There are few things in our health care system that are more unfair than surprise medical bills. Consumers think they have good coverage and are getting treatment in their health plan network only to get a huge unexpected bill in the mail because it turned out that something like the anesthesiologist at their recent surgery wasn't covered. How were they to know that? As you're sitting on the gurney about to ...

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Migrating to the U.S. as an international medical graduate, I was shocked by the health care culture of excess. Initially, it felt good to order a CT scan on everyone who had a fall or cardiac enzymes on anybody who had atypical chest pain. I felt powerful and light years ahead of the system I left behind, where you would have to very cautious about ordering diagnostic tests as, mostly, ...

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It was the middle of winter in downtown Chicago in 1995, and I was sitting across from an apologetic alcoholic holding a slimy NG tube. Mr. Smith, an emaciated man in his sixties, had been on my service for three days with acute pancreatitis, and this was the fifth nasogastric tube that had "slipped" out of his nose. Subsequently, his morning labs were just as bad as they had been on ...

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Negotiating lower drug prices in America could possibly stifle pharmacological innovation. But it would reduce health care cost for most Americans — and that should be all that matters. If the United States began to regulate drug prices, medications would become cheaper, and Americans would have more access to drugs with lower health care costs. If bills like S.99 - Medicare Drug Price Negotiation Act (MDPNA) ever passes, it would permit ...

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To put it simply, I’m scared by news headlines and conversations about the climbing rates of maternal mortality among Black women. I’m not surprised, however. As an internist, I regularly marvel at the advances that have been made in Western medicine, yet I pause and wonder why, in our profession, we continually get this mortality issue wrong. The conversation about the state of Black women’s health has reached a ...

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The gender imbalance in nursing, our nation’s largest profession, is a slow-to-change and complex problem steeped in stereotypes, economics, unconscious bias, power, and privilege in health care and society. Along with other diversity gaps in the nursing workforce, gender imbalance is another missing piece to achieving the highest quality patient care. Solving the gender imbalance could accelerate the profession in reaching its full potential. Diversity improves quality Addressing the gender gap represents ...

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Every day, 100 Americans are killed with guns. Forty-four percent of American adults report knowing someone who has been shot. As a society, we have come to accept gun violence as commonplace and not something to take immediate action on. We hear about a new mass shooting on the television, on social media, on the radio or from a friend. We shake our heads in disbelief, ponder on how this is ...

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How would you make sense of the following vignette:

  • Over a 40-plus-year period, a disease ("X") is diagnosed, its causes are defined, and effective treatments are prescribed
  • 30-50+ percent of people working in your organization are currently suffering from X and cry out for relief
  • The stakeholders in your organization not only fail to apply best practices for preventing/curing X; they actually enable the drivers/vectors of the epidemic to intensify
As ...

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Health care reform dominated the past three democratic presidential debates: twice as much time was spent as on foreign policy or climate change. Yet discussions of health care financing miss one critical issue that patients and providers desperately care about: sufficient time to communicate with each other. Presidential candidates focus on cost, policies, and logistics of implementation. But no one talks about how proposed plans will fix a ...

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Next in a series. The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating the five jobs we expect a health care system to do for us and then identifies which parties in the health care system (providers or insurers) have a natural incentive to fulfill each of those jobs. Those incentives arise naturally, but the big challenge ...

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