I’m not a big fan of bargaining and my half-hearted attempts to get a better price for a used car, garage sale find or contractor’s service have been mostly unsuccessful. There’s always that nagging feeling that the seller is laughing with delight once I’m gone, thinking, “I really pulled one over on that rube!” And so it has come as somewhat of a shock to me that medical care has become ...

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A good recipe is one that combines high-quality ingredients in appropriate quantities to produce a savory main course or a decadent dessert. It strikes me that, in order to answer the Affordable Care Act's call for us to aggressively pursue population health, we must first understand what the recipe calls for. Dichotomous as it may seem, the primary ingredient for population health is accurate, comprehensive data on the individuals who comprise the ...

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I advocated for the Affordable Care Act, and celebrated when it was passed. It’s good to have everyone covered, I thought. Insurance for everyone is the first step to health care for all. Alas, access to health insurance isn’t the same as access to health care. First there is the niggling detail of providers. We already have a primary care provider shortage.  Internists, pediatricians, family physicians are already working at full capacity in caring for ...

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If there’s anything that liberals hate it’s inequality – unless it’s the Federal tax code – and health care is a prime offender. The liberal mantra is that everyone should have the same access to basic health care. But this doesn’t just involve improving health care access and affordability for millions of uninsured Americans. It also involves limiting or impairing (through taxes) those health care plans liberals have decided are ...

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One could easily make a case that health care is today’s biggest consumer problem—not unlike those that sparked the consumer movement of the 1960s and 70s. Back then, consumer issues centered on problems with using credit, buying cars and home improvement services, and obtaining the best price for food, appliances, and just about every other new-fangled and expensive product that sprang from the post-war economy. Like many old consumer problems, health ...

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The massive confusion about Obamacare (the Affordable Care Act) is much worse than I thought. The Kaiser Family Foundation came out with a poll that shows 42% of Americans don't even know that Obamacare is the law. Seven percent of people think the Supreme Court struck it down and 12% think Congress repealed it. I understand that there is confusion about the way it will work and who will be affected. ...

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The seemingly irreconcilable conflict between the medical and nursing professions usually boils down to one question: who is in charge?  Physicians often use a football analogy: they are the quarterbacks of the team, calling the plays that others on the gridiron must follow, because of their greater training and skills.  Advanced practice nurses (APNs) respond: not so, we are also highly trained and qualified to call the plays and lead ...

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Unplanned readmissions to the hospital have been the focus of much attention in recent years for obvious reasons. First, they are relatively easy to measure using administrative claims data. Second, like all inpatient hospitalizations, they cost a lot of money–and are therefore a target for reducing spending. Third, they are a proxy for quality of care, as at least some portion of them are likely avoidable if the hospital does ...

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If a mosquito lands on someone’s head and you hit the mosquito with a shovel, is the death of the guy under the mosquito considered an unintended consequence? So now we know that the government of the United States of America is spying on its own citizens, not specifically on any one in particular, but massively and indiscriminately collecting troves of data on all American people. All perfectly legal, ...

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On a recent trip to Lincoln, NE, I visited Lincoln Industries, a company that makes chrome trims for Harley-Davidson motorcycles. I was curious about the firm’s award-winning wellness program, especially since more employers are penalizing workers by making them pay more for their health insurance if they fail to meet certain health goals. At the heart of Lincoln Industries’ wellness program is its Platinum Scorecard, which awards points to workers who ...

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