Is eliminating the presence of all disease a worthy goal? Gilbert Welch is part of the Dartmouth group of physicians and policy experts who advocate that we're doing too much testing and finding too many diseases. He asks, what exactly does "health" mean, and should it be defined as the absence of disease? Over time, the definition of "normal" has narrowed. For instance, more patients are being diagnosed with ...

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The United States is often compared, unfavorably, to health care systems of other countries. But it's refreshing to read that, yes, there are indeed countries that are worse off than we are. (via Ezra Klein) Like Russia, which allocates significantly less than the World Health Orgnaization's recommendation of 5 percent of government spending to health care. It's a hybrid public-private system gone wrong:

Ninety percent of Russians are technically covered. But, ...

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That's a controversial question that emergency physician Edwin Leap asks in a recent column. What's missing in the current health reform proposals is language enforcing one's sense of personal responsibility. So, as Dr. Leap writes, "there are people who really don't deserve health care reform . . .The 'elephant in the room' is that some patients (rich and poor alike) do nothing to care for themselves, take no responsibility for ...

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And it's not always because, as is portrayed in the media, that they get rich from doing so. I, or many other doctors, do not make a dime if I send a patient for an MRI. Rather, it's because there is financial incentive to see and churn through as many patients as humanly, or in some cases inhumanely, possible. Chris Rangel has a nice list, giving 10 reasons why doctors order ...

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Reducing health spending, as Congress is finding out, is difficult. Some health economists have pointed to medicalization of common complaints, like erectile dysfunction and attention deficit hyperactivity disorder, as one reason. Indeed, Dartmouth researchers, who are cited as favorites of the current administration, feel that an "epidemic of diagnoses" is what's making us sick. But, Darshak Sanghavi writes in Slate that this may be a red herring, and clouds what's ...

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Among physicians, there's tremendous contention as to who represents the "true" voice of doctors. There are indeed various lobbying groups, but as Stanford's Abraham Verghese writes in a recent WSJ column, "Our esteemed medical societies and academies aren't speaking for medicine; they are lobbyists, defending their financial self-interests, lining up for or against the latest bill being proposed," and that, "our great academic institutions and our esteemed medical schools have ...

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One of the hurdles impeding health insurance reform is convincing those already with insurance that the changes will benefit them. Indeed, according to most polls, more than 3 in 4 are satisfied with their own care, and according to The New York Times' David Leonhardt, "Americans say they want change, but they also want to preserve their own status quo." But, the status quo cannot be preserved if we're serious about ...

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The following is part of a series of original guest columns by the American College of Physicians. by Steven Weinberger, MD, FACP “Effectiveness” has become a buzzword these days in discussions about healthcare reform. It is often accompanied by different preceding modifiers, such as “cost” or “comparative,” each conjuring up different images in the minds of physicians, patients, insurers, and the pharmaceutical industry. Some say that cost effectiveness and comparative ...

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One of the reasons why large, integrated health systems are able to hold down costs is because they put their doctors on a salary. This divorces payment from volume of care, which is one of the major criticisms of a fee for service system. The pros and cons of such a system can certainly be debated, but the point is that it will be difficult to make such wholesale ...

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Hospitalist Bob Wachter comes up with a nice analogy explaining why health spending is soaring. Apologies for the block quote, but this should be read in its entirety:

You’ve just moved to a new town and stroll into a restaurant on the main drag for lunch. None of the large tables are empty, so you sit down at a table nearly filled with other customers. The menu is nice and varied. The ...

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