As we enter the New Year, I like to reflect on where we've been and where we're heading in medicine. By far and away, this is the most tumultuous time I have ever experienced in health care. It's strange really. I thought I'd try to make some realistic predictions of what patients should expect in the year ahead now that the "Patient Protection and Affordable Care Act" (PPACA) begins to sink it's ...

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His right testicle had jumped into his abdomen after he lost control of his motorcycle on the highway.   My 43-year-old patient, whom I’ll call Richard, in otherwise healthy condition, was brought to the ER with severe pain.  Fortunately, his testicle was still intact and only needed to be put in the proper place. I am an attending physician in the emergency department and trauma center at San Francisco General Hospital.  I ...

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Tthe ACA will now begin to transform how millions of Americans get health insurance coverage.  Most of us will find that the plans offered by our employers are mostly unchanged because they measure up to federal standards.  To the extent that some employers are imposing "negative changes, which include higher premiums, co-pays and deductibles, they've all been happening for more than a decade" because of employers wanting to curtail their ...

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This is the time many of us make resolutions about our lives -- often tied to our health and wellness. As the health care industry enters a new era of consumerism, people are seeking more and more ways to take ownership over their health and health care. While data about doctors, hospitals and health outcomes are becoming more available and transparent, we still have a long way to go. Perhaps in a ...

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David Blumenthal and others recently published a paper in the New England Journal of Medicine entitled "Health Care Spending -- A Giant Slain or Sleeping?" In it they look at the ongoing, and rarely discussed, phenomenon of slowing of health care spending, which has persisted over several years. Health care spending grew remarkably after the establishment of Medicare and Medicaid in the 1960's, resulting in the fact that health care costs ...

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In his farewell address to the nation on January 17, 1961, President Dwight D. Eisenhower warned the American people about the looming “military-industrial complex” which would sway public mindset and enhance money flow from government to the defense industry. This concept persists today with the practice re-adapted and launched against the health and welfare of the American people through the “hospital-industrial complex.” Health care organizations like the California and American Hospital ...

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Whatever the problems with the roll out of Healthcare.gov, the fact is that the government take-over of health care has been happening for more than a century. If we want a truly free market for health care, we have to think in broader and bolder terms than simply rolling back the ACA. With that in mind, here is a short list of patient-focused ways to get the government out of ...

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The Affordable Care Act is not so affordable if you own or if you are an employee of a small business. Here is why. Consider the owner of a small service business with one or multiple outlets (e.g., a large restaurant or a small chain of sit down restaurants, a chain of barber shops, a taxi company.) The owner has more than 50 employees but the business is still “small” with ...

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A study from Science found that those on Medicaid in Oregon made 40% more visits to the emergency department. The Oregon Health Insurance Experiment included about 90,000 low-income people and assigned 30,000 of them to Medicaid by lottery. It's essentially a naturally-occurring randomized controlled trial. The result seems to have caught the public policy experts by off guard:

“I suspect that the finding will be surprising to many in the policy ...

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From MedPage Today:

  1. Medicaid Growth Burdens EDs. A sudden influx of patients insured through Medicaid was associated with a 40% increase in emergency department visits.
  2. Even With ACA, Many May Be 'Underinsured'. People with chronic conditions will be better protected from crippling medical bills starting in January as the health law's coverage requirements and spending limits take effect
  3. Mechanical CPR Outcomes Similar ...

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