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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As Occupy Wall Street has gone from an obscure protest covered only on blogs and social media to a national phenomenon, the apparent parallels between the issues it is raising and the issues we have been raising in health care grows.  A growing number of protesters are calling themselves the "99 Percenters," referring to those who are not in the top 1% of earners.  The top 1% of income is clearly greater than $250,000 per year, and likely ...

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With all the debate about cost control, it’s clear that we doctors will have to police ourselves – or else politicians and insurance companies will exert even more influence over our practices than they already do. The main question is: Are we willing to let our physician colleagues exert influence on our care decisions? Taking a case from my field: at a conference this past week I met a radiology resident ...

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Why does health care cost so much more in the United States than in other countries? The answer is exceedingly complex; pharmaceuticals, hospitals, and physician services (among others) comprise the multiple slices of the health care pie that in the United States is about twice the size of the next largest spender for health care services. A new study from one of President Obama’s appointees (note: this study was written prior ...

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The relationship between doctors and their patients has changed dramatically over the past few years. Medical beneficence became paternalism and is now near obsolete. Shared decision making is the new lofty ideal we should all be striving for. It is guiding new health policy both in the UK, with the new mantra "nothing about me without me," and in the US. We are at the start of the Century of the ...

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Data from the Dartmouth Atlas show patients with chronic illness in their last two years of life account for about 32 percent of total Medicare spending, with much of that expense going toward physician and hospital fees associated with repeated hospitalizations. Opportunities to reduce medical expenditures during the last 2 years of life are often looked upon as a way to reduce the cost of healthcare while actually improving the ...

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After nearing the brink of political collapse, Congress and the President reached agreement on a plan for deficit reduction.  Part of the agreement is that a "super committee"will cut an additional $1.5 trillion from the federal budget.  Cuts are being considered for a range of programs, including Medicare.  As director of a wellness program for retirees, however, I remain acutely concerned about the impact Medicare cuts will have on ...

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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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