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Doing More With Less: Can We Efficiently Reduce Medicare Spending?

On my way to the annual two-day blowout health law seminar put on by Massachusetts Continuing Legal Education (MCLE) on Monday — I was second in the lineup, speaking about post-acute care and some of the innovations in that arena for dual eligibles, among other things — I heard a fascinating piece on NPR on one of the ideas floating around the supercommittee charged with cutting $1.2 trillion from the federal budget.  The idea: increase the minimum age for Medicare eligibility from 65 to 67, and save a bundle for Medicare in the process.

The problem with this deceptively simple idea (Social Security eligibility is migrating from 65 to 67, too, so it seems to be a sensible idea on its face), is that while it would save the federales about $6 billion, net, in 2014, it would cost purchasers of non-Medicare coverage (employers and individuals) about $8 billion, net.  Why?  The 65 and 66 year olds are the spring chickens of Medicare — they actually Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

Doctors And Patients Will Be Harmed By The Debt Ceiling Train Wreck

Watching the negotiations over the debt ceiling legislation is like watching an impending train wreck.

You see a train hurtling down the track, you see an unobservant trucker about to cross, you know that the train engineer and the truck driver have only a few moments to avert disaster, you try to yell and scream to get them to pay attention before disaster strikes—but you have this sinking feeling that your voice won’t be heard until it is too late.

Well, that is how I feel watching the collapsing negotiations over raising the debt ceiling. Responsible persons in both political parties know that a failure by Congress to authorize an increase in the debt ceiling will create incalculable harm to our country, even though some politicians seem to think that default would be no big deal.

But it would be a big deal, and here is why. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Can Crime Be Linked To Cuts In The Mental Health Budget?

From the New York Times today we have a story entitled, “A Schizophrenic, A Slain Worker, Troubling Questions,” a horrible story about a mentally ill man who killed a social worker in his group home. The story highlights the defendant’s longstanding history of violence with several assaults in his past. He once fractured his stepfather’s skull and his first criminal offense involved slashing and robbing a homeless man. (On another post on this blog Rob wondered why the charges were dismissed in that case; from experience I can tell you it’s probably because the victim and only witness was homeless and couldn’t be located several months later when the defendant came to trial.) The defendant, Deshawn Chappell, also used drugs while suffering from schizophrenia. Before the murder he reportedly stopped taking his depot neuroleptic and was symptomatic. The news story also suggested that he knew he was committing a crime: he got rid of the body, disposed of the car and changed out of his bloody clothes. Nevertheless, he was sufficiently symptomatic to be found incompetent to stand trial and was committed to a forensic hospital for treatment and restoration. At his competency hearing the victim’s family thought that the defendant was malingering his symptoms, while the victim’s fiance was distraught enough that he tried to attack Chappell in the courtroom. The point of the Times article appears to be an effort to link the crime to cuts in the Massachusetts mental health budget.

So what do I think about this story? Read more »

*This blog post was originally published at Shrink Rap*

Stents Break The Bank And FDA Gets Bigger Budget

ACP Internist continues its look at subjects important to internal medicine. Today, we follow the money.

Evidence-based medicine
The U.S. could save one-third of the $15 billion spent on stents annually if all doctors followed COURAGE trial conclusions and used generic drugs first, and stents only if pain persists. William Boden, FACP, headed that trial, and now says that reimbursement drives clinical practice. Dartmouth’s Elliott Fisher, MD, says this “perverse incentive” doesn’t improve health care. (Wall Street Journal, CNN)

Physician reimbursement reform
Following the Food and Drug Administration’s record-breaking budget allocation, seven former agency commissioners and interest groups are still saying it’s not enough to make up for years of underfunding. Even regulated industries want more funding to boost the public perception of product safety. (ACP Internist, Los Angeles Times)

*This blog post was originally published at ACP Internist*

Is Healthcare The Engine Of The US Economy?

Commenting on the President’s budget, an editorial in the Times on Feb 2nd juxtaposed three of our nation’s dilemmas: the deficit, jobs and health care.

“President Obama got his priorities mostly right. The deficit, compared with what it could have been, is $120B. That’s a lot of money. But it’s not too much at a time of economic weakness, when deficit spending is needed to put Americans back to work.”

“Medicare and Medicaid will cost $788B; that should be another reminder of why the country needs health care reform.” Read more »

*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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