Any backpacker traveling on a shoestring in Thailand knows not to blow their entire budget on premium whiskey in a premium hotel on the first night in Bangkok. Rather, you need to skip the occasional meal, stay in a cheap dorm with random strangers and drink cheap beer on Khao San Road if you wish to see the country and return home without having to wash dishes in a restaurant ...

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The need for what we are calling medical “quality” is acute, yet the strategies employed to obtain it are destroying medicine. Patient outcomes are inconsistent, care varies depending on many factors outside of disease state, and the cost of our medical system is not sustainable. But to fix this, most health systems employ non-clinicians to audit charts while checking boxes such as “A1C<8%?” and “DVT prophylaxis ordered within 24 hours?” ...

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Can politicians fix our health care system? Sure, but they and everyone else trying will have to realize what our political leaders have voiced, but not seen that the system is complex and the truth behind Einstein’s statement that we cannot fix a broken system using the same thinking that created it. The lack of those elements is why we are still stuck. Rather than repeating the arguments of the ...

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As an American internist and expatriate in the Netherlands, I still follow the unfolding U.S. health care drama. Critics of the Better Care Reconciliation Act (BCRA) are numerous, including doctors, patients, policy experts, and the former top U.S. health administrator — even President Barack Obama. The Dutch and other developed nations must be ...

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As our new president has said, health care is complicated. Republicans call for Obamacare’s repeal, but are hard-pressed to come up with a workable alternative. Democrats recommend improving Obamacare, but are largely silent as to how they would do that. Americans are caught in the middle of this apparent health care quagmire. But for America to flourish as a nation, a solution must be found. To start, we must frame the ...

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This week at each of our hospitals, a woman gave birth to a baby with a severe heart defect. Twenty years ago, these babies may not have lived. Today, after complex surgery and specialist care, each will go to school, live a normal life. The "medical miracles" that saved these infants — and that could save the child of someone you love — were perfected with support from Medicaid. New ...

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I was thinking of giving politics a break for my next column, instead focusing on some interesting news in the medical world. But alas, politics has permeated all aspects of life, whether professional sports or the latest TV series. Few television shows don’t have a same-sex couple or transgendered individual. Sports news can’t avoid discussions of race, climate change or gun control. What about the medical world? Is that too overrun ...

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I already know I sound like a broken record. Yet, I can’t fathom why I seem to be the only person talking about this. There have been numerous articles in both syndicated journals and the blogosphere about the many things wrong with the American health care system, including the overspecialization which we know leads to higher costs (but not necessarily better outcomes). Just as I feared, the New York Times ...

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As our elected officials consider to weigh the future of our nation’s health care, I thought I would take the opportunity to share a few vignettes of patients that I’ve encountered this year who exemplify the way that access to health care can make the difference between life and death.  The undocumented immigrant with seizures. We recently met a young undocumented Californian in his twenties in the emergency department, who came after ...

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As Republicans in the Senate are working diligently on the destruction of Obamacare, progressives in California are doggedly pursuing a distinctly opposite approach. The California single-payer bill (SB562), aims to expand health insurance coverage to all state residents regardless of income or immigration status. Just as Republicans at the federal level have tried to jam through their health care package without debate or adequate analysis of the downstream financial impact ...

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190 Pages