Harvard Pilgrim CEO Charlie Baker predicts the future of Medicare's reimbursement system:

In other words, Fee For Service is probably not going anywhere, but the federal government will work within its methodologies to dramatically step up its oversight and measurement activities around physician and hospital performance, and take very significant action based on its findings. This is why cost and quality "” despite the inadequacies of the Medicare Fee ...

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Michelle Malkin's piece below is no more one-sided than Sicko is. As is the case with most things, the truth lies somewhere in the middle.

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Michael Moore's naive push for a single-payer system is making top Democrats uncomfortable:

Stoking the passions of rank-and-file Democrats for a government takeover of the healthcare system amounts to political folly, respond some liberal veterans of Washington's healthcare battles.

"To presume that the private sector is going to sit idly by to see the destruction of private coverage I think is a misreading of reality," said Ron Pollack of ...

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Denials of contraception and other standard, legal medical care are becoming more common amongst religiously conservative physicians:

"I'll need the morning-after pill," she told him.

Dr. Gish looked up. He was a trim, middle-aged man with graying hair and, Boyer thought, an aloof manner. "No," Boyer says he replied abruptly. "I can't do that." He turned back to his writing.

Boyer stared in disbelief. No? She tried ...

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There is a reluctance to go, writes a physician in the BMJ:

"There's a bit of a reluctance to go," the author, Bruce Arroll of the University of Auckland, told the Health Blog in a phone interview yesterday. "You may not know many people there. You may not think it's appropriate. But I think the opposite "” the family is honored that you're there."

Recent research suggests not:

Suicide bombers are thus motivated by a "simple cost-benefit analysis", in which the 'benefits' of self-destruction outweigh the cost. The benefits are perceived by the terrorist to be so great - in terms of membership of the group, achievement of collective goals, the promise of benefits in the after-life, and so on - that they outweigh the cost.

Before getting too excited, the response rate was only 30 to 60 percent.

Just ask this question.

Should the mentally ill be allowed to vote? Shrink Rap has issues with this:

Can I cringe long and hard now? The mentally ill shouldn't vote? What's a mental illness? Anyone who's had an episode of depression or mania? Obsessive Compulsive Disorder? How about those panic attacks? And we can't figure out at what instant someone with dementia becomes unsafe to drive, how do figure out the instant at ...

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ICU woo

Homeopathy in a reputable medical journal. retired doc and Dr. RW do not approve:

The Journal does a disservice to its readers when it presents a homeopathic jargon filled discussion as if a scientific discussion is taking place. There was no editorial explaining the reasoning behind publishing such an article. One of the characteristics of science is its coherence.The sciences of pharmacology,physiology and toxicology build upon and are ...

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Snakebite

Great case from #1 Dinosaur.

A JAMA study suggests the variability of standard of care in malpractice cases:

The locality rule was a 19th century concept intended to protect rural physicians from being held to the same standards as physicians working in urban areas or at academic institutions, the authors said.

But, they note, modern communication has removed barriers to standardization -- no place is more than a phone call or a mouse click ...

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Drug seekers

Panda on the two philosophies when dealing with drug seekers, as well as ditching his PDA.

I stopped using my PDA as well a few weeks ago. ePocrates was nice, but the database kept corrupting and it wanted to sync all the time. I went back to Tarascon, which I haven't used since medical school. I never remembered it being so thick.

Paris Hilton's psychiatrist is apparently a Doctor of Osteopathy, and the press doesn't quite understand what the degree means:

Sophy is actually a D.O., or Doctor of Osteopathy. Though osteopaths are still considered licensed doctors in America (not, however, in Europe) and Sophy serves as the legitimate medical director of the L.A. County Department of Family and Child Services, he does not seem eager to tout his full credentials"”perhaps because ...

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Arnold Kling views Sicko and talks about an end of life care example the film brings up:

The case was of an African-American man who died of kidney cancer. His weeping wife had been told by a doctor that there was hope from a bone marrow transplant, but the insurance company denied the treatment. You were left to conclude that the decision was based on profits or racism.


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Apparently, the life support machine was too loud:

After the perpetual noise of what would prove to be his neighbor's life support machine "got on his nerves," he proceeded to simply unplug the device without precaution in order to ensure that "he got his peace and quiet."

The more doctors that treat a patient is not necessarily better. It's time to change the carrot:

Despite seeing many doctors, few patients get the treatments that are recommended for them, and few have their chronic diseases well-managed. For example, fewer than 30% of people with high blood pressure have it adequately controlled, according to the agency's most recent analysis of health-care quality. No surprise, really. Fee for ...

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He did it under his parents' watch:

The 15-year-old son of two doctors performed a filmed Caesarean section birth under his parents' watch in southern India in an apparent bid to gain a spot in the Guinness Book of World Records as the youngest surgeon.

Instead, the boy's father could be stripped of his licenses and may face criminal charges, officials said Thursday.

Dr. K. Murugesan showed a ...

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The NEJM is surprised that not every doctor follows EBM like gospel, again showing the disconnect between academic medicine and the real world:

"What we learned from this is that evidence-based medicine is easy to talk about but hard to implement," editor-in-chief Dr. Jeffrey M. Drazen said in an interview.

Maria gives us a somewhat bizarre psychiatry consult.

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