With the rollout of Obamacare, we are living in a moment in which there is no dearth of heated debates among friends, family, and co-workers. And often times, these debates degrade to become emotion vs. emotion, or even ad hominem, and so these initially well-meaning conversations morph into heated arguments that lead nowhere. (Even Immanuel Kant advised debaters to out-shout opponents when more civil methods of discourse had failed.) It is far ...

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A version of column was published on March 5, 2014 in the New York Times’ Room for Debate blog. To remedy our fragmented health system, reformers want to consolidate health care.  President Obama, for instance, has praised integrated health systems like the Mayo Clinic as a model for national reform.  To that end, the Affordable Care Act drives more hospitals to become more Mayo-like by purchasing physician practices.  Today, about 39% ...

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American consumers value the freedom to comparison shop. We like to survey a variety of options and select "the one" that what we really want. If we want triple-ply, select-a-size paper towels with a blue shepherdess imprinted on them, then we expect to be able to find them in aisle 9. Deny us options and we’ll take our business elsewhere. When it comes to health care, though, endless options may not ...

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I first heard about the ICD-10 when I was working at a small start-up, trying to develop an EMR for a string of dialysis clinics. It was always spoken of with a certain gravity, like the ominous visit from an aunt that nobody in the family likes, but feels obligated to see.  Practical (read: business) people hate ICD-10. It’s giant and unwieldy. Doctors think it’ll be an excuse to bilk ...

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Health insurance reform was long overdue. But did it need to be done the way the architects of the Affordable Care Act did it? Obamacare was enacted, and the private health insurance market fundamentally changed, so that we could cover millions of people who previously couldn't get coverage. Are enough people getting coverage who didn't have it before to justify the sacrifices the people who were already covered -- in the individual, ...

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We believe integrated will triumph fragmented every time. -Steve Jobs Two articles recently got my attention. The first was an interview by Dr. Robert Pearl, CEO of the Permanente Medical Group with my favorite author and thinker Malcolm Gladwell. On Pearl’s blog, he answered Gladwell’s request to tell people what is was like to be a doctor. The second was a NPR article, “When Facts Are Scarce, ER Doctor Turns ...

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The worst news in health care is not antibiotic resistance, drug-drug interactions, hospital acquired infections, lack of communication between systems of medical records, and certainly not the alarming rate of obesity in our youth. The worst news is the increasing number of dissatisfied physicians. The physician, also known in the system as a "provider," has been the direct target of assault by the government. The logic has been that if the physician ...

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There's a bit of buzz in the news recently over President Obama's nominee for surgeon general, Dr. Vivek Murthy. It's worth pausing here to note the last truly consequential surgeon general:  Dr. C Everett Koop single-handedly carried out the entirety of the Reagan Administration's AIDS response (to be clear -- this is true because of how little the Reagan administration did, not because of how much Koop did); fought hard ...

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In a recent article, Malcolm Gladwell dissected and diagnosed American health care. Throughout our interview, he tackled controversial topics from the Affordable Care Act and medical malpractice to the contrasting Canadian health care system and much more. I expected him to dive deep below the surface and provide new and intriguing perspectives. He didn’t disappoint. But it was his closing comment that caught me off guard. When I asked Gladwell what ...

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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 -- ...

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