When I was a family medicine intern, I met a diabetic patient in the hospital who had stopped seeing his regular doctor after he lost his job and his health insurance.  His untreated diabetes made his feet go numb.  He stepped on a nail and didn't realize it until he noticed a smell that cost him his foot. He spent thousands of dollars on the surgery and subsequent hospital stay—far ...

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Health reform was supposed to have been good news for the U.S. Preventive Services Task Force. Until 2009, this independent panel of federally-appointed experts in primary care and preventive health was not particularly well known, and its evaluations of the effectiveness of clinical preventive services had no binding authority on public or private insurance plans. Within the small circle of physicians and policymakers who were aware of the their ...

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Organized American medicine would like for physicians to "speak with one voice." If they could do so, and if that voice were in the public interest, not only in the self-interest of those physicians, it would be a very powerful voice indeed. Arnold (Bud) Relman, the esteemed former editor of the New England Journal of Medicine, once rightly told the International Committee of Medical Journal Editors that physicians speak with many ...

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This year, total federal spending in the U.S. is projected to be $3.6 trillion. The top three budgetary categories are:

  1. Medicare/Medicaid --  $826 billion
  2. Social Security --  $717 billion
  3. Defense/Wars --  $703 billion
Medicare and Medicaid costs alone account for 23% of total federal spending. If the magnitude of these projections does not alarm you, let’s look at it from a revenue perspective. This year, the total U.S.tax revenue is projected to be $2.2 ...

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It is in this arena that the public treasury has been most abused by government ineptitude, institutional inertia and Congressional negligence. The waste and fraud in the Medicare and Medicaid system is scandalous and is now the target of well-organized international crime. Estimations of the extent of this waste and fraud run as high as $150 billion. The United States Government has done nothing to effectively stop it. ...

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I usually write about healthcare reform from a pediatrician’s viewpoint, but what grabbed my attention recently was a story my husband, Randy, told me about an adult in his practice – a patient on Medicaid. Randy is a neurologist in a private practice, and Medicaid patients come from every corner of Rhode Island to see him. They make this cumbersome pilgrimage because he is a member of a dying breed: ...

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We hear that doctors do not like "protocol medicine" – they do not want to follow a "cookbook" when every patient is different. It is not a good understanding of the issues. Some years ago when I worked in a branch of he National Cancer Institute and then the University of Maryland Cancer Center, we admitted many patients with acute leukemia. The treatment approach including the necessary special tests to ...

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When I was in medical school, we had a class on health economics taught by William Kissick. I didn’t pay as close attention as I should have (especially given what I do now). But I remember one thing he stressed. It involved the iron triangle of health care. There are three aspects of health care systems that are essential: quality, cost, and access (thus the triangle). The problem ...

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So, here we are, between a Medicare rock and budget hard place. Costs are clearly a problem. Our healthcare system is the most expensive in the world. Take a look at the 2003 figures from the Kaiser Family Foundation. Per capita costs, in 2003, in the US were $3,394 above those of the UK. Doctors face difficult choices to save Medicare We need to work on the costs. That’s clear. But ...

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There are two camps in America: those who think that health care is a right and those who think that it's a privilege. Well, perhaps that's a bit of an oversimplification, but bear with me. Given these two respective positions, what are we to make of the health inequalities that are well documented in the United States? First, we must acknowledge that health is the product of multiple factors ...

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