The concept of sickness insurance began in Germany in 1883. Chancellor Otto Von Bismarck initiated insurance for the poor. A decision about how these services were to be delivered is critical to understanding the contentious debates around health care. Could Bismarck have given vouchers for care as needed? Alternatively, should the government control the needed health care facilities? Perhaps thinking the poor did not have the capability to manage their own health, he chose ...

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Dear patients, One year ago, I wrote to you about my concerns for the future of my practice in light of upcoming changes to the Medicare system.  I explained my anxiety about the Medicare Access and CHIPS Reauthorization Act (MACRA), a change in fee structure from fee-for-service (I treat you in the office, submit the bill to Medicare, and they pay the bill), to “value-based” payment (I treat you ...

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President-elect Donald Trump has repeatedly vowed to “repeal and replace Obamacare.” A logical question is: With what? The announcement of Rep. Tom Price (R-Ga) as Trump’s nominee for secretary of health and human services provides some answers. Unlike other Republican critics of the Affordable Care Act (ACA), Price, an orthopedic surgeon, has offered many replacement plans of unmatched detail. His Empowering Patients First Act was 242 pages ...

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It used to be that hospitals billed Medicare for the services they provided, and Medicare -- I know this is crazy! - simply paid the bills. Those days are rapidly receding into history. Soon, a significant chunk of hospital revenue will be at risk, under a series of Medicare pay-for-performance programs. The idea behind P4P (as the cool kids call it) is simple. Third-party payers, like insurance companies or the Medicare ...

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american medical associationThe AMA supports the nomination of Dr. Tom Price based on decades of interactions with him as a member of the AMA House of Delegates, Georgia state senator and as a member of the House of Representatives since 2005.  Over these years, there have been important policy issues on which we agreed (medical liability reform) and others on which we ...

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On Tuesday, November 29, President-elect Donald Trump named Dr. Tom Price, a former orthopedic surgeon, current Republican congressman, and chair of the House Budget Committee, as his pick for Secretary of Health and Human Services. The same day, the American Medical Association issued a press release enthusiastically endorsing Price for the position. The next day, Dr. Andrew Gurman, the president of the AMA, came to my hospital to ...

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MACRA -- the Medicare Access and Chip Reauthorization Act of 2015 -- is a disaster. It will take the joy out of practicing medicine without significantly improving patient outcomes (except in a circular way) or reducing cost, by moving medical decisions from the bedside to the C-suite. It benefits primarily the health policy community -- consultants, academics, executives -- who designed it. Ironically, MACRA was one of the few major pieces ...

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In the last decade, the federal government has undertaken considerable steps to control the way doctors care for their patients. Its goal is to improve healthcare quality and lower costs, but the very regulation tasked with achieving this has created a paperwork nightmare that actually does the opposite: it impedes care and increases costs. I’m referring to the Physician Quality Reporting System, or PQRS, which originated with the Tax Relief and ...

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Americans spend more per capita on medical care than just about any other country and, yet they often have little to show for it. Americans have worse access to care than people in other countries, and are often less likely to receive primary care services, like preventive therapies and screening tests. Determined to address these problems, Medicare leaders have been testing out new models of primary care, hoping to find ...

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The British National Health Service (NHS) was born in 1948, based on legislation passed that year mandating free high-quality health care for all paid by taxes. In contrast, the U.S. started Medicare in 1966 to provide health care to the elderly and the State Children's Insurance Program (SCHIP) in 1993 to fund health care for children whose parents were unable to afford it. Health care in the UK is still ...

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