We all want the advantage.  We put our kids in special preschools so they have the advantage.  We work 100 hours a week so our kids can do 8 activities and get the advantage. Tall people have an advantage, we’re told.  Poor people are “disadvantaged.” Well folks, there are a whole bunch of senior citizens in Massachusetts who are about to get disadvantaged starting September 1. UnitedHealthcare (UHC) will be
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Taking a page from firefighting to fix health care In firefighting, pump physics is one of the most critical things an engine company officer must understand.  How do we "get the wet stuff on the red stuff" in sufficient quantity without sacrificing penetrating power? The inverse ratio between volume and pressure (as the water pressure increases, volume decreases) has befuddled many a rookie lieutenant. The same, I think, is now true ...

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In the forty years since I started medical school, I have worked in socialized medicine, student health, a cash-only practice and a traditional fee for service small group practice. The bulk of my experience has been in a government-sponsored rural health clinic, working for an underserved, underinsured rural population. Today, I will make a couple of concrete suggestions, borrowing from all the places I have worked and from the latest trends ...

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I’ve listened over the years to well-meaning people say that the general public doesn’t care about physician payments, because they think all doctors are rich and any physician who complains is just whining. This is a huge mistake on the part of people who want to have a long-term relationship with comprehensive family physicians as their primary care givers, and those who want better health care at a lower cost. Let’s ...

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Labor unions have been reliable supporters of President Obama and his policies. Their support for Obamacare was critical to its passage in 2010. Yet they are continuing to learn that their members will be paying more for their health care, not less. One of the selling points of Obamacare was the lowering of health insurance costs. Nancy Pelosi promised, “Everybody will have lower rates.” President Obama was more specific, telling us that his ...

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I recently described the loathsome “relative value unit” (RVU) and its role in the decline in prestige and pay in primary care.  The RVU is maintained and updated by a small panel of 31 physicians called the Specialty Society Relative Value Scale Update Committee (RUC).  Twenty-seven of the 31 physicians are specialists, which is not at all representative of the physician workforce, given that primary care doctors comprise over one third of ...

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At the end of my interview with Chip Heath, co-author of the New York Times bestsellers “Made to Stick” and “Decisive,” I asked him what topic he’d like me to cover in the future. “I’m impressed by the culture you’ve created at Kaiser Permanente in Northern California,” he said. “You’ve generated quarter-to-quarter change that I think would have taken three years elsewhere. I don’t think most organizations know how to ...

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If you read my articles, then you likely know about the scam known as pay-for-performance (P4P).  This program not only fails to deliver on its stated mission to improve medical quality, but it actually diminishes it. In short, P4P pays physicians (or hospitals) more if certain benchmarks are met.  More accurately, those who do not achieve these benchmarks are penalized financially. I do not object to this concept.  Folks who perform ...

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A physician I have known for many years recently told me about his decision to enter the world of concierge medicine. His reasoning was telling, saying that it came down to a very simple decision on staying independent or becoming a hospital employee. He liked being an independent solo practitioner, and that was his primary motivation: to maintain independence in a time of consolidation. Richard Gunderman, writing for the Atlantic, tackled ...

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“It is immoral that the wealthiest nation on the planet does not provide affordable, high-quality health care to all of its citizens. Despite being the only global ‘superpower’ still standing, we trail much of the industrialized world in life expectancy, infant mortality, and countless other indicators of health. Until we fix our broken, prohibitively expensive delivery system, things will only get worse.” I’m not sure if anyone has used those ...

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