THE FUTURE OF HEALTH CARE DELIVERY IN U.S.A.

Facts…and Musings – gleaned from Readings, 2010 and 2011

 George A. Sprecace, M.D., J.D.

• Overturning ObamaCare (ACA) and substituting what is Needed!
• Existing shortage of M.D.’s to worsen with ObamaCare.
• The role of “Physician Extenders”
• My critique of the book: Partners in Health”.
• Changes in payment for medical care with ACA
• “Practice Guidelines” and the falsely low esteem accorded to Clinical Experience: “Low-Level Evidence”, according to the Academic world .
• Government to “start small” with “Essential Benefits”.
• Poor protection for “whistleblowers”…but there are Qui Tam actions….
• Anticipated increased demand for health care with increased coverage, but dependent on cost and government subsidies.
• The importance of Coordination of Care, by any willing physician, together with comprehensive care.
• Where acute care is mainly sought and received.
• “Death Panels”…and the Truth!
• Employers and Health Care coverage: their reactions and actions.
• Ranking of (and On) U.S. Health Care system in the world.
• Peer Review Immunity.
• Medical Home models – and Specialists.
• The unconstitutionality of ObamaCare: two examples.
• Society’s record on “fixing” society’s problems.
• “Sicko” is sick.
• Docs and Hospitals disgruntled.
• The Massachusetts experience to date.
• Opting out of Medicare….
• Medicare’s Actuary…Truth vs Spin. (WSJ editorial)
• The AMA: the good, the bad and the ugly.
• ObamaCare guts Medicare to pay for itself.
• New government interest in fraud, abuse, withholding of necessary care for profit, and anti-trust considerations, including with relation to Accountable Care Organizations (ACO).
• Accountable Care Organizations and “capitation”.
• ACO’s: Who’s in charge?
• My review of book by Robert Linden, M.D.
• My review of article by Frank Maletz, M.D.
• My comments and reactions re. L&M Retreat, June, 2010.
• Saying “I’m Sorry”.
• Representing M.D.’s in disciplinary actions.
• Peer Review.
• “Never Events”…not really.
• Hospital / MD Staff Integration: opportunities, problems and pitfalls.  “Win-Win, or “Lose-Lose”.
• ObamaCare and the expected explosion in litigation.
• Why Medicare Matters!
• Federalism and Health Care Reform: the role and initiatives of States
• Genetic Testing, Genomic Medicine…and the Law.
• Illicit Drugs: time for legal reform?
• ACA and Primary Care: Promise and Peril.
• Assisted Suicide vs Advanced Directives – and the Law.
• ACA and changes in Tax Law.
• ACA and great increase in Medicaid rolls.
• Political campaigns and donations: The U.S. Supreme Court speaks.
• The continuing saga of SGR.
• Private Practice Physicians and Anxiety/ Depression: their greatest challenge.  
• Hospital Hutzpa: its greatest risk. 
• ACO’s.  Much more to come.

GS:   About 50% of health care needs are life-style related.  Until that changes, Health Care is not an entitlement or a right.

About 30% of health care costs relate to Defensive Medicine, fueled by the threat of Medical Mal-practice suits and their abuse.  Until Medical Mal-Practice reform occurs, that will not change.