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Solving The Primary Care Crisis: Are We Training Enough Doctors?

In a few years, every American will be required to have health insurance. As a result, the 32 million people currently uninsured will seek out a personal physician. This role typically is filled by a primary care doctor, like an internist or a family physician.

While passage of the healthcare reform bill affirmed the belief that having health insurance is a right rather than a privilege, the legislation falls short on building a healthcare system capable of absorbing the newly insured.

Universal healthcare coverage is not the same as providing universal access to medical care. Having an insurance card doesn’t guarantee that individuals can actually get care. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

Massachusetts: A Foreshadow For Healthcare Reform?

Paul Levy, President and CEO of Beth Israel Deaconess Medical Center in Boston, suggests we watch Massachusetts for what might be coming with healthcare reform:

Things are playing out just as one might predict in the Massachusetts small business and individual insurance market. The Insurance Commissioner turned down proposed rate increases, the state’s insurers appealed to the courts, and now they can’t write policies.

Perhaps more concerning is what Dennis Byron, a commenter on Mr. Levy’s blog, says about insurance exchanges:

I care because I am one of those who has been cancelled by my insurer (Fallon), solely, I believe, because I am an individual, have been told to go to the exchange, but the exchange does not work. This is a perfect example of why you don’t want the guys that run the registry running your healthcare.

If nothing else, this exposes the risks inherent to mandating unproven policy initiatives on a national scale that have yet to be even worked out in a single state.

*Sigh*

-WesMusings of a cardiologist and cardiac electrophysiologist.

*This blog post was originally published at Dr. Wes*

Why The Healthcare Reform Bill Is Racist

We learn from the healthcare reform bill that the federal government will help subsidize Medicaid funding for all the new patients who qualify, but they will only do it for two years. After that, the states are on their own. Medicaid unfunded liabilities will crush state governments everywhere.

Why is Medicaid so expensive and going bankrupt? I’ll give you one example why. This is played out day after day, night after night in communities all across our country. And the only ones paying for it are you and me. The ones spending all the money have no incentive to stop.

I’m in the ER the other day when I see a chief complaint fly by on the radar. What is that chief complaint, you ask? Let me tell you a story.

Refused By Detox

The patient was so drunk even the community detox center refused him. So how did this play out? The patient was taken by ambulance from his home to a small-town community ER for altered mental status. There he was checked into the ER and seen by a small-town community ER physician, family practice resident, or PA or NP.

Diagnosis: Acute alcohol intoxication. Plan: Discharge to community detox center. Read more »

*This blog post was originally published at The Happy Hospitalist*

New Medical Drama “21” And The Evil SGR Conspiracy To Cut Medicare

Name: “21” (% to be cut from Medicare)

Protagonist: Dr. Rob and a cast of thousands of physicians (Kiefer Sutherland wouldn’t work for such small payment.)

Villain: Evil SGR (Sustainable Growth Rate) conspiracy to cut Medicare by 21% across the board.

Victim: The elderly population depending on Medicare for payment of their medical care.

Plot:  A follow-up to the popular drama “Lost” where members of congress were stranded in Washington D.C. with the task of reforming healthcare without any contact or communication from doctors and patients. This new drama “21″ tells the tragic tale of an industry under siege and a population facing possible disaster.

Already stretched to the limit by the paltry reimbursement from Medicare for primary care office visits, Dr. Rob and his band of physicians is hit by the evil conspiracy of SGR, a secret society whose goal is to harm the elderly people in the country by driving away all people willing to give them care. The congress, tired out from haggling over the healthcare reform bill, allows evil SGR to exert its power in the name of “fiscal responsibility.” Read more »

*This blog post was originally published at Musings of a Distractible Mind*

The Relationships Between Poverty and Healthcare

Readers interested in the relationships between poverty and healthcare will want to read several new postings on the Web.

One is an article about my Rhoades Lecture at the Wayne County Medical Society in Detroit, “Poverty and Healthcare in America.” It is posted on the World Socialist Web Site.

Second is by James Marks, MD, MPH, Vice President of the Robert Wood Johnson Foundation, entitled “The Poor Feel Poorly.” It is posted on the Huffington Post site.

Third is “Health and Healthcare in America’s Poorest City,” a tragic and dramatic portrayal of America’s failures to its own in Detroit, also on the World Socialist Web Site.

Finally, here is a link to a collection of papers on social inequalities in health by the McArthur Network on SES and Health, published by the New York Academy of Medicine under the title, “Biology of Disadvantage.”

*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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