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 ...

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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 ...

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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 ...

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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 ...

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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 ...

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"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 ...

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The Republicans have an alternative to Obamacare and they may have given the Democrats a big political gift. The proposal was unveiled by Republican Senators Richard Burr (NC), Tom Coburn (OK), and Orrin Hatch (UT). The Republican plan targets many of the most unpopular parts of the Affordable Care Act such as expensive mandated benefits and the resulting lack of choice, the individual mandate, the employer mandate, and age-rating disruptions. My sense is ...

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1. Process vs. product. Computers are just machines.  I repeat, they are just tools.  Health information technology is a shell which houses knowledge and human ability.  It is nothing more .  Electronic medical records may either streamline our thought processes or make them more cluttered.  They will not, however, lead to better or more perfect care.  They haven't yet, and they won't in the future. And they are prone to be ...

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I recently asked if Obamacare was unraveling. The Obama administration announced that they are delaying the employer mandate again. In the announcement, they said that large employers, those with at least 100 workers, will only have to cover 70% of their otherwise eligible workforce in 2015 and 95% in 2016 and beyond. The administration also said that employers with 50 to 100 workers will have their mandate to provide affordable health ...

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We all know that health care costs in the U.S. are too high.  But why is American health care so expensive?  Some experts blame the desire for profit.  Russell Andrews, a  neurosurgeon and author of Too Big To Succeed laments “the morphing of American medicine from a function of a humanitarian society into a revenue stream for health care profits, drug and medical device companies, hospitals, and insurance companies.  In essence, ...

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