It is easy to assume that the real problem with our healthcare system is “not enough” – not enough physicians, not enough MRIs, not enough money. But a growing number of studies show that more healthcare is not always better and the more expensive drug or treatment option is not necessarily the right choice.  In fact, sometimes more care – specifically care that you don’t need – can be harmful for ...

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Every week we read another article on the fuzzy math and ridiculous mark-up for our routine healthcare. Do your own research; see Elizabeth Rosenthal’s article in a recent Sunday New York Times, the $2.7 Trillion Medical Bill or Steven Brill’s lengthy tome in Time, Bitter Pill. We spend, and will continue to spend, more on healthcare than any other nation in the world and yet we are 38th in ...

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Getting your appendix out can cost between $2,000 and $180,000. Hip replacements run from $10,000 to more than $100,000. Hospitals, we have also learned, frequently mark up the price of cotton swabs and routine X-rays by 300 or 400 percent, with most patients oblivious to the reason their health care bills are so large. As a response to the hidden variability in health care prices, an increasing number of states ...

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There is a persistent narrative about emergency rooms. This narrative says that emergency rooms are overly expensive places to receive healthcare, that they are a cost drain on the hospitals they are attached to, and that they are a key driver of rising healthcare costs. A RAND study released recently challenges most of that narrative, and lends support to a view that most of us emergency physicians have long held: that ...

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For all of those out there anticipating the 2014 official roll out of Obamacare, officially known as Affordable Care Act (ACA), here is a cautionary tale. Many years ago, as I was growing my cardiology practice, it became evident that diagnostic services for my specialty, like stress tests and echocardiograms, were done less efficiently and cost more at the local hospital, than in the office. This stimulated many groups in the ...

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It has been a couple of weeks since the landmark Oregon experiment paper came out, and the buzz around it has subsided.  So what now?  First, with passage of time, I think it is worth reflecting on what worked in Oregon.  Second, we should take a step back, and recognize that what Oregon really exposed is that health insurance is a small part of a much bigger story about ...

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Getting rid of Medicare’s SGR formula has been organized medicine’s Holy Grail.  But medicine has gotten no closer to finding a solution to the SGR than the medieval knights did in their search.  This year could be different, though.  The House and Senate both are working on bipartisan plans to repeal the SGR and reform Medicare payments, plans that are being developed with the input of physicians. Yes, you heard that ...

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For all intents and purposes, the Affordable Care Act (ACA), the president’s signature piece of legislation, will provide more health care coverage to poor and underserved populations. Persistently disadvantaged communities have much further to go than those with insurance, and new means of accessing and paying for care will benefit them disproportionately. Nevertheless, with more than 20 percent of the nation’s black population uninsured, more than 30 percent ...

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Why do we never consider unintended consequences? Whether we are thinking of legislation or physician led guideline panels, or governing bodies (like ACGME), the lack of consideration of unintended consequences remains mind numbing. Let me provide some examples. Please read this articles about how the war on drugs has fueled the hepatitis C epidemic. One could also argue that this war damages more young people than the drugs themselves. Many illicit ...

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As someone who professionally closely tracks the debate over the transformation of the American health care clinical delivery system, I did not learn much new from the New York Times article: The $2.7 Trillion Medical Bill.  I did find the article’s approach useful in explaining how the wide variations in price for procedures contribute to the unnecessary high cost of American health care. Although the article did document many procedures ...

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