The recent budget crisis in many state Medicaid programs has led the directors of these health care programs for the poor to cast about for ways to cut their costs, and many have landed on a ‘solution’ that puts lives at risk and undermine the financial viability of an emergency care safety net that is already severely underfunded and overwhelmed.  Some 21 states use a variation of the old definition ...

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Why can’t the United States have a smarter health care system? That was the frustrating question that kept poking through my train of thought as I read a study from the most recent issue of Pediatrics, the official journal of the American Academy of Pediatrics (AAP).  The study, out of UCLA, examined the association between length of well-child visits and quality of the visits, including things like developmental screening and ...

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In March 2010 President Barack Obama and the Democratic-led Congress passed the single largest change in the American health care industry since the introduction of Medicare and Medicaid in 1965. The Patient Protection and Affordable Care Act (PPACA) aims to drastically change the way that health care is delivered and financed. It partially draws upon the idea of personal responsibility and its role in promoting individual health. Some states, notably ...

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What is an essential health benefit? I suppose that is a health or medical action, product, or process that should be paid for by someone other than the patient, in a society that provides so-called "third party coverage." Many very smart people and strong organizations have struggled with this issue for many decades. Prior answers, such as they are, have come from staff model HMOs like Kaiser Permanente, the Veterans Health Administration, ...

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We are finally in the midst of American football season again, after so many dull months. Are you ready for: "We're Number 1; we're Number 1"? School pride; conference pride; regional pride; confirmation of identity; proof of manhood. Think Summer Olympics in London, 2012. As the Gold Medals add up, the chants will ring out ... U.S.A, U.S.A. Goose bumps; spine tingles; national pride. Years back, when John McKay coached the USC Trojans, he ...

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Few things smell worse to me than the stank of a cigarette while trying to trying to load up on cholesterol via awesome blossom.  Perhaps one such thing is the beguiling tale of what perverse fate has befallen the gobs of cash money rewarded to state governments from Big Tobacco. This seemingly righteous pursuit was fought by brave attorneys general of 46 various states to regain money we dished out to pay ...

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By mid-November, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) must respond to the legal complaint filed in a Maryland federal court by six Augusta, Georgia family physicians. These doctors are not asking for money, but for relief from the negative effects brought about by CMS’ twenty year reliance on the American Medical Association’s Relative Value Scale Update Committee (RUC) ...

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The October 19 Health Affairs briefing entitled “Saving Medicare Dollars and Improving Care,” sponsored by the ABIM Foundation and other funders, was a watershed moment in which ideas that would require less spending on health care that would actually improve care for patients were discussed on K Street. This is a great message for patients and, it so happens, for the super committee deliberations a few miles away. Dr. Nancy Morioka-Douglas, Clinical Professor of Medicine/Family and Community Medicine ...

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Six months after Congress passed the health reform law last year, the Institute of Medicine of the National Academy of Sciences issued a landmark report on nursing. Although seemingly separate events at the time, it’s clear now that they are integrally linked: Never has quality care been more dependent on the total engagement of nurses as well as other health professionals. At its core, the Affordable Care Act is about ...

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Evidence based medicine. Just think about it for a second. This means now we actually practice medicine based on bona fide evidence? What the hell have I been doing for the past 25 years? Making it all up? And who wrote those thousands of articles I’ve read? Dr. Seuss? Evidence based medicine, or EBM, may be just another way to remove a physician’s autonomy. This trend has marched on for years, ...

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