The Silent Healthcare Revolution

AmbulanceThe presidential campaign is far enough along to confidently conclude that the health delivery revolution will not be televised. Instead, it will continue its quiet progress, remaking nearly a fifth of the economy without political, media or public awareness. Such is the course of American revolutions. Continue reading The Silent Healthcare Revolution

This is how you’ll feel when the GOP wins the Senate

GOP It’s the morning after.

You stayed up late watching election results on TV.  By the time you went to bed, the Republicans had won five of the six Senate seats they needed to take control of both houses of Congress.  As the networks called each state for the GOP, it felt like a trap door had opened beneath your feet, like a Munch scream, like a nightmare – a nauseating, slow-motion wreck you were powerless to prevent. Continue reading This is how you’ll feel when the GOP wins the Senate

Obamacare Prescription: Keep Calm and Carry On

President Obama signing the Affordable Care Act There’s growing angst in the health reform community that Obamacare is not succeeding as it should. Perhaps that’s nothing more than a response to the growing popularity of immigration and tax reform.

The basic premise of the complaint, as I understand it, is that the infrastructure is not as far along as some would like, which may lead to confusion when major elements become effective next year, that Americans remain ambivalent about the bill because they don’t know what it does for them and that this lack of enthusiasm – coupled with continued GOP opposition – will yield a bad result in Congressional elections next year. Continue reading Obamacare Prescription: Keep Calm and Carry On

Recasting the Medical Morality Play

Doctor and patient Many Americans have an unhelpful habit of viewing the health reform debate as a morality play where those who treat us, usually doctors and hospitals, are viewed as the good guys and those who pay for those services, generally insurance companies or government programs like Medicare, are seen as villains.

When a physician suggests another test, we assume that they’re trying to be helpful rather than merely increase their income. When an insurer refuses to pay for a test proven unreliable or has a less expensive alternative, we assume that the decision comes from heartless profit-maximizing bean counters. Continue reading Recasting the Medical Morality Play

Maybe We Don’t Have a Spending Problem After All

Boehner & Obama House Speaker John Boehner recently confided in an interview that what astonished him most during his marathon negotiations with President Obama on avoiding the fiscal cliff was when Mr. Obama said to him, “We don’t have a spending problem.”

When I read that, I was reduced to sputtering indignation: “We don’t have a spending problem??!! What planet is that man living on??!!”

And yet, just a couple of days later, I read a column by Matt Steinglass in the January 8 issue of the Economist that made me realize that Mr. Obama was entirely right. We don’t have a spending problem; we have a tax problem. Continue reading Maybe We Don’t Have a Spending Problem After All