Even the best of families have skeletons: the uncle who had some shady business dealings, the cousin in drug rehab, brother with the messy divorce and custody fight, or the adult kids who are maxed out on their credit and behind in their mortgage payments but have to “keep up appearances” with their expensive suburban lifestyle.  When these things happen, there is a tendency to “keep it all in the ...

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Just a little over a week into 2014, my new year started off with a bang -- literally -- as I got into an automobile accident that involved my car sideswiping another vehicle and then crashing my car into a tree at 30 MPH. The car was totaled, but fortunately, I (mostly) walked away from the accident with only a fractured sternum and bruising. Just a little over a week from ...

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Tthe ACA will now begin to transform how millions of Americans get health insurance coverage.  Most of us will find that the plans offered by our employers are mostly unchanged because they measure up to federal standards.  To the extent that some employers are imposing "negative changes, which include higher premiums, co-pays and deductibles, they've all been happening for more than a decade" because of employers wanting to curtail their ...

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At a time when Republicans and Democrats, House and Senate, can't seem to agree on anything, Medicare physician payment reform is the exception to the rule.  Recently, the House Ways and Means and Senate Finance committees reported out nearly identical bills to repeal the Medicare SGR formula and begin to move Medicare more rapidly toward paying physicians based on quality improvement activities -- the closest Congress has ever gotten to ...

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Readers of my posts know that I am a passionate advocate for the Affordable Care Act, or Obamacare if you prefer.  It isn’t that I have a pollyannaish view of the law itself, or the tortured political process that produced it -- far from it. The ACA is an imperfect law, created by imperfect people through an imperfect process, with imperfect results. After almost 34 years of experience in ...

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Obamacare is working quite well, in some places, for quite a large number of people.  But you wouldn’t know that from the constant media drumbeat about the problems with the healthcare.gov enrollment portal and the relatively small (fewer than 6%) of the population whose individual insurance policies have to be replaced because they don’t meet the law’s benefits and ratings standards. Now, before I get a rash of comments about how I can ...

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Dr. Bob Centor, author of the always provocative and thoughtful DB’s Medical Rants, suggests that the deep divide over the Affordable Care Act is based on “a major philosophic disagreement” over the respective roles of government and of individuals in choosing what is best for them:

The administration and their supporters believe that government’s job is to protect citizens from their bad choices. They want to decide what the people need and ...

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Recently, the chairs and ranking members of the Senate Finance and House Ways and Means committees released a bipartisan, bicameral plan to repeal the Medicare SGR and reform physician payments.  And this time, it looks like the effort could actually succeed: never before has there been agreement between the House and Senate, Republicans and Democrats, on a plan to repeal the SGR, never mind on what they would replace it ...

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A recent post observed that the “highly charged scope-of-practice” fight between the medical and nursing professions has resulted in social media hate speech -- too often, from physicians directed at other physicians. “Like bees to nectar, a post on the topic is sure to draw dozens of anonymous, hate-filled comments” write the authors.  They propose the following “principles for civil discourse” which I believe should apply more broadly to all social media ...

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Soon, millions of uninsured Americans will be able to enroll in qualified private health insurance plans offered through their state marketplaces, with federal dollars to help them afford it.  The state marketplaces, created by the Affordable Care Act (Obamacare) will begin enrolling eligible people on October 1, and eligible persons will have until March 31 to sign up.   The coverage and subsidies for those who sign up will start on ...

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