Pundit Wire

The war to reform American medicine has been won.

LyndonJohnsonSigningMedicareBillThe transformation began with the enactment of Medicare and medicaid during the Johnson years — which allowed prices to be contained as a growing percentage of bills were paid by large entities, especially the government — and the HMO act during the Nixon years — which endorsed the idea of an efficient system where experts decided on how to treat any problem,  effectively setting limits on volume.

Once the tools were in place to control both price and volume, the rest was just fine tuning,  which is still ongoing.  The basic principles were ratified in Obamacare and are no longer under serious challenge.  The change hasn’t relied entirely on government action, but reflects private sector movement in the same direction.

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Bigger American Medicine May Be Better

Unknown-12For better and worse, American medicine is increasingly controlled by large corporate entities and Obamacare is accelerating the transition. Observers including me who see our medicine as highly inefficient view this trend as an opportunity to impose rationality, but there are also clearly pitfalls.

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Hard to Split Cloud, Silver Lining

Signing healthcare reformTeasing out the link between moderation in health spending and subpar economic growth is a daunting but important task that could have a big and unpredictable impact on the American economy in the years and decades ahead.

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Encore for Proprietary Medical Schools?

Medical Schools Conventional wisdom holds that America faces a growing physician shortage and that one way of responding is by creating new medical schools.  Starting a new school is an expensive proposition which may explain the modest number that has opened in the past decade.  But now the private sector may be coming to the rescue by creating proprietary – or profit-making – schools to train physicians.

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So What’s the Problem?

healthcare If the good news we’ve been hearing about American health costs in the past few months turns out to be the new norm – it’s too early to tell – then much of today’s political debate is wildly misguided. Consultants predict 2014 will see abnormally low inflation, again. Medicare spending per beneficiary is dropping more than previously anticipated. And new tools provided by Obamacare to constrain costs could accelerate these trends.

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Once Upon A Climate Change

SONY DSC I wonder what would happen if the world’s storytellers and artists were to throw themselves into making the 2014 summit succeed. Invite the wizards of digital creation and distribution, the social media entrepreneurs and software geniuses, the networks and studios, to lend their talents to a communication campaign. Imagine if film-, video- and game-makers, musicians, photographers, screenwriters, graphic novelists, comedians, actors, essayists and fashionistas were inspired to tell the tale of climate change. Think of what designers, logo makers, branders and advertisers could contribute.

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Lobbying’s Hidden Persuaders

lobby There are two interesting additions to the annals of political influence which focus on quiet issue lobbying.

The quiet lobbying game works best when no one looks carefully at the sausage-making machinery. It offers a stark contrast to the money game where contributors present themselves as 800-lb gorillas who are willing to spend as much as it takes to make things happen their way.

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The Bang Of Your Medical Buck

doctor Is it wise policy to encourage Americans who already spend more than $8 billion annually on these tests to get more? And why does Obamacare, which generally favors evidence-based medicine, mandate this service despite new research suggesting mammograms don’t save lives.

Despite our discomfort with a public debate, our healthcare system is constantly asked what treatments are worth paying for.

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