Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Emergiblog In DC: The Panel, the Politics and the Ce-Ment Pond

RyanPodiumThis is Congressman Paul Ryan of Wisconsin, speaking at the Better Health “Putting Patients First” event  in D.C.

I should talk about how passionately he spoke about health care reform (he did), about why he does not believe government should be running health care (he doesn’t) or that he took the time to come and speak at 8 am even though he had been up until 2 am working on the health care bill (he did) or that he spoke right up until he – literally- had to run back to the House to vote (he did).

And I will talk about these things.

But first, let me state the obvious and get it out of the way so that I can go on to discuss the serious nature of the health care reform debate before us.


Seriously, is it just me or are politicians getting better looking?

There. Now I can move on to the meat of the matter.

(I had to say it because you all know I was thinking it!)


This event marked my first time in Washington, and just being there is awe-inspiring. Seeing the White House from the car window took my breath away, literally. I felt like Ellie May Clampett marveling at the ce-ment pond.  The National Press Club is a museum in and of itself.  Mother Jones and I were hoping we’d catch a glimpse of Sanjay Gupta, but he must have been off doing neurosurgery or something.


By now, you’ve probably read who was on the panel (Dr. Wes, DrRich, Dr.Rob, Dr.Kevin, me, and Better Health contributors Dr. Alan Dappen, Valerie Tinley, NP and “token” – his words, LOL – surgeon Dr. James Herndon).

I will tell you straight up that I learned much more than I contributed.

The panel shot from the hip and spoke from the heart. Some of us had notes, some of us illustrated our comments with anecdotes and one of us (*cough*) had no clue what was going to come out of her mouth until that moment.

I’ll give you a hint….it wasn’t Valerie…..


For the record, those of us on the panel were not told what to say, how to say it or what to believe, nor were we chosen based on what we do believe.  Some discussed concepts that should be taken into account no matter what plan we end up with, others were definitely against a single payer plan run by the government (*raising hand*).

The inefficiencies of national health plans of other countries were illustrated/discussed.  This hit me later: we should look at what works in those plans, not just what is wrong with them.  We don’t have to emulate them, just learn from them, and that includes the good and the bad.  It also applies to any universal form of coverage, not just a government-run plan.

Wish I had said that at the time.

So much for thinking on my feet (or on my butt, as the case may be).


There was some controversy about not having any patient bloggers on the panel.  There should have been. I hope that, as a nurse, I spoke for patients, but it was not the same as having someone there who navigates the system as a patient every single day.


The patient bloggers were in the audience, though, and if you go to Twitter you can find the live tweeting at “#patientsfirst”. There was a pretty healthy debate going on in the Twitterverse while the panel was up on the dais.

Here I am with Lisa Emrich (Brass and Ivory) and Kerri Morrone Sparling (Six Until Me). Duncan Cross was also there, but my pic was blurry!


While health care reform has been a hot topic for awhile, it was especially acute this week as the President was actively promoting a government run health care system and there seemed to be a huge sense of urgency to get what is called “America’s Affordable Health Choices Act of 2009″ passed ASAP.

The bill is over 1000 pages long.

I just downloaded it.

And Congress has not read it.

Folks, our representatives are being asked to pass legislation they have not had a chance to read.

While I will admit to being a bit unsure of exactly what happens in the Beltway (Civics classes and Schoolhouse Rock’s “I’m Just a Bill” notwithstanding), that can’t possibly be business as usual.

Can it?


I’ll say one thing: no matter what we believe, why we believe it or what our role is in the health care system, it is a conversation rife with strong opinions and passionate debate.

And, in the end, because we are all patients in one form or another at some point in our lives, the conversation is about us.

So, when you hear the phrase “putting patients first”, think of it as “putting me first”.

That may help you get a foothold in the morass of information that is the health care debate.

It worked for me.

*This blog post was originally published at Emergiblog*

Thoughts From The Official Twitter Reporter Of The Medblogger National Press Club Event

“The doctor will see you now.” I’m hoping to hear those golden words soon because I’m sitting in my primary care physician’s office on my day off from work. I’m lucky that I have a primary care physician who is still taking new patients. Did you know that a lot of primary care doctors are struggling to keep their doors open? That was just one of the issues that healthcare bloggers were talking about last week in Washington, D.C.

I was honored to receive an invitation to serve as the official Twitter Reporter for Better Health’s Putting Patients First event. The summit on healthcare reform took place last week at the National Press Club in Washington, D.C. I sat under the Twitter Gallery sign (pictured above) during the conference. The experience was amazing, but I’d like to make two suggestions to the management of the National Press Club. First, please install more electric wall sockets in your building. There were no wall sockets to plug my computer into during the conference, so my battery almost went dead while I was tweeting. Next, please have Anderson Cooper onsite when I’m in the building. He’s hot.

I was happy to finally get to meet the people behind the blogs that I read everyday. I met Kim from Emergiblog, Dr. Wes, DrRich, Dr.Rob, Dr.Kevin, and Better Health contributors Dr. Alan Dappen, Valerie Tinley, NP and Dr. James Herndon. I sat in the Twitter Gallery with Kerri Morrone Sparling from Six Until Me , Dr. Edwin Leap, and Evan Falchuk from See First Blog. I also got to meet Lisa Emrich from Brass and Ivory, and Duncan Cross. I think Kim was a knockout in her new Calvin Klein suit. Note to Fox News: You need to hire Kim as one of your Sunday morning talking heads. She has a lot of good ideas about healthcare reform and she looked right at home at the National Press Club. She also comes complete with her own professional wardrobe.

Every blogger expressed their personal viewpoint about healthcare reform at the conference. The bloggers were not told what to say, and I was not told what to tweet, or what comments to make before, during, or after the conference. We came to D.C. to add our voices to the healthcare debate. No, I didn’t agree with everything that I heard during the conference. I thought a lot of the information presented by the keynote speakers was bunk. I’m in favor of a public option healthcare reform bill, and I don’t like the disinformation being spread via partisan politics about this important issue. I get infuriated when members of Congress from both sides of the aisle play partisan politics while my patients languish in a healthcare system that’s literally killing them. I’m really very frustrated, and I’m just like everyone else in this country that wants to give our politicians a good swift kick in the butt. What gives me hope is seeing good people from both sides of this debate coming together at a healthcare blogger conference in Washington, D.C. Healthcare providers truly want to put patients first.

*This blog post was originally published at Nurse Ratched's Place*

KevinMD Addresses Crowd At National Press Club About Primary Care Crisis

The following are my prepared remarks at Health Care Reform: Putting Patients First, held at the National Press Club in Washington, DC, on July 17th, 2009.

President Obama recently declared that, “We are not a nation that accepts nearly 46 million uninsured men, women, and children.” And indeed, finding a way to provide universal health coverage to every American is one of the focal points in today’s health care debate. There are a variety of ways we can achieve this, ranging from a Medicare for all, single payer system to requiring everyone to purchase health insurance. But no solution can work unless we first deal with the shortage of primary care doctors.

After all, what good is having health insurance if you can’t find a doctor to see you?

As a primary care physician in Nashua, New Hampshire, a city that borders the state of Massachusetts, I have had the luxury of closely observing that state’s health reform efforts. And to their credit, Massachusetts currently enjoys near-universal health coverage, in part because of the mandate requiring every resident to obtain health insurance. Many policy experts are predicting that a national plan will closely emulate the Massachusetts model, so it’s worth noting any potential consequences.

Since reform began in 2006, the Massachusetts health care system has been inundated with almost half a million new, previously uninsured, patients, and the demand for medical services has rapidly outpaced physician supply. The wait to see a new primary care doctor is almost 2 months, leading patients to use the emergency room more often for routine visits. In fact, since the universal coverage law was passed, Massachusetts emergency rooms have reported a 7 percent increase in volume, which markedly inflates costs when you consider that treating simple conditions in the ER can be exponentially more expensive than an office visit. It’s no wonder that the plan has placed significant fiscal strain on the state’s budget, which is struggling to contain soaring health spending.

This affects hospitals like Boston Medical Center, which primarily serves the city’s poor. The state’s mandatory health insurance law is causing the medical center, according to a front page story in last Sunday’s Boston Globe, to brace “for dramatic financial losses, which some fear will force it to slash programs and jeopardize care for thousands of poverty-stricken families.”

Furthermore, consider the words of family physician Kate Atkinson, who practices in Amherst, Massachusetts. She had decided to temporarily accept new patients, as 18 doctors in her area had recently closed their practices or moved away.

“There were so many people waiting to get in, it was like opening the floodgates,” she says. “Most of these patients hadn’t seen the doctor in a long time so they had a lot of complicated problems. We literally have 10 calls a day from patients crying and begging.”

She closed her practice to new patients 6 weeks later.

I witness this phenomenon myself every day, with patients from Massachusetts routinely crossing the border to New Hampshire looking for a new primary care doctor.  These are people with chronic conditions like heart disease, diabetes, depression, and high blood pressure – all who need a regular physician to follow them.

And keep in mind that Massachusetts has the highest density of doctors per capita in the country. What do you think will happen to states that do not have a comparable supply of physicians?

Moving away from Massachusetts, let’s look at two other examples where universal coverage was promised before ensuring adequate primary care access. One would be our military veterans, who are guaranteed health care through the Department of Veterans Affairs, also known as the VA. Earlier this decade, the wait to see a primary care doctor in the VA routinely exceeded 50 days in various parts of the country. Although that number has improved, a recent report by the Office of the Inspector General concluded that more than a third of veterans still waited a month or more to see a doctor. And with tens of thousands returning home from Iraq and Afghanistan straining an already overburdened VA health system, it’s no wonder that my practice in Nashua, New Hampshire sees a fair amount of veterans who are unable to obtain timely care from their local VA clinic up north in Manchester, or from down in Boston.

Next, consider the care Native Americans receive via the Indian Health Service. Despite having guaranteed health care coverage, President Obama himself cites Indian reservations in South Dakota that have some of the lowest life expectancies in the Western Hemisphere. American Indians are twice as likely to die from diabetes when compared to whites, 60 percent more likely to have a stroke, 30 percent more likely to have high blood pressure and 20 percent more likely to have heart disease. Although each of these conditions can be treated or prevented with timely primary care, according to a 2005 Government Accountability Office report, patient waits within the Indian Health Service for routine women’s care and general physicals lasted anywhere between two and six months.

It is encouraging that the President and members of Congress recognize the threat that the primary care shortage poses to their health reform efforts. But some of the solutions being discussed, such as reducing medical school debt, increasing funding to the National Health Service Corps, and training more mid-level providers like nurse practitioners and physician assistants, fall woefully short. None will have any immediate impact, which will be especially critical if there’s a distinct possibility that already overwhelmed primary care doctors will be responsible for almost 50 million additional, newly insured, patients overnight.

Instead, we need to value primary care, and make it central to our health system. Rather than being encouraged to squeeze in appointments and rush through office visits, doctors need to be incentivized to practice patient-focused primary care, including, managing chronic diseases, providing preventive medicine guidance, and taking the time to counsel patients.

There’s no question that we need to find a way to provide health coverage for every American. But we must do so in a responsible manner, and that starts with ensuring that we have a strong primary care system first.

*This blog post was originally published at*

Congressman Paul Ryan’s Speech To Medical Bloggers At The National Press Club

Congressman Paul Ryan (R-WI)

Congressman Paul Ryan (R-WI)

*** Congressman Paul Ryan addressed the crowd at Better Health’s “Healthcare Reform: Putting Patients First” event. This is a transcript of his speech: ***

This event is a landmark in how we get discussion and debate going in the 21st century.  We are communicating with the grass roots, with medical bloggers here in this room and across the country.

Let me tell you this: I don’t want government interfering in the relationship between doctors and patients…and I don’t want insurance companies interfering either!  I want a vibrant health care market that lets patients choose the health care options that are right for them and their loved ones.  I want a free market democracy that puts patients first.  We can have this, and I’ll say something more about that in a minute.

Right now Congress is rushing through a health care overhaul that goes in the opposite direction.  It’s important to analyze the relative financial costs and benefits of these proposals, but our greater challenge is not the dollars and cents.  It goes to the issue of continuing the tradition of excellent health care that medical practitioners now provide.  It’s about the equal dignity of each human person…and the future of America as a free society.  The American character, and the principles of freedom & democracy which protect & preserve it, may be lost beyond recovery if Congress chooses the wrong path on health care reform—the path down which I believe the Obama Administration seems determined to lead our country.

Public health has always been a government priority.  Our Constitution’s Framers saw every individual as having a “right of personal security” which includes being protected against acts that may harm personal health.  This right is part of the natural right to life, and it is government’s very purpose to secure our natural rights to live, to be free, and to pursue happiness.

Now here is where believers in big government make their big mistake.  The right of each person to protection of health does not imply that government must provide health care.  The right to have food in order to live doesn’t require government to own the farms and raise the crops.  Government’s obligation is normally met by establishing the conditions for free markets to thrive.  Societies with economic freedom almost always have a growing abundance of goods and services at affordable costs for the largest number.  When free markets seem to be failing to meet this test – and I’d argue today’s health care delivery is an example – government should not supply the need itself.  It should correct its own interventions and liberate choice and competition.

We know from survey after survey that a vast majority of Americans are personally satisfied with the quality of their own health care.  The problem is really with health care delivery, which is growing too costly and leaving many people without coverage.  The proponents of government-run health care claim there are only two alternatives: either enact their plan or do nothing.  This is false. Government bureaucracy is not the answer to insurance company bureaucracy.

An authentic solution to the problem of affordability should be guided by the principles of moral and political freedom… respect doctor and patient privacy…restrain spending…and channel the energy of our free market system, not dry it up.   There is no lack of sensible alternative solutions proposed by Republicans to put patients first. Senators Coburn and Burr, and Congressman Nunes and I have offered one, called “The Patients’ Choice Act.”  It’s an example of how to eliminate government-driven market distortions that exclude many from affordable health care delivery.  More uninsured Americans can be covered by spending current dollars more wisely and efficiently than by throwing trillions more at the problem.  Our health care delivery alternatives are based on timeless American moral and political truths.

In essence, we believe that the dollars and decisions should flow through the individual patient, not from the government.  I want to see a market where providers truly compete against each other for our business as consumers and patients – not a bureaucratized system where health care providers vie for government favor as patients wait in line. Read more »

Better Health Sponsors Blogger-Politician Healthcare Reform Discussion At National Press Club

To join the event live, please contact Seating is limited…


Congressman Paul Ryan


Media Personality Rea Blakey

Thursday, July 9, 2009

Health Care Reform: Putting Patients First

Elected Officials Join America’s Top Medical Bloggers to Discuss the Real,

Clinical Impact of Health Care Reform

    WHAT: As the health care debate heats up on the Hill, join Representative Paul Ryan as he sits down with top medical bloggers from across the country to discuss health care reform and its impact on practicing clinicians. This keynote discussion will be followed by two panels of physician and nurse bloggers who will highlight the importance of putting patients first.  Topics covered will include key barriers to health care quality, affordability, and access as well as the potential pitfalls of a new public plan and ways to fix the current system without investing billions in a new one.

WHEN: Friday, July 17, 9:00 a.m. to 12:00 p.m.
WHERE: The National Press Club, Broadcast Operations Center 4th Floor, 529 14th St. NW, Washington, DC
WHO: Keynote: Representative Paul Ryan, (R-WI), House Budget Committee Ranking MemberModerator: Rea Blakey, Emmy award-winning health reporter and news anchor, previously with ABC, CNN, and now with Discovery Health

Host: Val Jones, M.D., CEO and Founder of Better Health

Policy Expert: Robert Goldberg, Ph.D., co-founder and vice president of the Center for Medicine in the Public Interest (CMPI)

Primary Care Panelists:

Kevin Pho, M.D., Internist and author of KevinMD

Rob Lamberts, M.D., Med/Peds specialist and author of Musings of a Distractible Mind

Alan Dappen, M.D., Family Physician and Better Health contributor

Valerie Tinley, N.P., Nurse Practitioner and Better Health contributor

Specialty Care Panelists:

Kim McAllister, R.N., Emergency Medicine nurse and author of Emergiblog

Westby Fisher, M.D., Cardiac Electrophysiologist and author of Dr.Wes

Rich Fogoros, M.D., Cardiologist and author of CovertRationingBlog

And Fixing American Healthcare

Jim Herndon, M.D., past president of the American Academy of Orthopaedic Surgeons and Better Health contributor


For more information on Better Health, visit

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…

Read more »

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…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

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…

Read more »

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…

Read more »

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…

Read more »

See all book reviews »