Almost everyone I know considers the American healthcare system to be a horrible mess, although some that are deeply into it are quite happy with it. It serves their interests well. Many do have big-time power. There are lots of candidates for the "most powerful" title. How about Regina Benjamin, the Surgeon General of the United States Public Health Service? Maybe Kathleen Sebelius, the Secretary of Health and Human Services? Consider Howard Koh, the Assistant ...

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Medicare needs to be reformed, but there's no easy solution to the problem.  As the average life expectancy increases, more-and-more politicians have proposed an increase in the Medicare eligibility age.  This increase in life expectancy, however, is an issue that only affects the wealthiest half of America -- the people that need Medicare the least -- because the life expectancy has only increased significantly in the richest half of ...

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Here are my next two principles of affordable healthcare reform. First, medicine must be practiced in a manner and in a place that is consistent with economic efficiencies, evidence based outcomes and the needs of the specific community that it serves. In healthcare delivery, quantitative must be balanced by qualitative. Specific community needs and the culture of that particular community must have equal and in certain cases, greater value than the ...

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An interesting legal case brewing in the medical world that's worth sharing. A group of six physician plaintiffs from Georgia are suing the government (the Secretary of Health and Human Services) in a federal district court claiming damages from the fact that Medicare, the massive program that covers the elderly and disabled, fails to execute due diligence by rubber-stamping a reimbursement structure that overvalues procedural medicine over cognitive services. Huh? Some background ...

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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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