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.

Margaret Mead was right about health care

Peggy A. Rothbaum, PhD

Health Policy

February 9, 2020

One of my graduate school professors proclaimed that what is wrong with our society is that most people have not reached formal operations or have not been in psychotherapy.

Formal operations is the stage of development, described by French researcher Jean Piaget, where we learn to take the perspectives of others, to disagree while maintaining a relationship, and to understand that we are not the center of the universe.

Psychotherapy is where …

How health care is like a convoluted financial investment scheme

Smart Money, MD

Health Policy

February 8, 2020

The business of medicine is unlike any other type of standard “business” in that health insurance and hospitals confound what would appear to be a simple exchange of services for a set price. You know that the confusion is bad when neither doctors nor the patients fully understand how the insurance system works. I have seen patients going into surgery for a lap chole being quoted a price that ended …

Improve mental health by improving how we finance health care

Steven Siegel, MD, PhD

Health Policy

February 3, 2020

It takes an average of 10 years between symptom onset for mental health conditions to be accurately diagnosed and therefore treated. In addition to general misunderstandings about mental health, the nationwide shortage of mental health providers is one unignorable cause for this devastating delay. But why is there a shortage? Well, the bottom line is … the bottom line.

In simple terms, insurance companies do not pay enough for mental health …

Why we need revolutionary medicine now

Seiji Yamada, MD, MPH, Arcelita Imasa, MD, and Gregory Maskarinec, PhD

Health Policy

February 2, 2020

Health care professionals, medical students, and students of public health are increasingly aware of the “social determinants of health.”

Everyone has begun to realize that poverty is the most important cause of illness. Too often, however, the analysis stops there, instead of asking what the root cause of poverty is, the question is: what causes those “social determinants”?

Why do resources remain unequally distributed, why cannot everyone access the same quality of …

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Why we need revolutionary medicine now

The primary care solution is obvious, but don’t expect policymakers to jump on board

Robert Pearl, MD

Health Policy

January 31, 2020

In a shocking development that could transform the medical profession, the International Journal of Health Services published the findings of a study titled, “Primary care, specialty care, and life chances.”

Using multiple regression analysis, the researchers concluded that “primary care is by far the most significant variable related to better health status,” correlating with lower mortality, fewer deaths from heart disease and cancer, and a host of other beneficial health outcomes. By contrast, …

These leaders will not fix health care

Matthew Hahn, MD

Physician

January 30, 2020

We constantly argue about how to fix the U.S. health care system. But what we must understand is that the most important issue isn’t how to fix health care. The issue is how to get our Congress, the President, and the health care industry to allow anything of importance to change at all. The problem is that all three have a vested interest in the current system. The health care …

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These leaders will not fix health care

What is “fair” payment for medical services?

Neal Biron

Health Policy

January 29, 2020

I write this hoping to appeal to common sense. When are we going to stop putting the cart before the horse? 99 percent of the rhetoric surrounding health care costs centers on a “fair” way to pay for it, “fair” reimbursement levels, and who should pay this “fair” level of payment, when the real issue is the amount being charged in the first place. What exactly is “fair”?

The real central, …

One person’s wasteful medical spending is another person’s income

Edward Hoffer, MD

Health Policy

January 29, 2020

In a New York Times article, “The Huge Waste in the U.S. Health System,” it stated that the estimated waste is at least $760 billion per year: “That’s comparable to government spending on Medicare and exceeds national military spending, as well as total primary and secondary education spending.”

Why is waste so prevalent? There are many sources. The biggest one, and the one that should most concern …

Why this physician supports Medicare for all

Thad Salmon, MD

Health Policy

January 24, 2020

Alexa Karsdan’s medical bill for a sore throat reached over $28,000. NPR told her story recently, but I want you to know why I am actually glad this happened. Why is it good news that her charges were so exorbitant, and that her insurance paid over twenty-five thousand dollars for one laboratory test? This story is a brilliant illustration of fundamental flaws in our health care …

Why generations need to talk to each other

Jane Orient, MD

Physician

January 24, 2020

The words of the year as 2019 ends appear to be “OK Boomer” and “woke.” To this Boomer, it appears that the younger generation is blaming us for all the evil in the world, from their perch of “woke” moral superiority. They consider us to be out of touch and over the hill.

According to Merriam-Webster, “woke” means “aware of and actively attentive to important facts and issues (especially issues of racial …

Obesity is America’s self-inflicted preexisting condition

Marilyn M. Singleton, MD, JD

Physician

January 23, 2020

Consuming too many potato latkes and Christmas cookies has left its mark on our waistlines. Unfortunately for Americans and their medical care, the seasonal overeating seems to last all year. Indeed, the American Medical Association has declared that obesity is a disease.

It may be more accurate to describe obesity as a contributor to certain diseases. Obesity raises the risk of premature death, heart disease, high blood …

Does socialized medical care provide higher quality than private care?

Peter Ubel, MD

Health Policy

January 22, 2020

Americans are not fans of socialized medicine. Sure, some people want socialized health care payment, including many people who are fans of Medicare for all. But even most Bernie Sanders supporters probably aren’t in favor of socializing the entire U.S. health care system, thereby making hospitals and medical clinics into government property. Americans are proud of the high quality of care offered by non-government providers, from their local community …

Your grocery cart on WIC

Hanna Saltzman

Health Policy

January 20, 2020

Karen smiled nervously, her swollen belly peeking out from under her stretched silver tank top. Six months pregnant with her first child, the eighteen-year-old had come to the WIC (Women, Infants, and Children) office for help with getting enough to eat. As a medical student with a background in nutrition advocacy and a future in pediatrics, I had asked to observe the WIC enrollment process.

Karen and …

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Your grocery cart on WIC

Only Biden, Bloomberg, and Buttigieg have health plans that have a realistic chance of becoming law

Robert Laszewski

Health Policy

January 19, 2020

In an earlier post, I pointed out that there is no better chance of passing a Medicare for all health care plan through Congress in the coming years than there was in 1977, or 1993, or 2009.

Then Elizabeth Warren showed us just how politically unrealistic single-payer health care is when she released her funding plan and then quickly backtracked to the public option …

Stop the war on PAs and NPs

Brent Lacey, MD

Physician

January 18, 2020

I think it’s time for physicians to end the assault on the clinical practices of PAs and NPs.

Are you worried about PAs and NPs taking your job? If you’re a good doctor, you should stop worrying. Great PAs and NPs are everywhere, and I think it’s time physicians embraced them.

PAs and NPs have excellent skills

My first rotation as a third-year medical student was in the emergency department. There was a …

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Stop the war on PAs and NPs

Changes are coming to health care in 2020. Are you ready?

David Conejo

Health Policy

January 17, 2020

Of the nation’s 3.5 trillion in annual health care spending, 90 percent is for people with chronic and mental health conditions. How long can this continue? Can health care institutes afford not to engage in the 2020 wave of preventative care health care disruption? For those riding the disruption wave, the answer is simple. CMS alone is providing more than 80 billion in reimbursements for preventive care …

The president’s plan for payment parity goes against what patients want

Lawrence John, MD

Health Policy

January 15, 2020

“Listen to your patient; he is telling you the diagnosis.”

This quote from famous physician William Osler is as true today as it was 100 years ago. And yet the latest version of President Trump’s executive order on Medicare threatens what patients overwhelmingly want: a physician involved in their care.

Section 5-C of the President’s order focuses on payment parity and supervision of mid-level providers. Changes to either issue would create unintended …

Stop penalizing physicians with pay for performance

Darcy Wooten, MD

Physician

January 10, 2020

Throughout my career, I’ve contemplated what it means to be a good doctor. While I still cannot fully articulate it, I know a good doctor when I see one. She’s the masterful diagnostician who can solve any medical mystery. He’s the physician-scientist who spends countless hours on finding a cure for HIV. She’s the colleague on my right, arguing on the phone with a patient’s insurance company to get a …

Why this doctor decided to run for political office

Michelle Au, MD, MPH

Health Policy

January 9, 2020

The practice of medicine is limited by what we can control. As students, we are taught to believe in the power of science, the importance of hard work, and the momentum of technological advancement as prime determinants in our patients’ outcomes. However, as we get further along in our careers, we come to realize that many of the factors that contribute to poor health are beyond our control at …

Corporate games have ruined the health care system

Osmund Agbo, MD

Health Policy

January 8, 2020

There are certain paradoxes of life that are beyond the realm of rational explanation. To me, one of such is that a country that figured out how to defy gravity and conquered the cosmos has time and time again proven to be incapable of taking care of the most basic human need, namely: a commonsense health care delivery system.

U.S. spending on health care in 2016 was estimated at about 17.2 …