delivery.  In both cases, there would be a …

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The deep professional rift between nursing and medicine

Health policy

Predicting the next 4 years of health reform

Although members of the Obama team are now celebrating their election victory, the next four years will not be smooth sailing. Ignoring the campaign rhetoric, there is still much more work to be done in order to reshape our health…

Although members of the Obama team are now celebrating their election victory, the next four years will not be smooth sailing. Ignoring the campaign rhetoric, there is still much more work to be done in order to reshape our health care system; the effect on academic medical centers and teaching hospitals will be significant.

The political conscience is still being driven by …

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Predicting the next 4 years of health reform

Physician voices

The problem with discussing politics in the exam room

5

Four years ago, as I was making rounds on the oncology floor, one of my patients with leukemia asked, out of the blue, "Hey, Doc, who you gonna vote for?" He had an Obama T-shirt by his bedside. Chuckling politely,…

Four years ago, as I was making rounds on the oncology floor, one of my patients with leukemia asked, out of the blue, “Hey, Doc, who you gonna vote for?” He had an Obama T-shirt by his bedside.

Chuckling politely, I asked him why he wanted to know. “I’m curious, Doc,” he said. “It tells me your worldview.” He said that if we agreed on who should be the next president, …

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The problem with discussing politics in the exam room

Health policy

Why across the board Medicare cuts are a bad idea

3

American Medical News featured an article with the disturbing title, "Massive health job losses expected if Medicare sequester prevails." I wasn't entirely sure what a "sequester" was, since I thought it was a verb. Sequestration, I thought, was the noun.…

American Medical News featured an article with the disturbing title, “Massive health job losses expected if Medicare sequester prevails.”

I wasn’t entirely sure what a “sequester” was, since I thought it was a verb. Sequestration, I thought, was the noun. (I hear a loud knock. It must be the grammar police.) The story, as I understand it, is that when our government decided to pull together and raise the debt ceiling, …

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Why across the board Medicare cuts are a bad idea

Health policy

The cost of health insurance in 2014: Get ready for sticker shock

7

What will health insurance cost in 2014? Will the new health insurance exchanges be ready on time or will the law have to be delayed? There will be sticker shock First, get ready for some startling rate increases in the…

What will health insurance cost in 2014?

Will the new health insurance exchanges be ready on time or will the law have to be delayed?

 There will be sticker shock

First, get ready for some startling rate increases in the individual and small group health insurance marketplace due to the changes the law dictates.

In a November 2009 report, the CBO estimated that premiums in the individual market would increase 10% to 13% …

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The cost of health insurance in 2014: Get ready for sticker shock

Health policy

Why cost and revenue will kill independent hospitals

2

Costs and revenue: This is the oxygen of any business, any organization. What are your revenue streams? How much does it cost you to produce them? Life is not just about breathing, but, if you don’t get that in-out equation…

Costs and revenue: This is the oxygen of any business, any organization. What are your revenue streams? How much does it cost you to produce them? Life is not just about breathing, but, if you don’t get that in-out equation right, there is nothing else life can be about.

Right now this enormous sector is turning itself inside out. It has turned the “transmogrification” setting to “warp.” Why? It’s all about …

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Why cost and revenue will kill independent hospitals

Health policy

The loopholes around penalizing hospitals for readmissions

7

With notably few exceptions, the American health care system has been financed on the basis of volume rather than value. That means that we’ve been paying providers for everything that they do, rather than paying them for the outcomes they…

With notably few exceptions, the American health care system has been financed on the basis of volume rather than value. That means that we’ve been paying providers for everything that they do, rather than paying them for the outcomes they produce. This is not common in other fields.

For example, if you are in an accident and have to take your car to a body shop, you (or your insurance company) …

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The loopholes around penalizing hospitals for readmissions

Health policy

Medical homes need ready access to good data

3

Recently, "60 Minutes" (in my view the last bastion of great traditional network news investigative reporting) described a for-profit hospital system that apparently uses percent targets (allegedly 20%) to encourage high admission rates by their ER doctors. In setting up…

Recently, “60 Minutes” (in my view the last bastion of great traditional network news investigative reporting) described a for-profit hospital system that apparently uses percent targets (allegedly 20%) to encourage high admission rates by their ER doctors.

In setting up this report, the reporter commented that as much as 10% of healthcare expenditures in this country were “unnecessary.”

Actually, most health experts I have read and consulted would put that number much …

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Medical homes need ready access to good data

Health policy

AMA: Patients are vulnerable to health plan monopoly power

3

A guest column by the American Medical Association, exclusive to KevinMD.com. When health plans have merged, they've said that a bigger insurance company would drive down premiums. The casual acceptance of this economic fallacy led to more than a decade…

A guest column by the American Medical Association, exclusive to KevinMD.com.

When health plans have merged, they’ve said that a bigger insurance company would drive down premiums. The casual acceptance of this economic fallacy led to more than a decade of unchecked megamergers that helped health plans cement dominant market positions across the country.

It’s now clear that when health insurers talk about taking over another plan, what they often mean is …

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AMA: Patients are vulnerable to health plan monopoly power

Health policy

Neither political party truly represents doctors or their patients

6

When you walked into the voting booth on Tuesday, November 6, did you do so with a feeling of calm certainty that the man who would get your vote for President was unquestionably the best choice, or even the only…

When you walked into the voting booth on Tuesday, November 6, did you do so with a feeling of calm certainty that the man who would get your vote for President was unquestionably the best choice, or even the only possible choice?  Did you feel confident that your candidate’s political party fully supports your political views as well as your personal values?

For many physicians, I suspect that the answer to …

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Neither political party truly represents doctors or their patients

Health policy

ACP: Practice transformation is more than checking off boxes

2

A guest column by the American College of Physicians, exclusive to KevinMD.com. Recently, I was invited to speak at an ACP chapter meeting on the topic of shared vision. In the talk, I used as examples Dr. Martin Luther King…

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Recently, I was invited to speak at an ACP chapter meeting on the topic of shared vision. In the talk, I used as examples Dr. Martin Luther King Jr., John F. Kennedy, and Steve Jobs, leaders whose visions inspired people and helped them to achieve great things. As I wrote the talk, it occurred to me that …

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ACP: Practice transformation is more than checking off boxes

Health policy

Do we really have the world’s best cancer care?

4

Those who resist health care reform point to America’s great cancer care – instead, we should protect “the best health care system in the world.” After all, if we’re the best, other countries should change, not us. Do we really…

Those who resist health care reform point to America’s great cancer care – instead, we should protect “the best health care system in the world.” After all, if we’re the best, other countries should change, not us.

Do we really have the world’s best cancer care?

A good indication is the American survival rate for breast cancer, the world’s longest. But …

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Do we really have the world’s best cancer care?

Health policy

4 essential elements of true health reform

7

I recently said I would describe the essential elements of "true reform." I realize others might add or subtract from my list, but here it is – at least for today: Payment reform. I put this first because no matter…

I recently said I would describe the essential elements of “true reform.” I realize others might add or subtract from my list, but here it is – at least for today:

Payment reform. I put this first because no matter what form or structure healthcare takes, without payment reform it will be doomed to failure. And by “payment reform” I mean switching from the “fee for service” model I discussed in …

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4 essential elements of true health reform

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