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.

Politicians can’t fix our health care system

Linda Girgis, MD

Health Policy

February 17, 2017

Health care costs are out-of-control, and many patients can no longer afford medical treatment. The system is broken, but no real fixes are visible on the horizon. Sure, politicians debate the road health care should take and act like they are very concerned about the health of Americans. Truthfully, however, they are driven by political agendas corporate influence. Little discussion is given to what it would take to fix the …

Here’s what’s really scary about Trump’s health care

Margalit Gur-Arie

Health Policy

February 14, 2017

It has come to pass: President Donald J. Trump. Are you scared? Are you planning to “resist” the policies you imagine President Trump will pursue by tweeting furiously with clever hashtags galore? Would you prefer to move my fastidious quotation marks from “resist” to “President”? This is, after all, the first President in a very long time to take office without the blessings and financial support of established “world order” …

Don’t repeal the ACA without a replacement

Anna E. Condino, MD, MPH, Andrew G. Lim, MD, Paul W. Charlton, MD, and Sabiha K. Barot, MD, PhD

Health Policy

February 9, 2017

Whether rejoicing or mourning, millions of Americans awoke on January 21st feeling suddenly at the threshold of a new and uncertain era. However, in public safety-net emergency departments across the nation — like Harborview Medical Center in Seattle, where we work — the service of healing continued seamlessly, paying no heed to the national drama that has unfolded for the past several months.

That day and into the night, there were …

What the ACA replacement must have

Manoj Jain, MD, MPH

Health Policy

February 7, 2017

Eight years ago when the tumultuous health care reform journey began, we couldn’t have imagined the roller-coaster ride it would take. The Affordable Care Act passing without a single Republican vote, surviving the Supreme Court ruling by the vote of a Republican-appointed judge, a disastrous roll-out of HealthCare.gov, thriving for four years with Obama’s re-election, and now its inevitable repeal with Donald Trump’s win.

So it may help to look back …

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What the ACA replacement must have

What are the ethics of health care reform?

Kenneth Lin, MD

Health Policy

January 26, 2017

It’s been a rough past couple of months not only for millions of Americans whose health care futures depend on decisions to be made by the new Congress and the Trump administration but for those of us who teach about the U.S. health system for a living. As one health policy expert I follow tweeted only half-facetiously, on election night: “Dear students: all that stuff I taught you about the …

Changes in the Affordable Care Act need to put patients first

William Harper, MD

Health Policy

January 24, 2017

The call came at 4:30 a.m. I answered when she called the second time, as I was too late to answer the first. “Dr. Harper. I think I need to go to the hospital. I just feel so weak.”

It was Bessie, a patient I have known for over 15 years. She’s been struggling for a few week, and while we are working through this struggle, we are clearly not doing …

Dear Dr. Price: 5 suggestions for the new Health and Human Services secretary

Suneel Dhand, MD

Physician

January 24, 2017

Dear Dr. Price,

Congratulations on your upcoming appointment as the new Health and Human Services Secretary under President Trump. As a physician myself, it’s great to know that a fellow physician will head up the agency. I’m sure you understand too, having been a practicing orthopedic surgeon, how disheartening and frustrating it is to have non-clinical “experts” making key decisions about health care.

I’m sure you’ve also seen the news about how …

How health care could crash the U.S. economy

Ron Howrigon

Health Policy

January 19, 2017

An excerpt from Flatlining: How Healthcare Could Kill the U.S. Economy.

In recent history, the U.S. economy has experienced the near catastrophic failure of two major market segments. The first was the auto industry and the second was the housing industry. While each of these reached their breaking point for different reasons, they both required a significant government bailout to keep them from completely melting down.

What is also true about both …

50 ways to lose your coverage if Obamacare is repealed

Bob Doherty

Health Policy

January 5, 2017

The Republican congressional leadership appears to be determined to move forward with a high-risk “repeal, delay and replace” plan, very early in the new 115th Congress to repeal (at least on paper) the Affordable Care Act’s key coverage provisions—Medicaid expansion, subsidies to make private insurance sold through the exchanges affordable, the individual and employer mandates, and the taxes to pay for coverage—by a simple majority vote, while delaying when the …

Obama gambled on health care and lost. Will Trump lose too?

Margalit Gur-Arie

Health Policy

January 1, 2017

President Barack Obama, whether wittingly or not, invested his entire political capital in reforming health care in America. He gambled and lost. Not because he had nefarious intentions, but because he left the gory details to a corrupt Congress and a shady cadre of lying and conniving technocrats, ending up with something vastly different from what he campaigned on. From everything I’m reading now, President-elect Donald Trump is about to …

How should the Affordable Care Act be modified?

Anonymous

Health Policy

December 31, 2016

The Affordable Care Act is perhaps the biggest overhaul of the U.S. health care system in many decades. Enacted by President Barack Obama in 2010, it made health care attainable and affordable to millions of Americans. Individuals with pre-existing medical conditions cannot be denied health care coverage; insurance companies have to cover essential health care needs including mental health and preventive services, children can be covered under their parents’ plans …

8 ways doctors can help patients affected by the impending repeal of Obamacare

Sandeep Palakodeti, MD, MPH

Physician

December 22, 2016

If you’re like me, you’re getting a bit restless hearing about what may or may not happen to the Affordable Care Act (Obamacare).

As doctors, we are trained to act. While administrators plan new quality improvement programs, we take each day as an opportunity to improve our practice and work more closely with our teams. While our clinics and hospitals try to figure out how to streamline workflows in our EHRs, …

Will repeal and replace of the ACA move us forward or set us back?

Yul Ejnes, MD

Health Policy

December 18, 2016

A guest column by the American College of Physicians, exclusive to KevinMD.com.

When the Trump Administration takes office, health reform as we now know it will not go away, but it will take a different form. I don’t think the changes will be as easy as opponents of the Affordable Care Act make them appear to be. …

Why it’s wrong to blame Obamacare for health care ills

Aravind Chandrasekaran, PhD and Daniel Martin, MD

Health Policy

December 16, 2016

The Affordable Care Act (ACA), often called Obamacare, has come under sharp criticism. Now, with the nomination of Rep. Tom Price (R-Ga.) for secretary of health and human services, there are concerns about whether it will be repealed or changed. Price, a physician, has been a long-time critic of the law and has devised proposals of his own to replace it.

While Price may have alternative proposals that may be easier …

This physician gives Trump some health care advice

Thomas D. Guastavino, MD

Health Policy

December 14, 2016

Dear President-elect Trump,

You have stated that one of the first things you will do in office is to overturn Obamacare. You state that you will keep coverage for pre-existing conditions and children to age 26 but beyond that is unclear. Speaker Ryan said it would be “patient centered” but what that means remains to be seen. You now have a former surgeon as head of HHS. If I may, I would …

Obamacare isn’t a job killer

Peter Ubel, MD

Health Policy

December 12, 2016

According to many conservative pundits, Obamacare is a job killer. Five days before Obama signed the law, in fact, speaker John Boehner declared that the president was pushing “his job-killing government takeover of health care that will hurt small businesses.” Years after the law was passed, critics continued trumpeting this theme, Ted Cruz calling Obamacare “the biggest job-killer in this country,” and even claiming …

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Obamacare isn’t a job killer

No matter what Trump does to health care, we must accept an imperfect reality

Rocky Bilhartz, MD

Health Policy

December 12, 2016

Tom is a forty-three-year-old self-employed painter and father of two.

He’s currently in remission from lung cancer, having been first diagnosed five years ago. At the time of his diagnosis, he did not have health insurance. Thankfully, for him, American law had finally made it illegal for health insurance companies to discriminate against individuals with preexisting conditions.

Tom had to be offered insurance at community rates. And, this was a good thing …

Repealing the Affordable Care Act won’t be a big deal. Here’s why.

Brian C. Joondeph, MD

Health Policy

December 12, 2016

Supporters of the health care status quo are outraged, predictably, over what they see as Donald Trump’s search-and-destroy mission on Obamacare. They cite all of the newly insured people under the Affordable Care Act — then turn to gloom-and-doom scenarios, insisting everyone will lose insurance, especially those who are low-income and on Medicaid.

Change is never easy, and it can sometimes be scary when facts aren’t known. So will millions of …

10 questions to frame the health care debate

Umbereen S. Nehal, MD, MPH

Health Policy

December 10, 2016

We are at a watershed moment for health care, both nationally and in Massachusetts.

Massachusetts, the state that first piloted the model, “Romneycare” in 2006, that was disseminated to the nation as “Obamacare” is now going full steam ahead with ACO models under the newly approved 1115 waiver, that received the CMS green light in early November. Having expanded to near universal coverage in 2006, now, at the end of 2016, we are taking on …

Why we must temper our unregulated free-market philosophy in health care

Peter F. Nichol, MD, PhD

Health Policy

December 9, 2016

Quick, name the most watched, financially successful and competitive sports league in the United States?

The NFL. Right?

Now, name the most tightly regulated, transparent sports league, one that has a multilayered system of wealth redistribution and the one of the strongest unions of any profession in the United States? The NFL.

Surprised?

This is not a coincidence

Major problems with concussions and Roger Goodell’s persona and salary aside, the NFL offers a tremendous lesson …