We have done it. We have decreased the increase in the cost of health care. Let us explain. For three decades (1980-2009), the cost of health care has been increasing each year at an average rate of 7.4 percent -- double the rate of inflation.  However, over the past three years, the increase in health care expenditure has remained at a low 3.1 percent. Is this decline ...

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There is so much entropy in health care right now.  So much finagling, so much shifting, so much arguing, so much uncertainty, so much shock.  Shock at prices, shock at waiting times, shock that doctors don't know how to increase referrals, shock that doctors aren't doing more to help.  What gives? In triage, you don't spend time with the expectant. Doctors are keeping their heads down.  They are still seeing patients.  They ...

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There are tens of thousands of policies in Medicare’s policy manual, which makes for stiff competition for the “Most Maddening” award. But my vote goes to the policy around “observation status,” which is crazy-making for patients, administrators, and physicians. “Obs status” began life as Medicare’s way of characterizing those patients who needed a little more time after their ED stay to sort out whether they truly needed admission. In many hospitals, ...

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I think we all have fantasies from time-to-time what we might do it we were made King for a day (only benevolent kings, of course—no despots need apply!)  What decrees might we issue to make the world a better place?   What changes would we order to make our politics better?  What improvements would we institute to make health care better?  Well, here’s my (health care) list: 1. I would decree that every ...

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"Doc, if I have cancer, I don’t want to know. Stop bugging me about this colonoscopy.” Mr. H said to me, his primary care physician, during our appointment. He folded his arms and nodded his head, indicating that his decision was final. “Mr. H, as uncomfortable as colonoscopies seem, they can actually find lumps that might grow into cancer, and cut them out before they ever become cancer. That’s why I’m bugging you so much about this.” I ...

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The specter of loss of choice and freedom to select the doctor you want haunts again. This time it’s being raised on the airwaves with an ad from Americans for Prosperity, a group that advocates limited government and free markets. The ad, an attack on Obamacare, plants doubt in viewers’ minds about whether they can choose their own doctor, a theme that continues to resonate with both the public and ...

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I guess what is so utterly frustrating is that the guys up there don't see what is going on down here. The march of health care reform continues with little realization of what it feels like to be one of the tiny peon foot soldiers on the ground. We are not deaf. We hear the politicians and policy wonks. We read as non-clinician "doctors," ivory towered administrators, and the business ...

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acp-logoA guest column by the American College of Physicians, exclusive to KevinMD.com. I will begin this month’s column with a confession on something that most people don’t know about me. I hope it doesn’t lose me any friends. I am a member of the AMA/Specialty Society Relative Value Scale Update Committee, better known as the RUC. Actually, I'm an alternate, but ...

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Detroit On July 18th 2013, the city of Detroit filed for bankruptcy. Early estimates size up Detroit’s as the biggest in history with composite debt figures approaching the ballpark of $20 billion. Through the eyes of a clinician why should we care and what does this mean for our practices. Detroit is dying. While filing for Chapter 9 bankruptcy may give the city an extra lifeline, ...

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One of the most  disheartening developments in the unrelenting political fight over the health reform law is the organized effort by its opponents to dissuade the public from signing up for coverage. Having failed in efforts to block Obamacare in the Supreme Court, or to elect a president or Senate that would work for its repeal, they are now working to kill the law by persuading people to not sign ...

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