President Trump told a group of Republican Senators that the House-based American Health Care Act is “mean” -- and on this he surely called it right! How else would one describe a bill that would take health insurance away from 23 million people, allow states to waive rules requiring insurers to cover people with preexisting conditions at no extra charge, and raise premiums and deductibles to the oldest and ...

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When I tweeted this on Monday morning about the House GOP bill to “repeal and replace” the Affordable Care Act, I had no idea that it would result in me appearing on MSNBC’s Last Word with Lawrence O’Donnell or that it and my other tweets would be referenced by NBC News, a New York Times editorial, or for that matter, a retweet from singer-songwriter John Legend! I mention ...

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The Republican congressional leadership appears to be determined to move forward with a high-risk “repeal, delay and replace” plan, very early in the new 115th Congress to repeal (at least on paper) the Affordable Care Act’s key coverage provisions—Medicaid expansion, subsidies to make private insurance sold through the exchanges affordable, the individual and employer mandates, and the taxes to pay for coverage—by a simple majority vote, while delaying when the ...

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One thing I’ve learned is that physicians who have gone into direct primary care (DPC) practices are passionate about their decision: they not only believe that DPC is better for their patients and their own professional and career satisfaction, many assert it is the answer to just about everything ailing primary care. There is an evangelical fervor among some DPC advocates to spread the word and convert other ...

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We all want this sometimes, don’t we?  We want the things in our daily lives that bug us the most, like long lines at the DMV, to just go away.  But how often does that really happen? As the senior staff person for ACP’s governmental affairs team in Washington, DC, I often hear from exasperated physicians who want ACP to just make things they don’t like go away, whether it's MACRA ...

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Recently, ACP offered practical solutions to physicians’ concerns about Medicare’s proposal to implement the new payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA). The College’s detailed recommendations, summarized here in a press statement that is linked to the comment letter itself, would replace CMS’s proposed and unnecessarily complex quality scoring system with a much simpler and understandable approach as developed by the College. We challenge CMS to completely ...

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I’ve had the chance to present the changes being brought by the Medicare Access and CHIP Reauthorization Act (MACRA) to audiences of hundreds of physicians -- at ACP’s Leadership Day on Capitol Hill, ACP’s Board of Governors and Board of Regents meetings, several educational sessions and a news briefing at the College’s Internal Medicine 2016 Scientific Meeting, and to the California Medical Association’s Leadership Academy.  I’ve also had chats with ...

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Just as the U.S. health care system is about to make performance measurement a central feature of … well, just about everything doctors do … some prominent and highly influential physicians are asking for a pause and reassessment. Writing for the New York Times, Dr. Bob Watcher argues that, "Two of our most vital industries, health care, and education, have become increasingly subjected to metrics and measurements. Of course, ...

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The fact that primary care is undervalued by Medicare and other payers has been long understood to be driving the precipitous decline in the numbers of new physicians choosing primary care internal medicine or family practice, and a growing exodus of established primary care physicians. Efforts to address this undervaluation have traditionally been to, 1) bump up the payments (relative value units) for the office visit codes traditionally billed by primary ...

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shutterstock_207314821 Fifty years ago, President Lyndon Baines Johnson signed Medicare (and Medicaid) into law.   Medicare’s relationship with physicians since then can best be described as a complicated one. First, recall that Medicare became law notwithstanding the American Medical Association’s fierce opposition to it. Three years prior to its enactment, AMA President Ed Annis warned that, "We doctors fear that the American public ...

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