Currently, the United States spends approximately 3 trillion dollars on health care, which is roughly 18% of our gross domestic product (GDP).  Not only is this more than every other country in the world, but it’s also more than the next 10 largest spenders combined.  Looking backwards, health care spending rose steadily from about 9% of our GDP in 1980 to about 16% in 2008.  Looking ahead, by 2020, health ...

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One of the many aspects of Obamacare adding overall costs for both patients and insurance companies is the feature called essential benefits. This means that Congress and the administration, in their infinite wisdom, have decreed that anyone purchasing health insurance must have a policy that includes emergency, maternity and preventative care, whether or not such coverage is needed or desired. For example, a middle-age man, such as myself, must have, and through the ...

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As the Wall Street Journal reported, there’s a growing shortage of qualified pilots in the US, driven by both economic reality and federal policy. Pilots typically start their professional careers at small, regional airlines -- airlines that pay, approximately, fast-food wages. Less than that, really -- for for the hours they work, many pilots make less than minimum wage.  After a few years, these pilots have enough flight time and experience ...

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It’s a strange business we are in. Doctors are spending less time seeing patients, and the nation declares a doctor shortage, best remedied by having more non-physicians delivering patient care while doctors do more and more non-doctor work. Usually, in cases of limited resources, we start talking about conservation: Make cars more fuel efficient, reduce waste in manufacturing, etc. Funny, then, that in health care there seems to be so little discussion about ...

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Round and round and round we go yet again. The system is broken. Do something. Health care reform! “Pay for performance” morphs into “measure (and pay) for quality.” The big problem is that no one has bothered to actually define the term, maybe because everyone assumes they know what it means -- and that everyone else agrees with them. Wrong. Quality is very much in the eye of the beholder, and ...

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Despite the political angst, the doomsday predictions and a very rocky launch, the Affordable Care Act has enabled more than 8 million Americans to acquire insurance coverage through the public exchanges. Health insurance increases the probability that patients will access the medical care they need. And my colleagues at Kaiser Permanente are already seeing some positive stories emerging as a result. They’ve shared dozens of stories with me about patients with undiagnosed ...

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Did you ever read a seemingly inconsequential sentence somewhere and it then just refused to leave your mind for days on end, triggering avalanches of thoughts way beyond the original intent, if there even was one? It just happened to me a few days ago when I read one more industry article about the recent Medicare data dump. The following remark was attributed to a primary care doctor: “The U.S. is ...

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California, along with the rest of the nation, is facing a serious primary care physician shortage that grows worse every year. As health care reform takes full effect and millions more Americans gain coverage and therefore can afford to seek the care they need, many will have trouble finding a family physician or other primary care doctor to care for them, as many patients already do. We must make certain ...

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As a future doctor, I believe that digital dialogue affords medicine a powerful responsibility to educate and engage. I believe physicians have a responsibility, as daily witnesses to the gaps and failures of public policy, to advocate for social justice and policy reform. I believe that medicine should extend beyond the proximate effects of illness and injury to address their root social etiologies. I’ve always held these beliefs with firm conviction. ...

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I've long been a skeptic when it comes to disclosing information about how doctors practice medicine, how hospitals treat patients and what both doctors and hospitals charge for their services. While I am all for transparency, it's still an open question how patients or consumers of medical care can actually use that stuff to find "the one that's right for you" or "the best" as marketers like to say. I'm dropping ...

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