FOR A CASE STUDY on the extremely uphill battle of reining in health care costs in this country, look no further than what’s happening with the dialysis industry in California.
To start, a few background facts you should know:
Dialysis is expensive. Cost estimates for the thrice-weekly blood filtration procedure average around $90,000 annually; this does not account for other health care costs for end-stage renal disease (ESRD) patients, who tend to have multiple chronic medical issues. An act of Congress in 1973 entitled all patients with ESRD to coverage under Medicare, providing a public option for a population long shunned by private insurers.
Then in 2014 the Affordable Care Act came along and prohibited insurers...
THERE'S A FASCINATING investigative piece over at Kaiser Health News by JoNel Aleccia about organs for transplant getting delayed in transit between donor and recipient, thus rendering them unusable.
It’s hard to tell from the various voices in the article if this is actually a significant problem in the organ procurement system, but I suppose one could make the argument that this should count as a health care “never event": no one should miss out on a life-saving transplant because the kidney was accidentally left in a cargo hold area at ATL.
The most surprising revelation in the article, though, is how human organs are transported around the country. There are 58 independent organ procurement organizations (OPOs) in the U...
IMAGINE a looming global crisis that threatens the health of countless people, confounding scientists and governments with its sheer magnitude and complexity and growing at a pace that will quickly exceed our ability to reverse course.
Sounds a little like climate change, right?
The existential threat I’m referring to in this case is microscopic: antibiotic-resistant bacteria and fungi.
In a way, antibiotic resistance is the climate change of medicine. It has potentially lethal outcomes for individuals, but curbing it requires a collective, multinational effort. And unfortunately, summoning the political will to address the problem has proven difficult.
OF ALL THE PEOPLE impacted by President Donald Trump’s executive order suspending immigration from seven Muslim-majority nations, one group is of particular importance to the U.S. health care system: foreign-born doctors and medical trainees.
About one-quarter of the physician workforce is comprised of international medical graduates—280,000 doctors in total, according to the American Medical Association (AMA). Many are here on temporary J-1 or H1-B visas, which are affected by the travel ban.
These doctors help to correct a critical shortage in primary care providers, particularly in rural parts of America. Several factors, including the relatively static number of U.S. residency slots, the expansion of insurance coverage...
DURING THIS RECENT emotional and divisive election cycle, much ink was devoted to analyzing the brave new political world we now live in, a world in which just about anyone with an audience and a platform can issue statements that are accepted as fact by millions of people, often in the face of solid evidence to the contrary.
Two major events in Western politics, the election of Donald Trump and Brexit, the U.K.’s vote to leave the European Union, have seen the elevation of personal belief to a throne once occupied by cold, hard truth, as well as the concomitant devaluation of facts to a mere subjective haziness. It used to be that only beauty was in the eye of...
The attending is chewing out the cardiology fellow, who came on duty just a half hour ago, for something that is not his fault. He—the attending—had asked the overnight fellow to place a pulmonary artery catheter in a patient, only to return in the morning to find that it has not been done.
"That's the problem with you guys these days," he complains. "Everything is just shift work for you—if you don't feel like doing something, you dump it on the people coming on after you."
This attending, though not of the House of God generation, was still old enough to have trained in the days before duty hour restrictions, before terms like "work-life balance" and "wellness" had worked their way into the...
The same day, the American Medical Association issued a press release enthusiastically endorsing Price for the position.
The next day, Dr. Andrew Gurman, the president of the AMA, came to my hospital to give grand rounds. He was shouted down by protestors in the audience, who demanded an explanation for his organization’s support of a public official committed to dismantling the Affordable Care Act and revoking the health insurance of millions of people.
IN THE YEARS since the medical community first got revved up on the idea of “value-based care”—the conceptual antithesis of the “more is better” fee-for-service model—a common target of criticism has been the “routine” physical, one of the most time-honored traditions in medicine.
The attacks come from all angles: The annual check-up isn’t cost-effective, it doesn’t lead to better outcomes, it actually might lead to worse outcomes, it’s a waste of doctors’ time, it’s a waste of patients’ time.
Such is the hostility toward the yearly physical that the Society of General Internal Medicine, as part of the Choosing Wisely campaign, recommended against routine check-ups for asymptomatic patients.
ON THE WAY to work the other day I heard a radio commercial advertising a local hospital network’s cardiac care services. In it, a patient’s daughter related her overwhelmingly positive experience with the hospital team that treated her 90-year-old father with a transcatheter aortic valve replacement (TAVR), a minimally-invasive alternative to open heart surgery.
It was a good commercial. It had all the elements: “I was worried at first, the doctors earned my trust, the surgery went well, everyone was so nice, now Dad is back at home and doing all the things he used to do, thanks to Hospital X.”
The problem with commercials like these is that they’re misleading, and they don’t really tell you anything at all about the hospi...