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.

What would an optimal government-run health care system look like?

Taylor J. Christensen, MD

Health Policy

December 5, 2019

Next in a series.

The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating the five jobs we expect a health care system to do for us and then identifies which parties in the health care system (providers or insurers) have a natural incentive to fulfill each of those jobs. Those incentives arise naturally, but the big challenge …

There is a profound lack of self-esteem in the medical profession

Vincent M. Proctor, PA-C

Health Policy

December 4, 2019

I have noticed a profound lack of self-esteem in our profession. I am concerned. Concerned for us, and for our patients.

We are the most noble of professions. However, we have compromised our morals, values, ethics, and virtues. We are now living, operating, and existing in a constant state of contradiction. It is tearing us apart from within.

We continue to work for less, with fewer resources and ancillary staff, all while …

My patients are America

Timothy Dempsey, MD, MPH

Physician

December 4, 2019

Dear Congress:

For the vast majority of you, I am not your constituent. But you should listen to me anyway. I am writing to show you that health care in America is not a political issue; it is a human one. The same can be said for immigration or education or any other issue that you work on. Let my patients explain this for me.

I walk into clinic to a full …

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My patients are America

What challenges do you see yourself facing as a doctor?

Eric Tian

Medical Education

December 3, 2019

“What challenges do you see yourself facing as a doctor?”

I’m sitting in a suit, facing a young Asian woman with black, round glasses across a desk. On the desk in front of her is an iPad, and she sits cross-legged, hands resting on her legs. I’m in my interview for medical school, and the woman across me, who introduced herself as Angela, is awaiting my response.

I pause and mentally check …

What would an optimal single-payer health care system look like?

Taylor J. Christensen, MD

Health Policy

November 29, 2019

Next in a series.

Is it finally time for wage insurance?

Kunal Sindhu, MD

Health Policy

November 28, 2019

America sits at the precipice of a crisis.

Automation has resulted in significant job losses — 47 perent of existing American jobs remain at high risk of being lost in the future. And at least some voters may have been reacting to automation in casting their ballots for Donald Trump in 2016. Yet, with the American politerati fixated on …

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Is it finally time for wage insurance?

Are Americans really the worst patients?

Anupama Verma, MD

Physician

November 22, 2019

A recent article was published in the Atlantic about Americans being the worst patients.

Americans are part of a broken and dysfunctional health care system with exorbitant costs, a maelstrom of bureaucratic red tape, and insurance coverage that barely covers what most people need.

But are they contributing to this system by being such bad patients?

The article in the Atlantic seems to imply that this is the case. The …

What would an optimal libertarian health care system look like?

Taylor J. Christensen, MD

Health Policy

November 21, 2019

Next in a series.

In prior posts, I described my Healthcare Incentives Framework. If you haven’t read those, I recommend you check them out first to have the full context for this post. But here’s a refresher of the main points of the framework without re-explaining all the rationale:

The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating …

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What would an optimal libertarian health care system look like?

“How are you doing?” A simple question with a big impact.

Johanna Vidal Phelan, MD, MBA

Physician

November 17, 2019

From October 25 to October 29, 2019, more than 10,000 pediatricians from all over the world gathered in the city of New Orleans, Louisiana, to attend the American Academy of Pediatrics (AAP) National Conference and Exhibition.

As the world’s largest pediatric medical education event, the AAP National Conference draws pediatricians, like me, to network with mentors and colleagues, learn about the latest clinical guidelines and policies, and be inspired to renew …

Where have all the doctors gone?

Valerie A. Jones, MD

Health Policy

November 17, 2019

As my husband passed the milestone birthday of 40, he thought it would be a good idea to get a physical exam as it had been several years since he saw a physician. Easy task, right? We soon came to find that the landscape of health care had been changing even faster than we thought.

We had just moved and needed to establish care in a new area. Multiple phone calls …

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Where have all the doctors gone?

The health effects of structural racism

Niran S. Al-Agba, MD

Health Policy

November 15, 2019

In the United States, the health of African-Americans lags behind most other racial minority groups. Compared to whites, black men and women face higher risks of chronic illness, infection, and injuries. Taken altogether, the average life span for African Americans is six years less compared to whites. If we can begin to acknowledge that health outcomes are often dependent on factors outside of the control of individual patients, their physicians, or their health …

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The health effects of structural racism

The cure to our malignant health system

Deane Waldman, MD, MBA

Health Policy

November 15, 2019

An excerpt from Curing the Cancer in U. S. Healthcare: StatesCare and Market-Based Medicine.

Clinical doctors can readily understand the continuing failure of the U.S. health care system. The attending physicians for Patient Healthcare–Washington, both legislative and executive branches–keep …

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The cure to our malignant health system

Why physicians should start thinking about climate change

Janice Boughton, MD

Health Policy

November 14, 2019

Climate change. Global warming. The greenhouse effect. Devastating wildfires, dangerous air quality. Catastrophic weather events and mass human migration. It all sounds like post-apocalyptic fiction except that it’s real. Inside our air-conditioned offices and homes, it can still be possible to be optimistic. Maybe it’s nothing out of the ordinary. Maybe it isn’t our fault and would have happened without human activity. Maybe we don’t know what will happen and …

How we can help our veterans die in peace

Diane D. Blier, DNP

Health Policy

November 11, 2019

The World War II veteran, now in his 90s and receiving hospice for end-of-life care, was playing military anthems on his harmonica for fellow veterans. But the next minute, reliving the horrors of combat, he grew agitated and started to cry. “Oh, all those bodies!” he suddenly called out. “Terrible, terrible! Oh, the bodies.” He finally blurted out what he had kept to himself for decades. Two days later, he …

The barriers to patients choosing higher-value providers and insurers

Taylor J. Christensen, MD

Health Policy

November 10, 2019

Next in a series.

I have developed a framework, which I call the Healthcare Incentives Framework, that helps me understand health care systems. It outlines the jobs we expect a health care system to do for us and identifies which parties in the health care system have the primary incentive to fulfill each of those jobs. This is helpful because, if we are unsatisfied with how …

A solution to reduce defensive medicine

David Lozar, MD

Physician

November 9, 2019

An excerpt from Technology and the Doctor-Patient Relationship.

As disturbing as the structure of malpractice insurance is in America, a more significant problem is the defensive style of medical practice it induces. In a large-scale survey done by Jackson Healthcare in 2010, between 73-92% of physicians self-reported ordering unnecessary …

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A solution to reduce defensive medicine

Increasing strictness of gun laws correlates with fewer children killed by guns

Christopher Johnson, MD

Physician

November 8, 2019

Between 2011 and 2015 there were over 21,000 children killed by guns. This recent study in Pediatrics, the journal of the American Academy of Pediatrics, further analyzes the question; it compares pediatric firearm fatality rates among the various states and then tests for correlation between children killed and the degree of strictness or not of the state’s gun laws. There are extensive data on whole populations showing that stricter …

Health coverage really isn’t covering much

Todd Rice, MD, MBA

Health Policy

November 7, 2019

I’m a healthy 48-year old, ASA physical class I anesthesiologist. At least I was healthy until an unintentional 20-pound weight loss over the summer, accompanied by an unquenchable thirst, insatiable appetite, blurry vision, and the bathroom frequency of an elderly prostatic.

My lab workup would reveal a fasting blood sugar of 310 mg/dL, an A1C >14, positive urine ketones, low C-peptide, and glutamic acid decarboxylase antibody (GAD-65) level that was off …

When physicians are complicit

Ann Colbert, MD, MPH

Physician

November 4, 2019

The other day I asked myself why do I focus my attention on immigrants when there are plenty of other underserved and neglected populations. When an opioid crisis surrounds me, why do I speak of a crisis at the border? When structural and overt racism contributes to an infant mortality rate of 10.97 for black women’s babies, twice the rate for the nation as a whole. When only 18 states …

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When physicians are complicit

Has health care lost its humanity?

Linda Girgis, MD

Physician

November 3, 2019

As doctors, most of us went into medicine with a true desire to help other people. What was once a noble profession is now being worn down by outside forces trying to control us. Third-party insurance companies are driven by profits, not by optimal care of patients. Politicians are driven by their own political agendas and party alliances without even acknowledging the real problems existing in the health care system.

Most …

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Has health care lost its humanity?