When I began my career as a physician in the late 1990s, I was relatively apolitical. Since then, as our health care system has crumbled, and as its demise (and our repeated failure to fix things) has increasingly affected my patients and my practice, I have become very political. In 2008, I began giving lectures in the community in support of a single-payer health reform model. My political leanings tend ...

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Health – /helTH/ – The state of being free from illness or injury Care – /ker/ – The provision of what is necessary for the health, welfare, and protection of someone or something. System – /’sistəm/ – A set of things working together as parts of a mechanism or an interconnecting network. It’s not keeping us Healthy, it doesn’t seem to Care, and it’s certainly no kind of System. What we’re got is ...

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We are a nation divided. Our two major political parties agree on essentially nothing. Republicans cannot agree even amongst themselves how to proceed on health care reform. It is demoralizing that even though U.S. health care has sunken to last among developed nations, our elected leaders are unable to envision or agree upon any effective solutions. We could all use a win. When it comes to health care reform, administrative ...

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Much has been written in recent weeks about the failure of direct primary care giant and pioneer Qliance. Much of the conversation has examined the reasons for their closing and the negative impact it will have on the direct primary care movement. Questions have been raised about the longevity of the movement, with many exclaiming that "If they can't sustain it, no one can." While I don't pretend to know all ...

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Any backpacker traveling on a shoestring in Thailand knows not to blow their entire budget on premium whiskey in a premium hotel on the first night in Bangkok. Rather, you need to skip the occasional meal, stay in a cheap dorm with random strangers and drink cheap beer on Khao San Road if you wish to see the country and return home without having to wash dishes in a restaurant ...

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The need for what we are calling medical “quality” is acute, yet the strategies employed to obtain it are destroying medicine. Patient outcomes are inconsistent, care varies depending on many factors outside of disease state, and the cost of our medical system is not sustainable. But to fix this, most health systems employ non-clinicians to audit charts while checking boxes such as “A1C<8%?” and “DVT prophylaxis ordered within 24 hours?” ...

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Can politicians fix our health care system? Sure, but they and everyone else trying will have to realize what our political leaders have voiced, but not seen that the system is complex and the truth behind Einstein’s statement that we cannot fix a broken system using the same thinking that created it. The lack of those elements is why we are still stuck. Rather than repeating the arguments of the ...

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As an American internist and expatriate in the Netherlands, I still follow the unfolding U.S. health care drama. Critics of the Better Care Reconciliation Act (BCRA) are numerous, including doctors, patients, policy experts, and the former top U.S. health administrator — even President Barack Obama. The Dutch and other developed nations must be ...

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As our new president has said, health care is complicated. Republicans call for Obamacare’s repeal, but are hard-pressed to come up with a workable alternative. Democrats recommend improving Obamacare, but are largely silent as to how they would do that. Americans are caught in the middle of this apparent health care quagmire. But for America to flourish as a nation, a solution must be found. To start, we must frame the ...

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This week at each of our hospitals, a woman gave birth to a baby with a severe heart defect. Twenty years ago, these babies may not have lived. Today, after complex surgery and specialist care, each will go to school, live a normal life. The "medical miracles" that saved these infants — and that could save the child of someone you love — were perfected with support from Medicaid. New ...

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