“CONSUMER-DRIVEN” HEALTH CARE VS. “PATIENT CENTERED” CARE You have detailed how and why a sound, ongoing doctor—patient relationship is the foundation of health care. These relationships, mutual trusts, must be or become unconflicted by the dollar bill. HYBRID HEALTH CARE SYSTEMS In “The French Way of Cancer Treatment,” Anya Schiffrin writes eloquently about the care that her father, Andre Schiffrin, received when he was diagnosed with stage-four-pancreatic cancer, and decided that he wanted to go to France, his birthplace, for treatment. Schiffrin had been undergoing chemotherapy at New York City’s Memorial Sloane Kettering, and his family was concerned: how

ABOUT MAGGIE MAHAR

Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the null.com blog and she’ll continue to write on both websites.. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex LEARNING FROM LIPOZENE: THE ANATOMY OF A DRUG SCAM Jeff and Robert, It is indeed a sad state of affairs, and over the past decade, things have gotten much worse. We essentially allow ourselves to be taken for a ride just as exploitive as Lipozene because our institutions are often unwilling or unable to do their jobs when it comes to containing costs, protecting the public interest, and generally making sure that the business of medicine

doesn

MAKING SENSE OF HEALTH CARE THROUGH ANALOGIES think the metaphor that works best is from Rashomon where folks touching different parts of the elephant (pardon my politics) come away with very different impressions. the majority of americans are insured and care about their rising costs, but have less interest in the problems of the uninsured. many analysts believe too much is done by an irrational and cost-insensitive system, but that A VERY OPEN LETTER FROM AN ONCOLOGIST Robert– As Peter point out, if you explains the risks and benefits to patients clearly and carefully (and I’m not talking about a 15-minute discussion) most will decide that they don’t want to put themselves through a treatment that offers very, very little hope–or hope of an extra two months of poor-quality life.. ATUL GAWANDE: “LETTING GO: WHAT SHOULD MEDICINE DO WHEN IT Summary: In the August 2 issue of the New Yorker, Boston surgeon Atul Gawande writes about the ambiguities that plague end-of-life care. With the candor that makes his writing both so credible and so moving, he acknowledges that, as a physician, he too has great difficulty “letting go” of a dying patient. Ultimately, Gawande suggests, the problem with the way we deal with death today is WHEN PATIENTS ARE BLIND-SIDED BY PHANTOM PROVIDERS One of the big issues not mentioned in the post is the issue of exclusive privileges. In order to assure sufficient coverage and comply with federal and state rules and regs, most hospitals grant hospital based medical groups (the RAPs and ER docs) exclusive privileges which grants one medical group sole rights to treat the hospital’s patients. STENT SCANDAL: A SHOCKING STORY, BUT NOT NEWS Over the weekend, the New York Times published a head-turning tale about Dr. Mark Midei, a star cardiologist at St. Joseph Medical Center in Townson, Maryland. According to federal investigators, Dr. Midei implanted potentially dangerous cardiac stents in the arteries of as many as 585 patients who didn’t need them. THE DOCTOR WHO INVENTED PSA TEST CALLS IT “A PROFIT-DRIVEN Times are changing. Americans are beginning to acknowledge that “early detection” is not the absolute answer to cancer. And many are recognizing that what seems a simple diagnostic test can carry more risks than benefits. “CONSUMER-DRIVEN” HEALTH CARE VS. “PATIENT CENTERED” CARE You have detailed how and why a sound, ongoing doctor—patient relationship is the foundation of health care. These relationships, mutual trusts, must be or become unconflicted by the dollar bill. HYBRID HEALTH CARE SYSTEMS In “The French Way of Cancer Treatment,” Anya Schiffrin writes eloquently about the care that her father, Andre Schiffrin, received when he was diagnosed with stage-four-pancreatic cancer, and decided that he wanted to go to France, his birthplace, for treatment. Schiffrin had been undergoing chemotherapy at New York City’s Memorial Sloane Kettering, and his family was concerned: how

ABOUT MAGGIE MAHAR

Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the null.com blog and she’ll continue to write on both websites.. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex LEARNING FROM LIPOZENE: THE ANATOMY OF A DRUG SCAM Jeff and Robert, It is indeed a sad state of affairs, and over the past decade, things have gotten much worse. We essentially allow ourselves to be taken for a ride just as exploitive as Lipozene because our institutions are often unwilling or unable to do their jobs when it comes to containing costs, protecting the public interest, and generally making sure that the business of medicine

doesn

MAKING SENSE OF HEALTH CARE THROUGH ANALOGIES think the metaphor that works best is from Rashomon where folks touching different parts of the elephant (pardon my politics) come away with very different impressions. the majority of americans are insured and care about their rising costs, but have less interest in the problems of the uninsured. many analysts believe too much is done by an irrational and cost-insensitive system, but that A VERY OPEN LETTER FROM AN ONCOLOGIST Robert– As Peter point out, if you explains the risks and benefits to patients clearly and carefully (and I’m not talking about a 15-minute discussion) most will decide that they don’t want to put themselves through a treatment that offers very, very little hope–or hope of an extra two months of poor-quality life.. ATUL GAWANDE: “LETTING GO: WHAT SHOULD MEDICINE DO WHEN IT Summary: In the August 2 issue of the New Yorker, Boston surgeon Atul Gawande writes about the ambiguities that plague end-of-life care. With the candor that makes his writing both so credible and so moving, he acknowledges that, as a physician, he too has great difficulty “letting go” of a dying patient. Ultimately, Gawande suggests, the problem with the way we deal with death today is WHEN PATIENTS ARE BLIND-SIDED BY PHANTOM PROVIDERS One of the big issues not mentioned in the post is the issue of exclusive privileges. In order to assure sufficient coverage and comply with federal and state rules and regs, most hospitals grant hospital based medical groups (the RAPs and ER docs) exclusive privileges which grants one medical group sole rights to treat the hospital’s patients. STENT SCANDAL: A SHOCKING STORY, BUT NOT NEWS Over the weekend, the New York Times published a head-turning tale about Dr. Mark Midei, a star cardiologist at St. Joseph Medical Center in Townson, Maryland. According to federal investigators, Dr. Midei implanted potentially dangerous cardiac stents in the arteries of as many as 585 patients who didn’t need them. THE DOCTOR WHO INVENTED PSA TEST CALLS IT “A PROFIT-DRIVEN Times are changing. Americans are beginning to acknowledge that “early detection” is not the absolute answer to cancer. And many are recognizing that what seems a simple diagnostic test can carry more risks than benefits. HYBRID HEALTH CARE SYSTEMS In “The French Way of Cancer Treatment,” Anya Schiffrin writes eloquently about the care that her father, Andre Schiffrin, received when he was diagnosed with stage-four-pancreatic cancer, and decided that he wanted to go to France, his birthplace, for treatment. Schiffrin had been undergoing chemotherapy at New York City’s Memorial Sloane Kettering, and his family was concerned: how MAKING SENSE OF HEALTH CARE THROUGH ANALOGIES think the metaphor that works best is from Rashomon where folks touching different parts of the elephant (pardon my politics) come away with very different impressions. the majority of americans are insured and care about their rising costs, but have less interest in the problems of the uninsured. many analysts believe too much is done by an irrational and cost-insensitive system, but that

ABOUT MAGGIE MAHAR

Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the null.com blog and she’ll continue to write on both websites.. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex ANECDOTAL EVIDENCE DOES NOT MAKE GOOD POLICY Recently, a series of anecdotes appeared on the website People’s Pharmacy, posted by readers who suffer from depression.They detail how switching from name brand antidepressants to generics—or in some cases from one generic to another—caused a return in symptoms. STENT SCANDAL: A SHOCKING STORY, BUT NOT NEWS Over the weekend, the New York Times published a head-turning tale about Dr. Mark Midei, a star cardiologist at St. Joseph Medical Center in Townson, Maryland. According to federal investigators, Dr. Midei implanted potentially dangerous cardiac stents in the arteries of as many as 585 patients who didn’t need them. THE ELECTRONIC MEDICAL RECORD AND THE DISAPPEARANCE OF Below, a guest post by Christopher Johnson, a physician who has practiced pediatric critical care for more than three decades. For many years, Johnson served as the Director of the Pediatric Critical Care Service at the Mayo Clinic and Professor of Pediatrics at Mayo

Medical School.

WASTE AND INEFFICIENCY IN HOSPITALS: A HOSPITALIST TELLS Below, a memo and a chart that a hospitalist recently sent to his residents. To protect his identity, I have removed the name of his hospital from the memo. Suffice to say that it is a well-known hospital in one of the 20 largest cities in the U.S., and that it is located in a very affluent section of that city. NEW STUDY FOCUSES ON MEDICAL ERRORS IN OUTPATIENT SETTINGS In the decade since the Institute of Medicine’s landmark report, "To Err is Human," revealed an epidemic of preventable medical errors and safety problems in the nation’s hospitals, virtually all of the safety efforts in health care have focused on improving inpatient care.According to the authors of a new study in the Journal of the American Medical Association, these efforts have DOES MEDICARE UNDER-PAY HOSPITALS? Below, a guest-post by HealthBeat reader Pat S. Medicare is the second largest health care payer in America, trailing only Medicaid. The program is very popular with its enrollees, with polls showing a higher level of satisfaction than with private insurance. Medicare is less popular with hospitals. HOW MARYLAND “BROKE THE CURVE”: A SOLUTION FOR Hi Maggie: There was a time when states also had “usury” regulations in place which would set the interest rates for all banks within a state regardless of where the parent bank was chartered.

ABOUT MAGGIE MAHAR

Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the null.com blog and she’ll continue to write on both websites.. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex HYBRID HEALTH CARE SYSTEMS A Hybrid Public/Private System. Many readers might assume this means France has a single-payer system, and that is the key to its simplicity and success. But in fact, France relies on a hybrid system that is not unlike Obamacare. The government picks up the “CONSUMER-DRIVEN” HEALTH CARE VS. “PATIENT CENTERED” CARE The consumer-driven model assumes that healthcare is a product to be. bought and sold, just like an automobile or a refrigerator. This just. isn’t the case. First, health care is a service, not a product, and. providing the service is as much an art as a science. This often

makes.

LEARNING FROM LIPOZENE: THE ANATOMY OF A DRUG SCAM Learning from Lipozene: The Anatomy of a Drug Scam. Posted on January 22, 2008 by The Century Foundation. Yesterday I was watching television and was bombarded with the following infomercial for a dietary supplement called Lipozene: No doubt your bull-you-know-what detectors are going haywire already, as well they should. MAKING SENSE OF HEALTH CARE THROUGH ANALOGIES Making Sense of Health Care through Analogies. In discussing what’s wrong with health care in America, we often cite statistics—such as the fact that the U.S. spends 16 percent of its GDP on health care, yet has a life expectancy of 77.8 years, below the average of 78.6 years for OECD countries. A VERY OPEN LETTER FROM AN ONCOLOGIST A Very Open Letter from an Oncologist. Posted on January 10, 2009 by Maggie Mahar. During the holidays, I received the letter below from Dr. Peter Eisenberg, Medical Director at California Cancer Care, an oncology practice in Northern California. A member of The Century Foundation’s Working Group on Medicare Reform. IS HEALTHCARE A “RIGHT” OR A “MORAL OBLIGATION”? Universal health care is, however, a moral obligation for an. industrialized society, and will not result in the apocalyptic. consequences promised by the jeremiads.”. What I like about calling healthcare a “moral obligation” is that it. presents healthcare, not as a right that “the demanding poor” extort. MEDICAL SCHOOL: HOW THE “HIDDEN CURRICULUM” SNUFFS OUT Dr. Chris Johnson reflects on how and why, so many medical students seem to lose that compassion for others that is “innate in all of us,” and causes many students to choose the profession in the first place. Johnson writes: “We need to prevent medical training from driving into the background, belittling it, or even

snuffing

ATUL GAWANDE: “LETTING GO: WHAT SHOULD MEDICINE DO WHEN IT Summary: In the August 2 issue of the New Yorker, Boston surgeon Atul Gawande writes about the ambiguities that plague end-of-life care. With the candor that makes his writing both so credible and so moving, he acknowledges that, as a physician, he too has great difficulty “letting go” of a dying patient. Ultimately, Gawande suggests, the problem with the way we deal with death today is THE DOCTOR WHO INVENTED PSA TEST CALLS IT “A PROFIT-DRIVEN Times are changing. Americans are beginning to acknowledge that “early detection” is not the absolute answer to cancer. And many are recognizing that what seems a simple diagnostic test can carry more risks than benefits.

ABOUT MAGGIE MAHAR

Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the null.com blog and she’ll continue to write on both websites.. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex HYBRID HEALTH CARE SYSTEMS A Hybrid Public/Private System. Many readers might assume this means France has a single-payer system, and that is the key to its simplicity and success. But in fact, France relies on a hybrid system that is not unlike Obamacare. The government picks up the “CONSUMER-DRIVEN” HEALTH CARE VS. “PATIENT CENTERED” CARE The consumer-driven model assumes that healthcare is a product to be. bought and sold, just like an automobile or a refrigerator. This just. isn’t the case. First, health care is a service, not a product, and. providing the service is as much an art as a science. This often

makes.

LEARNING FROM LIPOZENE: THE ANATOMY OF A DRUG SCAM Learning from Lipozene: The Anatomy of a Drug Scam. Posted on January 22, 2008 by The Century Foundation. Yesterday I was watching television and was bombarded with the following infomercial for a dietary supplement called Lipozene: No doubt your bull-you-know-what detectors are going haywire already, as well they should. MAKING SENSE OF HEALTH CARE THROUGH ANALOGIES Making Sense of Health Care through Analogies. In discussing what’s wrong with health care in America, we often cite statistics—such as the fact that the U.S. spends 16 percent of its GDP on health care, yet has a life expectancy of 77.8 years, below the average of 78.6 years for OECD countries. A VERY OPEN LETTER FROM AN ONCOLOGIST A Very Open Letter from an Oncologist. Posted on January 10, 2009 by Maggie Mahar. During the holidays, I received the letter below from Dr. Peter Eisenberg, Medical Director at California Cancer Care, an oncology practice in Northern California. A member of The Century Foundation’s Working Group on Medicare Reform. IS HEALTHCARE A “RIGHT” OR A “MORAL OBLIGATION”? Universal health care is, however, a moral obligation for an. industrialized society, and will not result in the apocalyptic. consequences promised by the jeremiads.”. What I like about calling healthcare a “moral obligation” is that it. presents healthcare, not as a right that “the demanding poor” extort. MEDICAL SCHOOL: HOW THE “HIDDEN CURRICULUM” SNUFFS OUT Dr. Chris Johnson reflects on how and why, so many medical students seem to lose that compassion for others that is “innate in all of us,” and causes many students to choose the profession in the first place. Johnson writes: “We need to prevent medical training from driving into the background, belittling it, or even

snuffing

ATUL GAWANDE: “LETTING GO: WHAT SHOULD MEDICINE DO WHEN IT Summary: In the August 2 issue of the New Yorker, Boston surgeon Atul Gawande writes about the ambiguities that plague end-of-life care. With the candor that makes his writing both so credible and so moving, he acknowledges that, as a physician, he too has great difficulty “letting go” of a dying patient. Ultimately, Gawande suggests, the problem with the way we deal with death today is THE DOCTOR WHO INVENTED PSA TEST CALLS IT “A PROFIT-DRIVEN Times are changing. Americans are beginning to acknowledge that “early detection” is not the absolute answer to cancer. And many are recognizing that what seems a simple diagnostic test can carry more risks than benefits. HEALTH BEAT BY MAGGIE MAHAR Editor’s Note– Below, a post by Dr. Clifton Meador, author of more than a dozen insightful, often witty books including Sketches of a Small Town, Circa 1940 and True Medical Detective Stories. (When reviewing Sketches on Amazon, I compared Meador to Mark Twain.) In the post below, Meador refers to one of his best-known stories, a tale set in the not too distant future titled “The Last

ABOUT MAGGIE MAHAR

Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the null.com blog and she’ll continue to write on both websites.. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex MAKING SENSE OF HEALTH CARE THROUGH ANALOGIES Making Sense of Health Care through Analogies. In discussing what’s wrong with health care in America, we often cite statistics—such as the fact that the U.S. spends 16 percent of its GDP on health care, yet has a life expectancy of 77.8 years, below the average of 78.6 years for OECD countries. IS HEALTHCARE A “RIGHT” OR A “MORAL OBLIGATION”? Universal health care is, however, a moral obligation for an. industrialized society, and will not result in the apocalyptic. consequences promised by the jeremiads.”. What I like about calling healthcare a “moral obligation” is that it. presents healthcare, not as a right that “the demanding poor” extort. ANECDOTAL EVIDENCE DOES NOT MAKE GOOD POLICY Recently, a series of anecdotes appeared on the website People’s Pharmacy, posted by readers who suffer from depression.They detail how switching from name brand antidepressants to generics—or in some cases from one generic to another—caused a return in symptoms. MEDICAL SCHOOL: HOW THE “HIDDEN CURRICULUM” SNUFFS OUT Dr. Chris Johnson reflects on how and why, so many medical students seem to lose that compassion for others that is “innate in all of us,” and causes many students to choose the profession in the first place. Johnson writes: “We need to prevent medical training from driving into the background, belittling it, or even

snuffing

SLEEP-DEPRIVATION: CAN RESIDENTS “LEARN” TO FUNCTION WITH In the past, the ACGME let residents work 30 hours at a stretch. But as of July 1, interns (a.k.a first year residents) will be limited to 16-hour tours of duty, following IOM’s recommendation. But, to the dismay of patient safety advocates, under the new rules second and third-year residents still will be permitted to work 28 hours at a

time.

WHAT MAKES MINNESOTA’S MAYO CLINIC DIFFERENT? Posted on October 15, 2008 by Maggie Mahar. After working at the Mayo Clinic in Rochester, Minnesota for nine years, Dr. Marc Patterson decided to change his life. In 2001, he moved to New York City to take a job as chief of pediatric neurology at New York-Presbyterian Hospital (NYPH). This year, Patterson returned to the Big House on the

Prairie.

STENT SCANDAL: A SHOCKING STORY, BUT NOT NEWS Stent Scandal: A Shocking Story, But Not News. Posted on December 8, 2010 by Maggie Mahar. Over the weekend, the New York Times published a head-turning tale about Dr. Mark Midei, a star cardiologist at St. Joseph Medical Center in Townson, Maryland. According to federal investigators, Dr. Midei implanted potentially dangerous cardiac

stents in

PFIZER ENLISTS A LABOR UNION (SEIU) TO PROMOTE THE Pfizer Enlists a Labor Union (SEIU) to Promote the “Cholesterol Con”. A couple of weeks ago Dr. Alicia Fernandez, an associate professor of clinical medicine at UC San Francisco, received a very unusual letter from The International Association of EMTS and Paramedics, an affiliate of The National Association of Government Employees (IAEP/SEIU).

ABOUT MAGGIE MAHAR

Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the null.com blog and she’ll continue to write on both websites.. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex HYBRID HEALTH CARE SYSTEMS A Hybrid Public/Private System. Many readers might assume this means France has a single-payer system, and that is the key to its simplicity and success. But in fact, France relies on a hybrid system that is not unlike Obamacare. The government picks up the “CONSUMER-DRIVEN” HEALTH CARE VS. “PATIENT CENTERED” CARE The consumer-driven model assumes that healthcare is a product to be. bought and sold, just like an automobile or a refrigerator. This just. isn’t the case. First, health care is a service, not a product, and. providing the service is as much an art as a science. This often

makes.

LEARNING FROM LIPOZENE: THE ANATOMY OF A DRUG SCAM Learning from Lipozene: The Anatomy of a Drug Scam. Posted on January 22, 2008 by The Century Foundation. Yesterday I was watching television and was bombarded with the following infomercial for a dietary supplement called Lipozene: No doubt your bull-you-know-what detectors are going haywire already, as well they should. MAKING SENSE OF HEALTH CARE THROUGH ANALOGIES Making Sense of Health Care through Analogies. In discussing what’s wrong with health care in America, we often cite statistics—such as the fact that the U.S. spends 16 percent of its GDP on health care, yet has a life expectancy of 77.8 years, below the average of 78.6 years for OECD countries. A VERY OPEN LETTER FROM AN ONCOLOGIST A Very Open Letter from an Oncologist. Posted on January 10, 2009 by Maggie Mahar. During the holidays, I received the letter below from Dr. Peter Eisenberg, Medical Director at California Cancer Care, an oncology practice in Northern California. A member of The Century Foundation’s Working Group on Medicare Reform. IS HEALTHCARE A “RIGHT” OR A “MORAL OBLIGATION”? Universal health care is, however, a moral obligation for an. industrialized society, and will not result in the apocalyptic. consequences promised by the jeremiads.”. What I like about calling healthcare a “moral obligation” is that it. presents healthcare, not as a right that “the demanding poor” extort. MEDICAL SCHOOL: HOW THE “HIDDEN CURRICULUM” SNUFFS OUT Dr. Chris Johnson reflects on how and why, so many medical students seem to lose that compassion for others that is “innate in all of us,” and causes many students to choose the profession in the first place. Johnson writes: “We need to prevent medical training from driving into the background, belittling it, or even

snuffing

ATUL GAWANDE: “LETTING GO: WHAT SHOULD MEDICINE DO WHEN IT Summary: In the August 2 issue of the New Yorker, Boston surgeon Atul Gawande writes about the ambiguities that plague end-of-life care. With the candor that makes his writing both so credible and so moving, he acknowledges that, as a physician, he too has great difficulty “letting go” of a dying patient. Ultimately, Gawande suggests, the problem with the way we deal with death today is THE DOCTOR WHO INVENTED PSA TEST CALLS IT “A PROFIT-DRIVEN Times are changing. Americans are beginning to acknowledge that “early detection” is not the absolute answer to cancer. And many are recognizing that what seems a simple diagnostic test can carry more risks than benefits.

ABOUT MAGGIE MAHAR

Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the null.com blog and she’ll continue to write on both websites.. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex HYBRID HEALTH CARE SYSTEMS A Hybrid Public/Private System. Many readers might assume this means France has a single-payer system, and that is the key to its simplicity and success. But in fact, France relies on a hybrid system that is not unlike Obamacare. The government picks up the “CONSUMER-DRIVEN” HEALTH CARE VS. “PATIENT CENTERED” CARE The consumer-driven model assumes that healthcare is a product to be. bought and sold, just like an automobile or a refrigerator. This just. isn’t the case. First, health care is a service, not a product, and. providing the service is as much an art as a science. This often

makes.

LEARNING FROM LIPOZENE: THE ANATOMY OF A DRUG SCAM Learning from Lipozene: The Anatomy of a Drug Scam. Posted on January 22, 2008 by The Century Foundation. Yesterday I was watching television and was bombarded with the following infomercial for a dietary supplement called Lipozene: No doubt your bull-you-know-what detectors are going haywire already, as well they should. MAKING SENSE OF HEALTH CARE THROUGH ANALOGIES Making Sense of Health Care through Analogies. In discussing what’s wrong with health care in America, we often cite statistics—such as the fact that the U.S. spends 16 percent of its GDP on health care, yet has a life expectancy of 77.8 years, below the average of 78.6 years for OECD countries. A VERY OPEN LETTER FROM AN ONCOLOGIST A Very Open Letter from an Oncologist. Posted on January 10, 2009 by Maggie Mahar. During the holidays, I received the letter below from Dr. Peter Eisenberg, Medical Director at California Cancer Care, an oncology practice in Northern California. A member of The Century Foundation’s Working Group on Medicare Reform. IS HEALTHCARE A “RIGHT” OR A “MORAL OBLIGATION”? Universal health care is, however, a moral obligation for an. industrialized society, and will not result in the apocalyptic. consequences promised by the jeremiads.”. What I like about calling healthcare a “moral obligation” is that it. presents healthcare, not as a right that “the demanding poor” extort. MEDICAL SCHOOL: HOW THE “HIDDEN CURRICULUM” SNUFFS OUT Dr. Chris Johnson reflects on how and why, so many medical students seem to lose that compassion for others that is “innate in all of us,” and causes many students to choose the profession in the first place. Johnson writes: “We need to prevent medical training from driving into the background, belittling it, or even

snuffing

ATUL GAWANDE: “LETTING GO: WHAT SHOULD MEDICINE DO WHEN IT Summary: In the August 2 issue of the New Yorker, Boston surgeon Atul Gawande writes about the ambiguities that plague end-of-life care. With the candor that makes his writing both so credible and so moving, he acknowledges that, as a physician, he too has great difficulty “letting go” of a dying patient. Ultimately, Gawande suggests, the problem with the way we deal with death today is THE DOCTOR WHO INVENTED PSA TEST CALLS IT “A PROFIT-DRIVEN Times are changing. Americans are beginning to acknowledge that “early detection” is not the absolute answer to cancer. And many are recognizing that what seems a simple diagnostic test can carry more risks than benefits. HEALTH BEAT BY MAGGIE MAHAR Editor’s Note– Below, a post by Dr. Clifton Meador, author of more than a dozen insightful, often witty books including Sketches of a Small Town, Circa 1940 and True Medical Detective Stories. (When reviewing Sketches on Amazon, I compared Meador to Mark Twain.) In the post below, Meador refers to one of his best-known stories, a tale set in the not too distant future titled “The Last

ABOUT MAGGIE MAHAR

Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the null.com blog and she’ll continue to write on both websites.. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex MAKING SENSE OF HEALTH CARE THROUGH ANALOGIES Making Sense of Health Care through Analogies. In discussing what’s wrong with health care in America, we often cite statistics—such as the fact that the U.S. spends 16 percent of its GDP on health care, yet has a life expectancy of 77.8 years, below the average of 78.6 years for OECD countries. IS HEALTHCARE A “RIGHT” OR A “MORAL OBLIGATION”? Universal health care is, however, a moral obligation for an. industrialized society, and will not result in the apocalyptic. consequences promised by the jeremiads.”. What I like about calling healthcare a “moral obligation” is that it. presents healthcare, not as a right that “the demanding poor” extort. ANECDOTAL EVIDENCE DOES NOT MAKE GOOD POLICY Recently, a series of anecdotes appeared on the website People’s Pharmacy, posted by readers who suffer from depression.They detail how switching from name brand antidepressants to generics—or in some cases from one generic to another—caused a return in symptoms. MEDICAL SCHOOL: HOW THE “HIDDEN CURRICULUM” SNUFFS OUT Dr. Chris Johnson reflects on how and why, so many medical students seem to lose that compassion for others that is “innate in all of us,” and causes many students to choose the profession in the first place. Johnson writes: “We need to prevent medical training from driving into the background, belittling it, or even

snuffing

SLEEP-DEPRIVATION: CAN RESIDENTS “LEARN” TO FUNCTION WITH In the past, the ACGME let residents work 30 hours at a stretch. But as of July 1, interns (a.k.a first year residents) will be limited to 16-hour tours of duty, following IOM’s recommendation. But, to the dismay of patient safety advocates, under the new rules second and third-year residents still will be permitted to work 28 hours at a

time.

WHAT MAKES MINNESOTA’S MAYO CLINIC DIFFERENT? Posted on October 15, 2008 by Maggie Mahar. After working at the Mayo Clinic in Rochester, Minnesota for nine years, Dr. Marc Patterson decided to change his life. In 2001, he moved to New York City to take a job as chief of pediatric neurology at New York-Presbyterian Hospital (NYPH). This year, Patterson returned to the Big House on the

Prairie.

STENT SCANDAL: A SHOCKING STORY, BUT NOT NEWS Stent Scandal: A Shocking Story, But Not News. Posted on December 8, 2010 by Maggie Mahar. Over the weekend, the New York Times published a head-turning tale about Dr. Mark Midei, a star cardiologist at St. Joseph Medical Center in Townson, Maryland. According to federal investigators, Dr. Midei implanted potentially dangerous cardiac

stents in

PFIZER ENLISTS A LABOR UNION (SEIU) TO PROMOTE THE Pfizer Enlists a Labor Union (SEIU) to Promote the “Cholesterol Con”. A couple of weeks ago Dr. Alicia Fernandez, an associate professor of clinical medicine at UC San Francisco, received a very unusual letter from The International Association of EMTS and Paramedics, an affiliate of The National Association of Government Employees (IAEP/SEIU).

ABOUT MAGGIE MAHAR

Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the null.com blog and she’ll continue to write on both websites.. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex HYBRID HEALTH CARE SYSTEMS A Hybrid Public/Private System. Many readers might assume this means France has a single-payer system, and that is the key to its simplicity and success. But in fact, France relies on a hybrid system that is not unlike Obamacare. The government picks up the “CONSUMER-DRIVEN” HEALTH CARE VS. “PATIENT CENTERED” CARE The consumer-driven model assumes that healthcare is a product to be. bought and sold, just like an automobile or a refrigerator. This just. isn’t the case. First, health care is a service, not a product, and. providing the service is as much an art as a science. This often

makes.

LEARNING FROM LIPOZENE: THE ANATOMY OF A DRUG SCAM Learning from Lipozene: The Anatomy of a Drug Scam. Posted on January 22, 2008 by The Century Foundation. Yesterday I was watching television and was bombarded with the following infomercial for a dietary supplement called Lipozene: No doubt your bull-you-know-what detectors are going haywire already, as well they should. MAKING SENSE OF HEALTH CARE THROUGH ANALOGIES Making Sense of Health Care through Analogies. In discussing what’s wrong with health care in America, we often cite statistics—such as the fact that the U.S. spends 16 percent of its GDP on health care, yet has a life expectancy of 77.8 years, below the average of 78.6 years for OECD countries. A VERY OPEN LETTER FROM AN ONCOLOGIST A Very Open Letter from an Oncologist. Posted on January 10, 2009 by Maggie Mahar. During the holidays, I received the letter below from Dr. Peter Eisenberg, Medical Director at California Cancer Care, an oncology practice in Northern California. A member of The Century Foundation’s Working Group on Medicare Reform. IS HEALTHCARE A “RIGHT” OR A “MORAL OBLIGATION”? Universal health care is, however, a moral obligation for an. industrialized society, and will not result in the apocalyptic. consequences promised by the jeremiads.”. What I like about calling healthcare a “moral obligation” is that it. presents healthcare, not as a right that “the demanding poor” extort. MEDICAL SCHOOL: HOW THE “HIDDEN CURRICULUM” SNUFFS OUT Dr. Chris Johnson reflects on how and why, so many medical students seem to lose that compassion for others that is “innate in all of us,” and causes many students to choose the profession in the first place. Johnson writes: “We need to prevent medical training from driving into the background, belittling it, or even

snuffing

ATUL GAWANDE: “LETTING GO: WHAT SHOULD MEDICINE DO WHEN IT Summary: In the August 2 issue of the New Yorker, Boston surgeon Atul Gawande writes about the ambiguities that plague end-of-life care. With the candor that makes his writing both so credible and so moving, he acknowledges that, as a physician, he too has great difficulty “letting go” of a dying patient. Ultimately, Gawande suggests, the problem with the way we deal with death today is THE DOCTOR WHO INVENTED PSA TEST CALLS IT “A PROFIT-DRIVEN Times are changing. Americans are beginning to acknowledge that “early detection” is not the absolute answer to cancer. And many are recognizing that what seems a simple diagnostic test can carry more risks than benefits.

ABOUT MAGGIE MAHAR

Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the null.com blog and she’ll continue to write on both websites.. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex HYBRID HEALTH CARE SYSTEMS A Hybrid Public/Private System. Many readers might assume this means France has a single-payer system, and that is the key to its simplicity and success. But in fact, France relies on a hybrid system that is not unlike Obamacare. The government picks up the “CONSUMER-DRIVEN” HEALTH CARE VS. “PATIENT CENTERED” CARE The consumer-driven model assumes that healthcare is a product to be. bought and sold, just like an automobile or a refrigerator. This just. isn’t the case. First, health care is a service, not a product, and. providing the service is as much an art as a science. This often

makes.

LEARNING FROM LIPOZENE: THE ANATOMY OF A DRUG SCAM Learning from Lipozene: The Anatomy of a Drug Scam. Posted on January 22, 2008 by The Century Foundation. Yesterday I was watching television and was bombarded with the following infomercial for a dietary supplement called Lipozene: No doubt your bull-you-know-what detectors are going haywire already, as well they should. MAKING SENSE OF HEALTH CARE THROUGH ANALOGIES Making Sense of Health Care through Analogies. In discussing what’s wrong with health care in America, we often cite statistics—such as the fact that the U.S. spends 16 percent of its GDP on health care, yet has a life expectancy of 77.8 years, below the average of 78.6 years for OECD countries. A VERY OPEN LETTER FROM AN ONCOLOGIST A Very Open Letter from an Oncologist. Posted on January 10, 2009 by Maggie Mahar. During the holidays, I received the letter below from Dr. Peter Eisenberg, Medical Director at California Cancer Care, an oncology practice in Northern California. A member of The Century Foundation’s Working Group on Medicare Reform. IS HEALTHCARE A “RIGHT” OR A “MORAL OBLIGATION”? Universal health care is, however, a moral obligation for an. industrialized society, and will not result in the apocalyptic. consequences promised by the jeremiads.”. What I like about calling healthcare a “moral obligation” is that it. presents healthcare, not as a right that “the demanding poor” extort. MEDICAL SCHOOL: HOW THE “HIDDEN CURRICULUM” SNUFFS OUT Dr. Chris Johnson reflects on how and why, so many medical students seem to lose that compassion for others that is “innate in all of us,” and causes many students to choose the profession in the first place. Johnson writes: “We need to prevent medical training from driving into the background, belittling it, or even

snuffing

ATUL GAWANDE: “LETTING GO: WHAT SHOULD MEDICINE DO WHEN IT Summary: In the August 2 issue of the New Yorker, Boston surgeon Atul Gawande writes about the ambiguities that plague end-of-life care. With the candor that makes his writing both so credible and so moving, he acknowledges that, as a physician, he too has great difficulty “letting go” of a dying patient. Ultimately, Gawande suggests, the problem with the way we deal with death today is THE DOCTOR WHO INVENTED PSA TEST CALLS IT “A PROFIT-DRIVEN Times are changing. Americans are beginning to acknowledge that “early detection” is not the absolute answer to cancer. And many are recognizing that what seems a simple diagnostic test can carry more risks than benefits. HEALTH BEAT BY MAGGIE MAHAR Editor’s Note– Below, a post by Dr. Clifton Meador, author of more than a dozen insightful, often witty books including Sketches of a Small Town, Circa 1940 and True Medical Detective Stories. (When reviewing Sketches on Amazon, I compared Meador to Mark Twain.) In the post below, Meador refers to one of his best-known stories, a tale set in the not too distant future titled “The Last

ABOUT MAGGIE MAHAR

Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the null.com blog and she’ll continue to write on both websites.. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex MAKING SENSE OF HEALTH CARE THROUGH ANALOGIES Making Sense of Health Care through Analogies. In discussing what’s wrong with health care in America, we often cite statistics—such as the fact that the U.S. spends 16 percent of its GDP on health care, yet has a life expectancy of 77.8 years, below the average of 78.6 years for OECD countries. IS HEALTHCARE A “RIGHT” OR A “MORAL OBLIGATION”? Universal health care is, however, a moral obligation for an. industrialized society, and will not result in the apocalyptic. consequences promised by the jeremiads.”. What I like about calling healthcare a “moral obligation” is that it. presents healthcare, not as a right that “the demanding poor” extort. ANECDOTAL EVIDENCE DOES NOT MAKE GOOD POLICY Recently, a series of anecdotes appeared on the website People’s Pharmacy, posted by readers who suffer from depression.They detail how switching from name brand antidepressants to generics—or in some cases from one generic to another—caused a return in symptoms. MEDICAL SCHOOL: HOW THE “HIDDEN CURRICULUM” SNUFFS OUT Dr. Chris Johnson reflects on how and why, so many medical students seem to lose that compassion for others that is “innate in all of us,” and causes many students to choose the profession in the first place. Johnson writes: “We need to prevent medical training from driving into the background, belittling it, or even

snuffing

SLEEP-DEPRIVATION: CAN RESIDENTS “LEARN” TO FUNCTION WITH In the past, the ACGME let residents work 30 hours at a stretch. But as of July 1, interns (a.k.a first year residents) will be limited to 16-hour tours of duty, following IOM’s recommendation. But, to the dismay of patient safety advocates, under the new rules second and third-year residents still will be permitted to work 28 hours at a

time.

WHAT MAKES MINNESOTA’S MAYO CLINIC DIFFERENT? Posted on October 15, 2008 by Maggie Mahar. After working at the Mayo Clinic in Rochester, Minnesota for nine years, Dr. Marc Patterson decided to change his life. In 2001, he moved to New York City to take a job as chief of pediatric neurology at New York-Presbyterian Hospital (NYPH). This year, Patterson returned to the Big House on the

Prairie.

STENT SCANDAL: A SHOCKING STORY, BUT NOT NEWS Stent Scandal: A Shocking Story, But Not News. Posted on December 8, 2010 by Maggie Mahar. Over the weekend, the New York Times published a head-turning tale about Dr. Mark Midei, a star cardiologist at St. Joseph Medical Center in Townson, Maryland. According to federal investigators, Dr. Midei implanted potentially dangerous cardiac

stents in

PFIZER ENLISTS A LABOR UNION (SEIU) TO PROMOTE THE Pfizer Enlists a Labor Union (SEIU) to Promote the “Cholesterol Con”. A couple of weeks ago Dr. Alicia Fernandez, an associate professor of clinical medicine at UC San Francisco, received a very unusual letter from The International Association of EMTS and Paramedics, an affiliate of The National Association of Government Employees (IAEP/SEIU).

ABOUT MAGGIE MAHAR

Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the null.com blog and she’ll continue to write on both websites.. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex “CONSUMER-DRIVEN” HEALTH CARE VS. “PATIENT CENTERED” CARECONSUMER DRIVEN HEALTH CARE MODELCONSUMER DRIVEN HEALTH CARE DEFINITIONCONSUMER DRIVEN HEALTH PLAN EXPLAINEDCONSUMER DRIVEN HEALTH PLANS EXAMPLESCONSUMER DRIVEN HEALTH PLAN DEFINITIONCONSUMER DRIVEN

HEALTH MOVEMENT

The consumer-driven model assumes that healthcare is a product to be. bought and sold, just like an automobile or a refrigerator. This just. isn’t the case. First, health care is a service, not a product, and. providing the service is as much an art as a science. This often

makes.

LEARNING FROM LIPOZENE: THE ANATOMY OF A DRUG SCAM Learning from Lipozene: The Anatomy of a Drug Scam. Posted on January 22, 2008 by The Century Foundation. Yesterday I was watching television and was bombarded with the following infomercial for a dietary supplement called Lipozene: No doubt your bull-you-know-what detectors are going haywire already, as well they should. A VERY OPEN LETTER FROM AN ONCOLOGIST A Very Open Letter from an Oncologist. Posted on January 10, 2009 by Maggie Mahar. During the holidays, I received the letter below from Dr. Peter Eisenberg, Medical Director at California Cancer Care, an oncology practice in Northern California. A member of The Century Foundation’s Working Group on Medicare Reform. IS HEALTHCARE A “RIGHT” OR A “MORAL OBLIGATION”? Universal health care is, however, a moral obligation for an. industrialized society, and will not result in the apocalyptic. consequences promised by the jeremiads.”. What I like about calling healthcare a “moral obligation” is that it. presents healthcare, not as a right that “the demanding poor” extort. MEDICAL SCHOOL: HOW THE “HIDDEN CURRICULUM” SNUFFS OUT Dr. Chris Johnson reflects on how and why, so many medical students seem to lose that compassion for others that is “innate in all of us,” and causes many students to choose the profession in the first place. Johnson writes: “We need to prevent medical training from driving into the background, belittling it, or even

snuffing

ANECDOTAL EVIDENCE DOES NOT MAKE GOOD POLICY Recently, a series of anecdotes appeared on the website People’s Pharmacy, posted by readers who suffer from depression.They detail how switching from name brand antidepressants to generics—or in some cases from one generic to another—caused a return in symptoms. SLEEP-DEPRIVATION: CAN RESIDENTS “LEARN” TO FUNCTION WITH In the past, the ACGME let residents work 30 hours at a stretch. But as of July 1, interns (a.k.a first year residents) will be limited to 16-hour tours of duty, following IOM’s recommendation. But, to the dismay of patient safety advocates, under the new rules second and third-year residents still will be permitted to work 28 hours at a

time.

THE DOCTOR WHO INVENTED PSA TEST CALLS IT “A PROFIT-DRIVENTHE PSA TESTWHO DEVELOPED THE PSA TEST Times are changing. Americans are beginning to acknowledge that “early detection” is not the absolute answer to cancer. And many are recognizing that what seems a simple diagnostic test can carry more risks than benefits. DID PRESIDENT OBAMA “LIE” WHEN HE SAID “IF YOU LIKE THEOBAMA KEEP YOUR DOCTOR QUOTEOBAMA LIE KEEP YOUR DOCTOROBAMA QUOTE IF YOU LIKE YOUR DOCTOROBAMA YOU CAN KEEP YOUR DR Political opponents have managed to score some points on this issue, but it makes little sense when you actually think about it. People tend to forget about the part of Obama’s “If you like your plan/doctor you can keep it/him” promise that was clearly implied.

ABOUT MAGGIE MAHAR

Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the null.com blog and she’ll continue to write on both websites.. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex “CONSUMER-DRIVEN” HEALTH CARE VS. “PATIENT CENTERED” CARECONSUMER DRIVEN HEALTH CARE MODELCONSUMER DRIVEN HEALTH CARE DEFINITIONCONSUMER DRIVEN HEALTH PLAN EXPLAINEDCONSUMER DRIVEN HEALTH PLANS EXAMPLESCONSUMER DRIVEN HEALTH PLAN DEFINITIONCONSUMER DRIVEN

HEALTH MOVEMENT

The consumer-driven model assumes that healthcare is a product to be. bought and sold, just like an automobile or a refrigerator. This just. isn’t the case. First, health care is a service, not a product, and. providing the service is as much an art as a science. This often

makes.

LEARNING FROM LIPOZENE: THE ANATOMY OF A DRUG SCAM Learning from Lipozene: The Anatomy of a Drug Scam. Posted on January 22, 2008 by The Century Foundation. Yesterday I was watching television and was bombarded with the following infomercial for a dietary supplement called Lipozene: No doubt your bull-you-know-what detectors are going haywire already, as well they should. A VERY OPEN LETTER FROM AN ONCOLOGIST A Very Open Letter from an Oncologist. Posted on January 10, 2009 by Maggie Mahar. During the holidays, I received the letter below from Dr. Peter Eisenberg, Medical Director at California Cancer Care, an oncology practice in Northern California. A member of The Century Foundation’s Working Group on Medicare Reform. IS HEALTHCARE A “RIGHT” OR A “MORAL OBLIGATION”? Universal health care is, however, a moral obligation for an. industrialized society, and will not result in the apocalyptic. consequences promised by the jeremiads.”. What I like about calling healthcare a “moral obligation” is that it. presents healthcare, not as a right that “the demanding poor” extort. MEDICAL SCHOOL: HOW THE “HIDDEN CURRICULUM” SNUFFS OUT Dr. Chris Johnson reflects on how and why, so many medical students seem to lose that compassion for others that is “innate in all of us,” and causes many students to choose the profession in the first place. Johnson writes: “We need to prevent medical training from driving into the background, belittling it, or even

snuffing

ANECDOTAL EVIDENCE DOES NOT MAKE GOOD POLICY Recently, a series of anecdotes appeared on the website People’s Pharmacy, posted by readers who suffer from depression.They detail how switching from name brand antidepressants to generics—or in some cases from one generic to another—caused a return in symptoms. SLEEP-DEPRIVATION: CAN RESIDENTS “LEARN” TO FUNCTION WITH In the past, the ACGME let residents work 30 hours at a stretch. But as of July 1, interns (a.k.a first year residents) will be limited to 16-hour tours of duty, following IOM’s recommendation. But, to the dismay of patient safety advocates, under the new rules second and third-year residents still will be permitted to work 28 hours at a

time.

THE DOCTOR WHO INVENTED PSA TEST CALLS IT “A PROFIT-DRIVENTHE PSA TESTWHO DEVELOPED THE PSA TEST Times are changing. Americans are beginning to acknowledge that “early detection” is not the absolute answer to cancer. And many are recognizing that what seems a simple diagnostic test can carry more risks than benefits. DID PRESIDENT OBAMA “LIE” WHEN HE SAID “IF YOU LIKE THEOBAMA KEEP YOUR DOCTOR QUOTEOBAMA LIE KEEP YOUR DOCTOROBAMA QUOTE IF YOU LIKE YOUR DOCTOROBAMA YOU CAN KEEP YOUR DR Political opponents have managed to score some points on this issue, but it makes little sense when you actually think about it. People tend to forget about the part of Obama’s “If you like your plan/doctor you can keep it/him” promise that was clearly implied. HEALTH BEAT BY MAGGIE MAHAR Editor’s Note– Below, a post by Dr. Clifton Meador, author of more than a dozen insightful, often witty books including Sketches of a Small Town, Circa 1940 and True Medical Detective Stories. (When reviewing Sketches on Amazon, I compared Meador to Mark Twain.) In the post below, Meador refers to one of his best-known stories, a tale set in the not too distant future titled “The Last MAKING SENSE OF HEALTH CARE THROUGH ANALOGIES Making Sense of Health Care through Analogies. In discussing what’s wrong with health care in America, we often cite statistics—such as the fact that the U.S. spends 16 percent of its GDP on health care, yet has a life expectancy of 77.8 years, below the average of 78.6 years for OECD countries. MEDICAL SCHOOL: HOW THE “HIDDEN CURRICULUM” SNUFFS OUT Dr. Chris Johnson reflects on how and why, so many medical students seem to lose that compassion for others that is “innate in all of us,” and causes many students to choose the profession in the first place. Johnson writes: “We need to prevent medical training from driving into the background, belittling it, or even

snuffing

ANECDOTAL EVIDENCE DOES NOT MAKE GOOD POLICY Recently, a series of anecdotes appeared on the website People’s Pharmacy, posted by readers who suffer from depression.They detail how switching from name brand antidepressants to generics—or in some cases from one generic to another—caused a return in symptoms. ATUL GAWANDE: “LETTING GO: WHAT SHOULD MEDICINE DO WHEN IT Summary: In the August 2 issue of the New Yorker, Boston surgeon Atul Gawande writes about the ambiguities that plague end-of-life care. With the candor that makes his writing both so credible and so moving, he acknowledges that, as a physician, he too has great difficulty “letting go” of a dying patient. Ultimately, Gawande suggests, the problem with the way we deal with death today is AHLTA CONTINUES TO DISAPPOINT AHLTA Continues to Disappoint. Last month I wrote a post highlighting a truly boneheaded development in the Department of Defense (DoD): the introduction of AHLTA, a new system of electronic medical records for the military. Usually I’m a big fan of electronic medical records (EMRs), but not in this case AHLTA is an entirely new system built THE DOCTOR WHO INVENTED PSA TEST CALLS IT “A PROFIT-DRIVEN Times are changing. Americans are beginning to acknowledge that “early detection” is not the absolute answer to cancer. And many are recognizing that what seems a simple diagnostic test can carry more risks than benefits. PFIZER ENLISTS A LABOR UNION (SEIU) TO PROMOTE THE Pfizer Enlists a Labor Union (SEIU) to Promote the “Cholesterol Con”. A couple of weeks ago Dr. Alicia Fernandez, an associate professor of clinical medicine at UC San Francisco, received a very unusual letter from The International Association of EMTS and Paramedics, an affiliate of The National Association of Government Employees (IAEP/SEIU). WHAT MAKES MINNESOTA’S MAYO CLINIC DIFFERENT? Posted on October 15, 2008 by Maggie Mahar. After working at the Mayo Clinic in Rochester, Minnesota for nine years, Dr. Marc Patterson decided to change his life. In 2001, he moved to New York City to take a job as chief of pediatric neurology at New York-Presbyterian Hospital (NYPH). This year, Patterson returned to the Big House on the

Prairie.

HOW MARYLAND “BROKE THE CURVE”: A SOLUTION FOR It turns out that in 2004, Maryland was spending slightly more than average ($5,590 vs. $5,283) — but less than sixteen other states including Massachusetts ($6, 683). More importantly, when the growth of medical spending in Maryland is compared to inflation in other states, Kaiser reports that from 1991 to 2004 Maryland’s total heath

care

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SELF-FULFILLING MEDIA NARRATIVES: HOW ONE MAN WOUND UP DECIDING THE FATE OF HEALTHCARE REFORM Posted on April 16, 2019

by Maggie Mahar

Personally, I am delighted that Justice Roberts voted to uphold the

Affordable Care Act

But I am troubled that the fate of U.S. healthcare turned on one man’s opinion. This is not how things are supposed to work in a

democracy.

Healthcare represents 16 percent of our economy. It touches all of our lives. If we don’t like the laws our elected representatives pass, we can vote them out of office. The Supreme Court, on the other hand, doesn’t have to worry whether its decisions reflect the will of the people. The Justices are appointed for life. This is why they are not charged with setting public policy. How then, did the Court wind up with the power to affirm or overturn

the ACA?

THE MEDIA SHAPES OUR EXPECTATIONS

As I suggested

when oral arguments began back in March, a “media narrative” drove the case to the Court – a fiction that caught on, in the press, on television, and in the blogosphere, where it began to take on a reality of its own. A handful of “state attorneys general and governors” saw “a political opportunity” and floated the idea that the law might be unconstitutional. The media picked up the story, repeated the heated rhetoric, and “fanned the flames … Before long, what constitutional experts thought was a non-story became a Supreme Court case.” These media narratives are based on what “that those in power and in the media have concluded is likely to happen,” observes Lyle

Denniston

,

known by some as the Dean of Supreme Court reporters. Writing on Scotusblog.com , he observes: “One ‘narrative’ about the health care law began building up in Washington, and perhaps beyond, right after the Supreme Court held its hearings in late March. The mandate, it was said, was going to be struck down, the government’s lawyer had blown it, and the President was going to be deeply wounded politically over the loss of his treasured domestic initiative.” Some media outlets were so persuaded by their own myth-making that initially, they reported that the Court had ruled against reform! Denniston explains that once the story goes viral, the conventional wisdom is then repeated, over and over, until “often, it seems, such ‘narratives’ become self-fulfilling.” He then points a “currently prevailing ‘narrative’ that most of the country is stubbornly committed to the Tea Party’s wish to limit the power of the federal government.” The facts contradict the fiction: Tea Party Candidates have been “losing steam” in recent elections. In April, a _WashingtonPost/ABC poll_ revealed that support for the Tea Party among young adults had plunged to 31 percent – down from 52 percent in the fall 2011. Half of those polled said that the more they heard about the Tea Party, the less they liked it

.

Tea Partiers claims that the Court’s decision invigorated its base, but offer little evidence. As I reported on

HealthBeat

last week, polling suggested that the ruling lifted support for reform among Independents, while having little effect on Republicans. MEDIA PROPS UP GOVERNORS’ THREAT TO THWART ACA Comments are off for this post Posted in Uncategorized NIHCM HEALTH CARE DIGITAL MEDIA AWARD: THE FINALISTS. Posted on April 5, 2015

by Maggie Mahar

Thanks to NIHCM for including “Obamacare’s Victims” parts 1

and 2

on the list (see below for a brief description of this two-part post) , and congratulations to all of the finalists. The award recognizes excellence in digital media that improves understanding of health care topics.A $10,000 prize will be presented to the winner at a dinner in Washington, DC on June 1, 2015. I URGE EVERYONE TO READ THE NOMINATED POSTS. IF YOU ARE INTERESTED IN HEALTHCARE AND HEALTHCARE REFORM, THIS IS A GOOD SHORT LIST OF “MUST-READ’S.”  YOU MAY NOT AGREE WITH ALL OF THEM, BUT THEY PROVIDE VALUABLE INFORMATION, AND HIGHLIGHT KEY CONTROVERSIES. Lisa Aliferis, Lisa Pickoff-White, Olivia Allen-Price, State of Health, _KQED_, 11/17/14

,

9/11/14

,

3/23/14

,

2/3/14

Julia Belluz, “The Science of Obesity and Weight Loss,” _Vox_,

11/27/14

,

12/19/14 ,

12/23/14

,

8/25/14

Aaron Carroll, Mark Olsen, Stan Muller, “Healthcare Triage—Using Evidence to Inform Policy

,”

_Healthcare Triage_, 1/19/14

,

6/9/14

,

10/6/14

,

5/26/14

Carlos Fioravanti, “The Stepping Stones to Rare Diseases

,”

_Pesquisa_, August 2014 Westby Fisher, “The ABIM Foundation, Choosing Wisely, and the $2.3

Million Condominium

”

& “Reviewing the Regulators

,” _Dr.

Wes Blog_, 12/16/14, 10/21/14 David Gorski, “The Problems with Right-to-Try,” _Science-Based

Medicine_, 3/8/14

,

4/27/14

,

7/21/14

,

11/2/14

Matthew Herper, The Medicine Show, _Forbes_, 1/8/14

,

6/12/14

,

8/8/14

,

12/7/14

Alexander Howard, TechRepublic, _CBS Interactive_, 6/10/14

,

3/11/14

Allan Joseph, “Treating Hepatitis C,” _The Incidental Economist_,

6/13/14

,

6/16/14

,

6/17/14

,

6/18/14

Sarah Kliff, “How America Pays for Health Care,” _Vox_, 9/2/14

,

12/22/14

,

4/17/14

,

12/2/14

MAGGIE MAHAR, “OBAMACARE’S VICTIMS, PART 1

AND PART 2

,”

_HEALTHINSURANCE.ORG_, 1/2/14, 1/3/14 Marc-David Munk, “The Future,”_ Considering American Healthcare_,

9/13/14

,

8/18/14

,

8/8/14

,

7/10/14

Elaine Schattner, “Cancer Patients Need More Guidance in Treatment Decisions,” _Forbes_, 8/28/14

,

8/13/14

,

9/24/14

,

11/2/14

Gary Schwitzer, “HealthNewsReview.org Posts 34 Pieces in 2014 on Imbalanced Media Messages on Screening Tests

,” Health News

Watchdog, _HealthNewsReview.org_, 10/1/14

,

7/9/14

,

6/25/14

,

9/16/14

_“OBAMACARE’S VICTIMS”– PART 1

AND PART 2

(SUMMARY) _

___(Note to HealthBeat readers: these posts originally appeared on HealthInsurance.org. )_ For more than two years, health reform’s opponents have been feasting on tales of Obamacare’s innocent victims—Americans who lost their insurance because it didn’t comply with the ACA’s regulations. Critics claim that now they have to shell out more than they can afford—or go without coverage. Trouble is, many of those stories just aren’t true

.

In Part 1

of the post, I write about a Fort Worth_ Star Telegram_ article that leads with the tale of Whitney Johnson, a 26-year-old new mother who suffers from multiple sclerosis (MS). Her insurer just cancelled her policy, and according to Johnson

, new

insurance would cost her over $1,000 a month. That claim stopped me in my tracks. Under the ACA, no 26-year-old could be charged $1,000 monthly –_ _even if she has MS. Obamacare prohibits insurers from charging more because a customer suffers from a pre-existing condition

. This rule

applies to all new policies, whether they are sold inside or outside

the exchanges.

At that point, I knew that something was wrong. When I checked the exchange – plugging in Johnson’s county and her age – I soon found a Blue Choice Gold PPO plan priced at $332 monthly (just $7 more than she had been paying for the plan that was cancelled). Co-pays to see a primary care doctor would run just $10 ($50 to visit a specialist) and she would not have to pay down the $1,500 deductible before the insurance kicked in. You’ll find part 1 here

and part 2

here.

If

you would like to comment, please come back to this post. 8 COMMENTS SO FAR -- ADD ONE Posted in Finalists ,

NIHCM Media Awards

, Obamacare's

victims ,

policies cancelled

“CLINICAL MAN”–BY CLIFTON MEADOR (WHY DO SO MANY OF US NEED MEDICAL TESTS TO TELL US THAT WE ARE WELL?) Posted on March 21, 2015

by Maggie Mahar

_EDITOR’S NOTE–_ Below, a post by Dr. Clifton Meador, author of more than a dozen insightful, often witty books including_ SKETCHES OF A SMALL TOWN,

CIRCA 1940

_

and

_T_RUE

MEDICAL DETECTIVE STORIES.

(When

reviewing _SKETCHES _on Amazon, I compared Meador to Mark Twain.) In the post below, Meador refers to one of his best-known stories, a tale set in the not too distant future titled _“The Last Well

Person .”

_The fiction, which was published as an “Occasional Note” in _NEJM_ in 1994, uses satire to comment on the folly of our obsessive drive to test and screen every well person in America–until we find something wrong with each and every one of them. That “Note” ultimately inspired Dr. Nortin Hadler to write a book that would help many begin to understand what is wrong with American healthcare: The Last Well Person: How to Stay Well Despite the Health Care System.

(2007)

This is not the first time that Clifton Meador has published on _HEALTHBEAT. _Some of his most popular posts include: –“The Mind-Body Connection: Could Psycho Somatic Conditions Account for 30% of Chronic Conditions? –“Unheard Hearts–a Metaphor” — “How Medicine Became a Growth Business;

”

_Today, Meador is a professor  of clinical medicine at Vanderbilt. The essay  below originally appeared on _THE PHAROS OF ALPHA OMEGA ALPHA HONOR SOCIETY,_ November 2011, and was recently cross-posted on THE HEALTH CARE BLOG

(THCB) _

___ M. M_

                                       CLINICAL

MAN

BY CLIFTON MEADOR

In 1994, I recorded a fictitious interview with the person whom I imagined to be the last well person on earth.  I mistakenly thought well people were disappearing and I wanted to call attention to their disappearance. I missed the big picture and now want to correct my misconceptions. Well people are not disappearing; instead, a new species of man is emerging:  _homo clinicus_. An evolution of the symbiotic relationship between man and medicine has been going on for some time. Lewis Thomas deserves the credit for an early spotting of the new species, first observed in America. He called our attention to this phenomenon in the 1970s. Nothing has changed so much in the health-care system over the past 25 years as the public’s perception of its own health. The change amounts to a loss of confidence in the human form. The general belief these days seems to be that the body is fundamentally flawed, subject to disintegration at any moment, always on the verge of mortal disease, always in need of continual monitoring and support by health-care professionals. This is a new phenomenon in our society. There has been a progression of terms for this new species. First, there was the “early sick” then “the worried well.” That was followed by “the worried sick.” We now have arrived at a definable new species that differs from pre-clinical man. Pre-clinical man lived largely with medicine out of his consciousness. In fact he lived to avoid medicine. Those of us who are still pre-clinical will recall the earlier saying, “An apple a day keeps the doctor away.” That is almost pure pre-clinical thinking. Pre-clinical man only went to the doctor when he was sick or injured. It was up to pre-clinical man to decide if he was sick or well. It did not take a physician to make that decision. If he felt all right he was well; if he felt sick he was sick. Not so with clinical man. Feelings are no longer a reliable guide to health. Feeling good is not enough. There must be objective data that nothing is wrong. That’s the problem. Something is always wrong if you look long and hard enough at or inside any human. As a medical resident told a colleague, “A well person is someone who has not been worked up. We can always find something wrong, if we look hard enough.” Continue reading → 4 COMMENTS SO FAR -- ADD ONE

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WILL THE SUPREME COURT SCUTTLE OBAMACARE SUBSIDIES? (NO. WHAT CAN’T

HAPPEN, WON’T. )

Posted on March 3, 2015

by Maggie Mahar

Not long ago, I ran across a photo of the Supreme Court captioned: “_Maybe this will turn out to be . . .  Obamacare’s death

panel?”_

The caption refers to the widespread belief that when the Supreme Court rules on the latest challenge to Obamacare (“King vs. Burwell”),  it will strike down most of the government subsidies that have made insurance affordable for so many middle-income and low-income families.  (This lawsuit has been financed by the “Competitive Enterprise Institute,” a libertarian group with long ties to tobacco disinformation campaigns, and more recently, climate change denial. The Koch brothers are among the funders of the

institute.)

The Supremes are expected to announce their decision in June. If Obamacare’s opponents prevail, the healthcare.gov system will have no choice but to cut off subsidies for as many as 7.5 million Americans in 34 states, including Texas and Florida, probably within a few weeks after the ruling is announced. The Kaiser Family Foundation has put together an eye-opening map revealing where subsidies are safe, and where they are at risk. The plaintiffs’ argument turns on just five words buried in the 900-page Affordable Care Act (ACA). In a paragraph describing the tax credits that will be available to people buying policies in online marketplaces, known as “exchanges” the law describes them as “EXCHANGES ESTABLISHED BY THE STATE.” Seizing on that last phrase, the libertarians who masterminded this legal challenge gleefully point out that only 16 states opted to set up their own insurance exchanges. The remainder of the marketplaces were established by the federal government. Ergo, the plaintiffs’ lawyers conclude, 34 states cannot legally offer subsidies to their citizens! As a point of fact, if a person reads the entire ACA, he or she will discover that the law also is very clear that, if a state refuses to open an exchange, the federal government will “establish and operate such Exchange within the State.”                 AN ABSURD ARGUMENT When the IRS drafted its rules for implementing the ACA it realized that, of course, Congress intended to make subsidies available both in the state and in the federal exchanges. By fixating on only five words, the plaintiffs’ lawyers ask the Court to ignore the broader goal of the “Patient Protection and Affordable Care Act”: universal healthcare. As Jeffrey Toobin put it in the _New Yorker_ earlier this month: “the King case is notable mostly for the cynicism at its heart. Instead of grandeur” –which is more typical of cases brought to the highest court in the land– “there is a smallness about this

lawsuit.”

I agree. The plaintiffs are concocting an argument based on semantics, not ideas. It is not that the ideologues bringing this case don’t understand the core mission of the ACA. They do.  They know that the goal IS TO PROVIDE AFFORDABLE HEALTH CARE TO_ ALL_ AMERICANS. But Obamaca’re opponents are quite coolly and cynically ignoring that mission while plucking a phrase out of the legislation, hoping that, if they sharpen it, by repeating it and  harping on it, they can use it to carve the heart out of Obamacare. Think about it: if subsidies disappeared in 34 states, millions would no longer be able to afford their insurance. At that point, young healthy Americans would drop their policies, leaving the insurance pool filled with sicker, older patients who felt they had no choice but to buy coverage–even without the government’s help. In order to pay for their care, insurers would hike premiums, and as rates levitated, more and more healthy customers would cancel their coverage. This in turn would trigger what experts call a “death spiral” as premiums rose to unaffordable heights, and insurers simply stopped offering coverage in many states. TO BELIEVE THAT LEGISLATORS MEANT TO OFFER SUBSIDIES ONLY TO PEOPLE WHO HAPPENED TO LIVE IN STATES that create their own exchanges IS TO BELIEVE THAT THE LAW WAS CONSCIOUSLY DESIGNED TO SELF-DESTRUCT. Continue reading → 7 COMMENTS SO FAR -- ADD ONE Posted in "death spiral"

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LOOK INTO THIS SURGEON’S FACE . . . Posted on February 23, 2015

by

Maggie Mahar

BELOW, A PHOTO FROM: Faith in Humanity @TheWorldStories

� Feb 16

A HEART SURGEON RESTING AFTER A  23-HOUR LONG  (SUCCESSFUL) HEART TRANSPLANT. HIS ASSISTANT IS SLEEPING IN THE CORNER CLEARLY, HE HAS GIVEN HIS ALL. IMAGINE WHAT HE WOULD LOOK LIKE IF THE SURGERY HAD FAILED.  THIS IS AN UNBELIEVABLY DIFFICULT JOB. Comments are off for this post Posted in heart transplant

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WHAT DOCTORS SHOULD– AND SHOULD NOT– SAY TO OBESE PATIENTS Posted on February 22, 2015

by Maggie Mahar

Below a remarkably candid and compelling essay by Emma Lewis titled “Why there’s no point in telling me to lose weight. ” It originally appeared in the January 2015 issue of _BMJ_ (formerly the _British Medical Journal_).  Hat-tip to Helen Haskell, president and founder of _Mothers Against Medical Error, _ who sent me Lewis’ piece. In her editorial (CROSS-POSTED BELOW), Lewis explains why she has “opted out” of the “weight-loss game.”  She confides that she has been “fat” since she was a child. She still remembers the humiliations, which continue to this day– especially when she visits a primary care doctor. It doesn’t matter whether she is seeing the physician because she has broken an ankle or needs contraception. Inevitably, he or she brings up her Body Mass Index (BMI.) And when a GP admonishes her that she should diet and work out, he rarely asks what she eats now, or how much she exercises.  He doesn’t listen; he lectures. In fact, Lewis does care about her health: she exercises regularly and has switched to a whole meal vegetarian diet. For years, she has been in good health. But her BMI remains above 30. WHAT MANY DOCTORS DON’T KNOW—AND WHAT EVEN THE EXPERTS DON’T

UNDERSTAND

What these general practitioners don’t know is what doctors and scientists who specialize in obesity have discovered:  the vast majority of overweight patients cannot shed pounds—and keep them off—EVEN IN HIGHLY CONTROLLED EXPERIMENTAL SETTINGS WHERE PATIENTS DIET AND EXERCISE UNDER A DOCTOR’S SUPERVISIOn.  As I explain in

the post below

two

years after starting a diet, roughly 95% will have put all of the

weight back on.

And even the experts who study the obesity epidemicdon’t understand

why.

Continue reading → 6 COMMENTS SO FAR -- ADD ONE

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, Why There Is No Point to Telling Me to Lose Weight LOSING WEIGHT—WHAT THE EXPERTS ARE RELUCTANT TO TELL YOU – PART 1 Posted on February 21, 2015

by Maggie Mahar

Have you ever shed 15 or 25  pounds and, then, over the next year or so, put it all back on? Usually, we blame ourselves. But, as I reported on _HealthBeat_ in 2008, physicians who treat obese and overweight patients know that only about 5% of us are able to lose weight and keep it off—even in highly controlled experimental settings where patients diet and exercise under a doctors’

supervision.

Over

two years, 95% of us will put the pounds back on, and in some cases,

add more.

A National Institutes of Health (NIH), working group study published in the January 2015 issue of the journal _Obesity_, confirms that

:

“Despite advancements in our understanding of obesity, weight regain after weight loss remains the most substantial problem in obesity treatment – WITH BOTH THE BODY AND THE MIND CONSPIRING AGAINST INDIVIDUAL EFFORTS TO MAINTAIN WEIGHT LOSS.”          WHAT RANDOMIZED CONTROLLED TRIALS

REVEAL

University of Minnesota Psychologist Traci Mann has spent 20 years running an eating lab and, based on her experience, she reports: “Long-term weight loss happens only to the smallest minority of people.” _ _ Indeed, when she and five other researchers analyzed outcomes for patients in randomized trails where one group dieted, and the other group did not, the studies showed that, after two years, the average patient on a calorie restricted regimen had lost only one kilogram, or

about two pounds,

while one third to two thirds of dieters had actually regained more weight than they lost. (In many of these trials, the patients not only cut calories, but also exercised.) What about folks who combine intensive lifestyle changes with drugs designed to help us lose weight? “Studies show that patients on drug therapy lose around 10 percent of their excess weight,” but “the weight loss plateaus after six to eight months,” UCSF’s Medical Center reports. “As patients stop taking the medication, weight gain usually occurs.”             LOW-CARB

VS. LOW-FAT DIETS

Does it matter which diets you try? At one time, most physicians were convinced that fatty foods led to obesity, and a low-fat diet offered the best route to becoming svelte. But in recent years, a growing number of doctors and health advocates have begun to argue that increased consumption of sugar and refined carbohydrates is the most likely explanation for our obesity

epidemic.

Last summer _WIRED _published an impressive in-depth review of what we do and do not know about whether certain foods will make us fat. The story notes that that in 2009, “Robert Lustig, a pediatric endocrinologist, rose to national fame after a 2009 lecture in which he called sugar ‘poison’ went viral on _YouTube._ _ _Meanwhile, newer science has undermined the consensus that fat is all that bad for you. A recent meta-analysis published in the _Annals of Internal Medicine_ found no clear evidence that eating saturated fat contributes to cardiovascular disease.” What about carbs? “In trials, carbohydrate restricted diets almost invariably show significantly better short term weight loss,” _WIRED_ reported, but “over time, the differences converge towards non-significance.”  In other words, the available evidence suggests that over the long term, both low-fat and low-carb diets fail. Continue reading → 13 COMMENTS SO FAR -- ADD ONE Posted in "randomized controlled trials"

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OVER-EATING: CONFUSING CAUSE AND EFFECT–DOES OVEREATING CAUSE YOU TO RE-GAIN WEIGHT, OR DO YOU EAT MORE BECAUSE YOU ARE OVERWEIGHT? Posted on February 21, 2015

by Maggie Mahar

Today, researchers are digging into what drives weight gain, and some are beginning to suggest that we have been confusing cause and effect. WHAT IF IT’S NOT OVEREATING THAT CAUSES US TO GET FAT, BUT THE PROCESS OF GETTING FATTER THAT CAUSES US TO OVEREAT?” Recently _The Journal of the American Medical Association (JAMA)

_

published a provocative piece

that

asked precisely that question. Shortly before publishing in _JAMA_, the authors, summed up their argument in a _New York Times_ Op-Ed: “Always Hungry? Here’s Why.” There, David Ludwig, a professor of pediatrics at Harvard Medical School and director the New Balance Foundation Obesity Prevention

Center

at Boston Children’s Hospital, and Mark Friedman, vice president of research at the Nutrition Science Initiative did a superb job of distilling their argument into terms a layman can

understand.

They suggest that chronic overeating represents a _SYMPTOM_ rather than the primary _cause _OF piling ON THE POUNDS. Indeed, Ludwig and Friedman argue, DIETING ITSELF MAY INDUCE CHANGES IN OUR METABOLISM THAT LEADS US TO REGAIN WEIGHT when we begin to lose it. They explain their theory:  When we eat hearty meals, “we lock . . . more calories away in fat tissue.” As a result, “fewer are circulating in the bloodstream to satisfy the body’s

requirements.”

In other words, there are not enough calories in our bloodstream to give us the energy to do what we want to do. “If we look at it this way,” they continue, “it’s a distribution problem: We have an abundance of calories, but they’re in the wrong place. As a result, the body needs to increase its intake. We get hungrier because we’re getting fatter.” Ludwig and Friedman compare the process to what happens when patients suffer from “edema, a common medical condition in which fluid leaks from blood vessels into surrounding tissues. No matter how much water they drink, PEOPLE WITH EDEMA MAY EXPERIENCE UNQUENCHABLE THIRST BECAUSE THE FLUID DOESN’T STAY IN THE BLOOD, WHERE IT’S NEEDED. “Similarly,” they suggest, “when fat cells suck up too much fuel, calories from food promote the growth of fat tissue instead of serving the energy needs of the body, provoking overeating in all but the most disciplined

individuals.”

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THE INDIVIDUAL MANDATE: HAS THE OBAMA ADMINISTRATION SILENTLY REPEALED THE RULE THAT VIRTUALLY EVERYONE MUST HAVE HEALTH INSURANCE? Posted on February 9, 2015

by Maggie Mahar

Obamacare’s critics continue to argue that the Affordable Care Act (ACA) will self-destruct.  Now, some claim that the mandate that uninsured Americans must purchase coverage– or pay a stiff fine— is so riddled with new “loopholes and exemptions

,”

that it no longer exists.                                           14

New Waivers

When the ACA passed Congress in 2010, it offered a handful of basic

exemptions

to

the mandate that everyone must be insured. For example, if the only comprehensive coverage available would cost more than 8% of a household’s income, the fine would be waived. Individuals who were in jail, or belonged to a recognized religious group that objects to all insurance, including Medicare and Social Security, also would be

excused.

But then, late in 2013, the administration quietly added some 14 new ways that uninsured Americans could dodge the fine

.

“This latest reconstruction” of the ACA received zero media coverage,” a _Wall Street Journal_ editorial declared, “and the Health and Human Services Department (HHS) didn’t think the details were worth discussing in a conference call, press materials or fact

sheet.”

Yet if the new waivers went largely unnoticed, reform’s opponents claim that the swelling list of escape clauses will have a huge impact. By 2016, they say, almost 90% of the nation’s 30 million uninsured will be able to ignore the mandate that they buy insurance—without paying the piper.

So

much for universal coverage. Just last week _Bloomberg_ reported that some Republicans politicians now refer to the new list of loopholes as a “stealth repeal” of the individual mandate.

To her

credit, _Bloomberg’s_ Caroline Chen points out the contradiction in the GOP’s arguments: the same critics who, in the past, argued that the mandate represented “unwarranted government coercion” now criticize it for being too “wimpy.” Can they really have it both

ways?

                                     “HARDSHIP

EXEMPTIONS”

The new waivers were designed to help those who are facing hard times. Some exemptions will suspend penalties for 3 months—others for a

year.

Perhaps the most important waiver bails out low-income Americans who have the bad luck to live in a state that has refused to expand Medicaid.  Originally, the ACA stipulated that states must extend Medicaid to adults earning less that 138 percent of the federal poverty level ($27,310 for a family of three

),

with the Federal government paying the lion’s share of the extra cost. At the same time, the ACA set out to help LOW AND MIDDLE-INCOME FAMILIES EARNING MORE THAN 138% of the FPL, by providing government subsidies designed to help them purchase insurance in their state

exchanges.

But then, two years after the ACA passed Congress, the Supreme Court blind-sided reform’s architects by ruling that states could opt out of expanding the federal/state. program. No surprise, politicians in Red states saw this as an opportunity to undermine Obamacare. Today, twenty-two states still are refusing to open the Medicaid umbrella to cover some of their poorest citizens. As a result, in many cases, only parents earning less than 50% of poverty ($9,893 for a family of three) qualify

for Medicaid,

WHILE CHILDLESS ADULTS REMAIN INELIGIBLE In almost all of these states.  (When Medicaid passed Congress in 1965 legislators decided that only “the worthy poor” should be

covered.

People

who didn’t have children were not considered “worthy”.) Continue reading → 9 COMMENTS SO FAR -- ADD ONE Posted in Affordable Care Act

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OBAMACARE FINES: HOW TO ESCAPE A HEFTY PENALTY IF YOU REALLY CAN’T

BUY INSURANCE

Posted on January 30, 2015

by Maggie Mahar

Already, the fear-mongers are sounding the alarm: If you don’t purchase exactly the type of health insurance that the Affordable Care Act (ACA) requires, come tax-time

the

IRS will slap you with a stiff penalty. As I explain in the post below, the ACA mandates that if you’re not already covered, you must buy insurance that includes “essential benefits”

such

as hospitalization, maternity and newborn care, and mental health services. Ignore the mandate this year, and you will be fined when you file your taxes next year.                                HOW MUCH WOULD YOU

OWE?

IF  YOU OPT OUT OF PURCHASING INSURANCE THAT COVERS YOU AND YOUR FAMILY IN 2015, THE PENALTY WILL EQUAL EITHER: *  1 percent of your  income over your “filing threshold” (about $10,000 for an individual $20,000 for a couple)  OR *  a  flat dollar amount, of $95 per uncovered adult and $47.50 per child, up to a maximum of $285, WHICHEVER IS GREATER. “Whichever is greater” means that WEALTHIER TAXPAYERS WILL BE REQUIRED TO PAY 1% OF THEIR INCOME, AND as a result can easily wind up owing significantly more than $285. This doesn’t mean that millionaires would be fined tens of thousands of dollars. An affluent family’s penalty also is capped, at the average cost of bronze plans sold in state Exchanges nationwide. In  2014, nationwide, the average bronze plan premium was $2,448 per individual and $12,240 for a family with five or more. This year, across the nation, average premiums were slightly higher, so a family of five earning more than roughly $145,000 would have to fork over a little more than $12,240.                        IF THIS SOUNDS COMPLICATED, TURBO-TAX MAKES IT SIMPLE If, at this point, your eyes are glazing over, the good news is that you can calculate _your_ penalty

,

quickly and easily, on Turbotax’s online calculator

. Just

type  in your income, zip code, and  the size of your household, and in about THREE MINUTES, TurboTax will tell you  the size of your fine—and, most importantly, whether you might qualify for an exemption to the penalty.                                HOW YOU MIGHT ESCAPE

THE FINE

The  chances that the IRS will fine you are slim. What the fear-mongers rarely mention is that, thanks to the many exemptions built into the law, only about 10 percent of the uninsured will owe a penalty. The Congressional Budget Office (CBO) estimates that in 2016,  JUST 4 MILLION UNINSURED AMERICANS WILL FACE FINES, WHILE 26 MILLION WILL QUALIFY FOR WAIVERS

.

Recently, I wrote a piece for Consumer Reports listing some of the most common exemptions: *  if the lowest-priced coverage available to you, even after applying  a government subsidy, would cost more than 8 percent of your household’s income, the fine is waived; * –if you earn less than $10,150 (or $20,300 for a married couple) and so are not required to file income taxes you owe no fine and don’t even have to apply for a wavier; * if you were uninsured for less than 3 consecutive months, you will

not be fined.

(As I explain in the post below,  this means that if you sign up for 2015 coverage by February 15 you will be insured as of March 1, and will not owe a penalty for 2015.)                      LITTLE KNOWN “HARDSHIP EXEMPTIONS”             On the Consumer Reports website, I also point out that late in 2013, the government added 14 new

waivers

for people who have experienced personal hardships such as domestic violence, substantial property damage from a fire or flood, from a fire or flood, the death of a close relative, a utility cut-off, or

bankruptcy.

Perhaps most importantly, the government is offering a one-year waiver to people who don’t qualify for Medicaid

because

they live in a state that has

refused

to expand the program

under

ACA rules.

To learn more about the hardship exemptions, HOW TO APPLY FOR ANY EXEMPTION, AND INFORMATION ON HOW YOU MIGHT ESCAPE THE PENALTY, BUT STILL BUY CATASTROPHIC INSURANCE, READ THE REST OF THE POST ON CONSUMER REPORTS.ORG. Comments are off for this post Posted in ConsumerReports.org

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RECENT POSTS

* Self-fulfilling Media Narratives: How One Man Wound Up Deciding the Fate of Healthcare Reform * NIHCM Health Care Digital Media Award: the Finalists. * “Clinical Man”–by Clifton Meador (Why Do So Many Of Us Need Medical Tests to Tell Us That We Are Well?) * Will the Supreme Court Scuttle Obamacare Subsidies? (No. What Can’t Happen, Won’t. ) * Look Into This Surgeon’s Face . . . * What Doctors Should– and Should Not– Say to Obese Patients * Losing Weight—What the Experts Are Reluctant to Tell You –

Part 1

* Over-Eating: Confusing Cause and Effect–Does Overeating CAUSE You to Re-Gain Weight, Or Do You Eat More BECAUSE You Are Overweight? * The Individual Mandate: Has the Obama Administration Silently Repealed the Rule that Virtually Everyone Must Have Health Insurance? * Obamacare Fines: How to Escape a Hefty Penalty If You Really Can’t Buy Insurance

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