Quality metrics and pay-for-performance have now been in existence long enough to start accumulating some efficacy data.  And the picture does not look good.  Paying doctors to improve their quality metrics does not, in general, improve those quality metrics.  Like all good scientists, we can now either question the data, or discard the hypothesis. Most payors and administrators appear to be reacting to the lack of efficacy data on ...

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Having graduated from medical school in 2008 and internal medicine residency in 2011, I am a physician-child of the Affordable Care Act (ACA) era. The belief that “health care is a human right” ran deep through my upbringing and life experiences, but training during a period of such intense debate over health care reform reinforced this ideal. My professional identity developed interwoven with a compelling national conversation about access and ...

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In no other field is change received with so much resistance and skepticism than in medicine.  The oath taken by physicians to “do no harm” is profoundly ingrained in the medical culture that any deviation from tradition is regarded as near blasphemy. As a physician, I frequently catch myself relying on superstition and past experiences more than on evidence and proof of progress.  As the world is witnessing an unprecedented technological ...

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A month into Donald Trump’s presidency, it is clear we are in for a wild and dizzying ride.  As is typical in matters of opinion, post-mortem analyses on how we got here are frequent and varied. However, I believe the Affordable Care Act was the iceberg which sunk Hillary Clinton’s ship.  Sure, there were both real and fabricated scandals which dampened enthusiasm among potential Clinton voters.  There were the emails.  There ...

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It won't work. Obamacare works for the poorest that have affordable health insurance because all of the program's subsidies tilt in their favor. Obamacare doesn't work well for the working and middle class who get much less support -- particularly those who earn more than 400 percent of the federal poverty level, who constitute 40 percent of the population and don't get any help. Because so many don't do well under the law, ...

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Rationing of health care services according to an individual’s ability to pay — or, as the case may be, the inability to do so — is becoming more prevalent in the United States, both in the public and private insurance spheres. Commercial payers, for example, increasingly require doctors to follow a complex and time-consuming authorization process. Recent surveys show that 75 percent of doctors complain about this often unnecessary step. Insurance ...

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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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