HEALTHY ONLINE

As I am writing this, you don’t yet exist, and I hope you never will. As I am writing this, at least half a dozen people are still standing in the quadrennial jousting tournament we call elections. Elections in America is that brief and fleeting period of time when Washington DC turns its gaze to the rest of the country feigning passionate interest in our lives. This time around America is staring back at you in seething anger. In the olden days, this would be the proper time for tar and feathers, for pitchforks, and for burning you in effigy. Nowadays, this is the time for Twitter trolling and lack of what you call decorum in public discourse. Like all well fed, self-described benevolent aristocrats in the past, you seem surprised at our indifference to your accomplishments, and shocked at our plebian preference for rough and tumble champions of our own choosing. Try not to worry too much. Time, and the robust voter suppression machine you and your “donors” built over centuries of enl...

The Centers for Medicare and Medicaid Services (CMS) is working hard to transition physicians’ payments from volume to value of services. The current Acting Administrator at CMS is a former top executive at United Healthcare, a commercial health insurance corporation. The previous Administrator at CMS is currently the president and CEO of America’s Health Insurance Plans (AHIP), which is the dominant health insurance lobbying group. It may therefore behoove us to rephrase the opening sentence: The corporate-government health care conglomerate is working hard to transition physicians’ payments from volume to value of services. In response, health care delivery corporations, which are employing large numbers of physicians, are joining their forces through mergers, acquisitions and other arrangements to better manage the transition of physician payments from volume based to value based models. When you ask the architects of this supposedly tectonic shift from volume to value to explain th...

In his last State of the Union address, President Obama stated that “anyone claiming that America’s economy is in decline is peddling fiction”. I agree. The American economy has roared back from the Great Recession with 14 million new jobs, a ridiculously low unemployment rate, a booming stock market and 57 brand new American billionaires in 2015 alone. The American people on the other hand are in a completely different boat. Almost a third of us are not working. Half of us have practically no savings and a record number is surviving on public assistance. Wages are stagnating and the middle class is shrinking. Student debt is skyrocketing and 20% of our kids live in poverty. Whereas in the immediate past the economy and the welfare of the people used to be one and the same, nowadays these terms have little if anything to do with each other. The President did acknowledge that “the economy has been changing in profound ways” and therefore “a lot of Americans feel anxious”. To allay our...

At the J.P. Morgan Healthcare Conference in San Francisco, Mr. Andrew Slavitt , acting administrator at the Centers for Medicare & Medicaid Services (CMS), announced on January 11th that “The meaningful use program as it has existed will now effectively be over, and replaced with something better”, and later clarified on Twitter that “In 2016, MU as it has existed-- with MACRA-- will now be effectively over and replaced with something better”. Meaningful Use is dead. Just like that. No apologies. No nothing. As someone who’s been lamenting the havoc wreaked by the program on both doctors and patients, I should be elated nevertheless. Well, I am not. Let’s start with appearances. The J.P. Morgan Healthcare Conference is the “largest and most informative healthcare investment symposium in the industry which brings together global industry leaders, emerging fast-growth companies, innovative technology creators, globally minded service providers, and members of the investment commun...

Click here to view: Reading of the Donald J. Trump children's book by Jimmy Kimmel We don’t win anymore in health care. After repeatedly drilling in our heads that America’s sick care system is a disaster, that those who care for the sick are incompetent and stupid, and that the sick themselves are losers, Meaningful Use was advertised as the means by which technology will make health care great again. The program has been in place for 5 years and the great promise of Meaningful Use is just around the same corner it was back in 2011. The only measurable changes from the pre Meaningful Use era are the billions of dollars subtracted from our treasury and the minutes subtracted from our time with our doctors, balanced only by the expenses added to our medical bills and the misery added to physicians’ professional lives. Meaningful Use, a metastasizing web of mandates, regulations, exclusions, incentives and penalties, is conveniently defined in the abstract as a set of indisputably wh...

It was a dark and stormy night. My computer didn’t catch fire while typing the previous sentence. No alarms were triggered warning me about the quality of such opening. I wasn’t prompted to select subjects and predicates from dropdown lists. I typed the entire sentence, letter by letter, not at all dissimilar to its first rendering back in 1830. Computer software in general, and Microsoft Word in particular, magically removed the hassles of quills, ink, paper, blotters, sharpeners, ribbons, whiteout, carbon paper, dictionaries, and all the cumbersome ancillary paraphernalia needed to support authoring, but made no attempt to minimize the cognitive effort associated with writing well.  Authoring great literature today requires as much talent and mastery as it did in the days of Edward Bulwer-Lytton.                               ...

Whenever you read a health care article, paper, book, blog post or even tweet, that substitutes the term consumers for patients, and the term providers for doctors, or physicians, you should inherently assume that the authors are advocating for something that will not benefit you or the people you care for, something that will most likely harm you financially and if you happen to be less than independently wealthy it will harm you physically in real and immediate ways. These advocacy pieces usually come dressed in the sheep clothing of empowerment, liberation, convenience, savings and democratization, but underneath it all, and often unbeknownst to the authors themselves, there is always an ominous incarnation of the wolf of Wall Street. Whenever you read something emanating from selfless, do-gooder (usually public or supposedly not-for-profit, but certainly for-revenue) institutions, alliances, consortia, coalitions, and such, note how you are always addressed in the third-person plur...