Senator Obama has gone on record saying that health care is a right. Bad move, pandering to his base. Dr. Wes warns that this is a slippery slope that will dwarf the current housing crisis. As Hawaii learned in the example below, providing this right will almost certainly drive the country into bankruptcy:

As we consider this entitlement, we must now ask ourselves how, exactly, the government ...

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Five questions

I was interviewed by Media Bullseye, where I answered the following questions:

1) What prompted you to blog/use social media?

2) What benefits--direct and indirect--have you discovered using this communications tool?

3) Writing is tough work, and blogs, with the need to be updated on a fairly regular basis, can be particularly challenging. How do you stay inspired, and how do you keep things interesting?

4) ...

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Doug Farrago comments on the failure of universal children's coverage in Hawaii, where the program was discontinued after 7 months. It's a good example of what would happen if health care was "free":

Families that had private coverage were dropping it so they could get the free care as well. I don't think this experiment should be ignored. It really needs to be examined to see what went wrong ...

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Health care myths

Is there enough money to reform health care? Is major change to the system politically impossible? Arthur Garson tries to break some myths surrounding reform, and how getting rid of waste can save $700 billion annually. That's a one financial bailout a year.

Hospital rap

From Whose Line Is It Anyway? Funny stuff.

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(via Life in the Fast Lane)

60 percent of health care workers, including doctors, don't receive their flu shots. Some hospitals are taking a hard line, requiring those who refuse shots to wear masks whenever in the hospital.

Should they be mandatory, akin to washing hands? Not everyone likes to be forced to take flu shots, as parents in New Jersey are demostrating.

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Reynolds' Pentad - fever, jaundice, RUQ pain, ...

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A family physician shares her ideas on fixing our health care system. Someone better put Elizabeth Pector in charge of something, because her ideas need to be instilled stat. Like this one, explaining why physicians deserve equal rights:

When it comes to equality, doctors get the short end of the stick in our health-care system. Payers now set non-negotiable fee schedules, meaning doctors can't set prices compatible with practice ...

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Brain Blogger writes on why communication is so poor in medicine. One reason is that physicians are discouraged from spending time with patients, which "sets the stage" for miscommunication. Rushed visits lead to important pieces of information to be overlooked.

Medicine is also becoming increasingly specialized, with the average Medicare patient seeing 5 to 10 doctors annually. Like a game of broken phone tag, ...

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Two lawyers write an article in JAMA, saying that it's the physician's moral obligation to give free care. They seem immune to the financial pressures doctors face, and as lawyers, really are not in a place to lecture:

Ludwig and Nestle adopt a scolding tone to physicians that ask for immediate co-payments and attempt to collect on overdue bills. The authors site the AMA's ethical opinion that urges 'compassion ...

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John McCain failed to show up for July's vote to avert physician Medicare payment cuts. Doctors smartly allied with seniors on this issue, and now McCain's stance is going to hurt him during the last weeks of the campaign.

Here's what I wrote back in July:

This charade seriously damaged the Republicans. They pretty much crapped on the medical profession, a normally reliable ally. The appearance ...

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Newsweek talks about the potential of Web 2.0 applications in patient-physician communication. As it stands, current electronic records are archaic and lack transparency - I read somewhere it's analogous to Windows 95 technology.

Patient-to-patient social networks are more advanced, and readily embraced by those with chronic disease. Can the transparency spread to physicians? Sure, but not until patient privacy regulations adapt to the rapidly evolving technology. If HIPAA casts ...

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I completed residency training at Boston Medical Center, so it saddens me to see they are going through difficult financial times.

BMC provides the majority of Medicaid care in Boston, and as such, are heavily dependent on the government to adequately reimburse for care to the poor and uninsured.

State budget cuts means that they will not be paid for the $64 million they provided in ...

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Genetic testing is all the rage, as was profiled recently in the NY Times. A recent study however, said that an inconclusive test result can just be as distressing as a positive result:

The findings are based on assessments of the long-term psychological adjustment of 215 women who had undergone BRCA testing. Of the group, 37 tested positive for a gene mutation, 31 received a true negative, and 147 ...

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A solo rheumatologist was not willing to pay the $150 to $200 per visit fee an American Sign Language interpreter would have cost to treat a deaf patient, especially in the setting where Medicare paid only $49 per visit.

He was sued as the patient didn't understand the side effects of the medications he was prescribing for her lupus:

But the patient claimed she never really understood the side-effects ...

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Hospitals and doctors are speaking out against the balance billing ban in California. Balance billing is the only mechanism that gives physicians a recourse against unilateral payment decisions made by insurance companies and the government. It has to be an essential feature of any major health reform proposal. (via the WSJ Health Blog)

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Primary care physicians can least afford to lose money. Limiting ...

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With Medicaid patients less likely to be screened, it is no surprise that this population tends to have more advanced cancer at the time of diagnosis. Barely more than half of primary care physicians screened this demographic appropriately for colon, cervical, or breast cancer. Patient non-compliance can't explain this, as the data came directly from the office notes. Neither than insurance coverage, since these screening tests are covered by Medicaid.

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Mayo Clinic for all?

Maggie Mahar waxes eloquent on the Mayo Clinic, and contrasts their care and outcomes compared to other health systems in the country.

While true that they provide higher quality care at lower costs, this is partly due to scale and the fact that the Mayo monopolizes health care in the Rochester, MN area. It's a similar situation to Kaiser Permanente in California.

One cannot extrapolate ...

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Much has been made of antibiotic overuse, and it's potential effect on the rise of drug resistant bacteria. Ben Brewer wrote a timely piece today on community-acquired MRSA, which is a symptom of indiscriminate antibiotic prescribing.

Determining whether upper respiratory infections are viral or not has always been a challenge. In today's practice environment, providers simply prescribe antibiotics to meet both patient expectation and to expedite ...

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A JAMA study is getting attention today, which reports that some cardiologists are going straight to angioplasty without a non-invasive stress test:

They found that fewer than half of the patients took a stress test on a treadmill within 90 days of their elective surgery. This rate varied significantly depending on the hospital patients were referred to, with rates ranging from a low of 22.1 percent to a high ...

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Medicaid's short-sightedness is apparent when they're considering cutting physician payments. Many practices can safely drop Medicaid patients without affecting their bottom line. Dr. Rob sums it up, saying that "a rise in the number of ER visits would be inevitable. This would significantly raise the cost to the system and worsen the financial shortfall for the Medicaid program."

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Put this into the "thanks for ...

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