I want to ration your health care. Well, I don't want to do it personally, and not to you specifically. And that's the problem. Policies on the individual and societal levels feel very different. We are not culturally prepared for "rational" rationing. We're happy to do it irrationally; if you don't have insurance, you're probably not going to get proton beam therapy for your prostate cancer. Someone might be willing ...

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“Health care costs are sky-rocketing!” “The percentage of the U.S. GDP devoted to heath care costs is the highest in the world.” “The cost of Medicare is unsustainable.” For most of us, the cost of health care (i.e., the dollars required by the system to produce and deliver care) isn’t what brings us the most anxiety. It’s when we’re patients or helping a loved one find care that so many of us are deeply ...

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Recently a neighbor backed into my car while I was leaving a food store. The damage was minimal, but she offered to have her insurance company pay for the repair. After contacting the company, I was offered several body shops, and chose the one closest to my home.  The work was completed in only two days, and while it was in the shop, I decided to also have some dents ...

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The American Academy of Family Physicians (AAFP) recently issued a new report describing its vision of primary care's future. Not surprisingly, the report talks about medical homes, with patient-centered, team-based care. More surprisingly, though, it makes a point to insist that physicians, not nurse practitioners, should lead primary care practices. The important questions are whether nurse practitioners are qualified to independently ...

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It’s a uniquely modern problem. We have the most obese impoverished population in the history of the planet and its been called the “hunger-obesity paradox." Even the homeless are now more than likely to be overweight with over 32% being officially obese. Think about that. Then think about every single picture you have ever seen from the Great Depression when 1 of every 4 Americans were out of work ...

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Trying to figure out whether Medicare vouchers are a good idea for patients and their physicians?  Then consider these two basic questions: 1.  How much will the federal government contribute? 2.  Who is at risk for health care cost increases? How much will the government contribute?  The traditional Medicare program has no set limit on how much the federal government will contribute to a beneficiary’s health care, although there are limits on how ...

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“We need to be screwed!” Not altogether surprising words to spill out of a college student’s mouth. But this particular student was not talking about sex. She was discussing the U.S. healthcare system—more specifically what she thought it would take for our two political parties to come together to find a reasonable way to control our nation’s healthcare costs. It was the last day of the semester, the last class discussion in ...

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I believe the projected shortage of physicians caused by  the Affordable Care Act will drive primary care into two opposite tracks. Each is a distinct and logical response to the patient overload and each points out gaping holes in our medical education that must be addressed. The Association of American Medical Colleges  estimates that there will be a shortage of 63,000 doctors by 2015 and 130,600 by 2025 in the wake ...

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He was a "frequent flyer" -- a patient with multiple health problems who gets admitted to the hospital repeatedly. It was usually because he hadn't taken his medicine correctly, if at all. When he left the hospital 10 days earlier, he told his physician that he wouldn't have problems filling his prescriptions, because he had Medicaid. But when he arrived at his local drug store, it wasn't so easy. "I was ...

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Accountable care is here – both as a way of doing business and an approach to providing high quality health care.  With accountable care, the potential for reducing overall health care costs, realigning incentives and focusing clinical resources on prevention and disease management is now a real opportunity. Physicians who aren’t ready to transition their practices to operate in a manner required under accountable care models will increasingly find themselves ...

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