Leaping Barriers to the Triple Aim
Feb17

Leaping Barriers to the Triple Aim

In  “The Triple Aim: Care, Health, And Costs” Berwick, Nolan and Whittington describe American healthcare as the most fragmented, most expensive and least effective care delivery system among all of the advanced economies of the world, and they identify the barriers to improvement. Their assertion remains a triple surprise for me. First, it was a true statement. Second, it did not disturb more people. Third, it is still true. The...

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Where Healthcare Should Focus in 2016
Jan20

Where Healthcare Should Focus in 2016

I have been looking forward to 2016 and asking myself where healthcare should focus in the year ahead. In this connection, Don Berwick’s speech at the 27th Annual IHI Forum had a profound effect on me. You can watch it on YouTube. I appreciated his insightful and historically astute descriptions of Era 1 and Era 2 of healthcare. The first era goes all the way back to Hippocrates and Galen and was dominated by clinical autonomy and...

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Attorney General Maura Healey Leads Healthcare Reform
Oct15

Attorney General Maura Healey Leads Healthcare Reform

As a member of the Advisory Council to the Health Policy Commission in Massachusetts, I was very interested in following the internet broadcast of the annual HPC Cost Trends Hearings early in October. At the core of the presentations was a debate about healthcare costs. For me the high point came when Attorney General Maura Healey and her staff made the sort of leadership statements that suggested to me that she was not in harmony...

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Another Hurdle Cleared at the Supreme Court!
Jun26

Another Hurdle Cleared at the Supreme Court!

  Thanks to the Supreme Court, healthcare reform has cleared another hurdle.  At 10:21 AM yesterday, as I was writing this week’s letter a banner appeared on my screen: NPR:Breaking News–Supreme Court Rules Obamacare Subsidies Are Legal Just seven words but a powerful message. Later I enjoyed looking at all the YouTube commentary on CNN. In particular I enjoyed the President’s words and the brief analysis of Jeffrey Toobin....

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5 Years Later, ACA Is a Big Deal
Apr21

5 Years Later, ACA Is a Big Deal

Last month we passed a big milestone: the fifth anniversary of the ACA (Affordable Care Act). Barack Obama used 22 pens on March 23, 2010 to sign the most important piece of social legislation so far in this young century. If you have about seven minutes, you can hear Joe Biden’s introduction of the President at the signing. Biden’s speech is pretty laudatory and positive but he does not overstate the significance of the President’s...

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Healthcare Is a Civil Right
Apr14

Healthcare Is a Civil Right

I see the current efforts to extend healthcare to all Americans to be an extension of the issues of equality of opportunity that were expressed by President Obama in his speech marking the 50th anniversary of the Civil Rights movement. Ironically, it is hard to imagine a great country with more than an eighth of its population denied access to one of the fundamentals necessary to be a productive member of society. Statistics often...

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The Future of Healthcare Payment
Feb26

The Future of Healthcare Payment

Healthcare payment models are changing. Since the passage four years ago of the Affordable Health Care act, even the total optimists have become somewhat frustrated with the ups and downs of implementation, and many progressives continue to call for even greater change, with new attempts at single-payer mechanisms that are unlikely to happen even if the Democratic Party were to control the Presidency and both houses of Congress....

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