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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An alarming article in Politico.com looks at what could happen if the Supreme Court determines that the Affordable Care Act’s individual mandate provision is unconstitutional—something that the current conservative leaning of the Court seems to indicate is somewhat more likely than not. Assuming that such a possible decision by the Court follows that of the Eleventh Circuit Court of Appeals in ruling that the mandate is unconstitutional but ...

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Here are my next two principles of affordable healthcare reform. First, healthcare reform cannot occur without tort reform. Anything less is akin to a drunk leaning up against a lamppost for support but insisting it is for illumination. It is well known that fear of malpractice suits accounts for defensive medicine; e.g., performing tests and procedures and making unnecessary referrals to assure staying out of the court room. We are all ...

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It’s become one of those trendy phrases, "unnecessary care." When you hear it on television or talkshow radio it’s usually said with a sneer. Indeed, the speakers almost spit the phrase out -- "unnecessary care" -- like it tastes bad.  It’s almost always accompanied by "fraud and abuse," or a not so subtle accusation that some doctor is profiting off this unnecessary care at the expense of some poor ...

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