I’ve written before about how children from poor families have a higher chance of needing PICU care than do children from more affluent families. Eligibility for Medicaid is a good marker for this; nearly half the population of most urban PICUs is made up of children on Medicaid, even though the national average (it varies a little from state to state) for children on Medicaid is about 25%. So poor kids are ...

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In this enlightened era of evidence-based medicine, you'd think that the progressive academics, viziers, and mandarins who are cluttering the policy making commentariat would pay more attention to what was tried before. That should be doubly true if those lessons come from that health care nirvana called Europe, where enlightened central bureaucracies wisely allocate health care for its caffè sipping, plaza strolling and beret adorned citizenry. Case in point is ...

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To paraphrase Clayton Christensen, author of The Innovator's Dilemma, when discussing healthcare, disruptive forces set the stage for meaningful innovation and consumer cost reductions. This is where we now find ourselves. What percentage of our nation's GDP is reasonable to spend on healthcare - 15%, 20%, 25%? What adaptations are necessary to maintain high quality for those who now receive it and simultaneously provide access to primary care and preventive ...

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While liability reforms have been good for the health of Texans, many laws favored by Governor Perry have damaged health.  As a physician on the Committee on Public Health of Bexar County Medical Society, I have been trying for many years to help not only my patients, but also Texans in general.  San Antonio, my home for the last 30 years, is reported to have a population mix very similar ...

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Yesterday was no different than many other days in my life as a consultant.  Two clients, three cities, and finally arriving late evening at the hotel. It had been a long day of travel and I was looking forward to getting into my room and off of my feet. As I got onto the elevator, for some reason, the inspection certificate caught my eye and I felt compelled to read ...

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I have come up with the idea of the century.  My idea will make your company the richest in the world while attracting millions of new patrons to your credit and debit card services.  I don’t know why no one has done it in the past.  It has made the insurers of America countless billions of dollars and now you can profit as well.  My only request is that you ...

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"Do you know how many people died in car crashes in the United States in 2010? 32,000. That’s the lowest number since 1949. That’s impressive, but wait: It’s far more impressive than it sounds at first, because people in the United States drove about 10 times as many vehicle miles in 2010 as they did in 1949. In other words, if you drove a car or truck in 2010, you ...

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The old doctors know.  The practice of medicine has changed in a very basic way over the last 20 years.  Physician relationships have lost their civility and have been replaced by a level of tension that takes the fun out of collegial interactions.  I remember my first year of family medicine as the only doctor in Weeping Water, Nebraska.  My personal medical community had gone from an entire medical ...

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It's really quite an ancient debate: 400 to 500 years before the birth of Christ, on the island of Kos (home of Hippocrates) originates the myth of Aesculapius, god of healing, son of Apollo and the nymph Coronis. As is not unusual in Greek mythology, Coronis meets a violent death, but the infant Aesculapius is saved. He is raised by a wise centaur, becomes skilled in healing arts, and succeeds in ...

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It was 1967.  I was an intern in the UCLA-Wadsworth VA Rotating Internship Program when I reported for my physical as part of the Berry Plan deferment.  For the younger set, physicians and dentists could elect to delay military service until completion of their first year of residency training, and we could elect our branch of service we preferred to serve in.  I chose the Air Force.  On the History ...

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