Health Policy: All Articles and Books

Making Practices Perfect

Articles — Tue, 26 Aug 2008 11:58:00 -0400

The waiting room of Ramona Seidel's family medicine practice is empty, and she works hard to keep it that way.

After several years in a traditional suburban group practice that blended pediatrics and family medicine, Seidel quit to start her own micro-practice in Annapolis: a low-overhead, high-tech office that gives her more control over how she treats patients and more time to spend with them. She's happier. Her patients are happier. And she's pretty convinced they are healthier having a physician who knows them well.

"It's more friendly; it's personal. She's very good about giving answers. It feels comfortable talking to her," said Ronald Porciello, 41, a contractor… more

Naming Names: Is There an (Unbiased) Doctor in the House?

Articles — Wed, 23 Jul 2008 01:29:00 -0400

Journalists often forget that conflicts of interest may bias the opinions of their expert sources. Jeanne Lenzer and Shannon Brownlee explain how, in an attempt to disentangle commercial messages from science, they have compiled a list of nearly 100 independent medical experts to whom reporters can turn.

Ho hum, another medical scandal in the news. Earlier this month US Senator Chuck Grassley announced his intention to investigate Alan Schatzberg, chairman of the psychiatry department at Stanford University and the incoming president of the American Psychiatric Association, about his multimillion dollar interest in Corcept Therapeutics, a company that is seeking to market a drug that Dr Schatzberg is researching with federal… more

Battle Of the Budget Slide Shows

Ron Tang — Fri, 30 May 2008 02:14:00 -0400

"Saving our future requires tough choices today" may be a banal sentiment, but it's not an easy one to challenge. That is the headline on the "Fiscal Wake-Up Tour," a slide show created by David M. Walker, formerly head of the Government Accountability Office. In hopes that it will be to the long-term budget deficit what Al Gore's "An Inconvenient Truth" slide show has been to climate change, Pete Peterson has set aside a billion dollars out of his recent windfall from the Blackstone Group to fund Walker's national tour and like endeavors.

Walker, Peterson, and groups like the Concord Coalition… more

Conditioning the Corporate Athlete

Ron Tang — Thu, 22 May 2008 11:47:00 -0400

Thirty-five years ago, in his classic Management: Tasks, Responsibilities, Practices, Peter Drucker declared that the means by which most people had long run their organizations -- through a mix of perks and punishment, rewards and reprimands -- was all but dead.

"The basic fact," Drucker wrote, "is that the traditional... approach to managing, that is the carrot-and-stick way, no longer works."

It was striking, then, to read a few weeks ago of Whirlpool's decision to suspend 39 workers who had claimed to be nonsmokers -- apparently in an attempt to avoid paying a $500 surcharge on their health insurance -- but then… more

Crossroads in Quality

adminn — Tue, 13 May 2008 11:43:00 -0400

Expanding insurance coverage is a critical step in health reform, but we argue that to be successful, reforms must also address the underlying problems of quality and cost. We identify five fundamental building blocks for a high-performance health system and urge action to create a national center for effectiveness research, develop models of accountable health care entities capable of providing integrated and coordinated care, develop payment models to reward high-value care, develop a national strategy for performance measurement, and pursue a multistakeholder approach to improving population health.

* * *

For the full text of this essay, please see the… more

The Long Road To Health Reform Requires Bipartisan Leadership

adminn — Tue, 13 May 2008 09:27:00 -0400

The United States appears headed toward another national debate about health system reform. Worry about access and health system deficiencies has reached critical mass, and polls indicate that health care leads the domestic agenda for the 2008 elections. This debate, like previous debates, will succeed or fail in Congress. We highlight key elements of recent sagas in health legislation and offer advice to the next president and Congress for improving the likelihood of a successful outcome in 2009-10:

make health reform a top legislative priority; be leaders, not partisans; and develop broad policy consensus but leave the policy details to Congress. more

Stealth Marketers

Ron Tang — Tue, 06 May 2008 07:11:00 -0400

A few weeks ago, devoted listeners of National Public Radio were treated to an episode of the award-winning radio series The Infinite Mind called "Prozac Nation: Revisited." The segment featured four prestigious medical experts discussing the controversial link between antidepressants and suicide. In their considered opinions, all four said that worries about the drugs have been overblown.

The radio show, which was broadcast nationwide and paid for in part by the John D. and Catherine T. MacArthur Foundation, had the air of quiet, authoritative credibility. Host Dr. Fred Goodwin, a former director of the National Institute of… more

Are You Confused Yet?

Ron Tang — Sun, 27 Apr 2008 05:49:00 -0400

Polls show that health care ranks near the top of voters’ concerns, especially among Democrats. And for those who say “the economy” is the top issue, health care is usually a major part of their financial worries.

And yet, voters must be awfully confused about where the Democrats stand on health care. On the one hand, both Barack Obama and Hillary Clinton say they want to insure everyone -- and in much the same way. On the other hand, they are beating each other up at every turn. Before the Pennsylvania primary, Mr. Obama ran yet another ad arguing… more

Knowing Me, Knowing You

Ron Tang — Sun, 20 Apr 2008 02:09:00 -0400

Do you want to Google your genes or peer into your future risks of heart disease or cancer? Now you can, according to direct to consumer testing companies. Gone are the days when genetic testing was limited to doctors ordering tests for rare, but prognostically potent, single gene disorders such as Huntington’s disease, Duchenne’s muscular dystrophy, or cystic fibrosis. Thanks to an explosion of newly discovered single nucleotide polymorphisms, or SNPs (pronounced snips), companies are marketing genetic tests for traits ranging from the mundane -- eye colour and wet ear wax -- to serious conditions such as Crohn’s disease and… more

Treatment Options

Ron Tang — Fri, 18 Apr 2008 21:00:00 -0400

In his new book, The Healthcare Fix: Universal Insurance for All Americans (MIT Press, 2007), Laurence J. Kotlikoff demonstrates that at some point between 2035 and 2050, the costs of Medicare and Medicaid (two health-care programs that serve only a minority of the population), combined with the costs of Social Security, will approximate the total current cost of the entire federal government as a percentage of GDP. Medicare and Medicaid, without Social Security, will surpass the current cost of government by 2082. To cover the deepening long-term deficits of those two programs would require raising roughly $70-trillion and putting it… more

Big Pharma's Golden Eggs

Ron Tang — Sun, 06 Apr 2008 05:25:00 -0400

Once upon a time there was an industry called pharma that was interested in doing well and doing good. Run by doctors and chemists, drug companies employed battalions of researchers whose scientific efforts resulted by mid-century in a flood of life-saving drugs, including antibiotics, vaccines, tranquilizers, antihistamines and steroids. As George Merck, president of the company founded by his father, put it in 1950, "We try never to forget that medicine is for the people. It is not for the profits. The profits follow... "

And how. Today, of course, drug companies are hugely profitable enterprises and the darlings of both… more

The New Specialty In Cancer Care

Ron Tang — Wed, 02 Apr 2008 07:50:00 -0400

On November 11, 2000, Mark Quasius, then 37, learned that the strange sensation in his right ear was caused by a rare carcinoma in his upper sinuses.

After a variety of treatments, including multiple surgeries on his head, lungs, pancreas, and hip bones, the prognosis for his advanced adenoid cystic carcinoma is pretty good. After consultation with Andrew Putnam, MD, a palliative care specialist at Lombardi Cancer Center and Georgetown University Hospital, his life is pretty good too. Dr. Putnam brought Quasius’s unrelenting pain from the tumor behind his right eye under control after surgeons concluded that, for now, the risk… more

Let's Stop Running Scared

Ron Tang — Sun, 30 Mar 2008 06:49:00 -0400

Felt a little short of breath the other day, walking up a hill. Uh-oh. A nugget of worry lodged for a moment in my mind. At 50-something, I'm in decent enough shape. I don't smoke. I walk several miles most days, and I can still beat my 40-something friend at tennis. Not exactly a candidate for a heart attack. But still. I've read all those stories about women like me, the ones with no risk factors for cardiac disease who were suddenly hit with an attack.

Maybe you've had the same worries -- wondered whether some sharp little twinge was heartburn… more

Let's Try a Dose. We're Bound To Feel Better.

Ron Tang — Sun, 23 Mar 2008 07:20:00 -0400

"Socialized medicine" is the bogeyman that just won't die. The epithet has been hurled at every national health plan since the New Deal -- even Medicare, which critics warned would strip Americans of their freedom.

And now it's back. Republicans from President Bush on down have invoked the specter of socialism in denouncing Democrats' attempts to expand publicly funded health insurance for children. Erstwhile GOP presidential contenders Rudy Giuliani and Mitt Romney lambasted the health plans of the leading Democratic candidates for mimicking "the socialist solution they have in Europe" (Giuliani) and trying to impose "a European-style socialized medicine plan" (Romney).… more

Competing Prescriptions

Ron Tang — Sun, 09 Mar 2008 10:39:00 -0400

With the March 4 primaries delivering finality on one side of the partisan divide and uncertainty on the other, it’s a good time to take stock of where the candidates are on health care. For now, most attention has centered on the scrap between Hillary Clinton and Barack Obama over an “individual mandate” requiring everyone to have health insurance. But this fight will look like a college seminar discussion compared with the take-no-prisoners battle that’s likely to emerge between John McCain and whomever the Democrats eventually nominate.

That’s because, when it comes to health care, Republicans are from Mars and Democrats… more

An Untold Story?

Ron Tang — Wed, 27 Feb 2008 00:00:00 -0500

New generation antidepressants aren’t all they’re cracked up to be. That seems to be the central message in the meta-analysis published this week by Irving Kirsch and colleagues in PLoS Medicine,[1] and it was this message that made the headlines. Kirsch’s conclusion follows on the heels of similar studies showing that statins are useful in only a small subset of patients taking the drugs[2] and earlier studies finding that the safety and performance of cyclo-oxygenase-2 (COX 2) inhibitors were worse than they first seemed.[3] All of which further reinforces previous criticisms that regulators in the United Kingdom and the United… more

A Mandate isn't Mandatory

Ron Tang — Tue, 26 Feb 2008 00:00:00 -0500

As the primary fight between Hillary Rodham Clinton and Barack Obama reaches fever pitch, the domestic policy battle has boiled down to a single technical phrase: "individual mandate."

Clinton's healthcare plan includes such a mandate, requiring that everyone obtain health coverage. Obama's does not (though he does require that children get coverage). This difference, Clinton is insisting, is reason enough for anyone who wants universal coverage to support her. As Clinton argued in last Thursday's debate: "If you do not have a plan that starts out attempting to achieve universal healthcare, you will be nibbled to death, and we will be… more

Price Check

Ron Tang — Fri, 15 Feb 2008 00:00:00 -0500

For American progressives, it's hard to name a more pressing -- or long-awaited -- goal than achieving universal health coverage. Today, prospects for that goal seem better than they have in years, if not for the fact that the Democratic presidential hopefuls are bickering over the details of how to do it.

But obsessing over universal coverage has obscured a far more complex and worrisome problem in our healthcare system, and that is the question of costs.

The United States, as we all know by now, spends more per capita on healthcare than any other country on the planet, and by a… more

Tough Tax Questions for Presidential Candidates

Ron Tang — Thu, 14 Feb 2008 00:00:00 -0500

The current crop of Presidential candidates sound a lot like they did in prior years with promises of new targeted tax breaks, loophole closures, increased taxes on the rich and new spending programs. Have the candidates not read the doom and gloom budget reports from the Government Accountability Office (GAO), Congressional Budget Office (CBO) and others?

The fiscal agenda for the next President and Congress must include some very difficult decisions that go beyond just tweaking the tax system. Below, we’ll look closer at some key fiscal issues that have tax implications. Questions are posed that could help gauge how… more

Why the Budget Gap Shouldn't Derail Health Care Reform

adminn — Tue, 15 Jan 2008 15:06:00 -0500

As Gov. Arnold Schwarzenegger has released his budget threatened by $14 billion of red ink, many are asking whether California can afford the ambitious health care reforms that passed the state Assembly in December. Given the social and economic costs of leaving as many as 6.5 million Californians uninsured, the better question may be: Can we afford not to? Those worried by the possible impact of the budget gap on health reform include Senate President Pro Tem Don Perata, whose chamber must vote for the health reform bill for it to move forward. Perata's concerns must be taken… more