Health Policy: the Obama Era

Physician and policy commentary on health care under the Obama administration, covering the Affordable Care Act, insurance reform, and the political decisions that reshaped American medicine.

How the Obamacare exchanges will transform health care

Robert Pearl, MD

Health Policy

October 7, 2013

When the next phase of the Affordable Care Act (ACA) kicks into gear January 1, 2014, each state will be required to offer its residents access to health care insurance through an online marketplace, often referred to as a “health insurance exchange.” These exchanges are now open for business on Oct. 1, 2013, allowing individuals to sign up online, by phone or in-person, with health insurance coverage starting next year.

Until now, buying health …

The problem with Obamacare is that it doesn’t do enough

John Mandrola, MD

Health Policy

October 7, 2013

Obamacare is here. It’s really here.

You might be wondering what’s been going on in the hospital or office — the contact points where health care actually happens.

The funny thing is: nothing seems any different.

And this is the problem with Obamacare. It hasn’t, won’t, or perhaps couldn’t, change the fundamental problem with US health care. Namely, that it is too big, too disruptive, and too devoid of nuance. In this way, health care …

Can President Obama and the GOP agree on improving health reform?

Bob Doherty

Health Policy

February 2, 2011

Everything seems to be pointing toward two years of partisan and ideological confrontations over health reform. The leadership of an emboldened Republican party has made it clear that it will use its newfound House majority to seek to “repeal and replace” the Affordable Care Act (ACA), and if that doesn’t work, to “defund” it. Huge GOP gains in statehouses make it likely that more states will resist implementation. Meanwhile, President …

Childhood obesity and chronic illnesses that result from being overweight

David B. Nash, MD, MBA

Patient

January 4, 2011

Our national health status is in imminent danger from the effects of a condition that most population health experts acknowledge is out of control.

I am speaking of obesity — and, in particular, its increasing prevalence in American adolescents and children.

Almost every study that has been done concerning obesity shows a correlation with soda consumption. As a result, some states and municipalities have tried to implement initiatives that make it more …

Why the sustainable growth rate formula (SGR) is here to stay

Jaan Sidorov, MD

Health Policy

August 29, 2010

According to the Washington Post, it is highly unlikely that Congress will undo the planned “sustainable growth rate formula” (SGR) mandated Medicare fee schedule cuts. While there’s an outside chance of a fix, the American Medical Association, as well as other organized physician groups, can’t be happy about the constant threat of the 20% payment reductions.

Recall that the SGR was signed into law back in 1998. It was designed to …

Why general internists are quitting clinical medicine

Glenn Laffel, MD, PhD

Health Policy

July 16, 2010

The Association of American Medical Colleges predicts that by 2025, the US health system will have 46,000 fewer primary care physicians than it needs.

If the prediction proves correct and we fail to develop effective mitigation strategies, the manpower shortage will create quite a mess. Ironically, the health reform law signed by President Obama in March will exacerbate the problem by increasing demand for services provided by primary care physicians.

The American …

Who really benefits from President Obama’s health reform plan?

Erin Marcus, MD

Health Policy

June 15, 2010

I don’t know about you, but as I watched coverage of President Obama signing the health care bill three months ago, it was hard not to notice the constant ads for power wheelchairs. Emblazoned across the ads was a flashing notice reminding viewers: Medicare may cover this!

Don’t get me wrong. As a primary care doctor who takes care of low-income patients, I was glad to see something being done to …

President Obama should have had colonoscopy without sedation

Michael Kirsch, MD

Conditions and Diseases

April 19, 2010

by Michael Kirsch, MD

Does anyone out there know why President Obama underwent a virtual ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year?

In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless special risk factors are present. Of course, maintaining the president’s health is in the national interest, so I understand why professional screening guidelines might not apply to him. For …

How health reform can be popular with the American public

Kevin

Health Policy

April 1, 2010

The health reform legislation was decidedly unpopular, with a variety of polls showing the majority disapproved of the bill.

What did the people want?

The ACP’s Bob Doherty linked to a post by Princeton’s Uwe Reinhardt, who observed 10 things that the public wants in health care reform:

1. Lets only patients and their own physicians determine how to respond clinically to a given medical condition, never an insurance clerk or, even …

Read more…

How health reform can be popular with the American public

Why being President of the United States is a health hazard

Kevin

Patient

February 24, 2010

Originally published in MedPage Today

by Liz O’Brien

Exactly whom are we honoring on Presidents (or is it President’s) Day?

A. George Washington
B. George Washington and Abraham Lincoln
C. All presidents

The answer is more complicated than you’d ever expect. Probably A is most correct, but if it were up to me, I’d pick C.

Certainly every one of these 43 men has earned the …

How President Barack Obama’s State of the Union speech will impact healthcare reform

Kevin

Health Policy

January 27, 2010

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

President Barack Obama’s State of the Union speech Wednesday night will likely focus on job creation and the economy and not — as many Democrats once hoped — on congratulations for the passage of healthcare reform.

In the week following the election of Republican Scott Brown to the U.S. …

When political discourse is like borderline personality disorder

Marya Zilberberg, MD, MPH

Health Policy

October 7, 2009

When I was a kid in Odessa my Dad and I went to see The Sound of Music at least 17 times in the span of 3 months. Remember that song sung by the nuns when Maria is late for the vespers, “How do you solve the problem like Maria?” One nun says “She’s an angel”, another one counters “She’s a demon”, when the voice of reason from Mother Superior …

Analysis of the Senate Finance Committee health care reform bill

Kevin

Health Policy

October 3, 2009

Originally posted in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

The Senate Finance Committee finished work on its healthcare reform bill in the wee hours of Friday morning, paving the way for a committee vote next week.

After considering hundreds of amendments, the committee is now waiting for a cost-estimate from the Congressional Budget Office (CBO) before it …

Medical malpractice reform by President Obama and the White House

Emily P. Walker

Physician

September 19, 2009

by Emily P. Walker, Washington Correspondent, MedPage Today

The White House today announced details of a $25 million grant program to test alternatives to the tort system for medical liability cases.

In his Sept. 9 speech before Congress, the president announced he would direct Kathleen Sebelius, Health and Human Services secretary, to launch pilot programs meant to cut down on physicians …

Can the American Medical Association still be an influential voice in health reform?

Kevin

Health Policy

June 29, 2009

The repercussions after Obama’s speech to the AMA’s delegates continue to be felt.

Not least of which are the murmurings of the other professional physician groups, who say that the AMA does not represent a majority of physicians. In this piece from pediatrician Rahul Parikh, he notes that about 30 percent of physicians are AMA members. Remaining doctors belong to groups with more liberal political leanings, including the American …

Reflections from the AMA: President Obama’s Speech

Kevin

Health Policy

June 21, 2009

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

We have a historic opportunity for health reform this year and the AMA was delighted to welcome President Obama to our Annual Meeting in Chicago earlier this week. Like the President, we are committed to health-care reform that will provide all Americans with affordable, high-quality health coverage.

I was personally honored …

My reaction to President Obama’s speech to the AMA

Kevin

Health Policy

June 15, 2009

I was seeing patients during the actual speech, so I had to rely on the transcript.

The points that interested me the most were any language pertaining to malpractice, addressing the AMA’s recent concerns about the public plan option, and reforming the physician payment system.

I think he did pretty well.

Regarding the physician payment system, he again addressed McAllen, Texas, which is fast becoming the symbol of what’s wrong with American …

Maggie Mahar: Removing the hazardous waste from healthcare

Maggie Mahar

Health Policy

June 8, 2009

Most of us are now familiar with the estimates that as much as one-third of our health care dollars are squandered on ineffective, often unnecessary, unproven and overpriced products and services. But which third?

The fat in our health-care system is not hanging out conveniently on the edges of the steak, waiting to be trimmed. It will take a scalpel, a keen eye, and a steady hand to remove at least …

AMA: Curbing the rise in health care costs is key to health-system reform

Kevin

Health Policy

May 14, 2009

The following is the first in a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

In an unprecedented endeavor aimed at achieving health-care reform this year, the American Medical Association (AMA) stood with President Obama and other key health-care stakeholders Monday to announce efforts to “bend the spending curve” on health care. U.S. health-care …

How the primary care doctor shortage threatens Obama’s health reform plan

Kevin

Physician

April 27, 2009

Top story in The New York Times.

Excellent.

There’s hope that maybe, just maybe, we’re getting through to the decision makers in Washington.

The article itself is old news to regular readers of this blog, and regurgitates many of the arguments impeding health reform, as well as the problems in solving them.

“Obama administration officials, alarmed at doctor shortages, are looking for ways to increase …