The Affordable Care Act (ACA), sometimes called “Obamacare,” dominated health care media coverage this year. And rightly so. It is the most significant change in American medicine in more than half a century. But the legislation is just one aspect of a complex and highly fragmented system. It is also just the beginning (not the end) of the process to fix U.S. health care. Beginning January ...

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This week in the New York Times, Drs. Scott Gottlieb and Ezekiel Emanuel make the case that there will not be a physician shortage as a result of the Affordable Care Act (ACA). Both have extensive experience in policy and have held respected positions in government. Based on a projected need of nearly 90,000 more physicians by 2020, I have difficulty seeing how a shortage will not occur. The ...

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Next year will be a landmark year for America. Since our Great Recession and its far-reaching effects on the economy, housing markets, jobs, relationships, personal savings, spreading wealth, increasing poverty, divided politics and collapsing health care system, America seems to be purging a lot of karma. Doctors play a huge role, allowing themselves to become puppets pulled by the purse strings of politicians, conglomerates and a divided country gone wild. As we ...

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It’s that time of year when the OECD publishes its "Health at a Glance" comparative health indicators, and The Commonwealth Fund follows with an international survey of health care related activities. A cursory review of these documents always ends up with the customary assessment of American health care: much more expensive than all others, wasteful and inefficient. But this is the month of December, and health care workers are ...

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“You look nice today. People don’t come to chemo in suits very often.” The friendly and familiar receptionist mentioned as I was checking out, the always full jar of lemon flavored hard candy on the shelf between us. As I pocketed a few of the candies, I managed to swallow the nausea and metallic taste just enough to say, “Thanks. I have a job interview today.” During my senior year in ...

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If you learn nothing else today, I would ask you to learn that moral hazard is the cause of medical price hyperinflation. Moral hazard is not just two words that don’t seem to go together. Moral hazard is when the person who bears the economic burden of a decision is not the decision maker. In the health care setting, moral hazard is when the third party payer (insurance/government) bears the ...

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It is pretty easy to be against Obamacare these days. The federal government can’t come up with a working website to help people buy health insurance. The president misled people about whether they could hold onto their old insurance plans. And come next tax day, the least popular provision of the Affordable Care Act -- the individual mandate -- will be implemented for the first time. Lost amidst all this controversy is ...

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As I was watching CNN news recently, I noted in the headlines different ways Obamacare is failing.  Current problems discussed were the customers’ sticker shock of high deductible plans (up to $12,700 for families), the president blaming the insurance companies for having substandard plans, and the people blaming the president for losing their current insurance. One patient even complained, “My new health care plan tripled in price, and now, it is ...

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The catchy title of a recent Harvard Business Review Blog post, The Big Barrier To High Value Health Care: Destructive Self-Interest, suggested that the Institute for Healthcare Improvement (IHI) is forging arrangements that can overcome fee-for-service reimbursement’s propensity to drive excess. As the honest broker, IHI could advocate for arrangements of mutual self-interest based on the right care, better outcomes and less money. Employers and unions would get lower costs, with ...

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I practiced surgery for many years in a very large hospital.  In the 1980s, the marketing department launched a campaign with the tagline, “A Leader in World Medicine.”  About the same time, two of my colleagues created the Hernia Institute, sensing gold in them them groins.  They placed ads in the sports pages of our local newspaper, right next to those of the topless clubs. These initiatives had two things in ...

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