“Everyone I know agrees that President Obama’s problem is that he isn’t liberal enough.  Everyone I know believes that the problem with Obamacare is that it gives insurance companies too much power, when what we really need is a single payer system where the government runs everything, like Canada.  Everyone I know believes that  the answer to gun violence is to ban guns,  and if the Supreme Court won’t allow that, to at least license, ...

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The fate of the Affordable Care Act (ACA) will be the big issue in the upcoming mid-term congressional elections, with Republicans and their allies continuing to press for repeal, believing that it is a winning issue with voters (or at least the base voters who lean Republican). Opinion polls are not as clear-cut, though. Although more Americans continue to have a less favorable than more favorable view of the law, ...

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During ACP’s annual meeting in Orlando recently, the American College of Physicians released a new position paper on reducing injuries and deaths from firearms -- the first comprehensive update of College policy since the late 1990s. (I am a co-author of the paper.) Published as an online-first article in the Annals of Internal Medicine, the paper is the result of an extraordinarily comprehensive review of the evidence of the causes and ...

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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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