After 12 years of blogging, I wonder if I should have titled my blog “unintended consequences.” So many rants focus on the unintended consequences that follow from health care policies. The aphorism (falsely attributed to Samuel Johnson) states, “The road to hell is paved with good intentions.” Too often our policy makers, be they bureaucrats in government, insurance company managers or guideline creators, think like a chess beginner. They see the ...

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After more than 40 attempts to pass legislation calling for repeal or significant changes to the health law, opponents of the Affordable Care Act have moved their focus from the House floor to the courthouse. Currently at least four lawsuits are working their way through state and district court -- and one case awaits a nod from the Supreme Court -- that would make it illegal for the federal government ...

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I am a solo, independent family physician and my practice is not a silo. It is not a cold, stagnant, immobile, potentially dangerous storage facility where data to be used by insurance companies and statisticians is held until it is finally purged. No, my office is a visually and emotionally comforting, innovative, healing environment where information is shared and confidence is enhanced. It is an oasis. My practice is embedded in ...

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For a very long time, one of the most valuable business assets in New York City was a yellow cab taxi medallion. With recent value in the $1 million dollar range, ownership of the medallion was a virtual cash annuity, combined with equity growth (in 2004 medallion prices were in the mid $200,000 range and have increased in value 15% year over year in the 9 years since). As one ...

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There are few things more important than our health and our health care. Solving health care for everyone is critical to becoming a healthy, vibrant society. Because our government has controlled our health care for two generations, election realities and political rancor obscures our ability to collectively solve the problem. Allow me to use a fictitious government program, "Foodaid," to defray the noise and illustrate how government-control of our health ...

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Health care costs far too much. We can do it better for half the cost. But if we did cut the cost in half, we would cut the jobs in half, wipe out 9% of the economy and plunge the country into a depression. Really? It’s that simple? Half the cost equals half the jobs? So we’re doomed either way? Actually, no. It’s not that simple. We cannot of course forecast with ...

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There is no doubt that Affordable Care Act has changed the landscape of medicine in the U.S.  Now, private practice is becoming a thing of the past. Financial pressures, increasing regulatory requirements, electronic medical records and outrageously complex coding systems are forcing long time private physicians to enter into agreements with academic centers and large hospital systems in order to survive. As a result, medicine today is more about increasing patient ...

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Whether you’ve praised or vilified Obamacare, see it as an amazing achievement or an existential threat, it is the law of the land.  The price transparency created by online exchanges, a vital part of the law, stands to make cost the biggest driver of choice. This, along with cuts in government health spending, will disrupt the economics of health care in dramatic new ways. Our first response to this brave new ...

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The venerable University of Texas MD Anderson Cancer Center in Houston will accept patients with traditional Texas Medicaid health insurance, and some patients in Medicaid managed care plans. Memorial Hermann, another large health system in Houston, will accept traditional Medicaid patients and also those in Medicaid managed care plans. Neither institution will accept the Blue Cross Blue Shield HMO silver plan sold on the Affordable Care marketplace, according to 
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The 2-1 decision by the DC Court of Appeals striking down federal premium subsidies, in at least the 27 states that opted for the feds to run their Obamacare insurance exchanges, has the potential to strike a devastating blow to the new health law. The law says that individuals can get subsidies to buy health insurance in the states that set up insurance exchanges. That appears to exclude the states that do ...

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