Getting Better Value from Medicare

Maggie Mahar is an author and journalist on health care. She discusses many issues related to the business of medicine on her blog. Here her paper on Getting Better Value from Medicare. Whether you agree with her or not, this piece highlights many of the problems with Medicare (and health insurance in general) and presents some potential solutions.

P.S. She also does a good job breaking down the McCain and Obama health plans.

Worried sick over our health care

Love the subtitle of this excellent piece from the Chicago Tribune "But candidates don't address why American medical care costs too much and isn't as good as it should be."

"Polls show voters worry a lot about health care and how much they spend on it. Presidential candidates John McCain and Barack Obama have responded by peddling plans they claim will help more Americans attain and afford care.But neither candidate has focused publicly on treating the real problem: why American medical care costs too much and isn't as good as it should be."

Defensive Medicine Gets Offensive

Dr. Benjamin Brewer is a blogger for the Wall Street Journal. His insightful piece on the cost of defensive medicine get at the heart of the matter of what physicians face in day to day practice. He estimates that defesive medicine accounts for 10% of health care costs, but I believe this is probably an underestimate.

Paying Doctors and Lawyers

How do doctors and lawyers get paid? Very differently! This post points out some of the differences.
The reality is that our current health insurance system does not reimburse well for cognitive aspects of care, and doesn't reimburse at all for things like phone calls, paper work, etc.
Many primary care physicians have done these later services for free out of professional obligation towards their patients. However, this will not likely be the case for much longer. Physicians will either start billing patients directly or demand that everything be done in an office visit. Not the most effective way to practice medicine, but it will likely help pay the bills.

It's not our fault!

It's not our fault! claims physician Dr. Rob on his blog. It's the systems.
This post really explains how the business of medicine has changed the doctor patient relationship, and probably explains why so many of our students don't want to go into primary care.

Factors Associated with Medical Students' Career Choice Regarding Internal Medicine

OK, I am biased regarding the study, since I am one of the investigators. Nonetheless, the paper on student interest in Internal Medicine shows that some of the business aspects of medicine, not only physician pay but also how services are reimbursed and deliver, are having a dramatic impact on students' desire to choose IM and primary care fields. The paper is published in today's JAMA educational issue and is titled Factors Associated with Medical Students' Career Choice Regarding Internal Medicine. I have published my own comments on my blog.

The Pitfalls of Linking Doctors’ Pay to Performance

Excellent article in the New York times about the pay for performance initiative and the unintended consequences of trying to legislate professional behavior.

Americans Who Have Insurance —But Still No Access To Care, Part I

This is an outstanding post from journalist Maggie Mahar who talks about not the 47 million who lack insurance, but the bigger problem in health care for those who have insurance. Here piece summarizes many of the problems nicely, particular the importance of a robust primary care system, and why this is in extreme jeopardy. The piece mentions a NEJM published panel discussion that included GW's own Sara Rosenbaum and mentions and upcomming JAMA study that our recently graduated seniors participated in.

The True Cost of Care

Thanks to Cynthia Kahn for sending me a link to this article on the complicated relationship between the market and government health programs. As you listen to the debates on health care, you will indeed here dichotomies of "private" vs. "public" solutions, as well a negative characterizations of "government run" and "socialized" medicine. This article demonstrates that these disctinctions and definitions are not all that clear.

Remarks by Dr. Claudia Fegan at Reception at the DNC in Denver

Here are the remarks by Dr. Claudia Fegan at a reception at the Democratic National Convention in Denver, last week. It was forwared to me by Dr. Keimowitz and posted on the Physician's for a National Health Program's web site. I am not necessarily advocating for a universal, single payer system, but Dr. Fegan's words are strong, and this clearly shows one role that business has had in medicine.