Detroit On July 18th 2013, the city of Detroit filed for bankruptcy. Early estimates size up Detroit’s as the biggest in history with composite debt figures approaching the ballpark of $20 billion. Through the eyes of a clinician why should we care and what does this mean for our practices. Detroit is dying. While filing for Chapter 9 bankruptcy may give the city an extra lifeline, ...

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One of the most  disheartening developments in the unrelenting political fight over the health reform law is the organized effort by its opponents to dissuade the public from signing up for coverage. Having failed in efforts to block Obamacare in the Supreme Court, or to elect a president or Senate that would work for its repeal, they are now working to kill the law by persuading people to not sign ...

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Imagine your 7-year-old son’s face, abdomen, and legs begin to mysteriously swell one morning. Your initial reaction as a parent would likely be to worry first. However, your second instinct is probably to rush to your computer and search the Internet for what might be going on. This is easy enough for the roughly 72% of people in America who have a computer with Internet access in their homes. Now, ...

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Creating a patient-centered medical home within our existing system seems, at times, like a Herculean task. Getting all the pieces in place so that we can make the needed changes sometimes seems too vast to get it all right. We find ourselves asking: Why bother? Is our healthcare system that broken? Is the way we take care of patients now failing, satisfactory, or outstanding? If we just continue on the path ...

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I’m not a big fan of bargaining and my half-hearted attempts to get a better price for a used car, garage sale find or contractor’s service have been mostly unsuccessful. There’s always that nagging feeling that the seller is laughing with delight once I’m gone, thinking, “I really pulled one over on that rube!” And so it has come as somewhat of a shock to me that medical care has become ...

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A good recipe is one that combines high-quality ingredients in appropriate quantities to produce a savory main course or a decadent dessert. It strikes me that, in order to answer the Affordable Care Act's call for us to aggressively pursue population health, we must first understand what the recipe calls for. Dichotomous as it may seem, the primary ingredient for population health is accurate, comprehensive data on the individuals who comprise the ...

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I advocated for the Affordable Care Act, and celebrated when it was passed. It’s good to have everyone covered, I thought. Insurance for everyone is the first step to health care for all. Alas, access to health insurance isn’t the same as access to health care. First there is the niggling detail of providers. We already have a primary care provider shortage.  Internists, pediatricians, family physicians are already working at full capacity in caring for ...

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If there’s anything that liberals hate it’s inequality – unless it’s the Federal tax code – and health care is a prime offender. The liberal mantra is that everyone should have the same access to basic health care. But this doesn’t just involve improving health care access and affordability for millions of uninsured Americans. It also involves limiting or impairing (through taxes) those health care plans liberals have decided are ...

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One could easily make a case that health care is today’s biggest consumer problem—not unlike those that sparked the consumer movement of the 1960s and 70s. Back then, consumer issues centered on problems with using credit, buying cars and home improvement services, and obtaining the best price for food, appliances, and just about every other new-fangled and expensive product that sprang from the post-war economy. Like many old consumer problems, health ...

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The massive confusion about Obamacare (the Affordable Care Act) is much worse than I thought. The Kaiser Family Foundation came out with a poll that shows 42% of Americans don't even know that Obamacare is the law. Seven percent of people think the Supreme Court struck it down and 12% think Congress repealed it. I understand that there is confusion about the way it will work and who will be affected. ...

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