A guest column by the American Medical Association, exclusive to KevinMD.com. Every physician caring for Medicare patients knows that the current payment system isn’t working. Most seniors know it too. For much of the last decade, patients and physicians have joined together to tell their elected officials that the system is broken. The response from members of Congress has been to ...

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It sounds like heresy, but recent evidence challenges the long-held belief that the annual physical is beneficial for healthy adults. Researchers at the Nordic Cochrane Center in Copenhagen wrote that although a regular check-up with multiple screening tests might seem to offer the advantage of catching problems like heart disease and cancer early, their review of studies involving some 180,000 adults actually found no benefit. People who had ...

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Seniors need more Medicare choices, or do they? The answer depends, of course, on who’s doing the asking. Republicans and others advocating a voucher plan for Medicare invoke the choice argument as the rationale for transforming Medicare from social insurance provided by the government to privatized arrangements between individuals and the marketplace. Under a voucher system, the government would give seniors and people who are disabled a fixed amount of money ...

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I grew up in Rochester, NY.  Statistically, this means that I probably had a family member who worked at Eastman Kodak, as the company employed over 62,000 people in Rochester at its peak.  I did, in fact, have two: my father and my brother-in-law.  My brother and I both worked there during two fun and profitable summers of our college years in the delightful “roll coating” division.  It actually paid ...

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In the ancient and oft-told story of the blind men and the elephant, several sightless men seek to learn the nature of the great beast, none of them familiar with it prior to the encounter.  One, who feels the trunk, describes the elephant as powerful and snake-like.  Another who examines one of the mighty legs, opines that the animal is like a great tree.  Still another, having first touched a ...

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Having established that the U.S. spends twice as much per person on healthcare as the average per person cost in all other developed countries – but with no better overall results – it is time to ask how this happens. Obviously, there are many factors contributing to this dangerous cost escalation, but in my mind two stand out. The first is our unrealistic expectations as American healthcare consumers. Here are a bunch ...

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Thirty percent of health care spending — amounting to $750 billion a year — is wasted, according to a recent report by the Institute of Medicine. I know. As a doctor, I am party to this waste, and I think doctors can play a major role in recovering it. In a private conversation, a cardiologist tells me about his partners — "loose guns" he calls them. "At the hint of chest pain ...

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The Democrats and the Republican parties’ approaches to Medicare are quite different.  Which approach is better? That is the wrong question. Or at least not the most important question. Instead we should consider what could be done now to actually improve patient care quality as a means to reducing costs. Is there a good solution to the Medicare issue? Setting aside either the Democrats’ approach to basically enact price controls by ...

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Much of what passes for debate on health care during this election year is focused on the macro side, on big issues like how do we cover the uninsured or restructure Medicare and Medicaid financing.  But for all of the talk about vouchers and block grants and insurance mandates, the candidates are missing the micro issues that really matter most to doctors and their patients, which is how health care ...

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There is a serious cost problem in USA health care which no one denies. Yet when it comes to suggested solutions, there is a wide divergence of opinion.  Attempts to use experts and evidence based guidelines for care are somehow viewed as government interfering with decisions which should be between the doctor and her patient. States and insurance schemes have made varying attempts to deal with this.  The Oregon Health ...

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