Last fall I was witness to a miraculous event. I rarely take off from work, but did so on a Friday to go to Baltimore to lend moral support to my family doctor friend, Cathy Maslen. She and her workmates at Chase Brexton Health Care (a community health clinic in the Baltimore area with a focus on the gay and transgender community and the inner-city poor) were doing something that ...

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A physician friend commented recently that practicing doctors and nurses, the highly trained professionals who understand health care better than anyone else, are always too busy working to be involved in health care administration and reform. It is one of the most basic and profound problems affecting our health care system -- one of the reasons that health care in America does not get better. And it got me thinking. Once ...

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With the ruination of American teaching using “value-based” purchasing and payment concepts virtually complete, the U.S. government is now training its sights on medicine with similar intentions. With the new MACRA pay-for-performance program, CMS bureaucrats believe they can force health care providers to practice better “quality” care by collecting clinical performance, practice-related, and cost data, and basing payment increases and penalties on the results. There is one big problem associated with ...

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The American health care system is broken, but it is not really “health care” that is the problem.| The science of medicine, the tests, and the treatments available are better than ever. It is health care bureaucracy that is the problem. But doctors, nurses, and patients bear the brunt of the dysfunction. Medical professionals are unable to practice, and patients are denied the care they need, even though it is readily ...

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We’ve taken care of Jane and her son, Sam, for a long time (the names are fictitious, but the rest of the story is true, and the real patient approved this story, in case you were wondering). At first, the focus was Sam, with typical well and sick visits. He was one of the sweetest kids we knew. Sam also had a very significant learning disability. At one point I asked ...

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The Trump administration has made clear its intentions to drastically reduce the size and intrusive nature of government. Let’s hope that extends to the Medicare Access and CHIP Reauthorization Act, otherwise known as MACRA, the heavy-handed new government “value-based payment” program for medical care, enacted in 2015, and set to rear its ugly head beginning this year. MACRA must die. MACRA is administrative overkill in an industry already overburdened by ...

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Health care reform as it is typically discussed in America is dead for now. By “as it is typically discussed,” I mean broad “big picture” health care reform, which deals primarily with how we organize payments: government vs. free market, multi-payer vs. single payer, profit-based vs. not-for-profit. The Democrats tried. Obamacare’s shortcomings stem largely from the fact that neither President Obama nor the larger Democratic Party had the political power ...

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Like they have a gun to their heads, congressional Republicans, led by Paul Ryan, are moving ahead at warp speed to pass a sweeping new health care bill to replace Obamacare. Despite an almost deafening roar of objections from the many people who would lose coverage or whose insurance costs might go up; from major medical groups; and even from within its own party, they continue onward with this health ...

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One of the popular critiques of the American health care system is that it is high-volume, low-quality, and that this is a direct result of the traditional fee-for-service approach to paying doctors for medical care. In the past, doctors and hospitals have been paid much the same way that we pay for other goods and services. When they provide a service, such as an appointment or a procedure, they are ...

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