The process of becoming an excellent physician is one of mastery.  The passion of the child is replaced by the studiousness of the teenager, and the bottomless energy of the young adult.  The leap from decision to clinician takes decades.  Forged in the steel of experience, trampled by pain and tortuous repetition, ability accrues. The apprentice guards his knowledge closely.  He bows to the alter of the sacred skill that he ...

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This post deserves a caveat — health care shouldn’t be a political issue. When someone comes into my office because they have chest pain, I don’t ask them, “What’s your political leaning?” before administering care. And now after reading about the recent delay of ICD-10 in Congress, I realized that my choice in practicing direct care was the most political and least political thing I could have done. According to
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If my car insurance isn’t linked to my employer, should my health insurance? A recent projection by S&P Capital IQ, a research firm in the financial industry, estimated that 90% of Americans will receive health insurance from government exchanges by 2020. If this estimate were to come to fruition, it would represent a monumental shift in the structure of the American health care system. For over half a century, employer-sponsored ...

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"All patients are alike. This one complains about the same things that the last one did." "Every patient is unique. We can never find a way to make each one of them happy." Remember that 1980s public health paradox: Do you focus on intensive interventions that might produce significant improvements in outcomes for a defined, high-risk group or do you direct energy to system-level changes that may achieve more modest outcomes ...

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“If you insure them, they will come.” Those words might as well be the mantra of hospitals across the country, because they can expect an onslaught of customers thanks to the expansion of health insurance under Obamacare. A recent study published in Science showed increased emergency room use among people in Oregon who became eligible for Medicaid, compared to others who, literally by the luck of the draw, were not chosen to ...

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While grappling with the costs and imperfections of our health care system in recent years, a multitude of experts in the field found it useful and enlightening to compare health care to a variety of more familiar industries, and to suggest that health care should adopt operational models that have been shown to work well in those other industries. From the financial industry, we learned that health care must be computerized. ...

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Why the VA scandal is a red flag for single payer advocates "I will not stand for it.” That’s what President Obama said about the deepening VA health care crisis.  It’s also a lightening rod for how partisans want to frame the ongoing health debate. Some are eager to link the VA scandal to Obamacare, and more broadly, government-run health care. Others extol the virtues of the VA, holding it as ...

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House Energy and Commerce Committee Republicans seemed surprised recently when representatives of the insurance industry reported that they didn't have enough data yet to forecast prices for next year's health insurance exchanges, the market was not about to blow up, and that so far at least 80% of consumers have paid for the health insurance policies they purchased on the exchanges. The executives also reported there are still serious ...

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The Affordable Care Act expanded Medicaid eligibility this year in those states which decided to follow its provisions. That means lots of people are now newly eligible for Medicaid. However, the number of people signing up for Medicaid in the states has been underwhelming. Which raises a question: How much can we expect enrollment numbers to increase over the next few years? To begin to answer that question, a group of ...

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Currently, the United States spends approximately 3 trillion dollars on health care, which is roughly 18% of our gross domestic product (GDP).  Not only is this more than every other country in the world, but it’s also more than the next 10 largest spenders combined.  Looking backwards, health care spending rose steadily from about 9% of our GDP in 1980 to about 16% in 2008.  Looking ahead, by 2020, health ...

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