Let me start by saying that I love my father dearly. We have an excellent relationship, and talk regularly. So there’s no bitterness in this post, nor any desire to engage in armchair psychology.My father, now retired, was a general and thoracic surgeon, who was triple-boarded in critical care, and ran a trauma unit in inner-city Philadelphia. He was in private solo practice for most of his career. He worked ...
Aaron E. Carroll, MD
Health reform and the iron triangle of health care
When I was in medical school, we had a class on health economics taught by William Kissick. I didn’t pay as close attention as I should have (especially given what I do now). But I remember one thing he stressed. It involved the iron triangle of health care.There are three aspects of health care systems that are essential: quality, cost, and access (thus the triangle). The problem ...
How a specialty pharmacy denies a physician his medication
Holy crap.My medication did not arrive today.How can this possible be happening? Do they not know this medication is not optional?Let me recap. I called over a week ago for a refill. I am only allowed (by my insurance) to use the (non-local) specialty pharmacy that they own for this medication. They told me my medication would arrive yesterday, which was the day after I’d use my last ...
A primer on brand name drugs and generics
That there are some serious misunderstandings out there about the difference between name-brand drugs and generics, as well as some bizarre assumptions about the merits of newer drugs. So here’s a quick primer on how you (and everyone else) are sometimes not getting accurate information about your pharmaceuticals.As a society, we’re addicted to drugs. Almost all of them are legal, and we’re not abusing them per se, but we want ...
Doctors can reduce malpractice by being better people
My father, although retired, is a general and thoracic surgeon, triple boarded in critical care, who ran a trauma unit. My brother is a pretty successful lawyer. Whenever I visit them, inevitably at least one night ends with the three of us around a table, and the two of them going at it about who is to blame for the malpractice system.My father, of course, blames the lawyers; my brother ...
Why moral hazard fails in health care
I’m going to take the time to review a topic that is one my pet peeves, one you hear bandied about all the time in discussions of more consumer directed health care. It’s a topic I came back to repeatedly on my old blog – the moral hazard.Basically, the moral hazard is the idea that people insulated from risk behave differently than people exposed to risk. For instance, ...
Wanting better health care shouldn’t be conservative or liberal
I remember this one moment back in the midst of health care reform when I was sitting in a radio studio, feeling pretty glum about the whole ordeal, and I mused aloud, “I wonder if anyone is enjoying this at all.”For some of us, improving the health care system is more than a passing fancy. I’m a health services researcher. It’s my job. Those people on the TV pay attention ...
Pay cuts for government health care subsidies
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 ...
Why Medicaid would be better off as a federal program, like Medicare
This is a perfect example of why Medicaid is not the same as Medicare:
Having counted on Washington for money that may not be delivered, at least 30 states will have to close larger-than-anticipated shortfalls in the coming fiscal year unless Congress passes a six-month extension of increased federal spending on Medicaid.Governors and state lawmakers, already facing some of the toughest budgets since the Great Depression, said the repercussions would ...
