There’s something compelling about the personal narrative that vast mountains of quantitative data cannot rival. Anecdotes are, quite simply, powerful. They tap into our shared humanity, making something seem somehow more real by putting a face on it. This is why, if you follow politics for very long, you will find numerous cases of policymakers championing issues that have touched their own lives in some way. For example, Senator X doesn’t care about issue Y, until they ...

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Most of us want to know how to fix this healthcare mess these days. We’re scared about the future and how we’re going to afford costs that never, ever seem to stop skyrocketing. We’re scared about the world our kids are going to inherit and the phenomenal debt they’ll be haunted by throughout their lives. We’re scared about living in a country that’s cowering under the hefty weight of fear ...

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A better approach to primary care is imperative for improving the delivery of health services to our nation’s population. As a family medicine resident, I see the need first hand in the mountains of East Tennessee. It’s 11:30pm on a Sunday night when the medical student and I receive the ER call. “A thirty-two-year-old diabetic male with uncontrolled sugars and right arm cellulites, I think he needs admission.” When I reach the ER, ...

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"Educate the young, regulate the old." That quote has literally followed me around the world. I can vividly remember when first making the statement. I was one of five “safety experts” on the closing panel at an international safety and quality meeting in Sydney, Australia a number of years ago. The thought was that the five of us would somehow be able to share “pearls” of wisdom regarding what was ...

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The Supreme Court’s imminent decision on the Affordable Care Act will trigger a political firestorm whether they accept the legislation in its entirety, throw out every page of the 906-page bill or do something in between, which is the most likely outcome. If the high court follows the polls, it probably will rule the requirement that individuals purchase insurance – the mandate – is unconstitutional but leave the rest of “Obamacare” ...

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Healthcare costs keep rising. Your insurance premiums go up, your deductible and co-pays go up, pharmacy benefits go down. Despite the high cost you get little time with your physician, insurance statements are complex beyond belief and “customer service” seems to be a foreign concept. To combat high costs we are often told that rationing will be necessary. Is that true? Why are costs so high in this very dysfunctional healthcare ...

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Stranded capital is a new term, a derivation of the term stranded costs that emerged from the deregulation of electric companies. It refers to “the existing investments in infrastructure for the incumbent utility which may become redundant in a competitive environment.” Many academic medical centers are weighing the importance of meeting current demand while considering the risk that, in a future competitive environment, dramatic declines could occur in the need ...

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I was recently honored to attend a discussion at the White House, convened by Health and Human Services Secretary Kathleen Sebelius. It was one of those rare "clear my schedule immediately" invitations; I thank my patients and family for allowing me to take this last minute trip. Physician leaders from around the country were invited to the White House for a dialogue with lead government health officials (specifically administrators from the ...

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There is enormous waste in American healthcare delivery. One estimate is anywhere from 20% to nearly 50% of total expenditures are frankly unnecessary. What is this waste?  Is it real? Could it be eliminated or at least reduced? How difficult would such a reduction be to achieve? And what would be the unintended consequences? Donald Berwick, the former administrator for the Centers for Medicare and Medicaid Services, along with Andrew Hackbarth ...

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The Medicare physician payment formula is a case-study in failed policy. Physicians have long known that it is not working. Polls show that an overwhelming 94 percent of Americans believe the massive cuts it schedules are a serious problem for seniors. Even members of Congress from both parties agree – and that is no small accomplishment – that it is ...

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