So you want a CAT scan?

Who knew healthcare could be so complex?  On the eve of a healthcare vote, the two sides have sharpened their respective arguments.  The GOP proposal for health care reform rests on health savings accounts and high deductible health plans.   The basic premise is that price opacity, and deep pocketed third party payers drive up…

A tale of three brain tumors

There are 80,000 new cases of primary brain tumors diagnosed every year in the United States.  About 26,000 of these cases are of the malignant variety – and John McCain unfortunately joined their ranks last week.  In cancer, fate is defined by cell type, and the adage is of particular relevance here.  Cancer is akin to…

The case for the BCRA

Dr. Jha writes on these pages in typically stirring fashion about his views on the recent health care kerfuffle and rightly so fingers what the real focus of our efforts should be: Cost.  He ends by slaying both sides because of their refusal to confront the hospital chargemonster – the fee schedule hospitals make that…

Enrollment

Tweet storm Patient I saw recently 60 y/o woman found down in the parking lot Witnessess began CPR. EMS found VT on arrival, shock delivered Neurologic outcome thought to be moribund, but 10 days in to an ICU stay, pt awakes! She gets a cardiac cath (non obstructive CAD) ICD placed for secondary prevention She…

The Science of Medicaid

I remember 7 South at the Children’s hospital very well.   I remember the distinctive smell, the large rooms, the friendly nurses, and Shantel.   For a brief period of time, Shantel and her little boy – a too skinny child named James – were there every time I was there with my little girl….

The AHCA Fail: What winning feels like…

You may have heard that repealing and replacing Obamacare recently failed.  The analysis of what went wrong comes from many corners.  Andy Slavitt, former insurance executive and most recent director of CMS, writes that the ‘failure of Trumpcare can be seen as a rejection of policies that Americans judged would move the country backward.’  Apparently,…

Health care policy: The provenance of experts?

Arguably, the most consequential moment of the nascent Trump administration will take place later today when Congress Votes on the first iteration of the bill known as the American Health Care Act (AHCA).  If the success or failure of the bill to this point is to be judged by its reception from policy thinkers on…

Defending the coronary stent

A kerfuffle ensued recently when an oncologist and expert on evidence based medicine took the field of cardiology to task over the evidence for placement of the ubiquitous coronary stent.  What started with a lengthy article in Propublica that included coronary stenting for stable coronary disease as a prime example of a procedure done without evidence…

The case against Obamacare

The Senate has taken its first step to repeal Obamacare.  By a final party line vote of 51-48 the Senate approved a budget resolution setting the stage for rolling back much of the Affordable Care Act. Consternation reigns among Democrats who have closed ranks and promise catastrophe. Bernie Sanders, the top democrat to lead the…