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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Mitt Romney’s “let them eat cake” comments on 60 Minutes serves to illustrate how badly both sides of a political debate can confuse an issue. In 2010 he criticized emergency room care as a potential  loophole used by people to get “entirely free care” while avoiding having to pay for health insurance and in his book No Apology, the Governor outlined the idea behind Massachusetts health care reform as ...

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As I approach my 50th birthday, I worry about Medicare not being there for me when I become eligible. I have some inside knowledge about Medicare. My parents and in-laws are patients on Medicare. As a doctor, I am a provider for Medicare, and as a public health educator I am a consultant for a Medicare quality improvement organization. Everyone, including the leaders of both Democratic and Republican parties, agrees that ...

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I am riled up—almost to the point of being inflamed. I hate it when doctors get dragged through the mud. It’s a matter of pride. Doctors are my team. The latest kerfuffle centers on how much we should charge for return patient visits. The difference here is between moderate and moderately high visits–or about $30. When the Center for Public Integrity is investigating your profession, it’s unlikely to be good news. And it ...

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The debate over fee-for-service physician payment often is misunderstood to be about the technicalities and relative merits of the RUC, relative value units, P4P and the SGR.  It isn’t—instead, it’s what the fee itself represents (and who decides), and what the service being provided actually is (and how it’s described). Let me explain.  Analysts across the political spectrum agree that the health care system needs to move ...

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