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.

Did Obama break the law to save the Affordable Care Act?

Kevin R. Campbell, MD

Health Policy

October 20, 2016

Recently, a federal audit found that the Obama administration has illegally redirected funds related to collections from the Affordable Care Act that, by law, should have been deposited in the U.S. Treasury. President Obama, under the guise of executive order, used these tax dollars to bail out insurance companies that have experienced hundreds of millions of dollars in losses due to their participation the Affordable Care Act (ACA) exchanges.

In their …

Bullying isn’t just for kids. Do you do it?

Edwin Leap, MD

Physician

October 19, 2016

I well remember being bullied on the school bus. On many cold, wet mornings (a large portion of the year in West Virginia, by the way), I found my junior-high self sitting in front of high school juniors and seniors who turned their class rings upside down, then used them to hit lesser life forms on the top of the head in a whipping motion. Turning around in pain and …

Donald Trump triggers deep-seated human instincts

Anonymous

Physician

October 19, 2016

My dad is a locally famed and sincere career politician. All my life I have seen him value public service over personal wealth. As a young lawyer, he worked in Washington DC for the Department of Justice during the civil rights movement, and he often shares stories of his tour of duty in 1960’s Alabama. After that service, he came back to West Virginia where he has been elected to …

This election is focusing on the wrong health issues

Miranda Yaver, PhD

Health Policy

October 19, 2016

For all the media’s (and candidates’) attention to candidate health over the course of this presidential campaign, we seem to be spending precious little time in the presidential debates discussing the candidates’ actual health plans.

Those on the left have “diagnosed” Mr. Trump as unhinged and mentally unstable, calling attention to a narcissistic personality consistent with a DSM diagnosis, though in violation of the “Goldwater Rule.” They have further raised the Read more…

This election is focusing on the wrong health issues

Health care: The big issue Trump and Clinton choose to ignore

Manoj Jain, MD, MPH

Health Policy

October 17, 2016

For me, the saddest part of the 2016 presidential election is not that we have two of the most disliked presidential candidates in history but that so little attention is being paid to health care.

You may have noticed that health care rarely comes up in campaign speeches or in debates, and when it does it’s often scripted empty promises. Donald Trump has a plan entitled “Healthcare Reform to Make America …

Why do so many Americans hate their health care system?

Peter Ubel, MD

Health Policy

October 13, 2016

There is lots to love about American health care. We have some of the best clinicians in the world, as evidenced by the huge number of people who come to the U.S. from other countries when they are sick. Yet the American people are less satisfied with their health care system than are citizens of the majority of other developed countries.

Why do people in the land of the Mayo Clinic …

We are all responsible for behavior change

John Corsino, DPT

Health Policy

October 4, 2016

Helping our patients make better health decisions can be a challenge. Whether we aim to get them out of bed in the hospital or off of the couch at home, factors contributing to follow-through may be complicated, and the best strategies to facilitate the right choices are seldom clear.

As providers, we would hope that a long and healthy life would serve as the most powerful incentive for behavior change, but …

The Affordable Care Act presents challenges for college students

Aldebra Schroll, MD

Health Policy

October 1, 2016

The school year is back in session, and our student health center is busy. As a college health doctor, I have been able to watch the rollout of the Affordable Care Act (ACA) among this population. Since its passage, more of our students are now insured, but many unique challenges still persist for this population.

Young adults have historically demonstrated high rates of un-insurance. An estimated 30 percent of those 19 …

What’s wrong with socialized medicine, and what we can learn from the NHS

Janice Boughton, MD

Health Policy

September 26, 2016

The British National Health Service (NHS) was born in 1948, based on legislation passed that year mandating free high-quality health care for all paid by taxes. In contrast, the U.S. started Medicare in 1966 to provide health care to the elderly and the State Children’s Insurance Program (SCHIP) in 1993 to fund health care for children whose parents were unable to afford it. Health care in the UK is still …

This version of health care is purely a business

Jeff Kane, MD

Physician

September 23, 2016

Many of us harbor an archaic view of what health care is, so let me offer a little history. During the past century, it’s changed from Healthcare 1.0 to 2.0, and now it’s Healthcare 3.0.

In the early twentieth century, Healthcare 1.0 was a service, though it amounted more to personal contact than effective medicine. At best, medications and procedures were hit-and-miss, so doctors relied heavily on their relationship with their …

Somewhere between the extremes: The ideal health system for America

Suneel Dhand, MD

Health Policy

July 7, 2016

This is my 12th year as a physician in the United States. I was born in London, grew up in Berkshire, and decided to become a doctor when I was a teenager. I remember being asked what I thought about the National Health Service (or NHS, the UK’s government-run health system) during my medical school interview. That question is almost a rite of passage for anyone applying to medical school in …

What this medical student learned from doing a rotation in Thailand

Taylor J. Christensen, MD

Health Policy

June 13, 2016

As an American medical student doing an elective in Thailand, I was initially troubled when I saw how Thai patients were treated. I’m not speaking of the way Thai physicians apply medical science, mind you — they rely on UpToDate and sundry U.S. guidelines just as we do — but that was mostly where the similarities ended.

Morning rounds with the team of residents (sans attending, but apparently there was one …

This is why health care is not a system

Margalit Gur-Arie

Health Policy

May 29, 2016

The Merriam-Webster dictionary has many definitions for the term system, but the most straightforward, and arguably the most applicable to our health care conversation is “a regularly interacting or interdependent group of items forming a unified whole.” The common wisdom is that our health care system is broken, and hence, our government is vigorously attempting to fix it for us through legislation, reformation, and transformation. We usually work ourselves into …

Read more…

This is why health care is not a system

Improving our health system requires a culture change. Can it happen?

Robert Pearl, MD

Health Policy

May 20, 2016

Most industrialized nations have long supported the idea that access to health care is a fundamental right, and have built centrally planned systems to accomplish that goal. The result has been universal coverage that delivers excellent-quality outcomes at lower costs than the United States.

In some countries, such as England and Canada, the government controls both financing and certain aspects of health care delivery, while in others, including Australia, Sweden, and …

The state of health care in America: Smell the bacon

Anonymous

Health Policy

May 19, 2016

I am forced to attend one of these mandatory continuing medical education (CME) events. My malpractice insurance provider has a deal with the state medical association. To get lower rates, I have to be a member of the association and every 2 or 3 years attend a risk management training session.

I make it on time, despite the traffic.

As I walk into the lobby of this rather nice building, looking for …

Why Obamacare is not economically realistic

Brian C. Joondeph, MD

Health Policy

May 18, 2016

United Healthcare announced that it plans on exiting most of the Obamacare insurance plans by 2017. Not their traditional commercial insurance plans or Medicare supplements, but specifically the insurance plans offered through the state exchanges of Obamacare.

Didn’t President Obama tell Americans that if they liked their insurance plan, they would be able to keep it under Obamacare? Actually he did, at least 36 times. So what happened?

In …

What can physicians do to increase empathy about the health of populations?

Liang Chen, MD and Sandro Galea, MD, MPH, DPH

Health Policy

May 12, 2016

As physicians, we are charged with extending empathy to our patients. In addition to a professional responsibility, empathy is also a mechanism for improving patient care and professional satisfaction. It has been associated with better patient satisfaction, clinical outcomes, fewer medical errors and lawsuits, as well as provider happiness. However, while physicians can be expected to pursue the ideal of empathy towards individual patients, that …

To make big heath care changes, think small

Stephen Beeson, MD

Health Policy

May 9, 2016

The changes to health care — not just in policy, regulation, and payment but also the tectonic shifts in how we define, evaluate, report and are paid for care — can make us all feel like we’re on a runaway train.

Alongside the runaway train are the significant improvement opportunities in health care we must somehow address — less variance, improved patient engagement, coordination of care, adherence to evidence, waste reduction …

6 medical breakdowns in my mother’s care. And 1 close call.

Marion Mass, MD

Physician

April 17, 2016

I dialed the number to return the call of the nursing home. The nurse who answered the phone was relieved to hear my voice on the other line: “Dr. Mass, thank God you called back! She has been pacing since she woke up, and she refuses to take her meds. We’ve kept her away from Catherine, so they don’t get into another fistfight. But we can’t handle her here anymore. …

Improve health care services for our most vulnerable

Katie Bayne

Health Policy

April 13, 2016

My dad was recently diagnosed with cancer. Overnight, he found himself faced with tough care decisions, small insurance crises, and the overwhelming bureaucracy of cancer. He was also about to become tasked with managing a daily care routine far outside the scope of his usual morning ritual.

Since his diagnosis, he has returned to the hospital twice with pneumonia. While many cancer patients become prone to bacterial infections due to a …