If we listen to the president, fixing the American health care system is too complicated.  It is not actually that complicated. The number one issue is cost. Even with many millions of people unable to access care, we already spend close to twenty percent of every dollar in the U.S. on health care. If we hope to include everyone in the health care system, then we need to lower health ...

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A couple of weeks ago I visited Canada. It was my first visit in a very long time. We were in Ontario, spending most of the time in the Toronto area, and also getting to visit the majestic Niagara Falls for the day. I’ve heard so much over the years about the differences between neighbors USA and Canada, and in even just a few days there, agreed that there are ...

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STAT_Logo One of Max’s friends taught him an easy way to buy shady drugs. What he learned almost killed him, and it opened my eyes to a hiding-in-plain-sight source of dangerous drugs that is amplifying the opioid epidemic. When Max (not his real name) developed pancreatitis a decade ago, his physicians prescribed opioids to ease his extreme ...

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My wife Beth and I had a rather spirited discussion about how we in the U.S. might be able to pay for the health care of our citizens. Being ever practical, and also owning the job of writing the checks that pay for the health insurance our company offers its associates (including us), Beth in effect is arguing for a national consensus on something we might describe as a baseline ...

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For its many users, health care’s fee-for-service reimbursement methodology is like an addiction, similar to gambling, cigarette smoking, and pain pill abuse. Doctors and hospitals in the clutches of this flawed payment model have grown dependent on providing more and more health care services, regardless of whether the additional care adds value. I don’t use this metaphor lightly, nor wish to trivialize our nation’s growing problem with addiction. Rather, as a ...

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I am not a curmudgeon, but I am worried about the current plight of health care and the attack on the Hippocratic Oath. Bigger health care is sold as better and more efficient with the premise of lowering health care costs. The promised financial outcomes and efficiencies for the physician and their patients have not materialized. Instead, while physicians struggle with non-clinical demands on their time, patients are being pushed ...

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As policy experts cling to pay-for-performance (P4P) as an indicator of health care quality and shy away from fee-for-service, childhood immunization rates are being utilized as a benchmark.  At first, glance, vaccinating children on time seems like a reasonable method to gauge how well a primary care physician does their job.  Unfortunately, the parental vaccine hesitancy trend is gaining in popularity.  Studies have shown when pediatricians are specifically trained to counsel parents on ...

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Mark Letterman’s rheumatoid arthritis had been progressing unrelentingly despite popping dozens of pills each week -- eight methotrexate pills on Mondays alone. Letterman felt like he was 63 going on 93. If rheumatoid arthritis progresses unchecked, it is as debilitating of a disease as can be imagined. Don’t think garden variety arthritis that only interferes with activities like, um, gardening. Think: finger and wrist joints so inflamed it feels like your ...

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I want to talk about the word everyone seems to use: drama.  This word is used in many facets, to describe conflict, negative interactions with others, disagreements, or obstruction to a new idea. No one likes drama. Yet some people seem to instigate it, and others seem to have to deal with it on a rotating basis. We all wish we could ignore it, avoid it, and leave it for people who ...

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Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to “usual care” in highly controlled environments, outcomes such as a 0.4 per day decrease in length of stay with ...

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