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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Donald Trump’s Promise
Nov22

Donald Trump’s Promise

Where Does The Real Controversy Lie? The Democratic position on healthcare and the philosophy expressed in Paul Ryan’s “A Better Way” and the brief paper that the Trump campaign had on their website agree on more than you might expect. Both sides focus on the immediate need of lowering the expense of healthcare. The differences are in the path to solution. A close reading of what is available leads to the conclusion that everyone says...

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How To Think About ACOs
Sep27

How To Think About ACOs

Elliott Fisher first described the concept of the ACO in an article in Health Affairs in December 2006. As of January 2016 there were over 800 ACOs, but there is huge variation in form and execution of an idea that looked simple at the start. Since 2011 the number of people getting their care from a CMS, Medicaid or Commercial ACO has grown from zero to over 28 million. That means that close to 10% of Americans get their care from an...

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Old Fashioned Values Applied to Complex Times in Healthcare
Sep13

Old Fashioned Values Applied to Complex Times in Healthcare

  An “Interested Reader “ and friend recently sent me a eulogy that he delivered at his father-in-law’s funeral. Let me give it to you to read, and then invite you to think with me about Don Berwick’s recent call for Era 3, the “Moral Era” of healthcare.   I have been thinking about my nearly 50-year long relationship with Granddad, …Charlie to work colleagues, friends and neighbors. He brings to mind Churchill’s...

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