Washington Watch

Physicians have become devalued in modern health care

Anonymous

Policy

June 2, 2018

I’m writing this piece because I’m finally at the point that I am truly angry. I am angry at how physicians have become devalued in modern health care. I’m angry at how systems of care have participated in this by replacing physicians with lesser trained mid-level practitioners. I’m angry at how our title “doctor” has been hijacked to allow patients to be misled or, in many cases, deceived.

It wasn’t that …

The skinny on skinny health insurance

Mark Kelley, MD

Policy

May 24, 2018

The Affordable Care Act (ACA), widely known as “Obamacare,” has survived several repeal attempts by Congress. Storm clouds, however, are still on the horizon.

The ACA’s individual mandate obligates every American to be covered by comprehensive health insurance. This requirement has been the most unpopular feature of the law. That’s because healthy people, especially those who are self-employed or between jobs, have found the ACA premiums too expensive.

They are not alone. Health …

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The skinny on skinny health insurance

America leads the world in high tech care and health care costs

Mark Kelley, MD

Policy

April 14, 2018

Why is U.S. health care so costly compared to other developed countries? A recently published report provides some insights.

In a study of 11 countries, Harvard researchers found that while the United States has the highest health costs relative to its GDP, its use of services is average. More specifically, the U.S. ranks lower than nearly every other country in doctors’ visits, hospitalizations, hospital days, and consultative services.

The difference is …

How inflation will affect our health system

Robert Pearl, MD

Policy

March 19, 2018

All eyes are on interest rates as investors look for more signs of trouble ahead.

If their concerns over higher-than-expected inflation prove accurate, many players in the U.S. economy will suffer the burden of higher costs. But perhaps no sector would feel the strain more than health care. Higher costs would be just the start of many problems to come for providers, insurers and, eventually, patients.

Surging inflation would create a vicious …

Here’s why health insurance is different from other insurance

Joseph Crisp

Policy

February 19, 2018

Anyone who has ever tried to buy health insurance in the open marketplace knows how difficult and expensive it can be. I spent years working at jobs that did not provide health insurance, and I remember the annual feeling of dread when I received notice of the new premium increase. The only way I could keep the cost affordable was by continually raising the deductible until eventually, I was paying …

Do physicians make the best politicians?

Anonymous

Physician

January 4, 2018

Even though we have probably 20 years of work remaining as physicians, like a lot of you, I like to think about how we will spend our retirement years. After all, in twenty years we will still only be in our early fifties, hopefully with no dependents and a lot of financial security. Of course, my wife and I are interested in traveling, spending time with grandchildren (hopefully), gardening and …

Insurance and the destruction of our health care system

Peggy A. Rothbaum, PhD

Policy

December 11, 2017

When interviewing for my book, I asked about insurance, but the topic came up even when I didn’t specifically ask about it. It was never positive in relation to practice.

A doctor said, “I expected to be around tough and hard cases. I expected it to be hard. I did not expect to have to think if the insurance company will not pay for it.”Another one said, “This completely changes the …

Can universal health care and capitalism coexist? Yes, here’s how.

Catherine Cheng, MD

Policy

December 4, 2017

Eat what you kill.

Sounds like a mantra from a survival reality show, right? Akin to “eat or be eaten,” “kill or be killed.” It’s also a common reference to the prevailing business model in our American scarcity-minded, competition-driven, fee-for-service health care culture. How ironic, the application of these words to this profession. It was explained to me essentially as: “Every man for himself, and you’re a minion. You are expected …

5 shifts to move health care in the right direction

Halee Fischer-Wright, MD

Policy

November 29, 2017

The truth about change in health care was never more perfectly captured than in an episode of Sex and the City, when Carrie Bradshaw lamented that we keep “should-ing all over ourselves.”

In the past decade, those of us on the front lines of health care have seen the passage of nine major pieces of federal legislation that, combined, have profoundly affected how they work. We’ve seen the number of people …

A modest proposal in response to eliminating the individual mandate

Jonathan Kohler, MD

Policy

November 15, 2017

In 1729, a prescient Jonathan Swift wrote an essay that has a place in the health care debates of 2017. “A modest proposal for preventing the children of poor people from being a burthen to their parents or country, and for making them beneficial to the publick” reads almost like the title of a modern academic manuscript. Then, as now, it was important to look past the title before re-tweeting, …

Paging the surgeon general: America needs you

Linda Girgis, MD

Policy

November 14, 2017

The Office of the Surgeon General existed since 1871 when Dr. John Woodworth was appointed the first supervising surgeon of the national hospital system. In the previous year, the Marine Hospital was reorganized into the national hospital system. On January 4, 1889, Congress formally recognized the new personnel system as the Commissioned Corps. The Corps was established along military lines and initially consisted of only physicians. They …

Different perspectives but the same goal: providing the best possible care to patients

Yul Ejnes, MD

Physician

October 21, 2017

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

For this column, my 61st for the American College of Physicians (ACP), I thought it would be interesting to look back at the first 60 and review the trends and topics that inspired me to write 800 to 900 words every month. Rather …

What does it mean to be a progressive doctor?

Surafel Tsega, MD

Policy

September 15, 2017

A curious post popped up on my Facebook feed recently: “Another doctor running for office!” A picture of an attractive family was nestled below that exclamation, asking to show your support (in the form of dollars) for this doctor running as a Democrat for the House of Representatives. It had that sense of enthusiasm that implied I was obligated to be excited, but instead came off more like Jeb Bush’s …

Health care reform: A free-market solution works in other countries

Kent Holtorf, MD

Policy

September 13, 2017

Repealing and replacing the Affordable Care Act is on indefinite life support. The political consensus was that President Trump needed to pass health care reform to be able to move forward with his legislative agenda. While this may be true, the passing of any repeal and replacement bill without fundamental reforms has little chance of long-term success, likely defining Trump’s presidency as a failure no matter how successful he is …

When we talk about quality, what exactly do we mean?

John Corsino, DPT

Policy

September 12, 2017

It’s a health care buzzword for sure, but when we talk about quality, what do we mean? We can compare the quality of similar things and focus on its absence, but otherwise, putting the idea into words becomes complicated. Context is important. And so is perspective: One’s position within the health care system influences how he defines quality to a larger degree than it does at a restaurant, or in …

A reminder that physicians are artists

Shannon Tapia, MD

Physician

September 8, 2017

Anyone entering medical training is taught that medicine is an art, one that combines scientific knowledge, discovery and application with its practice. It is both art and applied science. It should never become nor has it ever been only all one or the other.

To be medicine at all, the noble vocation that so many brilliant minds sacrifice to pursue in service to their fellow humans, the practice must balance art …

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A reminder that physicians are artists

The parable of the pizza shop

Emily Dalton, MD

Physician

September 1, 2017

One day a man decided to open a pizza shop. The first week he sold pizzas and collected money from his customers; the happy customers ate hot pizza, and the man made some money.

The next week many of his customers who came in had pizza insurance, and had already paid Blue Wall Insurance for their pizzas. Since so many of his customers had purchased pizza insurance, the man signed a …

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The parable of the pizza shop

The Big Short in health care: What happens after the bubble bursts

Suneel Dhand, MD

Policy

August 30, 2017

Last week a physician friend recommended watching the movie the Big Short. The description given to me was that it was a great movie that was all about a bunch of guys who saw the 2008 financial crisis coming. Sure enough, that very weekend, I planned a night in to get take out and watch it on Netflix.

And it sure didn’t disappoint. Starring Ryan Gosling, Steve Carrell, Christian Bale, and …

Physicians: Use your voice to make the difference

Vineet Arora, MD

Physician

August 28, 2017

Recently, there have been many times when you may have gotten a news alert on your phone or checked the latest Twitter hashtag and wanted to scream. Or you were too busy to even check until later that day and did not know what to say other than to lurk and watch a train wreck in progress. You may have thought about saying something, but paused and wondered, “Is this …

Fix the pay imbalance between specialists and primary care physicians

Zachary Janowski

Policy

August 27, 2017

Reformers have expended considerable effort to change the way Medicare buys health care for millions of Americans, finding a wide range of support across the political spectrum. But Medicare’s current structure may doom these reforms. Some primary care doctors fear that the skewed incentives in Medicare’s pricing system will get built into any new system, whether it is “accountable,” “affordable,” or “value-based.” This fear is well-founded. If special interests buy …

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