Policy

Placebo Television gives another take on President Obama’s address to the AMA

Family physician Doug Farrago, of Placebo Journal fame, gives his take on President Obama’s speech to the AMA.

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Why do health policy experts and wonks hate doctors?

Health policy experts have never been shy about their antagonism towards doctors.

The focus now appears to be on physician pay, with the Washington Post’s Steven Pearlstein, for one, continuing his anti-physician columns. Derek Thompson, over at The Atlantic (via @AllergyNotes), continues the assault, with a recent blog entry wondering if doctors deserve to be paid less.

I touched upon this topic last year, in a USA Today op-ed, …

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Reflections from the AMA: President Obama’s Speech

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

We have a historic opportunity for health reform this year and the AMA was delighted to welcome President Obama to our Annual Meeting in Chicago earlier this week. Like the President, we are committed to health-care reform that will provide all Americans with affordable, high-quality health coverage.

I was personally honored …

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10 President Obama posts you may have missed

With entries dating back to 2004, here are 10 classic blog posts on President Obama:

1. How the primary care doctor shortage threatens Obama’s health reform plan

2. The Obama health care summit, and did the President offer any clues to the upcoming health reform effort?

3. Is Physicians for a National Health Program the biggest threat to Obama’s health reform plan?

4. Did Obama provide any health care clues …

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Successful health reform requires changing physician incentives, my take in The New York Times

I have a piece in The New York Times’ Room for Debate blog, discussing how reforming physician incentives is a key to health reform.

Here’s an excerpt:

Some health policy analysts blame the medical profession entirely for the role they play in rising health care spending. And indeed, doctors have tremendous influence in the tests being ordered and treatments prescribed. But singling out …

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Why this private health insurance CEO is against a public plan

It’s not because of what you think.

The common thought is that health insurers will quiver at the sight of a government plan, with the public option offering lower premiums to patients due to leaner administrative burdens.

But Charlie Baker, CEO of Massachusetts’ Harvard Pilgrim Health Care, isn’t so worried about that. Instead, he first wonders about the government’s competence in handling another large bureaucratic program:

I worry less about the impact …

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My reaction to President Obama’s speech to the AMA

I was seeing patients during the actual speech, so I had to rely on the transcript.

The points that interested me the most were any language pertaining to malpractice, addressing the AMA’s recent concerns about the public plan option, and reforming the physician payment system.

I think he did pretty well.

Regarding the physician payment system, he again addressed McAllen, Texas, which is fast becoming the symbol of what’s wrong with American …

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Is Obama serious about medical malpractice reform?

Or is it a red herring?

President Obama is making a much-ballyhooed address to the American Medical Association today (and will be live-Tweeted over at MedPage Today), and perhaps not coincidentally, there’s a piece in today’s New York Times saying that Obama himself is one of the few supporters willing to address the issue of malpractice reform.

According to the piece, “In closed-door talks, Mr. Obama has been making the …

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KevinMD Live Q&A on health care reform, today at 11:30am Eastern

Health reform is rapidly gaining momentum, with details of the proposed plan coming into focus.

Yesterday, The New York Times reported on the AMA’s supposed opposition to the controversial public plan option, which has been the polarizing issue du jour. The AMA has since clarified their views.

I’m opening up a Live Q&A at 11:30am Eastern today to answer your health reform questions. I don’t pretend to be a …

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How we spend the most money on futile care

A 90-year old man with a pancreatic mass, almost definitely pancreatic cancer, was admitted to a hospital.

Surgeon Jeffrey Parks does the initial surgery consult on this terminal case, and recommends hospice care.

The next evening, he’s shocked by the “astounding amount of medicine [that] had been practiced” during the day:

Consults had gone out to GI, oncology, and nephrology. The GI guy had ordered an MRCP and, based on some mild …

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Should doctors be on a salary?

Health policy experts rightly state that the physician payment system, which pays fee-for-service, financially encourages doctors to order more tests.

The opposite extreme, as we’ve heard many times, is the Mayo Clinic, which salaries their doctors.

But could there be unintended consequences to placing physicians on fixed pay. For one, you are going to seriously dent productivity. Now, some say that may be a blessing in disguise, since the …

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Should doctors competitively bid for Medicare rates?

Frustrated by Medicare’s price-fixing tactics?

One idea is to introduce a competitive bidding system. It’s a well-known fact, and one that strongly influences current health policy decisions, that some areas of the country have more doctors and provide more medical services than others, with no additional, appreciable benefit.

In an op-ed in The New York Times, pulmonologist Peter Bach, former senior adviser to the administrator of the Centers for Medicare …

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Will comparative effectiveness research really save money?

President Obama hopes so.

But, as Abraham Verghese writes, we can’t be so sure of that. The great cost-cutting hopes proposed by the government, which also include information technology and preventive medicine, all have very little data that show there will be any meaningful cost savings.

Are we focusing on the wrong things for cost control? Instead of making the difficult decisions, which includes revamping the physician payment system, …

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Reforming health care using the Massachusetts model won’t relieve ER overcrowding

It’s looking more and more likely that federal health reform will look very similar to what’s going on in Massachusetts.

As I’ve written in the past, expanding coverage is easy, controlling costs is not. And Massachusetts has taken the route of least political resistance and did the former.

I’ve written previously that expanding coverage without re-aligning incentives to produce more primary care doctors will simply increase waiting times and crowed …

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5 top medical comments, June 7th 2009

Here are some of the more interesting comments readers have left recently.

1. David Block on the ACP’s guest column, A practice model for increasing the appeal of General Internal Medicine:
Weinberger talks about the efficiency of Care. Our commentators talk about the efficiency of Consumption. Weinberger assumes the one-on-one of two individuals, known to each other, who together negotiate the terms of personhood. Medicine is “spiritus”; no wonder he became …

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Will the public limit the degree of health reform?

Despite the poor shape of the American health system, public preference is the limiting factor in how far we can change the system.

Ezra Klein notes the lessons learned from 1994, saying that there is a status-quo bias, and that people “want more options,” and “don’t want to be forced out of their current arrangements.”

This is one reason why something radical, like a single-payer health system, won’t take off. …

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10 Medicare posts you may have missed

With entries dating back to 2004, here are 10 classic blog posts on Medicare:

1. Hospitals lose money by preventing patient re-admissions

2. Covering a virtual colonoscopy, or not, will test the cost-cutting will of Medicare

3. Medicare now requires physician essays for hospice care, as if pre-authorizations weren’t bad enough

4. Why hospitalized Medicare patients get re-admitted so frequently

5. Once you hit Medicare age, good luck finding a …

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How to get doctors to embrace health care reform

Doctors still wield tremendous influence in the health care debate, since they still have the confidence of most patients.

If Congress and the Obama administration can convince doctors to support health care reform, it can be, as the ACP’s Bob Doherty notes, “decisive in determining if the public will be behind the effort, because voters are much less likely to support health care reform if told that it will result …

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Is rationing health care impossible in the United States?

As long as as 911 and EMTALA remain, the answer appears to be yes.

EMTALA is the flawed, unfunded, mandate forcing hospitals to provide a medical exam to anyone who presents to the emergency department. Emergency physician White Coat envisions a scenario where a family who is denied care can simply call emergency services, or show up in the ER, to get the care they want.

For instance, what if Medicare …

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