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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Peter Singer confronts rationing of medical care head-on two weekends ago in a piece in The New York Times. It's gained plenty of traction within the blogosphere, but none better than hospitalist Bob Wachter's opinion on the issue. In his take, he channels Joseph Stalin, saying, "A single death is a tragedy, a million deaths is a statistic.” And that's really the driving force behind the mindset against rationing medical ...

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The following is part of a series of original guest columns by the American Medical Association. by J. James Rohack, MD Physicians know first-hand the frustrations of caring for patients in our broken system and also the joys of patient care that get us out of bed before the sun rises. The AMA is committed to getting health reform this year – so that the joys can again outnumber the ...

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It's no secret that one of the keys to cutting health care costs is changing the way doctors are paid. One proposal that has been used in some integrated health systems, like the Geisinger Health System in Pennsylvania which uses a similar model, is to not pay for complications. Known as the Prometheus model, the system proposes that "half of the costs from avoidable complications must be paid for by ...

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When it comes to preventing Medicare's so-called "never" events, sometimes the solution is worse than the problem. I wrote about it last year in the USA Today, saying, "While withholding payment for inexcusable medical mistakes is a sensible concept, Medicare’s decision to penalize hospitals for more nuanced complications raises the bar too high. You cannot regulate perfection." And preventing patient falls has nuance written all over it. The New England Journal of ...

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The American Medical Association recently gave unqualified support to the House health reform bill, H.R. 3200, and that is drawing the ire of some of their supporters. To be sure, H.R. 3200 is the most left-leaning of the proposals, and there is clear ideological opposition to the so-called "public plan," which expands the government's role in our health care system. It's a tremendously sensitive topic, with some expressing their outrage ...

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