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The More Things Change

The fact that presidents have been trying to get some form of universal, government supported health insurance for almost 100 years now has been well publicized. What is less known is why — with the exception of the passage of Medicare and Medicaid in 1965 — almost all of their efforts have failed to produce substantive change. It’s instructive to …

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The Limits of Guidelines

Jerome Groopman published a provocative and thoughtful essay In the February 11, 2010 New York Review of Books  about the way one determines “quality health care.” Groopman’s focus is on clinical guidelines and just how prescriptive they can be. He makes a fundamental distinction between guidelines that can be applied in a standardized way (e.g., how to clean a catheter to …

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The Status Quo? Think Again

The last time a major effort at health care reform was tried, it died an ignoble death. Bill and Hillary Clinton were certain that they had read the political signals correctly and that health care reform was a winning issue for them. Bill Clinton framed health care as an essential economic issue after he was elected and before he became …

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Health Reform in Pieces: Mental health and health care reform

There is much speculation — and advice — about what to do about health reform given the change in Congress since the Massachusetts’ Senate race. Some policy makers and pundits are advising that it would be better to take small bites out of health reform — rather than trying to continue down a path focused on change to the entire …

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What does Massachusetts say about health reform?

Well, every politician for the past 100 years has known that health care reform is the “third rail” of politics. And, if they didn’t know before Massachusetts, they know it now. So, why did health reform fail this time? Is it for the same reasons it has in the past or is there something unique about this moment or this …

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Is concentrated power a good or bad thing when it comes to health care plans?

During the debate about health care reform, there has been much discussion about the need for a public option. The advocates for that option talk about the need to assure real competition in health care. About the public option, Robert Reich said, “…without a public option, the other parties that comprise America’s non-system of health care — private insurers, doctors, …

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The devil is the detail

Health reform is exciting and both the House and Senate bills have elements that could greatly improve the way care is delivered for millions of people. But, with all those great things, you have to know that there are lots of things in those more than 1,900 pages of the House bill and more than 2,000 in the Senate bill …

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What’s a person to do?

“Breast-screening advice is Upended” (Wall Street Journal, November 17, 2009) For years, we have been told that we should have a mammogram every year after age 40 and in 2002, this advice was repeated by the same folks who now are recommending that most women can wait until 50 for routine mammograms. Does it make anyone think about the margarine …

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Health reform gone too far?

I was having a debate the other day about whether the health reform bill going through Congress was a good or bad thing and whether it went too far or not far enough. This dialog is occurring with my friends and colleagues who are strong European model supporters – let’s put all docs on capitation/salary – and my friends who …

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