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.

Health care is expensive. It’s time to treat the cause.

Dr. Meg Hansen

Health Policy

October 29, 2018

We do not rely on the benevolence of the butcher, the brewer, or the baker to feed ourselves — Adam Smith observed in the “Wealth of Nations” (1776) — but on their regard for their own interest. The desire to pursue a profitable living also holds true for doctors and nurses, notwithstanding the moral dimensions of their labor.

Health care is a service like any other. We ought to expect price …

The British are unafraid to talk about rationing. That’s something to admire.

Richard Young, MD

Health Policy

October 23, 2018

I am a huge fan of Britain’s National Health Service (NHS), but probably not for the reasons many people might assume. It’s not because it’s “socialist” (a horribly inaccurate description), or that it’s nationalized, or anything like that. I’m a huge fan because somehow the people of Britain have developed the courage to talk about health care using very adult language. In the U.S., we can rarely progress beyond the …

Lessons from the meeting of different value-based concepts

Joshua Liao, MD

Health Policy

October 19, 2018

Value remains one of the most widely invoked and variably interpreted concept in American health care delivery. Beyond patients, stakeholder groups across the health care ecosystem are undertaking value-based initiatives, including payers (e.g., value-based insurance design and payments), provider organizations (e.g., value-based care redesign), pharmaceutical companies and pharmacy benefits managers (e.g., value-based pricing and formularies), and private companies (e.g., value-based technology assessment).

This trend highlights a critical point: Discussions about value …

How to pay for long-term care

Kevin Tolliver, MD, MBA

Health Policy

October 19, 2018

The topic of paying for long-term care is an overlooked issue in health care.

None of us want to think about living our final days in the nursing home, but statistically speaking, many of us will. How will you pay for it? What are the options?

Long-term care in this country can be divided into two general classes based on funding: governmental and private payers. In terms of government programs, Medicaid will …

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How to pay for long-term care

Market-based approaches solving the opioid epidemic

Julie Craig, MD

Medications

October 17, 2018

Mary first took oxycodone after a minor surgery and found she liked it. Returning to her surgeon a month later with vague ongoing pain, she received another prescription. Her primary care provider took over from there — until one day that physician checked a urine drug screen and a prescription monitoring program (PMP) report, only to find that she was obtaining various opioids from several providers. The physician cut her …

Medical bankruptcies happen less frequently than you think

Peter Ubel, MD

Health Policy

October 15, 2018

Elizabeth Warren describes medical bills as “the leading cause of personal bankruptcy” in the United States. She bases that opinion in part on her own research, in which she and her collaborators surveyed people who had experienced personal bankruptcy, asked them whether they’d experienced health-related financial distress, and concluded that 60 percent of all bankruptcies in the U.S. result from illness …

5 fears physicians face today

Robert Pearl, MD

Health Policy

October 12, 2018

Like prep sports or prime-time television, medical meetings have seasons.

In the spring and fall, my calendar fills with invitations to speak. I try to get to the venue a few hours before I’m scheduled to speak, so I can “take the pulse” of fellow doctors, asking them about their practices, patients and the future of medicine.

Figuratively speaking, the industry’s pulse is racing with fear. I’ve observed that in just the past …

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5 fears physicians face today

Is there parity in mental health or are we still dealing with a paucity?

Katherine Gantz Pannel, DO

Conditions and Diseases

October 11, 2018

With the recent 10-year anniversary of the Mental Health Parity Act being signed into law, comes the reminder that we still have so much work to be done. Unfortunately, blatant discrimination in health insurance coverage for mental health and substance abuse has continued despite this legislation. The Parity Act required that dollar limits on mental health benefits be no lower than the dollar limits for medical and surgical benefits offered …

How health insurance contributes to our failing system

Edward Hoffer, MD

Health Policy

October 11, 2018

An excerpt from Prescription for Bankruptcy: A doctor’s perspective on America’s failing health care system and how we can fix it.

Many years ago, while I was involved in developing the pre-hospital emergency medical care system in Massachusetts, I went with a group to meet with the then-president of Blue …

Doctors as the gatekeepers of marijuana is a race to the bottom

John Schumann, MD

Medications

October 10, 2018

This year Oklahoma voters made a clear choice to legalize medical marijuana, joining thirty other states that permit cannabis for medicinal use.

Unsurprisingly, immediately in the vote’s aftermath, patients began asking me to “prescribe” medical marijuana licenses, as the new law stipulates users must have as a precondition for legal purchase. The new law does not, however, specify qualifying diagnoses for which medical marijuana might be clinically …

Medicine is a word with 3 meanings

Hans Duvefelt, MD

Physician

October 9, 2018

Everybody is a stakeholder these days in what we broadly call medicine, or health care. But there is little agreement on what medicine is and what the priorities of the health care “industry” should be.

I propose this breakdown of medicine into three separate phenomena.

1. Micromedicine
2. Macromedicine
3. Metamedicine

Let me explain:

Micromedicine: one on one, real doctoring

Doctors from antiquity have served their patients one on one, as individuals. Osler, the father of modern …

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Medicine is a word with 3 meanings

Considering the recent setbacks of evidence-based medicine

Kenneth Lin, MD

Health Policy

October 8, 2018

For my students in 2018, it’s difficult to imagine an era when there was no such thing as evidence-based medicine (EBM). When I started medical school in 1997, though, the term had only been in use for six years, having been introduced by Dr. Gordon Guyatt at McMaster University (though EBM’s intellectual origins can be traced to several key individuals). When I tell trainees how recently EBM …

The way U.S. drug makers price their products is legal, but it’s not moral

Robert Pearl, MD

Medications

October 3, 2018

While walking through the duty-free at Dulles International Airport in Washington, DC, I happened upon the price tag of an imported French purse. Looking around, I wondered how many travelers could afford a $2,000 handbag.At the gate, I found a seat and logged on to the internet, where I happened upon a story about the CEO of Nostrum Laboratories, Nirmal Mulye. In an interview, Mr. Mulye explained why he raised the …

The nursing shortage: then and now

Way Chiang, BSN, DO

Health Policy

October 2, 2018

I remember when I started nursing school about a decade ago, that there was a near militant attitude describing the nursing shortage. School administrators, politicians, and journalists hopped on this easy bandwagon and talking point. Research and polls of dubious quality rode the tidal wave of popular opinion. Unsurprisingly, their genesis in an echo chamber yielded predictably confirmatory responses. As graduation time was fast approaching, the class began to job …

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The nursing shortage: then and now

How pharmacists lost control of their profession and why you should care

Kim Ankenbruck, RPh

Medications

October 2, 2018

An excerpt from The Pharmacist is a Whore: How Pharmacists Lost Control of Their Profession and Why You Should Care.

The day patients became customers was a black day for us all. Don’t get me wrong, pharmacy has always been a service profession, and we take that …

One of the biggest lessons medical school can teach you

Prerana Chatty, MD

Medical Education

October 1, 2018

I spent my first two years of medical school collecting stories. I journaled about my thoughts in the anatomy lab. I wrote about what it was like to learn how to interview and examine patients, about the immense honor and privilege I felt just being able to don a white coat with a stethoscope around my neck. I wrote about the patients that touched my heart – the patient with …

Simplicity is the cure for our complex health system

Praveen Suthrum

Health Policy

September 28, 2018

In country after country, I witness the same sad situation: caring, often-brilliant men and women toil in the health care industry to care for others, but to do so they must battle the system itself. That system has lost sight of what matters, which is humans caring for other human beings.

To simplify things a bit, every health care system on earth has three main stakeholders:

Patients
Physicians and clinicians
Administrators

Yes …

Why do we think obesity is caused by lack of exercise and not junk food?

Martha Rosenberg

Health Policy

September 27, 2018

There are now more than 700 million obese people worldwide, 108 million of them children, reported the New York Times in 2017. In Brazil, food giant Nestle sends vendors door-to-door hawking its high-calorie junk food and giving customers a full month to pay for their purchases. Nestle calls the junk food hawkers, who are themselves obese, “micro-entrepreneurs.”

Big Food is increasingly targeting poor countries as “emerging markets” to …

Patient autonomy in times of shortage

Deepak Gupta, MD

Health Policy

September 27, 2018

Being self-aware sometimes to the point of turning self-critical — I, as a constituent of an anesthesiologist’s society, am writing this freestanding letter to bring forth our ethical questions and concerns regarding a shortage of not only medications but also skills, funds and time.

Scenario 1: Patient requests for spinal anesthesia for cesarean section, but a shortage of hyperbaric spinal anesthetics warrants epidural anesthesia as its replacement. What must be done? …

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Patient autonomy in times of shortage

Why historically black colleges and universities matter

Bassam Zahid, MD

Medical Education

September 26, 2018

Every few months, there happens to be another breathless news story about racism in health care. Mass media seems shocked, progressives angrily tweet, while conservatives claim that somehow it was all President Obama’s fault.

Meanwhile, the four relatively unknown and certainly underappreciated historically black college or university (HBCU) medical schools in the United States (Howard University, Meharry Medical College, Morehouse School of …

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