HEALTHY ONLINE

There are close to a quarter million primary care physicians in the U.S., more than any other individual specialty, and about half the total number of all specialists combined. Yet, somehow, primary care seems to lack the power and social influence necessary to chart its own professional course. As the availability and granularity of specialist physicians increased, the value proposition of a generalist primary care doctor seems to have become unclear to those who pay for medical services and to physicians as well. As a result, primary care medicine was forced to price itself lower than specialized medicine, and now it is being forced to compete with a variety of other business models. Primary care seems to be experiencing an identity crisis, unable to decide if it is the cornerstone of medicine, or an antiquated service whose time has passed. What is primary care? The primary care name itself can be understood in two very different ways, depending on how you translate the word primar...

Did you know that the Ford Motor Company which created the first mass produced horseless carriage in 1908 is one of the largest manufacturers of automobiles a century later? Did you notice how cars today look almost the same as the Model T? They are all made of metal, have four wheels, a steering wheel, a dashboard, a windshield, two rows of seats and an engine. Closer inspection reveals that all newer car manufacturers make cars that look and feel just like the cars made by the Ford Motor Company. And they all drive on roads and use wheels, wheels, the hottest disruptive innovation of the Neolithic era. Truly disruptive innovation, unlike its short lived destructive cousins, stretches across millennia of useful applications. Strangely enough, beds and tables and chairs, and the houses they furnish, look basically the same as those used by Louis XIV. Bread loaves and wine look the same too, and so do fishes. Another thing that hasn’t changed much from the beginning of time is the ferti...

If F. A. Hayek were alive today, he would support the revival of labor unions in general and professional labor unions in particular. Towards the end of the Second World War, Hayek wrote a book warning us all that allowing governments to engage in extensive central planning of economic activities is nothing more than a road to serfdom for humanity. F.A. Hayek was not an Ayn Rand sociopath, and he included in his vision reasonable government regulation of markets, strong safety nets, and something that looks awfully similar to the avant-garde “ guaranteed basic income ” discussed nowadays in some European countries. Unfortunately for us, and kudos to Prof. Hayek, seventy years after the publication of his book, we are well on our way to universal indentured servitude. Ordinary Citizens In September 2014, Martin Gilens and Benjamin Page, two Princeton researchers, published the results of a longitudinal study on policy decisions in the U.S. from 1981 to 2002. After crunching enormous am...

You may not be ready to admit it even to yourself, but you know it’s changing. Permanently. Some say it’s for the better. Others say it’s for the worse. Most don’t really care much one way or the other. After all, health care has been evolving and changing over thousands of years, and the experts best positioned to evaluate the health care turmoil of our times are yet to be born. Those of us who are now in the eye of the storm have an understandable tendency to analyze high velocity changes, such as the number of uninsured or the number of hospital mergers, but the slower and more permanent changes are unfolding deep below the surface. Perhaps the most enduring alteration to what we call health care is the diminishment of medicine as a whole, and the fading importance of its practitioners, starting with the outer edges of primary care. The “Looming” Primary Care Physician Shortage We’ve been experiencing a “looming” primary care doctor shortage for several decades now, and so far it so...