A sleeping dragon awakes. At our weekly health policy colloquium recently, the presenter described plans for our organization to form its own accountable care organization, or ACO. The idea behind an ACO is to find patients who get the majority of their primary care within our system, and then "attribute" their health care and all of its attendant costs to that system, making the providers ultimately responsible for providing both high-quality and ...

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After the 2014 elections: Is Obamacare safe? By decisively taking control of the U.S. Senate and increasing their majority in the House of Representatives, the Republicans now have a chance to force some modest changes in the Affordable Care Act, but they will not be able to repeal or reverse it.  But Republican gains in state legislatures and governorships may put the brakes on Medicaid expansion, leaving millions ...

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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 ...

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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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What we are trying to do is create a system that gets rid of the human factor. - an internal medicine physician I heard this statement in a patient safety seminar designed for medical residents. I paused, shuddered even, as a resident who writes poems and reads novels in my free time. To my surprise no else blinked an eye. And why should they? The concept that physicians’ humanity and empathy shape health ...

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Just north of Denver, Jefferson County has become a battleground in the fight over performance-based pay for teachers.  The recently elected school board plans on implementing “[a] compensation system that recognizes and rewards our great teachers,” according to school board president Ken Witt.  The response of the local teachers’ union was for teachers to call in sick and enlist students in protesting what they describe as a proposed “patriotic curriculum.” The protests are a ...

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As people select health insurance during open enrollment, what many don’t realize is how the creation of the health insurance exchanges or health insurance marketplace via the Affordable Care Act (a.k.a. Obamacare) will ultimately result in Americans becoming less healthy and more insolvent. Let’s review the pros and cons. Although the Affordable Care Act provided important benefits of expanding and ensuring coverage with preventive benefits, insurability of all regardless of prior ...

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Glory days: Is a golden age of medicine on our doorstep? The practice of medicine is changing faster than anyone can keep pace with. As a hospital physician at a relatively early stage of my career, I’d say that a sizeable number of physicians that I work with are towards the latter end of the spectrum. I find that these doctors, typically over the age of 50, are struggling the most to keep ...

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A while back I was sitting in a Toronto coffee bar and, as I often do in another country, I began chatting with people about their health care system. One employee taking people's orders was about to go off duty and sat down to visit. "I'm tired of hearing you Americans talk about rationing in Canada," he said. "Let me tell you how many MRIs I had when I was ...

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Most mornings, I opt to take the red line commuter train from my apartment in Bethesda, Maryland to my hospital in Washington, DC. Despite the costly two-way fare, it’s a worthwhile journey because it’s a chance to observe the various other commuters making their way to all sorts of destinations. It’s a people watcher’s dream! Some look dressed to impress on Capitol Hill or in corporate offices. Others look as ...

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