Thursday, February 16, 2017
Repeal and replace Obamacare--STAT!
Am I referring to Obamacare here or Obama himself?
I am glad that we have a new president. Like most of the country, I was ripe for a change of direction and a new approach to foreign and domestic affairs, and we are certainly getting that. New readers here might erroneously suspect that I voted for Trump. I didn't. For the first time in my presidential voting history, I wrote in my choice for our top two office holders.
I have written multiple posts on my unfavorable views of Obamacare since it was jammed through congress without a single Republican vote. (Do I sound slightly partisan here?) Interested readers are invited to peruse posts on this blog within the Health Care Reform Quality category, if you dare.
There are two kinds of people who oppose Obamacare:
• folks who believe it is wrong on policy grounds
• folks who wield it as a political cudgel to bash Obama.
Some opponents are a hybrid of both of the above.
I was also suspicious that the Affordable Care Act (ACA) was always an interim step preceding a full nationalization of our health care system. Obama is on the record favoring such a policy during his 2008 campaign. If Obama could have achieved this politically in one step, he would have. The ACA represented the political upper limit that he could achieve, hoping that this would make a full would bring us within reach of a government takeover. Some conspiratorial skeptics believe that the ACA was designed deliberately to fail so that private insurance companies would have to abandon it, as they have. Then, the beneficent government would have to step in to rescue Americans who needed medical coverage STAT! While I offer no opinion on this wild charge, there were many smart people who averred when the ACA was delivered to us, that the numbers would never add up. And they didn't.
It is my belief that government is simply not equipped to assume control of the entire health care system and operate it at the highest level of quality possible, while controlling costs. Remember how smoothly the healthcare.gov web site release was? Do you think this would have happened if Google or Facebook was in charge? Which company do you have a higher opinion of in terms of quality and efficiency, the Bureau of Motor Vehicles or Amazon? If folks want to have a government insurance plan like Medicare, I am fine with this. But, give us access also to the free market. I like choice because competition breeds excellence. When FedEx came onto the scene, it forced the U.S. Postal Service to really step up, which they have.
And, we all know that the plan's proponents were somewhat less than truthful. Feel free to Google Jonathan Gruber to become reacquainted with his 2014 comments which make reference to stupid American voters and other niceties. How long did it take the Obamians to admit that the statement, “If you like your doctor, you can keep your doctor,” was known to be false from the outset?
Let's face it. The ACA promised us quality and cost control and in my view it has failed on both counts. I do congratulate the president here, as I have previously, for taking on the challenge of health care reform. Republicans over several presidential administrations failed to seriously confront this challenge. And the plan does cover more Americans, which we all agree is a necessary goal. But, the collateral damage of this achievement warrants a new direction, admitting that it may not be possible to uproot the entire tree.
The replace part is going to be tougher than the repeal part. Will the GOP take a lesson from their adversaries and jam it through without a single Democrat vote?
This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
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Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
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Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
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David Katz, MD
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Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.
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Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).
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Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
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The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.