Mr. President, Please Read Chapter 6, “The Affordable Care Act in Hindsight”
May23

Mr. President, Please Read Chapter 6, “The Affordable Care Act in Hindsight”

In August 2015 I gave a talk on the history of the evolution of health insurance that was part of a seminar entitled “Practicing in the Era of Healthcare Reform.”  I concluded my talk with a slide labeled “Persistent Problems.” I recently reviewed the presentation and was surprised by how appropriate the list still is as we face the continuing dilemma of “repeal and replace.”   Persistent Problems: [As of August 2015] Healthcare...

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If I had Three Wishes From the A.I. Genie
May16

If I had Three Wishes From the A.I. Genie

I do not stake my hopes for the future of healthcare on new legislation or changes in payment methodologies. Those are necessary but insufficient if we are ever going to respond effectively to the challenge to achieve   …Care better than we’ve seen, health better than we’ve ever known, cost we can afford,…for every person, every time…in settings that support caregiver wellness. I believe that the challenge of the Triple Aim...

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Puerile High Fives in the Rose Garden After the House Votes to Repeal and Replace the ACA
May09

Puerile High Fives in the Rose Garden After the House Votes to Repeal and Replace the ACA

I have watched my favorite teams lose championship games. I remember the sinking feeling that I experienced when Richard Nixon was elected for the second time, even after it was really pretty clear that he was a crook. I suffered when Jimmy Carter, one of the most honest and earnest men ever to enter politics, lost to Ronald Reagan who was the champion of making America feel good about its defects. I read Bush One’s lips and was...

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Let’s Keep Trying to Save the Gains of the ACA
May02

Let’s Keep Trying to Save the Gains of the ACA

It may seem strange to you, but each time I hear that the president and the Republican leadership are making an effort to resuscitate their attempt at repealing and replacing the ACA, I immediately think of the surprising last scene from “Fatal Attraction,” the terrifying 1987 movie with Glenn Close and Michael Douglas. You may remember that in the chilling last scene Douglas is attacked with a butcher knife by Close. She is obsessed...

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Perhaps an Explosion Would Be the Most Efficient Route to the Triple Aim
Apr25

Perhaps an Explosion Would Be the Most Efficient Route to the Triple Aim

After the failure of Paul Ryan’s American Health Care Act to get passed over the internal squabbling of House Republicans despite their forty four vote majority, David Brooks wrote an interesting tongue in cheek column entitled “The Coming Incompetence Crisis.” He articulated his concern:   …I worry that at the current pace the Trump administration is going to run out of failure. So far, we’ve lived in a golden age of...

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Where We Should Focus
Apr18

Where We Should Focus

In a recent essay Michael Dowling, the CEO of Northwell, the massive health system with 21 hospitals in metropolitan New York and Long Island, points out that the most frustrating aspect of the current healthcare debate is that “it is ideological and not practical.” He describes the debate as “…contentious, tumultuous and exhausting to keep up with.” These comments set the stage for his central contention that through it all and...

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The Joy of Working in an Integrated System of Care That Is Continuously Improving
Apr11

The Joy of Working in an Integrated System of Care That Is Continuously Improving

I believe that better care that is economically sustainable and available to everyone while producing healthier communities without unacceptable personal sacrifices from individual health professionals is only possible in a professional environment and culture that respects the contributions of all health professionals. When I use the phrase “I to we” I am talking about everyone who is employed in healthcare from the staff that parks...

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The Search For a Better Future State
Apr04

The Search For a Better Future State

The failure of the president and House Republicans to launch a credible process to “repeal and replace” the ACA creates a moment of opportunity for those who would like to contribute to the search for a better future state for healthcare. The challenge of providing affordable, quality care to all Americans has flummoxed politicians, healthcare policy experts, clinicians, healthcare administrators, insurance executives, employers, and...

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