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.

Almost half of health care workers are not doctors and nurses. Health policies must address their burnout too.

Irving Gold

Health Policy

November 28, 2021

Vaccination rates are climbing, and COVID-19 cases are decreasing. While this is surely a relief to most of us, many health care workers are bracing themselves for a significant post-pandemic fallout. Far from getting a much-needed reprieve from an emotionally and physically draining 20 months, these professionals will be forced to work under similar strain to deal with the backlog of procedures now being scheduled again.

There is abundant evidence of …

Why the Build Back Better Act is an investment, not a cost

Shirin Shafazand, MD

Health Policy

November 28, 2021

The original Build Back Better Act proposed various provisions to improve Americans’ lives, including two years of free community college, child care assistance, and investments in clean energy. The steep price tag has led many to question whether or not we can afford to spend so much.

But as a pulmonary and critical care physician at a major metropolitan hospital, I have a different question: can we afford not to?

Every day in …

What medicine can learn from the antiwork movement

Brendan James Flanagan, MD

Physician

November 26, 2021

A record number of Americans are choosing to quit their jobs. This phenomenon has been termed The Great Resignation by economists. The reasons for the Great Resignation are multifactorial and a subject of great debate, but some insight can be gleaned from the rise of a movement that has been called ‘antiwork’. This movement is probably best embodied by the immensely popular /antiwork Reddit forum, where aggrieved employees share stories …

How advanced analytics can help social determinants of health

Mike Dulin, MD, PhD

Health Policy

November 25, 2021

Health care costs in the U.S. have increased dramatically over the past five decades, from $74 billion in 1970 to $3.8 trillion in 2019. This trend has been fueled in large part by an increase in the number of people who struggle with chronic conditions such as cancer, diabetes, hypertension, and lung disease. Stanford University School of Medicine estimates that 50% of Americans suffer …

Health care has crossed into a realm of moral injury and systemic collapse

Anonymous

Physician

November 23, 2021

Recently I have been more quiet than usual. Less writing. Less fire and brimstone. Quiet, at least for me. But anyone who is paying attention knows that when the most passionate and the most invested get quiet, something is truly amiss. Whether it be a looming threat or a very real and present crisis is unknown, but the fact remains that in that silence lives the very real possibility of …

“Take it or leave it” is not negotiation but coercion

Paul Pender, MD

Health Policy

November 23, 2021

“Take it or leave it” is not negotiation but coercion.

Physicians have been subject to this tactic for much too long. As an ophthalmologist in clinical practice for nearly four decades, I experienced too often what a recent author on KevinMD described as a one-sided arrangement with a health insurance company. “Here is the fee schedule. Here is the document to sign.” End of story.

If you object to the terms of …

How to address the mental health fallout of climate change

Rishab Chawla

Health Policy

November 22, 2021

An existential crisis

On August 9, the 2021 Intergovernmental Panel on Climate Change (IPCC) Sixth Assessment Report made public what many had feared. Global temperature warming to 1.5 C is all but inevitable by 2040 — even by the most optimistic scenarios — unless radically drastic steps are taken to end the use of fossil fuels.

Severe weather events such as California wildfires and Atlantic hurricanes of the past …

Open enrollment: It’s time to leave your insurance plan behind

Andy Schoonover

Health Policy

November 20, 2021

Research shows inadequate health insurance accounts for nearly 67 percent of all bankruptcies. This statistic is staggering, and illustrates a difficult reality for the many American families navigating today’s insurance market.

Not only can medical debt become a heavy burden – it can impact every facet of an individual’s life; compromising financial stability and potentially even exacerbating underlying medical conditions, creating complications due to the stress it causes. …

How did we let insurers run health care?

Gary Lawson and Marcia Lawson

Medications

November 15, 2021

How did we Americans allow health insurers to dictate how physicians practice good medicine? The hypocritic oath says, “Do no harm.” We should not allow insurance company profits to prevent proper care for patients.

Our insurer is now telling our young adult son, a Crohn’s patient (Crohn’s is not yet a curable disease), who has been in remission since he began taking Remicade over 11 years ago to switch to a …

Direct primary care is an answer to volume-based insurance reimbursement models

Troy A. Burns, MD

Health Policy

November 10, 2021

An excerpt from Medical Answers Now!: How Direct Primary Care Guarantees Fast Access to Your Doctor.

Health care costs are out of control and volume-based insurance reimbursement models are felt to be contributing to the problem. Medicare and most major private medical insurance carriers have begun testing and transitioning to reimbursement models that pay for health care services based on the …

It is time for the Supreme Court to help stem gun deaths

David Galinsky, MD

Health Policy

October 29, 2021

Every morning when I turn on the local Philadelphia TV news to hear the weather report, I also hear about the shootings that have occurred. This morning I heard that a 66-year-old man was shot while driving past his old high school. A fight had broken out between teenagers, a gun was pulled, and he was shot in the head.

The reporters sound concerned, sad, and even outraged. I thought that …

The blueprint for a Gold Medal Health Care System

Jeffrey Fraser, MD

Health Policy

October 29, 2021

An excerpt from Blueprint for a Gold Medal Health Care System.

We do not currently have a Gold Medal Health Care System. There may be more than one way to build one, but this book is about my vision of a Gold Medal system, and I will henceforth refer to my version as the Gold Medal System, or simply …

The success of Australian firearms regulation: What it could mean for children

Christopher Johnson, MD

Health Policy

October 24, 2021

An article in the New England Journal of Medicine in 2018 noted the sad milestone that firearms were causing 15% of all deaths in children and adolescents. Somewhat encouraging, a later study showed states with stricter firearm laws correlated with lower numbers of firearm deaths in children. The relationship was quite linear, as you can see below. The authors had specific criteria for weak vs. strong gun laws: if …

Systemic racism and Indigenous deaths in health care

Benjamin Brookwell

Health Policy

October 23, 2021

Ni cta ni akohikon: That hurts me.

Carol pe ntamici: Carol, come see me.

Ni taci sa micta mackikikatakoiin: They are overdosing me on drugs.

Wipatc tca: Do it quickly.

Those were the chilling words of Joyce Echaquan, broadcasting live from Facebook on September 28, 2020 at 10:27 am (English translation provided).

On September 26, 2020, Joyce Echaquan went to De Lanaudière Hospital in Joliette, Quebec. She was suffering from severe stomach pain. …

This doctor will be running for the legislature in the future

Anonymous

Health Policy

October 20, 2021

You don’t know who I am yet, but you will in the future.

I haven’t decided yet if I will run for the House, Senate, or the U.S. Congress. If you are a health care professional, whether it be a doctor able to change medicine, nurses, respiratory technicians, dieticians, phlebotomists, patient care technicians, janitors, and food service employees, you will want to hear this.

We can donate as much money as we …

Medical debt is the enemy of everyone

Robert E. Goff, MBA

Health Policy

October 17, 2021

An excerpt from End Medical Debt: Curing America’s $1 Trillion Unpayable Healthcare Debt.

Medical debt is the mortal enemy of the patient, the physician, the hospital, the community, the state, and the nation. When we think of others’ debts, we tend to think such debts are their personal responsibility. If they’re unable to pay the debt, it’s their problem. (We make …

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Medical debt is the enemy of everyone

To “fix” health care delivery, turn to a value-based health care system

David Bernstein, MD, MBA

Health Policy

October 16, 2021

With over two-thirds of the public believing that health care should be a top policy priority, there is no debating the importance of “fixing” our health care delivery system. On one extreme of the aisle, there is a growing chorus in support for “Medicare-for-all,” a single-payer, government-funded approach estimated by two independent studies from both liberal– and conservative-leaning institutes to cost …

HIV/AIDS vaccine underscores need for better health access

Alyson O’Daniel, PhD

Health Policy

October 11, 2021

“HIV has been a blessing in my life.”

Lola was a 48-year-old woman living in Denver when I interviewed her in 2002 about her HIV-positive diagnosis. She said the diagnosis improved her life in important ways; she had received income and housing support, nutritional assistance, health insurance, medication assistance and primary and infectious disease health care based on that diagnosis.

She said her sense of life’s purpose had changed, her basic needs …

Women are still being “burned at the stake” in medicine

Diana Londoño, MD

Physician

October 7, 2021

Are you a woman, and your sanity has been questioned? Congratulations: You are now an activist.

There is such a thing as implicit bias in which we may not be aware of how our subconscious thoughts are affecting our conscious thoughts, opinions, or actions we have daily.

They manifest in all aspects of life. Whether you come to see me for a surgical consultation and when you walk into the room, you …

Sexism in medicine: Alive and well or a dying breed?

Diane W. Shannon, MD, MPH & Nadia Obaed, Dieula John, MD, C. Elena Cervantes, MD, and Miriam Zylberglait Lisigurski, MD

Physician

October 7, 2021

Thirty-five years ago, as a first-year student, I (DWS) wrote an article for my medical school’s student-run newspaper titled, “Sexism in Medical School.” The article highlighted three examples of sexism:

In the middle of a pathology lecture, the professor projected a photo of a woman in a skimpy bikini lounging on a sports car to “liven things up.” He then showed a photo of a kitten, “So you ladies don’t …
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Sexism in medicine: Alive and well or a dying breed?