Your doctor’s exam room is getting overcrowded. Modern US health care means that, like it or not, you and your physician are sharing that once private space with an insurance executive constantly hissing in your doctor’s ears to move it along. You are also sharing it with pharmaceutical marketers,  lobbyists from the food industry ... special interest groups of every stripe. Now move over and make room for one more interested ...

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Imagine what health care in the United States could look like if we devised a system that was based on sound medical practice and proven cost effectiveness.  What if we put our brains, energies and passion behind designing the smartest health care system possible? That was the question that kept poking through my train of thought as I read a study that appeared in the most recent issue of Pediatrics, the ...

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Why can’t the United States have a smarter health care system? That was the frustrating question that kept poking through my train of thought as I read a study from the most recent issue of Pediatrics, the official journal of the American Academy of Pediatrics (AAP).  The study, out of UCLA, examined the association between length of well-child visits and quality of the visits, including things like developmental screening and ...

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I usually write about healthcare reform from a pediatrician’s viewpoint, but what grabbed my attention recently was a story my husband, Randy, told me about an adult in his practice – a patient on Medicaid. Randy is a neurologist in a private practice, and Medicaid patients come from every corner of Rhode Island to see him. They make this cumbersome pilgrimage because he is a member of a dying breed: ...

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One year after passage of the Patient Protection and Affordable Care Act, the debate roars on, in Congress and everywhere else. And these debates often revolve around a big question, even when it is left unspoken or implied: Is health care a basic human right? In 1990 I made a quantum leap from practicing in the Navy’s single-payer, universal-coverage health care system into civilian pediatrics. Having been insulated from ...

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With the roll out of the Affordable Care Act and perhaps more significantly the approach of the 2012 elections, public discussions of healthcare reform has been drowning in an alphabet soup of ACOs (not to be confused with the above ACA), CMS, SCHIP, and RUVs, just to name a few. The challenge is twofold. Most of these plans/systems/agencies deal with how to better pay for a seriously flawed system.  ...

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The Wall Street Journal reported that a study of prescription patterns in 2009, conducted by IMS Health, showed that 25% of children in the US were on regular medication. IMS Health is a firm that provides "marketing intelligence" to pharmaceutical companies. The firm’s job is to keep the $800 billion per year global pharmaceutical industry on a continued pattern of growth.  Hopefully these consultants accomplished something quite different this week. Hopefully they ...

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If we are going to make rational decisions about health care reform, it helps to understand the medical economics of a primary care practice. I was ten years out of medical school by the time I joined Narragansett Bay Pediatrics, a group practice in southern Rhode Island, and I was earning a salary of $48,000 for my “part-time” position. I worked in the office 24 hours per week, and covered nights ...

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An excerpt from The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine (Chelsea Green Publishing, 2011). We all make mistakes. To err is human—unless you are a doctor. This is a lesson that began in med school. If something went wrong, some­one else was to blame. Attending physicians blamed the residents, who blamed the interns, who blamed whomever else was within range—med student, nurse, patient. We gave ...

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I used to practice pediatrics. It has been several years since I decided to leave medicine, but people still ask me about it, and I find myself offering neat explanations between gulps of coffee. Of course, the full truth is much more complicated. The full truth has as much to do with our health care system and our culture as it does with me. My journey in pediatrics was not entirely ...

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