To me, Medicaid is Obamacare’s sleeping giant -- the enabler of federal power and control over the health system. It is a far more powerful enabler than health exchanges, which have gotten most of the publicity. It surpasses the number of uninsured and underinsured that the exchanges have enrolled. In the next year, four million more Americans will joing Medicaid’s rolls. It already covers one third of America’s uninsured. Under Obamacare, ...

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Oft expectation fails, and most oft there. Where most it promises. - Shakespeare, All’s Well That Ends Well It may seem a strange thing to say, but I believe the U.S. suffers from unrealistic expectations. We expect government, health, and hospital officials to get things right the first time around. This is unrealistic. People, and believe it or not, including politicians, are never perfectly competent in things they are never experienced before. Disease ...

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What happens when the federal government and the states have split responsibilities for caring for Medicaid beneficiaries? Not much, other than casting blame on one another or on doctors for not providing the care. Buried on page 26 of the front section of a recent New York Times is a story about Medicaid patients not finding doctors or having to traveling long distances to find one. It says a federal inquiry finds ...

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Most hospital managers have never had the power to exert leverage over their most valuable resource, the physician, who, after all, admits the patients who make the hospital’s economic existence possible in the first place. So I wrote in introducing a chapter in my first book in 1988. I hastened to add, however, at the close of that chapter, these admonishments: 1. The economic powers of the hospital is shifting from those ...

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"Do you know how many people died in car crashes in the United States in 2010? 32,000. That’s the lowest number since 1949. That’s impressive, but wait: It’s far more impressive than it sounds at first, because people in the United States drove about 10 times as many vehicle miles in 2010 as they did in 1949. In other words, if you drove a car or truck in 2010, you ...

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Whether specialists make too much money depends on whom you ask. Policy experts If you ask policy experts, most of whom are progressives, they will say  "yes, of course, specialists make too much money." Too many specialists making too much money spoil the national health care broth. Just look at any other country, especially countries with government-run systems. Specialists there make one-half of what our specialists bring home. Look at their total ...

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Everybody has a theory of what’s wrong with American health care and why costs are high. I have my own theory – talk is cheap. By this, I mean Americans and third party payers are unwilling to pay more for what mere talk is worth. They do not want to pay more for a visit to the family doctor, ...

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Huge holes exist in the health reform law you can drive an 18-Wheeler through. These holes are not "devils in the details." They are so obvious nobody talks about them. They are the proverbial elephants in the room. I suppose this makes sense. It takes an 18-wheeler to transport ...

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Hold onto your hats. I am about to enter dangerous territory. I am about to suggest maybe doctors should profit from dispensing medications from their office to offset declining reimbursements and rising expenses by using prescriptions as a source of ancillary revenues. Why dangerous?  For a number of reasons. One, physicians still grapple with the perception that it is improper for a physician to make money from ...

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Electronic health record (EHR) advocates in Washington don’t seem to get it. They don’t seem to understand that hospitals and doctors aren’t rushing to install EHRs because many EHRs, despite the constant talk that EHRs are a prerequisite for good care. Caregivers are not walking the talk, because in their view, EHRs,

  • aren’t ready for prime time
  • slow productivity
  • decrease revenues,
  • show scant returns on investment
  • don’t talk to one ...

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