Public Health & Policy

Digging deeper into the Commonwealth Fund health rankings

Policy

July 22, 2014

The Commonwealth Fund just published its fourth Mirror, Mirror on the Wall study comparing the U.S. health care system with other countries, and as in all previous studies, we ranked as the absolutely worst health care system in the developed world, bar none.

Yikes.

The Commonwealth Fund studied many health care domains, and we didn’t rank in first place for anything. The best we managed to do is place a lackluster third …

5 controversies surrounding the Affordable Care Act

Lawrence D. Brown, PhD

Policy

June 8, 2014

The continued implementation of the Affordable Care Act (ACA) in 2014 will be as controversial as in previous years.

Here are five main areas of concern:

1. The individual mandate. By what right does the federal government “force” its citizens to buy a product they may not want? The Supreme Court upheld the mandate in 2012, but that does not end the matter. Partly — perhaps largely — because the ACA sets …

The salaries of health executives: What can doctors do?

Kevin R. Campbell, MD

Policy

May 29, 2014

Health care reform is a reality. The ACA and its associated mandates have forever changed the landscape of medicine in the U.S. today. The Obama administration touts the goals of reform as providing affordable, cost effective, high quality care for all Americans. Certainly these are noble and lofty goals: But have we completely missed the mark?

Today, many remain uninsured and the majority that have signed up for the exchanges are simply …

What is the main cause of the primary care crisis?

Stephen C. Schimpff, MD

Policy

February 10, 2014

Next in a series.

Primary care physicians (PCPs) have too little time per patient which means too many referrals to specialists, too little time listening and thinking, no time to delve into the stress or emotional causes of many symptoms and substantial frustration by PCP and patient alike.

Previously in this continuing series on primary care, I described a patient with a straight forward if unusual symptom who was bounced …

Why Medicaid patients use the emergency department for primary care

Kevin Pho, MD

KevinMD

January 3, 2014

A study from Science found that those on Medicaid in Oregon made 40% more visits to the emergency department.

The Oregon Health Insurance Experiment included about 90,000 low-income people and assigned 30,000 of them to Medicaid by lottery. It’s essentially a naturally-occurring randomized controlled trial.

The result seems to have caught the public policy experts by off guard:

“I suspect that the finding will be surprising to many in the policy …

Read more…

Why Medicaid patients use the emergency department for primary care

The cheapest form of health care is to let sick people die

John F. Hunt, MD

Policy

December 21, 2013

If you learn nothing else today, I would ask you to learn that moral hazard is the cause of medical price hyperinflation.

Moral hazard is not just two words that don’t seem to go together. Moral hazard is when the person who bears the economic burden of a decision is not the decision maker. In the health care setting, moral hazard is when the third party payer (insurance/government) bears the …

An anesthesia practice is sold, and a warning to young doctors

Karen S. Sibert, MD

Physician

December 6, 2013

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We were startled to learn recently that Sheridan Healthcare Inc., a physician services company based in Florida, has bought one of the largest private anesthesiology group practices in California, the Medical Anesthesia Consultants Medical Group Inc. (MAC) of San Ramon.

The deal, which closed November 14, is Sheridan’s first in California, and “provides a platform that will accelerate our expansion in the California …

Is health care a right or a business? It’s time to make a choice

Luis Collar, MD

Policy

December 1, 2013

The recent health care discussion in the media has centered around the implementation of the Affordable Care Act, now no longer a lengthy, inert document but rather a living, breathing manifestation of what should be a collective, unambiguous vision for the delivery of care in the United States. It is, however, anything but comprehensive in scope, and the coverage has primarily focused on crashing websites, politics, calls for resignations, and …

Why physicians are hesitant to take Medicaid patients

Peter Ubel, MD

Policy

November 18, 2013

In an earlier post, I presented some data on which kind of physicians in the United States are most and least likely to see new patients who receive Medicaid, the state/federal program to pay healthcare costs for low income people. Now a recent study lays out some reasons why many physicians are so reluctant to see such patients.

Not surprisingly, it starts with low reimbursement rates. Medicaid pays about 61% …

Should smokers pay higher health insurance premiums?

Carol Duh-Leong

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

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 …

Obamacare covers screening colonoscopies, with a catch

Stephen C. Schimpff, MD

Conditions

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? …

Hostile dependency: The real reason for physician burnout

Wes Fisher, MD

Physician

October 14, 2013

A piece recently appeared in the New York Times entitled “Who Will Heal the Doctors?”

The piece is written by Donald Borstein and I encourage all to read it. Mr. Bornstein offers a solution to the doctor burnout problem in health care, a course called “The Healers Art,” now being promoted in US medical schools that uses “mindfulness” as his means of creating compassionate, caring doctors as a way forward.

I should say …

Medical students may find themselves without a job

Christy Duan

Education

October 12, 2013

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“Well, if medicine doesn’t work out, you can always fall back on waiting tables,” I joked with my waiter, who, like me, happens to be a medical student. We were bonding over completing our first year of medical school — he, in Detroit, and myself, in the Bronx. He liked waiting tables and decided to work during his last summer of …

What health care in the United States can learn from Nepal

Brad Wright, PhD

Policy

September 5, 2013

Beautiful Nepal Photos (10)

In the US, many health care woes are blamed on the federal or state government. Whether there is too little oversight and lack of transparency or too much interference and regulation, it seems that policy and politics often end up getting blamed for health care system troubles. But what happens when one lives in a country with no functioning …

The broken window theory in health: Examples of graffiti we can fix

Vineet Arora, MD

Physician

August 15, 2013

I just left the most unusual conference I have ever attended. First, it was small: 25 invited participants. Second, it was all women. Third, it was all women who have done amazing things …make that “trailblazing things.” They were journalists at major news outlets, retired military officers from the highest ranks, senior leaders (in some cases, the most senior leader) at major federal and state health care agencies, Fortune 500 companies, large …

The demand apathy that doctors increasingly face

Jordan Grumet, MD

Physician

August 10, 2013

Monday afternoons are always the same. I pick up the kids from their grandparents. We drive home with their backpacks and a carton of home made food. We park in the garage, and carry all the contents of the car into the house. As the kids unload, I push the recycle container to the front for street pickup the next day.

Occasionally, I stop and socialize. Yesterday, I waited at the edge …

Our patients pay for dumbed down American medicine

Jordan Grumet, MD

Policy

August 4, 2013

I guess what is so utterly frustrating is that the guys up there don’t see what is going on down here. The march of health care reform continues with little realization of what it feels like to be one of the tiny peon foot soldiers on the ground. We are not deaf. We hear the politicians and policy wonks. We read as non-clinician “doctors,” ivory towered administrators, and the business …

4 complaints of physician employees and 1 solution to fix them

Dike Drummond, MD

Physician

June 30, 2013

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 …

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