Legislative bodies are moving with unprecedented swiftness to ensure we lead healthier lives. From bans on soda to bans on fast food, from mandates on health insurance coverage to mandates on EMR use, from bans on trans fats to mandates on care delivery models, our governments (federal, state, and local) are supposedly helping us live well. But our current approach to health care is about as scientific as our approach to fashion -- ...

Read more...

His is the story of which American dreams are made: a first-generation immigrant who grew up in South Florida, where he worked on weekends to support his father’s small business. After winning a spot at Harvard at 16, he set his sights on medicine and leadership. He founded an international non-profit focused on HIV/AIDS youth education while at Yale for medical school -- and threw on an MBA for good ...

Read more...

Frontline caregivers across the United States -- and in many other countries, no doubt -- are bombarded by multiple quality improvement (QI) projects. A clinical unit might simultaneously be engaged in efforts to reduce readmissions, eliminate hospital-acquired infections and other complications, increase hand-hygiene compliance, improve performance on core measures, and enhance the patient experience. The demands brought by participating in all of these efforts risk overwhelming health care professionals, who ...

Read more...

Most people, regardless of their political leaning, can agree that the market for health care in the United States isn’t really working well. Take one step further, though, and disagreement rapidly ensues. On the left, the common understanding is that a market failure has occurred, and that the proper thing to do is have government intervene to correct that failure -- usually by expanding public insurance programs, subsidizing private insurance, and ...

Read more...

Malcolm Gladwell hasn’t written much about American health care. But that doesn’t mean he hasn’t been thinking about it. And it sure hasn’t stopped many of his powerful ideas like “tipping point,” “outlier” and “blink” from gaining entry into the national health care debate. In his most recent book, “David and Goliath,” Gladwell reshaped our perspectives on the underdog and highlighted our tendency to over-value certain strengths. In the health care ...

Read more...

Recently JAMA published a special theme issue on critical issues in U.S. health care. Among the contributors was Dr. Ezekiel Emanuel, the oncologist, bioethicist and former White House adviser on health policy. In his article, “Going to the Moon in Health Care: Medicine's Big Hairy Audacious Goal (BHAG),” Emanuel argues that contemporary medicine is in need of vision, an overarching, aspirational goal "like going to the moon that can make ...

Read more...

Physicians in Congress are on the rise. From 1960 to 2004, only 25 of the 2196 members of Congress were physicians. During an era that brought such fundamental changes to health policy as the creation of Medicare and Medicaid, physicians were disproportionately less likely to hold congressional office than their counterparts in law (979) and in business (298). In recent years, the ranks of physician-representatives have swelled -- twenty physicians ...

Read more...

Safety net emergency departments are frequently blamed for being the source of rising health care costs. After all, they care for the millions of underserved and un-insured Americans forced by a variety of circumstances to visit ERs for their primary care and low-acuity concerns. With the Affordable Care Act (ACA) reforms initiated in January, demand for emergency services will rise significantly. Medicaid already covers over 50 million individuals – most of ...

Read more...

The administration has confirmed that the individual policies that were supposed to be cancelled because of Obamacare can now remain in force another two years. For months I have been saying millions of individual health insurance policies will be cancelled by year-end -- most deferred until December because of the carriers' early renewal programs and because of President Obama's request the policies be extended in the states that have allowed it. The ...

Read more...

"Hey doc, I saw on an ad on the TV last night about this new asthma inhaler.  Shouldn't I give it a try?" This type of question would occur several times a week.  When I started practicing medicine it was considered unethical to advertise medical treatments.  Now, we're bombarded with enticements for tests and treatments.  The inhaler the patient requested cost $264 a month -- more than double what he was ...

Read more...