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Solving The Health Care Crisis By Understanding The Uncertainty And Variability Of Health Care

Every day in the U.S. countless experts discuss plans and policies to contain the cost of health care using words and concepts that run counter to our (the public’s) experiences with finding and using care. Most of us ignore the steady stream of proposals until one political party or the other crafts an inflammatory meme that resonates with our fears of not getting what we need. At which point, we leap into action online, in town meetings and in the voting booth. As Uwe Reinhardt noted in his Kimball Lecture at the recent 2011 ABIM Foundation Forum, researchers and policy makers “cannot even discuss the cost-effectiveness of health care without being called Nazi(s).”

Our discomfort with the array of private and public sector proposals to improve health care quality while holding down costs should not be surprising. Most of us hold long-standing, well-documented beliefs about health care that powerfully influence our responses to such plans. For example, many of us believe that:

… if the doctor ordered it or wants to do it, we must need it.

… talking about less expensive treatments makes us feel that others are trying to bargain-shop our care and that scares us.

… clinical care does not vary much among our own doctors and hospitals.

… when we talk about the “quality” of health care we are referring to Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

What Should People Receiving Health Care Be Called? Empowered Patient Vs. Health Care Consumer

“There is a better way – structural reforms that empower patients with greater choices and increase the role of competition in the health-care marketplace.” Rep. Paul Ryan (R-WI) August 3, 2011

The highly charged political debates about reforming American health care have provided tempting opportunities to rename the people who receive health services.  But because the impetus for this change has been prompted by cost and quality concerns of health care payers, researchers and policy experts rather than emanating from us out of our own needs, some odd words have been called into service.  Two phrases commonly used to describe us convey meanings that mischaracterize our experiences and undervalue our needs: “empowered patient” and “health care consumer.”

As one who has done serious time as a patient and who spends serious time listening to talks and reading the literature that use these words to describe us, I ask you to reconsider their use.

“Empowered patient” The fabrication of the verb “to empower” from the noun “power” was used in the civil rights and community development movements to describe a benevolent bestowal of influence on disenfranchised individuals and groups by those who had previously excluded them.  When used in relation to health care, the word perpetuates the idea that we are passive entities, waiting to be gratefully endowed by our clinician or a new policy with the right and ability to act on our own behalf.  Our “empowerment” takes place not as a result of our own will or preference, but rather because we have been given permission to act in a different way by some external agent.

This word is Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

I’m Glad Economists Aren’t Practicing Medicine

I was invited to speak at the National Library of Medicine’s 2010 Annual Conference. Today I heard fellow speaker Uwe Reinhardt, Ph.D., discuss healthcare economics, and although his presentation was entertaining, as a physician I found it to be rather disturbing.

On the one hand I understand Reinhardt’s desire to engage Americans in a rational conversation about limited healthcare resources. My friend Dr. Rich Fogoros has been calling for this for many years. Yet, I was disappointed by his enthusiastic reductionism — that peoples’ lives should be reduced to a mere societal cost equation. He also said that, “When America grows up, it will look a lot more like Europe,” and cited a conversation with Dr. Phil Gingrey as an example of the congressman’s over-valuing human life. Read more »

Is Lack Of Kindness The Greatest Barrier To Healthcare Reform?

Ancient people couldn’t understand why solar eclipses happened, so they looked for explanations that fit what they saw:

A recurring and pervasive embodiment of the eclipse was a dragon, or a demon, who devours the sun. The ancient Chinese would produce great noise and commotion during an eclipse, banging on pots and drums to frighten away the dragon.

They weren’t crazy, although if we accept their explanation, their solutions seem pretty illogical.  I mean, would a dragon big and powerful enough to eat the sun really be scared away by people banging on pots and drums?

I guess I don’t understand the skittishness of giant sun-devouring dragons.

But this the trouble.  When you come at a problem with a faulty premise — and insist on keeping that premise — it leads you down some very strange paths. Read more »

*This blog post was originally published at See First Blog*

Will Decreasing Physician Salaries Reign In Healthcare Costs?

That’s a sensitive topic that progressive reformers often bring up as one way to control health spending.

Over at Slate, Christopher Beam takes a balanced look at the issue. He acknowledges that, yes, American physicians get paid proportionally more than the average employee when compared to other countries.

But that should always come with the caveat that other countries, like Great Britain and France, heavily subsidize medical education, while the average American medical student graduates with debt in excess of $150,000. Furthermore, the cost of medical malpractice insurance is significantly more fiscally burdensome for doctors Stateside.

Listen to Princeton’s Uwe Reinhardt, a favorite economist of health reformers, who says, “doctors’ take-home pay (that is, income minus expenses) amounts to only about 1 percent of overall health care spending, or about $26 billion. That’s a drop in the ocean compared with overhead for insurance companies, billing expenses for doctors’ offices, and advertising for drug companies. The real savings in health care will come from these expenses.”


By the way, thanks to Mr. Beam for including a quote and link from yours truly.

*This blog post was originally published at*

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Latest Book Reviews

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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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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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