President Obama hopes so. But, as Abraham Verghese writes, we can't be so sure of that. The great cost-cutting hopes proposed by the government, which also include information technology and preventive medicine, all have very little data that show there will be any meaningful cost savings. Are we focusing on the wrong things for cost control? Instead of making the difficult decisions, which includes revamping the physician payment system, ...

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It's looking more and more likely that federal health reform will look very similar to what's going on in Massachusetts. As I've written in the past, expanding coverage is easy, controlling costs is not. And Massachusetts has taken the route of least political resistance and did the former. I've written previously that expanding coverage without re-aligning incentives to produce more primary care doctors will simply increase waiting times and crowed ...

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Here are some of the more interesting comments readers have left recently. 1. David Block on the ACP's guest column, A practice model for increasing the appeal of General Internal Medicine: Weinberger talks about the efficiency of Care. Our commentators talk about the efficiency of Consumption. Weinberger assumes the one-on-one of two individuals, known to each other, who together negotiate the terms of personhood. Medicine is “spiritus”; no wonder he became ...

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Despite the poor shape of the American health system, public preference is the limiting factor in how far we can change the system. Ezra Klein notes the lessons learned from 1994, saying that there is a status-quo bias, and that people "want more options," and "don't want to be forced out of their current arrangements." This is one reason why something radical, like a single-payer health system, won't take off. ...

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With entries dating back to 2004, here are 10 classic blog posts on Medicare: 1. Hospitals lose money by preventing patient re-admissions 2. Covering a virtual colonoscopy, or not, will test the cost-cutting will of Medicare 3. Medicare now requires physician essays for hospice care, as if pre-authorizations weren’t bad enough 4. Why hospitalized Medicare patients get re-admitted so frequently 5. Once you hit Medicare age, good luck finding a ...

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Doctors still wield tremendous influence in the health care debate, since they still have the confidence of most patients. If Congress and the Obama administration can convince doctors to support health care reform, it can be, as the ACP's Bob Doherty notes, "decisive in determining if the public will be behind the effort, because voters are much less likely to support health care reform if told that it will result ...

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As long as as 911 and EMTALA remain, the answer appears to be yes. EMTALA is the flawed, unfunded, mandate forcing hospitals to provide a medical exam to anyone who presents to the emergency department. Emergency physician White Coat envisions a scenario where a family who is denied care can simply call emergency services, or show up in the ER, to get the care they want. For instance, what if Medicare ...

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Changing the way doctors are paid is more important than the debate over the public insurance option, or the arguments over whether we should adopt a single-payer system or not. Atul Gawande's recent New Yorker article is a tour de force, and gets down to the core of why American health care is so expensive. I won't bother summarizing it here - it deserves to be read in its ...

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Sonia Sotomayor has been named as a potential favorite to fill the upcoming Supreme Court opening. But she has type I diabetes, and diabetes blogger Amy Tenderich discusses whether this will work against her. As she puts it, this can be a ground-breaking decision, "where survivorship with chronic illness meets the glass ceiling." There are arguments in the blogosphere back and forth, but Ms. Tenderich raises some interesting points. For instance, ...

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There's no doubt that those with pre-existing conditions find it difficult to obtain individual health insurance. In a minority of states, some are able to become a so-called "group of one," where they become a company. All in the name of obtaining health coverage. And yes, landscaping happens to be one of the more common fronts for these groups. This is just one tip that those with pre-existing conditions can use ...

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