We all know about the increase in Medicaid patients resulting from Obamacare, and how this is exacerbating the shortage of providers who accept Medicaid. I see Medicaid patients in Denver, where there is a reason for the shortage that is often overlooked: managed care Medicaid. The managed care concept peaked decades ago, a failed attempt to reduce health care spending by forcing patients to go to only one doctor or ...

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Overwhelmingly, doctors’ reimbursement has been the target of government programs and insurance companies.  The idea underlying this movement has been, pay doctors less and curtail their incentive to see patients and the cost of medical care will decrease.  As a result of this faulty reasoning, we have ushered in the era of unhappy doctors, those retiring early, and those asking for extra payments to justify the hours needed to give ...

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As our nation struggles with the mind-boggling algebraic-like task of reigning in on health care expenditures while increasing provider access and high-quality medical care, provider payment structures are in flux between traditional payment methods and relatively new financial structures. While I am no means an expert of health policy nor medical business and financing, I think it's important for medical trainees and enthusiasts alike to understand the very general basics of ...

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So you think there is a war on doctors, don’t you? It certainly looks that way from your particular vantage point. The government is deftly intruding into your professional life with a computerized fifth column that is extracting information on your every move, and to add insult to injury, it forces you to actually collect the data which is to be used against you in the court of public opinion. ...

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People have criticized the Affordable Care Act for amounting to a large transfer of wealth, from wealthy Americans to those not as well-off. But the real transfer of wealth has been from United States to other developed nations, whose health care costs we have subsidized for many years by paying so generously for many of our health care services. No better example of this comes to mind than the price ...

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This is often proposed, but I have trouble understanding it. Real outcomes are not blood pressure or blood sugar numbers; they are deaths, strokes, heart attacks, amputations, hospital-acquired infections and the like. In today’s medicine-as-manufacturing paradigm, such events are seen as preventable and punishable. Ironically, the U.S. insurance industry has no trouble recognizing “Acts of God” or “force majeure” as events beyond human control in spheres other than health care. There is ...

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I recently read the New York Times article on the ridiculous amount that insurance company executives and hospital administrators make. So the reason that American health care is so expensive is not because doctors earn too much, or drug companies charge too much or device manufacturers are making ever more expensive devices with ever expanded indications. Except that it is all of that and more. Hospital administrators and insurance company executives do ...

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The continued implementation of the Affordable Care Act (ACA) in 2014 will be as controversial as in previous years. Here are five main areas of concern: 1. The individual mandate.  By what right does the federal government “force” its citizens to buy a product they may not want? The Supreme Court upheld the mandate in 2012, but that does not end the matter. Partly -- perhaps largely -- because the ...

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“Get the suits out of medicine.” This refrain has become commonplace among physicians, who worry that patient care, the essence of medicine, is increasingly taking a backseat to bureaucratic demands on safety metrics and electronics health records as well as corporate measures of efficiency. Without physicians, after all, there is no health care system for administrators to administrate, they say. Not only do top-down regulations make patient care more cumbersome, they ...

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Walter White and the narrow networks of Obamacare As we behold the continued wonders of Obamacare, we receive another reminder of the president’s empty promise: “If you like your doctor, you can keep your doctor.”  The New York Times observed, “No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network -- or pay much more for the privilege of going to any provider ...

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