My hospital, UCSF Medical Center, is thriving. Our profits this year will be nearly $200 million. We’re building a sparkling clinical complex – a combined women’s, children’s, and cancer hospital – adjacent to our new downtown biomedical research campus. We are installing a state-of-the-art computer system. US News & World Report calls us the 7th best hospital in the country. Our students, residents, and fellows have never been better. Yet angst is in the ...

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What’s the most effective way to predict which patients will be hospitalized in the coming year? The Heritage Provider Network, a managed care group in California, hopes to answer this question through its sponsorship of the Heritage Health Prize, a $3 million X Prize-like competition for health care. The contest invites participants to develop a prediction algorithm to identify patients who will spend time in the ...

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Boondoggle – a scheme that wastes time and money. Perhaps this is not the best way to describe the many efforts that are being made to try to keep patients with non-urgent problems from using the emergency department, but from where I sit, deferral of ED care is a cost-saving tactic that not only fails to deliver much in the way of cost savings, it also is a strategy that ...

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Rationing is defined as the controlled distribution of scarce resources, goods, or services. In health care, rationing is not a new concept and has been occurring for years, most often in times of emergency but also when resources are merely limited or demand is greater. For example, an increased need for ventilators in the winter months during flu epidemics; organ transplants are dictated by the availability, or the shortage, ...

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The New York Times recently ran an op-ed by Paul Krugman with the intriguing title, "Patients Are Not Consumers." Here’s an open letter to him: Dear Dr. Krugman, As a comparative effectiveness researcher, I agree with many of the arguments that you are making in your most recent article. However, I disagree with your main point that patients are not consumers. I understand your sentiment and agree that patients are more ...

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There has been a significant outcry against the proposed ACO regulations: everything's wrong and nothing's right about them, or so some would have us believe. Today's "nattering nabobs of negativism" focus on: the estimated price tag for complying with the regulatory requirements (IT and other infrastructure incuded), the slim chance of success by ACOs in righting the wrongs of decades of bloat in the health care system, ...

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"Doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation’s taxpayers should have no obligation to pay for it." So argues Dr. Rita Redberg, a cardiologist and professor of medicine at the University of California, in a provocative op-ed published in the New ...

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It's pretty simple, really. Once people gain actual real-life experience with a government program, they abandon their fear of the unknown, see its benefits more clearly, and become invested in its future. We've seen that with Medicare, which consistently pleases its beneficiaries. Part D has similar traction, and now we've learned that the citizens of Massachusetts are increasingly happy with that state's health reform. I'm not arguing that Massachusetts, Part D or even ...

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An excerpt from Balancing The Budget is a Progressive Priority. It is our cultural fear of death and inability to discuss the limits of medicine to forestall death that enables the politics of health reform to be so potent. When I did a post-doctoral fellowship in England in the mid-1990s, a professor I met who had lived in the U.S. explained to me why he thought health policy discussions in that nation ...

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Major journals have slipped in another article that apparently was designed for controversy and for widespread distribution to media outlets. The New York Times rapidly picked it up. As the nation enters the final months before 29.5% fee cuts for Medicare physician services, there will be many more of these that reach the light of day - too many if this is an indication. What is common to major journals, media ...

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