Originally published in MedPage Today by Emily P. Walker, MedPage Today Washington Correspondent The notion of a public health insurance plan appears to be evaporating from the Senate's healthcare reform bill, replaced in part with an expansion of Medicare -- an idea that's meeting resistance from doctor and hospital associations. A proposal to scrap the public plan to allow people as young ...

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The costs of healthcare have been rising exponentially, but people's incomes have not. Despite the biggest economic expansion over the last 50 years, and despite astronomic rise in our productivity, the real wages for the bottom 80% of all earners have not increased one iota since 1975. This means that, while the costs for all products and services have grown at the pace of inflation or more rapidly (as in ...

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The Senate health reform bill proposes to add 2,000 residency slots, in the hope to increase the number of primary care doctors and general surgeons. I'm going say right now, that isn't going to work. Similar in concept to building more medical schools, nothing is going to change the skewed generalist:specialist ratio unless the professional incentives of each field changes. And I'm not just talking about money, although that's a huge factor. The ...

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What if cost cutting measures were put into place, but no one listened? That's the question cardiologist Sandeep Jauhar asks in a recent, excellent, New York Times essay. In the piece, he writes about the problem of Medicare readmissions, a significant cost driver. One of the ways to decrease the frequency is to financially reward hospitals that have low re-admission rates. There's one problem, however. Doctors don't see ...

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When we talk about efficiency in the business world, we are basically talking about getting as much profit as possible. This profit is wrung out of the system by reducing production costs to the maximum extent possible and by charging the top price that the market allows. Some of the ways in which the US companies have increased their efficiencies over the last 30 years are, 1) by moving manufacturing to ...

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Originally published in HCPLive.com by Alan Berkenwald, MD The approaching fire storm over the “patient-centered medical home” model reminds me of the destructive powers seen before in HMOs. Once seemingly destined to revolutionize organized medicine, the HMO model nearly destroyed it. We can learn from past failures. We need to promote best-practice models and make physicians accountable for their actions, both physiologically and ...

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Will the billions we're thinking of spending on health care reform matter if we don't address poverty and homelessness? Surgeon Amina Merchant has her doubts in a Washington Post opinion piece. She observes something that's rarely mentioned, namely, that some patients abuse the health system to their benefit:

"I am suicidal with a plan," they say. People know that that phrase is a key to the psychiatric ward. After it ...

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Originally published in MedPage Today by Emily P. Walker, MedPage Today Washington Correspondent After weeks of closed-door meetings, the Senate leaders released their $849 billion healthcare reform bill on Wednesday evening, paving the way for a procedural floor vote soon. The bill, combining versions approved by the Finance Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee, would create a ...

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Poor McAllen, Texas. The much maligned city has been in the health policy crosshairs ever since Atul Gawande's seminal New Yorker article on health costs. Now, it has the added distinction of being the worst place in the country to live with allergies. The reason? Apparently, there's one allergist for the entire city. One. And according to this piece in Newsweek, that means more primary care doctors and non-allergy specialists ...

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Nearly one-third of the American population is obese, and 5 percent is classified as morbidly obese, defined as more than 100 pounds overweight. The obese are more likely to have health issues, and, subsequently require more frequent trips to the hospital. Ambulance workers say that patients weighing over 350 pounds present additional challenges to transport, and require specialized equipment and additional workers. Where should the money come from to cover the ...

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