Jeff Kaplan

While the changes President Obama and Democratic leaders in Congress are proposing are considerable (they could reduce the deficit within two decades), they aren't a government takeover.

To improve the insurance coverage of mental healthcare, employers and group health plans are ruled against discrimination (ie, providing less coverage for mental health conditions than physical ones).

I feel they picked my pocket! Consider what happened to me-I broke my leg (a 4" fibula fracture). An orthopedist inserted a 4-inch plate, but the surgical wound wouldn't close.

Doctors are relatively uninformed about healthcare systems, outcomes research or healthcare economics, specifically the costs of care and cost-benefit.

Witness the outrageous 20-30% administrative overhead of medical insurance companies....That includes a covert and obnoxious 'cost-savings-is-more-important-than-patient-care' reward system.

There's a concept in healthcare insurance where all risks in a community of interest, a market, are pooled - community rating; and then there's experience rating where the healthy are advantaged in more ways then one and the sick are marginalized, paying disproportionately more into the pool just to have a seat at the table.

In a given year in the US, 1/4th of US men and 2/5ths of US women attempt to lose weight, unfortunately, they often fail to keep the weight off.

These past months, we have been discussing reality - we are not doing well compared to other systems of care; we cannot afford to continue what we are doing--it's a veritable shell game.

Sen. Joe Lieberman is officially working to block health care reform in the Congress; he especially desires de-postponing any kind of "health care reform" until the economy has recovered.

Read a prime example of costly, possibly harmful procedures where well over half are deemed unnecessary...

We need to get away from employment-based health care.

The pundits are going to have their field day with this one. "The danger [with this Bill] is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we've tried health reform and it didn't work. But the real problem will be that we didn't really try it.

We rank 19th among industrialized countries in preventable deaths in such conditions as diabetes, epilepsy, stroke, influenza, ulcers, pneumonia, infant mortality, and appendicitis.

Clearly, women live to older ages and are more likely to use medical services than their male counterparts. So, given the premise that it's OK to charge more for heavier users of care, it's not irrational to assume that women can be charged more.

Remember, we have essentially 2 options; All we can do is pick the lesser of the evils. Example: Federal control is bad; corporate control is worse.

I was out of town on business and had a 'slip & fall.' After many tries and many hours on the phone, Oxford could not direct us to a plan orthopedist—hand surgeon? Yes; Foot and ankle? Didn't happen. Ironically (or was it?), that bureaucratic hurdle saved them a bundle.

Achieving patient-centered care is difficult, yet essential; paternalism is, of course, out.

I say we should let those who are screaming against the health insurance reform bills because they're "Socialist" opt out - not just from the bills, but also from ALL of "Socialism."

In "Getting Past Denial — The High Cost of Health Care in the United States," the authors observe, again, Jack Wennberg's (Dartmouth) dictum written about extensively at the end of the last century and earlier—the cost differences between regions and practices may be unwarranted.

Dr. Marc Siegel writes about five critical and central healthcare reforms.

Are we ready to deal without discrimination with potential genetic endowment or burden, given the great variability in penetrance and expressivity (how genetic diseases are manifest, if at all)?

Healthcare is already being rationed. Major healthcare decisions are already being made every day by insurance companies, not doctors.

The concept of healthcare reform is pointless unless we address fraud and waste. It matters little whether providers are cognizant of the fact they are defrauding or are just financial dullards.

To reiterate—the big opportunity in healthcare reform is in being aware of what's going on and what is not—measuring and managing; managing and measuring.

Managed Care is an opportunity to do just that—manage the care and create a balance of its three interdependent components: access, cost and quality.

People are living longer and the population is aging; as a consequence, we are seeing more need for chronic disease management, but at the same time, there is a decline in the availability of primary care physicians.

On the one hand, there's rationing... And on the other hand, there's measurement and management...

So you thought healthcare reform is just a matter of political finesse, emulating other industrialized countries (docs making less, long queues and rationing [more on that aspect, next week]) or incentives realignment?

How much will it cost to develop and maintain a durable, access facilitated, variation reduced, efficient and cost-effective healthcare system that also includes a doc-payment fix?

It was fairly easy in last week's post to justify looking hard at the costs of care. All I had to do was reference population studies that show wide, unexplainable variation in tests, procedures, the costs, its quality, or benefit (outcomes).