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…

National Health Expenditures continue to accelerate in 2015

In 2009 a youthful Barack Obama addressed a joint session of congress on health care on a cold fall evening.  The country was still recovering from the great financial crisis, and the new President was now attempting to turn the nation’s eye to health care. As he had done many times before, Obama spoke powerfully of…

Why Trump won? A brief tutorial for Harvard medical students

Mike Milligan, a Harvard medical student, recently writes in THCB about the shock felt throughout his medical school upon the election of Donald Trump.  Seeking to understand how it may be that ‘equality, service and compassion’ were defeated, Mike settles on the narrative that appears to have taken hold of the elites on the left…

Trade-off’s in heart failure

On the day Donald Trump was elected, I wrote about the inverse relationship that may exist between heart failure readmissions and heart failure mortality – a topic I had been itching to write about for some time.  It all started in 2012 when The Center for Medicare and Medicaid Services (CMS) instituted the Heart Failure…

Death and Readmissions

Eugene’s wife is on the phone.  She has been taking care of Eugene for 41 years.  I supposedly take care of his heart, weakened by two prior heart attacks.  I say supposedly because his wife does all the heavy lifting.  She makes sure he takes his medications when he should.  She watches his weight every…

Medicare Advantage – the cup that spilleth over

I was asked to see an unfortunate elderly man – Harry – one afternoon.  He had multiple coronary stents placed for coronary disease over the course of the last ten years, and after presenting with difficulty speaking, was found to have a brain tumor.  The neurosurgeon was hoping I could provide some reassurance about how…

Making Accountable Care Organizations great again

Test your Accountable Care Organization knowledge: Select all of the options that are True If you belong to an ACO you qualify for the alternative payment model track in MACRA Most ACO’s are enrolled in to a two sided risk model – (They share profits and losses with Medicare) In 2015, ACO’s saved Medicare more than a…