Much of what passes for debate on health care during this election year is focused on the macro side, on big issues like how do we cover the uninsured or restructure Medicare and Medicaid financing.  But for all of the talk about vouchers and block grants and insurance mandates, the candidates are missing the micro issues that really matter most to doctors and their patients, which is how health care ...

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There is a serious cost problem in USA health care which no one denies. Yet when it comes to suggested solutions, there is a wide divergence of opinion.  Attempts to use experts and evidence based guidelines for care are somehow viewed as government interfering with decisions which should be between the doctor and her patient. States and insurance schemes have made varying attempts to deal with this.  The Oregon Health ...

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Mitt Romney’s “let them eat cake” comments on 60 Minutes serves to illustrate how badly both sides of a political debate can confuse an issue. In 2010 he criticized emergency room care as a potential  loophole used by people to get “entirely free care” while avoiding having to pay for health insurance and in his book No Apology, the Governor outlined the idea behind Massachusetts health care reform as ...

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As I approach my 50th birthday, I worry about Medicare not being there for me when I become eligible. I have some inside knowledge about Medicare. My parents and in-laws are patients on Medicare. As a doctor, I am a provider for Medicare, and as a public health educator I am a consultant for a Medicare quality improvement organization. Everyone, including the leaders of both Democratic and Republican parties, agrees that ...

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I am riled up—almost to the point of being inflamed. I hate it when doctors get dragged through the mud. It’s a matter of pride. Doctors are my team. The latest kerfuffle centers on how much we should charge for return patient visits. The difference here is between moderate and moderately high visits–or about $30. When the Center for Public Integrity is investigating your profession, it’s unlikely to be good news. And it ...

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The debate over fee-for-service physician payment often is misunderstood to be about the technicalities and relative merits of the RUC, relative value units, P4P and the SGR.  It isn’t—instead, it’s what the fee itself represents (and who decides), and what the service being provided actually is (and how it’s described). Let me explain.  Analysts across the political spectrum agree that the health care system needs to move ...

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Walmart's sheer size makes almost any of their initiatives newsworthy. That said, despite being a lightning rod for criticism on employee benefits and health care, they have introduced initiatives with far-reaching impacts. Their generic drug program began in September 2006 - more than 300 prescription drugs for $4/month or $10 for a 90-day supply – and was widely emulated, disrupting retail drug markets and generating immense social benefit. Imagine the difference ...

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A recent commentary in the Journal of the American Medical Association titled, "The Iron Triangle of Health Care: Access, Cost, and Quality" reflected that any health care system can only optimize two of the three elements - quality, access, cost.  A health care system which provides the finest quality and best access cannot do so without raising costs to unaffordable levels. An inexpensive health care system available to ...

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The New York Times recently did an expose on hospital overbilling by a group of cardiologists at some hospitals owned by the Hospital Corporation of America (HCA). Immediately after a few days, a rather gloating article about how HCA had become the poster boy of Wall Street with its double digit growth strategy appeared. If the first story had not raised enough doubt about the prudence of ...

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It was some doctor show on cable: Nurse McCarthy bustles into the hospital room, says “Good morning!” brightly, and crosses the brilliantly polished linoleum floor to the window. Humming to herself, she sweeps open the curtains to the view of the brick wall across the airshaft, then goes to the patient on the right and checks his dressing, clucking and offering encouragement. After a few moments she does the same ...

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