At this time in history, it may serve us well to reflect on the tortuous past, the harrowing present and the unpredictable future of health care in America. First and foremost we must recognize we do not have “a health care system” -- rather our health care is delivered in an uncoordinated, misaligned and exorbitantly expensive fashion. For example, 1 in 5 Medicare patients are readmitted to the hospital within 30 days of discharge, ...

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As is customary for every administration in recent history, the Trump administration chose to impale itself on the national spear known as health care in America. The consequences so far are precisely as I expected, but one intriguing phenomenon is surprisingly beginning to emerge. People are starting to talk about single payer. People who are not avowed socialists, people who benefit handsomely from the health care status quo seem to ...

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Pause with me for a moment and create an image in your mind of the quintessential healthy person. What do you see? I picture someone who is slim and agile. They probably bike or walk to work and engage in daily exercise. They cook for themselves, use fresh vegetables and few processed foods. They find satisfaction in their career and home life, mange stress well and devote time to meaningful hobbies ...

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Republicans have been waiting a long time for this moment. After sixty previous attempts to repeal the Affordable Care Act, commonly known as Obamacare, their moment has arrived. President-elect Trump and Speaker Ryan believe that they can repeal Obamacare and roll back the clock. It won’t happen. Here’s why. 1. Millions will lose health insurance. Pre-Obamacare, nearly 20 percent of Americans went uninsured,  and this disproportionately affected lower-income levels. Those are ...

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As a presidency draws to a close, it is natural to consider the legacy it etches upon the pages of history.  For the most part, a first lady's legacy is a sidenote.  There are a few exceptions, of course.  Eleanor Roosevelt, Jackie Kennedy, and Nancy Reagan come to mind.  I believe that Michelle Obama's legacy will be one of the more notable of the modern era. For better or worse, race ...

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President Barack Obama, whether wittingly or not, invested his entire political capital in reforming health care in America. He gambled and lost. Not because he had nefarious intentions, but because he left the gory details to a corrupt Congress and a shady cadre of lying and conniving technocrats, ending up with something vastly different from what he campaigned on. From everything I’m reading now, President-elect Donald Trump is about to ...

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United Healthcare announced that it plans on exiting most of the Obamacare insurance plans by 2017. Not their traditional commercial insurance plans or Medicare supplements, but specifically the insurance plans offered through the state exchanges of Obamacare. Didn’t President Obama tell Americans that if they liked their insurance plan, they would be able to keep it under Obamacare? Actually he did, at least 36 times. So what happened? In ...

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Recently, I have discussed networks (Internet and electricity), but I would be remiss if I didn’t spend a few moments on the networks that are most likely to rob us of personal choice and increase costs: Health care networks. Wait, didn’t President Obama promise us that the new health care law would preserve choice for us? Didn’t he promise us lower costs?  Well, in spite of much good ...

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shutterstock_164492462 Anti-Obamacare critics often claim that “every” physician they know hates Obamacare. For instance, pediatric neurosurgeon and GOP Presidential candidate Dr. Ben Carson told Fox News that “he's spoken to hundreds of doctors throughout the country about the Affordable Care Act, and not one of them ‘liked’ President Barack Obama's signature health care law.” Doctors hate Obamacare, it’s alleged, because it ...

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One of the goals of the Affordable Care Act (a.k.a. Obamacare) was to increase access to primary care physicians. The notion is that if people have insurance it would be easier for them to get appointments with primary care physicians. This is because many physicians are unwilling to accept new patients who are uninsured. Further, a key component of the ACA was to increase physician reimbursement for Medicaid because this program ...

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As we enter year two of the Affordable Care Act, we have seen many issues arise during implementation.  Through both executive order and executive memorandum, President Obama has unilaterally changed the law more than 100 times in order to advance his political agenda. When it became important to publicize enrollment and increased coverage of the uninsured, the president, and the ACA provided for an increased payment scale for patients with Medicaid. ...

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shutterstock_160922276 By decisively taking control of the U.S. Senate and increasing their majority in the House of Representatives, the Republicans now have a chance to force some modest changes in the Affordable Care Act, but they will not be able to repeal or reverse it.  But Republican gains in state legislatures and governorships may put the brakes on Medicaid expansion, leaving millions ...

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Just north of Denver, Jefferson County has become a battleground in the fight over performance-based pay for teachers.  The recently elected school board plans on implementing “[a] compensation system that recognizes and rewards our great teachers,” according to school board president Ken Witt.  The response of the local teachers’ union was for teachers to call in sick and enlist students in protesting what they describe as a proposed “patriotic curriculum.” The protests are a convenient ...

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It's been pretty quiet lately on the Obamcare front. So quiet, that there has been a flurry of articles recently over how Obamacare has dropped to a second or even third tier issue and will hardly matter come election-time. Wishful thinking. Obamacare has largely been out of the news cycle for a couple of months but that is about to change. A few thoughts. The 2015 rate increases have been largely modest. Does that prove Obamacare ...

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“We lost our regular doctor with Obamacare, so now we have to see you.” I routinely ask my new patients how they heard about our pediatric office, and this is the answer I dread most. My pediatric practice is a very nice and modern private office, and in my opinion, full of excellent physicians. I entrust my own children’s care to my partners. But none of that matters when you’re the rebound doctor, the ...

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For years, critics of Obamacare (Affordable Care Act), have predicted that it would turn out to be a “train wreck” -- or something worse.  But now we know that by every objective measure, the ACA is working out pretty darn well.  Let’s run through the “train wreck” predictions, and what we now know to actually be the case: Train wreck prediction #1: “Obamacare will lead to skyrocketing health care cost increases and ...

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After more than 40 attempts to pass legislation calling for repeal or significant changes to the health law, opponents of the Affordable Care Act have moved their focus from the House floor to the courthouse. Currently at least four lawsuits are working their way through state and district court -- and one case awaits a nod from the Supreme Court -- that would make it illegal for the federal government ...

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"Health insurance is not health care." That is not original. I borrowed it from Los Angeles County Department of Health Services Director Mitchell Katz's JAMA Internal Medicine editorial about problems with ensuring access to health care for Medicaid recipients whose cheap public insurance usually doesn't even pay doctors enough to recoup costs of care, let alone earn a living. But somehow, during the impassioned political debates that preceded Obamacare, the botched rollout of ...

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The administration has confirmed that the individual policies that were supposed to be cancelled because of Obamacare can now remain in force another two years. For months I have been saying millions of individual health insurance policies will be cancelled by year-end -- most deferred until December because of the carriers' early renewal programs and because of President Obama's request the policies be extended in the states that have allowed it. The ...

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The Republicans have an alternative to Obamacare and they may have given the Democrats a big political gift. The proposal was unveiled by Republican Senators Richard Burr (NC), Tom Coburn (OK), and Orrin Hatch (UT). The Republican plan targets many of the most unpopular parts of the Affordable Care Act such as expensive mandated benefits and the resulting lack of choice, the individual mandate, the employer mandate, and age-rating disruptions. My sense is ...

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