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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Is Obamacare even partly responsible for the slowdown in health care costs? That is silly. First, Obamacare is not a health care reform law; it is a health insurance reform law. No one on either side of the debate has ever argued anything different. Does the law have some limited cost containment features in it? Yes. But these are either pilot projects or are years from being fully implemented. I have heard the ...

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Readers of my posts know that I am a passionate advocate for the Affordable Care Act, or Obamacare if you prefer.  It isn’t that I have a pollyannaish view of the law itself, or the tortured political process that produced it -- far from it. The ACA is an imperfect law, created by imperfect people through an imperfect process, with imperfect results. After almost 34 years of experience in ...

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The field of medicine is one of the most rewarding occupations out there. Few occupations allow such an incredible opportunity to directly impact the life of a fellow human being and see the amazing results of something you did. Few occupations are allowed inside the most intimate and vulnerable moments of the human condition. In a word: amazing. But medicine for people has quickly given way to medicine for business. Business needs ...

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It’s lonely at the top. The buck stops here. I take full responsibility. Noble sentiments. But the idea that one person, at the top, or elsewhere in an organization, is solely to blame for a complex failure in novel territory is as unhelpful as it is limited. In fact, the blame game is less useful today than ever before. Consider Healthcare.gov. The idea that a project as ...

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The independent payment advisory board (IPAB) is a key feature of the ACA. This board will do what many countries already do -- have an independent expert panel to assess the effectiveness of procedures, imaging studies, pharmaceuticals, etc. Why do we need this board? We need careful assessments of new trends in medicine. Let me suggest two situations. We have read much about increasing colonoscopy costs. We have a controversy about ...

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Would you purchase a new phone without knowing its data plan? For almost everybody, the answer is an obvious “no.” We simply cannot make a good choice if we don’t know how much coverage the phone will offer, or how much money it will end up costing us. Unfortunately, this type of blind decision is exactly the sort that many could face when purchasing a plan in the new health insurance ...

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Lately I've gotten hooked on watching the reality TV show, the Deadliest Catch.  It's astounding to me what these guys go through to catch crab in the Bering Sea. One of the recurring themes on the show is the new crop of "greenhorns" -- new recruits to the profession of working crab boats -- that try to show they can hack "the world's most dangerous job" each year.  They often come with ...

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I recently stumbled across a blog post by Dr. Jay Parkinson, an entrepreneur and founder of Sherpaa, who reflected on a recent private breakfast with New Yorker and best selling author Dr. Atul Gawande.

The question posed by Gawande: Can technology be a change agent for health care? The inevitable answer is yes, with one important caveat. It’s not the technology that will change the practice of medicine, it’s the doctors who ...

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From 27,000 enrollments in October to a reported 100,000 enrollments in November, the Affordable Care Act’s website is apparently working better and getting more people signed up. But is it fixed well enough to handle the expected wave of at least many hundreds of thousands of people eager to get guarantee issue health insurance for the first time or replace a canceled policy by January 1? Here are some of the press ...

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