37 years ago, at the very tail of the civil rights movement, my community health center (CHC) was established in Oakland to fill an unmet and urgent need. A growing population of immigrants were settling in downtown Oakland and had few choices for health care. Community surveys conducted by local leaders confirmed that residents received significantly less health care than the rest of the population largely due to a ...

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How to slow Medicare’s escalating costs has been the big health care policy issue recently, with Republicans and Democrats offering competing proposals, each part of broader plans for reducing the federal deficit—projected to be $1.5 trillion this year, with the government borrowing 40 cents for every dollar it spends. Unfortunately, neither the Medicare proposal of Representative Paul Ryan’s House Budget Committee, nor that offered in response by President Obama, can ...

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Living in Washington, DC, I can not help but notice that many interest groups are up in arms about the debt ceiling debate (or more aptly, brinksmanship) going on between the Congress and the President. AARP is running a full-length TV ad that carries a stern warning to politicians: hands off Social Security and Medicare, or else. The energy lobby has a radio ad that direly warns: raising taxes on them would ...

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Danielle and Robb Deaver are living proof of the awful reality of Nebraska’s ill-conceived “fetal pain” law. The law, which took effect last October and is the only one of its kind in America, prohibits abortions in the state after the 20th week of pregnancy. It is based on the discredited notion that a fetus may feel pain at that stage of development. Physicians who break the law face ...

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Health care leaders are busy talking to attorneys and consultants about how to set up Accountable Care Organizations (ACOs). A recent Advisory Board survey found that 73 per cent of hospital finance executives said that creating such an organization was a top priority for their health system.

Last year my most popular keynote topic was patient-centered medical home creation; this year everyone wants a presentation on ACOs. However not ...

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There is no "right" answer to the healthcare reform issue. There are facts, opinions, myths, politics and reality, all in no particular order of magnitude. Unfortunately, thus far and likely in the future, the reform will be political and thus costly and painful and will not address the core issues involved in fixing the inherent systemic problems. There have been many things written with regard to this topic and I ...

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Republican budget guru Paul Ryan had a plan to end Medicare as we know it to be replaced with a series of less-generous vouchers. The House of Representatives has voted to implement this plan. The political side of this has been written about a lot, and I am not going to rehash what has been better covered elsewhere. I do want to address what seems to be a persistent ...

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The revelations about the huge golden parachute given the outgoing CEO of ostensibly non-profit Massachusetts Blue Cross Blue Shield induced some public discussion about the disconnect between executive compensation and the mission of health care organizations. First, new proxy statements revealed the compensation of executives of two large for-profit health care insurers/managed care companies. Cigna As reported by the AP, via ABC News, the CEO got a big raise:

Cigna Corp. ...

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Sometimes you just don't want to be right.  Over the past 5 years, I have seen an alarming pattern arise in my profession.  Many of my patients have heard me talk about Soylent Green, an old Charleton Heston movie.  The premise of the movie seems absurd.  Can you imagine the government of the United States providing for all the needs of its people including healthcare, food, clothing, and even death? David ...

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Medical malpractice reform is one of the few health care policy issues where there is a real possibility of agreement between the White House and Congress. A common refrain is that the fear of lawsuits leads physicians to practice defensive medicine, ordering too many tests just to cover their behinds in case of a lawsuit. It drives up costs without creating benefits. There’s some truth to this argument, ...

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