by James Gaulte, MD Apart from some apparently radically contradictory expressed views on patient "centeredness" and patients being in control, the newly appointed head of CMS, Dr. Donald Berwick, has made it clear what sort of medical system he would have for the United States. What he wants is well explained in this commentary from National Review Online as is the authors' reasoning of why ...

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In an editorial published the New York Times, a strong argument was made for studying the relative effectiveness of screening colonoscopy and sigmoidoscopy.  Based on a review in JAMA of three studies conducted outside the US that showed no difference in colon cancer mortality or incidence when the two procedures were compared, the Times proposed a US study to answer this question. Comparative effectiveness (CE) research, a relatively new concept in ...

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Whether we have commercial insurance through our employer or Medicare, the incentives are poorly aligned to lower costs and improve quality. In fact, they actually encourage greater and greater expenditures. In most instances, our insurance covers everything from prevention to basic routine care to complex care of serious illness. Coverage may not be all that good for some things like preventive care and our primary care ...

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An eagle-eyed reader let me know that the Kaiser Family Foundation has a nice subsidy calculator up that you can play with.  You enter information about your income and situation, and you get to see how much health insurance and care will cost you in 2014. It’s not all good news. Let’s say you are a 60 year old divorcee in 2014.  You make $46,136, which is 401% of the ...

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Health reform will do a lot of things that most Americans don't realize it will do, and it will not do a lot of things that many Americans mistakenly believe it will do. One of the most recognizable components of health reform that didn't actually become law is the public option. The public option was the lighting rod in the health reform debate. After all, it had a concise name, and ...

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Hard choices and healthcare reform are here.  Donald Berwick, M.D., has been installed as the administrator for the Centers for Medicare and Medicaid services as a “recess appointment” by President Obama. Dr. Berwick is an academician, a pediatrician who has spent the bulk of his professional existence as the CEO of the Institute for Healthcare Improvement of Cambridge, MA.  He is an outspoken advocate for the single-payer system, admires Britain’s National ...

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There are strange things going on in the Massachusetts health care insurance market. For those from out of state, here are some quotes that will give you a sense of the contradictions in the public policy arena. They are, respectively, from two stories that appeared on the same day in the Boston Globe: "Rate cap for insurer overturned" and "Officials give up cutting health perks."

1. An insurance ...

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Everyone understands the need for a robust primary care workforce in making healthcare more affordable and accessible while keeping those in our care healthy.   With the aging of America and healthcare reform, even more Americans will need primary care doctors at precisely the same time doctors are leaving the specialty in droves and medical students shun the career choice.  So as a practicing primary care doctor, I've watched with ...

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Recently, the 21 percent cut in Medicare physician reimbursements was replaced with a 2.2 percent pay hike. Later this year, Congress will have to consider the matter once again, just as it has ever year since 2003. This is the third time this year that Congress has averted Draconian cuts to physician’s payments. What, you might wonder, is going on? Here is the back-story.  In 1997, Congress enacted a so-called "sustainable growth ...

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As might be expected of reform legislation, the Patient Protection and Affordable Care Act (PPACA) places a lot of emphasis on innovation. Reasonably enough, most of the potential changes—at least in Medicare—are to be preceded by pilot or demonstration projects designed to test their feasibility. In fact, according to one health care blogger with time on his hands, PPACA includes no less than 312 mentions of demonstrations and 80 mentions of ...

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