Today, I come back to the tragedy of medical economics in this country. And I would apply that word "tragedy" in at least two ways. The first tragedy is that we are headed for fiscal disaster in this country because of healthcare costs. We now spend twice as much per person on healthcare as the average per person cost of all developed countries. During the past several decades, the inflation rate for ...

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Recently, "60 Minutes" (in my view the last bastion of great traditional network news investigative reporting) described a for-profit hospital system that apparently uses percent targets (allegedly 20%) to encourage high admission rates by their ER doctors. In setting up this report, the reporter commented that as much as 10% of healthcare expenditures in this country were "unnecessary." Actually, most health experts I have read and consulted would put that number much ...

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I recently said I would describe the essential elements of "true reform." I realize others might add or subtract from my list, but here it is – at least for today: Payment reform. I put this first because no matter what form or structure healthcare takes, without payment reform it will be doomed to failure. And by "payment reform" I mean switching from the "fee for service" model I discussed in ...

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Now that President Obama has won a second term, discussions about healthcare have seemingly disappeared from the public's radar. Big mistake – although I do understand the public's shifting interest in the General's sex life and, much more serious, the heartbreaking tragedy of the renewed hostilities between Israel and Gaza. I do expect that healthcare costs will be back on the radar fairly soon as discussions about the fiscal cliff intensify – ...

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Having established that the U.S. spends twice as much per person on healthcare as the average per person cost in all other developed countries – but with no better overall results – it is time to ask how this happens. Obviously, there are many factors contributing to this dangerous cost escalation, but in my mind two stand out. The first is our unrealistic expectations as American healthcare consumers. Here are a bunch ...

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