HEALTHY ONLINE

I like reading Dr. Kevin Pho’s blog . I read, or at the very least scan, his diverse collection of essays every day. The posts themselves are mostly good, but I like reading the comments section more, and most of all I like the anonymous comments, because those are rare insights into how regular, everyday doctors think. I read Health Affairs and JAMA and NEJM and the New York Times to figure out what “thought leaders” say, and medical associations’ websites for “leadership” messaging. And guess what? The anonymous, and sometimes not so anonymous, opinions of the rank and file are diametrically opposed to official party lines. Of course, most doctors don’t read or comment on blogs, don’t speak at conferences and don’t write opinion pieces for mass media outlets. Over the years, I spoke with many members of the silent majority, not a representative sample by any means, but a good indicator that anonymous commenters are closer to being representative of popular opinion than their much mor...

I was reading the popular HIStalk health IT news/opinion site the other day when I ran into a blurb stating that beginning in 2014, a new “North Carolina law requires hospitals with EHRs to connect to the state’s HIE and submit data on services paid for with Medicaid funds”. For the uninitiated, HIE stands for Health Information Exchange, and in this context it refers to a federally funded organization whose mission is to facilitate clinical information exchange in the State. There are similar organizations in most every State, funded back in 2009, alongside Meaningful Use and other shovel ready economic stimulus activities, through the ARRA and its HITECH Act. The noble goal of HIE organizations everywhere is to improve care for patients by simplifying interoperability between disparate EHR technologies, allowing clinicians timely access to relevant, up-to-date medical information at the point of care. It makes perfect sense that North Carolina would like to “nudge” hospitals into sh...

It’s that time of year when the OECD publishes its " Health at a Glance " comparative health indicators, and The Commonwealth Fund follows with an international survey of health care related activities. A cursory review of these documents always ends up with the customary assessment of American health care: much more expensive than all others, wasteful and inefficient. But this is the month of December, and health care workers are people too, so maybe a short moratorium on bad news and criticism may be in order, allowing these folks to pursue a little bit of happiness during the Holiday season. A deeper dive into the vast amounts of data in the OECD report exposes all sorts of measures where the United States health system performs magnificently. Therefore, without further ado, let’s look at the top 10 achievements of American health care. Number 10: Generic prescription rates in America are highest in the world. In fact the rates are so high, that the OECD didn’t dare show...

In a New York Times opinion piece Scott Gottlieb, MD joins forces with Ezekiel Emanuel, MD to inform us all that “No, There Won’t Be a Doctor Shortage”, and just to clarify, Dr. Gottlieb goes on to say in a subsequent Forbes article “That Doesn't Mean You'll Have Access To Them”.  Doctors, it seems, are destined to be like the lights of Hanukkah candles – only for looking at, not for using. As tempting as it may be, let’s not hastily assume that the more fortunate members of society, like the authors of these articles, are brazenly suggesting that maintaining a good supply of doctors for themselves, is as simple as denying everybody else access to physicians. Of course not. To dispel our concerns that an aging population and expansion of health insurance may somehow require more doctors, Drs. Gottlieb and Emanuel urge us to look at the great State of Massachusetts where universal insurance has been in place for years and no shortages have been observed. According to the Censu...

As Obamacare is winding its way through a hellish bureaucratic labyrinth of its own creation, accompanied by cheers and boos from the blood thirsty spectator crowds, confusion, fear, trepidation, despair and exhilaration, are gripping America’s doctors all at once, because whatever else is accomplished in the next decade, medicine will never be the same. At the confluence of cutting edge technology, great poverty and unimaginable fortunes, a new vision for the practice of medicine is beginning to emerge. Medicine was formed during times when sickness was never far from death. It was devised by old men who went to bed every night thinking that they may never awaken, and it was institutionalized by women who shunned life’s earthly pleasures. They understood the fears of old age, the loneliness of disease, and the comfort and serenity that come with putting your life in the hands of God, when all was said and done. They built houses for the poor and sick and downtrodden, with larger than...

The Sustainable Growth Rate (SGR) formula was enacted into law in 1997 to tie Medicare payment for services to physicians to the overall status of the economy. Basically, if the U.S. Gross Domestic Product (GDP) does well, doctors get more money, and if it does poorly, doctors get less money for the same service. A decade of tinkering with legislation for circumventing the application of the SGR formula, preferably a few days before or after it was due to take effect, resulted in failure to save $150 billion dollars over the last decade. For the next decades, the Congressional Budget Office estimates that avoidance of the SGR formula will fail to save us a mere $139 billion, so this should be a perfect time to let bygones be bygones and come up with a more gentle strategy to cut physicians’ Medicare reimbursement. More gentle, because if we do decide to cash in on our SGR savings on January 1st, doctors are looking at an approximately 24.4% cut in the Medicare fee schedule for 2014. B...

If you are a staunch conservative who believes that free markets should solve health care, or that poor people should work harder and have more skin in the game, or that governments should stick to building armies, you don’t need to read this post, unless of course you enjoy being aggravated by clueless liberals. If you are one of the talking heads posing as a progressive, while repeating the empty slogans of Obamacare (e.g. no one can be denied care any longer, children under the age of 26 can stay on parents’ plans, not perfect but a good a first step, etc.), you should probably not read this either, because you are far beyond the point where independent thinking is an option. If you are none of the above, and have a few minutes between updates on the completely irrelevant status of the Obamacare website, you may want to read on. Obamacare Strengthens Medicaid Medicaid is the public health insurance plan for the poor. Medicaid’s continued existence is an affront to human decency. Unl...