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Medicare will pay your practice to keep chronically ill patients out of the hospital, so why do most practices leave that money unused? Rachel Yates, a registered nurse and health care executive, joins …
Medicare will pay you to keep patients well. Most practices miss it. [PODCAST]
When I started medical school, I pledged to take care of anyone who would walk through the door. I pledged not to discriminate between my patients and to advocate for them both inside and outside the clinic. Like many first-year medical students, I entered medicine with a certain idealism. I believed medicine was fundamentally about serving those who needed care most, and I assumed everyone around me would agree with …
Why physician advocacy matters more than ever
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Medicare for All keeps dying in Congress. So what would actually get the major players to agree on universal coverage? Health care journalist Ken Terry returns to lay out a different model, one …
How to fix health care without Medicare for All [PODCAST]
The committee had met six times. The quality data was clear. The care pathway was evidence-based. The physicians in the room nodded. Six months later, nothing had changed.
Not because the initiative was wrong. Not because the physicians were resistant. Because the environment it landed in was never built to hold it.
This is the diagnosis most physician leaders never make, not about their patients, but about their organizations. They identify the …
Why change fails in health care organizations
In the 1970s, the American hospital was, in the industry’s own language, an “open workshop.” A physician kept an office down the street, admitted patients to the hospital when they needed a bed or an operating room, and worked largely independent of whoever managed the building. The doctor made the medical decisions; the administrator kept the lights on and the ledgers balanced. It was an arrangement with obvious flaws (fragmentation, …
The corporatization of medicine, in salaries and beds
As California voters decide between Xavier Becerra and Steve Hilton for governor, one growing public health concern needs more focus from both: the surge in underage online gambling. Easy access through phones and apps creates risks that could spiral if left unchecked. AB 2617, the Protecting Kids from Online Gambling Act, provides a practical starting point. Advancing, refining, and enforcing solid measures here should be a priority regardless of …
How California can stop underage online gambling
Nobody is asking this out loud. They should be.
Consider any mid-sized American city. A physician shortage that predates the pandemic. A growing population. Enough employer density to attract outside capital. A physician opens an independent concierge or DPC practice. The panel fills. The model works. The relationship medicine covenant holds.
Then the room changes.
Private equity is reshaping concierge medicine
Anyone who uses social media is likely to encounter messages about tobacco harm reduction. This information comes from multiple sources with varying and overlapping agendas. At one end of the spectrum, the World Health Organization and most public health authorities emphasize the risks associated with nicotine in all forms. Their primary concern is preventing nicotine initiation among adolescents and young adults, thereby reducing future tobacco-related disease. At the other end …
What’s missing from the tobacco harm reduction debate
The U.S. health care system is facing a serious workforce shortage. In pediatric oncology, the stakes are especially high. But the issue is not simply a lack of available positions. Increasingly, it is a recruitment and retention challenge.
Recent pediatric hematology-oncology fellowship data shows that while training positions increased by 36.6 percent between 2009 and 2025, applicants increased by only 8.3 percent. During that same period, the applicant-to-position ratio declined …
The pediatric oncology workforce shortage is widening
Twenty-five years ago, 15-year-old Lewis Blackman died following elective surgery at a respected South Carolina hospital. Since he was placed in a suboptimal ward that was inadequate for his condition, his health worsened from a perforated ulcer and overwhelming infection, warning signs were missed, family concerns were not adequately escalated, and life-saving treatment came too late. His death became one of the most influential patient safety cases in American …
Hospital overcrowding makes safe care impossible
Health care is fundamentally broken when the patient has to choose between a day’s wages and a basic clinical checkup. In the rural landscape of California’s Imperial Valley, this is not a hypothetical dilemma. It is a daily reality for thousands of frontline agricultural workers and underserved families.
As a primary care physician operating independent clinics along the California-Mexico border, I have watched the conventional, centralized health care delivery system repeatedly …
Rural health equity starts outside the clinic walls
Every day in medicine, we hear a familiar refrain: “I want to do the right thing for my patients, but my hands are tied by the system.”
It is a comforting narrative. It casts doctors, administrators, and clinical leaders as helpless victims of an invisible and rigid machine. It positions them as casualties of a vast medical-industrial complex driven by insurance mandates, regulatory compliance, and predatory billing cycles. We shrug our …
Why health care leaders keep blaming the system
For generations, the struggles between patients and health insurers have played out in the quiet corridors of bureaucracy and the echoing halls of the courts. When a claim is denied, the journey that follows is often a weary procession: appeals, reviews, complaints, and lawsuits. Even when an insurer is found at fault, the reckoning is almost always measured in a payment here, a penalty there, and maybe a sanction filed …
When a health insurance denial leads to death
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America feels like the ultimate noncompliant patient.
We stabilize her, patch the wounds, manage the crisis, discharge with recommendations, and within four to eight years she is right back in the ICU on another freedom tangent that destabilizes the entire body of democracy again. The cycle repeats endlessly. Reactive instead of preventive. Fragmented instead of coordinated. Profitable instead of sustainable.
And honestly? The same dysfunction reflected in the country is reflected in …
America on life support: A hospital social worker reflects
We live and work in a sick society. I know this isn’t a revelation as much as a cruel reality. The disparity between those with means and those without is noticeable in every available metric dissecting the spending habits of Americans, credit card indebtedness, retail, stock market portfolios. In this sick system, I am so tired of hearing about the ultra-rich whine and complain about the “difficulties of being …
Wealth inequality is a clinical problem, not political
Health care spending in the United States reached about 18 percent of GDP in 2024, totaling $5.3 trillion, or roughly $15,474 per person. That’s dramatically higher than peer countries, which average around 11 percent. Yet patient outcomes haven’t kept pace.
Two major, interconnected problems stand out: exploding administrative overhead that diverts money away from actual care, and a systemic preference for treating problems after they occur rather than …
The hidden tax driving up U.S. health care costs
American health care faces many challenges: rising costs, workforce shortages, an aging population, increasing chronic disease burden, and growing administrative complexity. Yet one of the most important health care crises receives far less attention than it deserves: the declining physical and emotional well-being of the health care workforce itself.
Physicians, nurses, respiratory therapists, pharmacists, physical therapists, and countless other health care professionals devote their careers to caring for others. Yet many …
The health care workforce crisis we keep ignoring
During my pediatrics rotation, I met a 13-year-old girl with obesity. She was trying to follow her doctor’s advice to eat healthier and exercise more, but it was tough: She lacked access to a gym, her neighborhood lacked sidewalks, and local traffic was fast and busy. It was not safe for her to walk or rollerblade alone, despite her motivation to be more active.
Her problem is a common one in …
The built environment is shaping our patients’ health
I am a proud Pakistani Hoosier.
My father immigrated from Pakistan in 1992 in search of a better life than what was possible back home. After moving around for work in those early years, my parents settled outside Indianapolis when I was four years old, and Indiana has been home ever since. As I now pursue my medical education, I find myself thinking often about the two places that shaped me …
From Pakistan to Indiana: climate change and patient health
In health care, we often describe what we are experiencing as system failure. We point to clinician burnout, staffing shortages, administrative burden, and the growing distance between those delivering care and those designing it. We talk about breakdowns in communication, gaps in safety, and the increasing strain placed on a workforce asked to adapt faster than it can recover. The language is familiar. The concern is real. But the conclusion …
Health care system design isn’t failing, it’s working
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