One of the popular critiques of the American health care system is that it is high-volume, low-quality, and that this is a direct result of the traditional fee-for-service approach to paying doctors for medical care. In the past, doctors and hospitals have been paid much the same way that we pay for other goods and services. When they provide a service, such as an appointment or a procedure, they are ...

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I can envision a comprehensive design for health care in the United States that will expand access and control costs while conforming to our shared national values of personal responsibility, care for thy neighbor and free enterprise. After dozens of attempts to repeal, defund, delay or restrict Obamacare, the Republicans now have the opportunity to do all of the above. The problem is that it is not clear what should be ...

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Imagine a smoking ban in the privacy of your own home? For over 2.3 million residents of public housing, this will be their reality. On November 12, 2015, former Secretary of Housing and Urban Development (HUD), Julian Castro, announced HUD’s policy for “smoke-free” federally funded public housing. The policy requires that residents refrain from “using tobacco products in their units, common areas, and within 25 feet of public housing and ...

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Knee replacements are booming. Between 2005 and 2015, the number of knee replacement procedures in the United States doubled, to more than one million. Experts think the figure might rise sixfold more in the next couple decades, because of our aging population. Since many people receiving knee replacements are elderly, Medicare picks up most of the cost of such procedures. In response to this huge rise in expenditures, ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. When the American College of Physicians (ACP) and the other primary care societies introduced the Patient-Centered Medical Home (PCMH) over 10 years ago, the model was untested.  Here’s a look at how the PCMH recognition process has evolved and how my ...

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I’m a member of the 25,000-strong medical school graduating class of Obamacare. We were pre-med college students during the debate over the Affordable Care Act (ACA) and began medical school during its implementation. We put ourselves into deep debt and studied late into the night with the promise that we would practice medicine in a system that promoted insurance coverage, reduced medical bankruptcy, and incentivized high-quality care. Increasingly, we see that promise ...

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America’s health care system is broken and no longer works.  Many practicing physicians are unhappy with the way insurance companies control medicine.  Most patients are unsatisfied with the benefits they receive from the health insurance companies and with the lack of choice they have in who cares for them.  Patients are frustrated with the exorbitant cost of prescription medicine.  They wonder why this system often doesn’t allow them to receive ...

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Health care costs are out-of-control, and many patients can no longer afford medical treatment. The system is broken, but no real fixes are visible on the horizon. Sure, politicians debate the road health care should take and act like they are very concerned about the health of Americans. Truthfully, however, they are driven by political agendas corporate influence. Little discussion is given to what it would take to fix the ...

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It has come to pass: President Donald J. Trump. Are you scared? Are you planning to “resist” the policies you imagine President Trump will pursue by tweeting furiously with clever hashtags galore? Would you prefer to move my fastidious quotation marks from “resist” to “President”? This is, after all, the first President in a very long time to take office without the blessings and financial support of established “world order” ...

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Whether rejoicing or mourning, millions of Americans awoke on January 21st feeling suddenly at the threshold of a new and uncertain era. However, in public safety-net emergency departments across the nation -- like Harborview Medical Center in Seattle, where we work -- the service of healing continued seamlessly, paying no heed to the national drama that has unfolded for the past several months. That day and into the night, there were ...

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