In the giddy days after the passage of ACA, I was chatting to a PhD student in health economics. He was in love with the ACA. He kept repeating that it would reduce costs, increase quality and increase access. Nothing original. You know the sort of stuff you heard at keynotes of medical meetings; "Healthcare post-Obamacare" or "Radiology in the new era." Talks warning us that we were exiting the ...

Read more...

I think it’s fair to say Jonathan Gruber will not be offered the role of Pinocchio. Although intelligence agencies, in search of the truth serum, might have an interest in the ingredients of what he drinks. Please put away the pitchforks. Gruber deserves credit for honesty and bipartisanship. Plus a complete rejection of Disneyland economics. If you’re looking for transparency, the other face of honesty, Gruber is ground zero. Stupidity, though, was ...

Read more...

No CT scans for old smokers? "Traditionally, doctors used to be called in when needed. But this is now changing. Increasingly it is the doctor who calls the person in by issuing an invitation. Healthy people are asked to visit the surgery for a 'check-up,' or 'screening,' when their computerized records show they are 'due.' Non-attendance is known as 'non-compliance,' indicating an element of recklessness and irresponsibility." - Petr ...

Read more...

Instead of being hysterical about Ebola, respect it Some years ago I was in Australia’s Northern Territory. The intrepid explorer that I was, I was croc-spotting from the comfortable heights of a bridge over the East Alligator River. The river derives its name because it is east of something. And because it’s croc-infested. I was reading a story about a German tourist (it’s usually a German) who was attacked by ...

Read more...

If another case of Ebola emanates from the unfortunate Texas Health Presbyterian Hospital, the root cause analysts might mount their horses, the Six Sigma black belts will skydive and the safety champions will tunnel their way clandestinely to rendezvous at the sentinel place. What might be their unique insights? What will be their prescriptions? One never knows what pearls one will encounter from after-the-fact risk managers. I can imagine Caesar consulting a Sybil ...

Read more...

Its time to talk trade offs in health care An advantage of being a foreigner, or a recent immigrant to be precise, is that it allows one to view events with a certain detachment. To analyze without the burden of love, hate or indifference for the Kennedys, the Clintons or the Bushes. To observe with both eyes open, rather than one eye looking at the events and the other looking ...

Read more...

Britain’s most prolific serial killer was a general practitioner (GP), Dr. Harold Shipman. He wasn’t England’s most famous murderer. That accolade goes to Jack the Ripper. The Ripper killed five women in the streets of Whitechapel. Shipman might have been responsible for over 200 deaths. Shipman’s legacy to the medical profession was not just a permanent simmering of mistrust. He triggered the introduction of revalidation, Britain’s version of maintenance of certification ...

Read more...

88.2% of all statistics are made up on the spot. - Victor Reeves There’s a growing movement in medicine in general and imaging in particular which wishes to attach a number to everything. It no longer suffices to say, “You’re at moderate risk for pulmonary embolism (PE).” We must quantify our qualification. Either by an interval: “Your chances of PE are between 15 and 45%.” Or, preferably, a point estimate: “You have a 15% chance ...

Read more...

A recent report from the Commonwealth Fund, which placed U.S. last amongst developing nations in health care, analyzed Britain’s high score on the management of chronic conditions. The authors attributed care coordination to the widespread adoption of health information technology in the National Health Service (NHS). That’s like someone saying Chinese food is tasty because chopsticks are widely used. Like quants so fastidious about decimal points they’ve missed the overall point. Where do ...

Read more...

The recent disagreement between Uwe Reinhardt and Sally Pipes in Forbes is a teachable moment. There’s a dearth of confrontational debates in health policy, and education is worse off for it. Crux of the issue is the more efficient system: employer-sponsored insurance (ESI) or Medicaid. Sally Pipes, president of the market-leaning Pacific Research Institute, believes it is ESI. Employers spend 60% less than the government, per person: $3,430 versus $9,130, ...

Read more...

3 Pages