There was a time when communities took care of the medical needs of their members without the intervention of governments and without the corrupting influence of health insurance. Can we ever go back to a system of mutual aid at a time when healthcare costs have grown astronomical?
Our guest today shows us that the idea of cost sharing is not only viable but is a lived reality for thousands of families across the United States. Dale Bellis began his work in healthcare in 1988 as an administrator with the first cost-sharing ministry ever begun in modern times. He was instrumental in passing legislation in 11 states exempting cost sharing ministries from insurance regulations. He also introduced technology and administrative techniques to streamline person to person cost-sharing. In 2012, he founded Liberty Healthshare, which provides an opportunity to live free from insurance and government-mandated healthcare to a large and growing number of American families that share fundamental values and a strong belief in personal responsibility.
In the mind of the public, American physicians are represented by one prominent organization, namely, the American Medical Association. Yet, only a minority of American physicians currently belong to the AMA, which has long grown comfortable with political and government intrusions into healthcare.
Who should represent physicians when doctors may hold very divergent views on matters of politics, economics, ethics, and even science? Should there be one voice or a plurality of voices? Our guest today is the executive director of the Association of American Physicians and Surgeons (AAPS), an organization that sprung up in the 1940s as an alternative to the AMA and to staunchly defend private medicine free of government interference or coercion.
Dr. Jane Orient obtained her medical degree from Columbia University and is in a solo internal medicine practice in Tucson, AZ. She is a prolific writer, having penned hundreds of op-eds in national and local media outlets. She is the author of numerous books, notably Your Doctor is Not In: Healthy Skepticism About National Health Care and Sutton’s Law, a novel about where the money is in medicine. She is also the editor of the famous textbook Sapira’s Art and Science of Bedside Diagnosis, now in its 4th edition.
Radiology holds a special place in the medical ecosystem. Radiologists are “the doctors’ doctors” and the treatment of a patient rarely proceeds without a radiologist furnishing an opinion. But the field of radiology also faces challenges: the crusade against “wasted imaging,” the rise of artificial intelligence, the dependence of radiology on hospital systems, and the de facto barrier that separates radiologists from patients.
What does the future hold for radiology and what could one wish for it? Returning to the show is Dr. Saurabh Jha, Associate Professor of Radiology at University of Pennsylvania Perelman School of Medicine. He shares his perspective with his characteristic wit and humor.
Some drugs cost more than diamonds though their health benefit seems marginal. Others cost less than a package of M&Ms though they are demonstrably life-saving. Some drug prices have spiked to 3-fold, 4-fold, or even 10-fold from what they were just a few years ago. Drug pricing seems to be an irrational and incomprehensible aspect of our economy.
To help us gain clarity on the matter, we have as our guest Amitabh Chandra, the Malcolm Wiener Professor of Public Policy at the Harvard Kennedy School of Government and the Henry and Allison McCance Professor of Business Administration and the Harvard Business School. He is among the best decorated healthcare economists alive, having received the highest awards in the field. He is an elected member of the National Academy of Medicine, a member of the Congressional Budget Office panel of health advisors, and a research associate at the National Bureau of Economic Research.
Professor Chandra has published seminal papers in the most highly ranked journals of economics and medicine. His research has been featured in The New York Times, The Washington Post, CNN, Newsweek, and on National Public Radio and has testified to the US Senate on matters of healthcare policy.
For decades, the academic cardiology community has focused its attention on pharmacological interventions to prevent heart disease. Our guest is an accomplished clinician-scientist who tells us his personal story that led him from the lab bench to becoming interested in dietary interventions and in the ketogenic diet in particular.
Dr. Weiss is Associate Professor of Medicine at the University of California San Francisco. He has a stellar academic pedigree, having received his MD degree from Johns Hopkins Medical School, where he also trained as part of his internship and residency. He completed his fellowship in cardiology at UCSF and has had an illustrious career as a basic science investigator at UCSF, studying the relationship between heart disease and metabolism. He is also the co-founder of a start up company, Keyto, to help people measure their blood ketone levels in real time as part of a diet management program.
Doctors have been suspected, accused, or convicted of fraud since time immemorial. But, in the era of third-party payment for health care, such charges have taken on an entirely new form, particularly when the third party in question is the federal Medicare program. How does the government proceed to establish that Medicare fraud has taken place? How does it distinguish fraud from poor judgment or incompetence? And what does that mean for the practicing physician who submits thousands of claims a year to Medicare?
To help shed light on the legal procedures, tactics, and tricks that can send a physician to a federal jail, our guests are Kyle Clark and Andrew George, defense attorneys who specialize in white collar crime and healthcare fraud. Messrs. Clark and George work for the global legal firm Baker Botts, LLP, and they recently authored an op-ed in the Wall Street Journal on this subject entitled “A Second Opinion Becomes a Guilty Verdict.”
For a few decades in the mid-twentieth century, the American Medical School represented the pinnacle of academia and its faculty were mightily engaged in the “triple threat” of research, teaching, and patient care. Today, however, the medical ivory tower is subordinated to hospital systems, overburdened with the menial task of “generating revenue,” and is but a pale image of its former self. On this episode, our guest helps us trace the history of the American medical school from its humble 19th century beginnings to its present day turmoils.
Dr. Milton Packer is an internationally recognized clinician, teacher, and scientist in the field of heart failure research. He has served as Chief of Cardiology at Columbia University in New York City and, subsequently, as Chair of the Department of Clinical Science at the Southwestern Medical School in Dallas. He is currently the Distinguished Scholar in Cardiovascular Science at Baylor University Medical Center.
Dr. Packer has received many teaching awards, mentored dozens of young clinical investigators, completed innumerable successful research projects, and served as a leader in many professional organizations. He is now also well known and admired for his regular column on MedPage Today, “Revolution and Revelation,” in which he mixes wisdom and polemics to the delight of his many readers.
How do we know that a treatment works or not? Billions of healthcare dollars are at stake in the answer to that question. For decades, that answer has largely hinged on theories from a field of human inquiry that combines the precision of mathematics with the accuracy of astrology. We are talking of course, about statistics and statistical inference.
To help us understand better this mystical science, we have as our guest Dr. Michael Acree who has spent his entire career working for the University of California San Francisco as a data scientist and a teacher of statistical science, helping countless researchers make sense of the data they had obtained. Michael is now retired and is completing a book on the history and philosophy of statistical inference. He joins us to tell us the whole truth about what is sometimes referred to as the science of mendacity!
We have become highly sensitized to the question of conflict of interest in healthcare—and rightly so. But the dominant narrative seems to be one-sided: doctors and scientists getting personally paid by industry sponsors and letting those payments color their judgment, consciously or unconsciously.
Personal financial conflict of interest is certainly an important and pervasive problem, but there are many aspects of COI that get less attention and may be equally harmful to society at large. To discuss this topic, our own Anish Koka engages Michel Accad in a lively discussion that tries to probe the topic in depth, even when such probing reveals uncomfortable truths.
It doesn’t take great insight to assert that healthcare waste is rampant. There is an obvious epidemic of testing and treatments that make no difference in patients’ lives or could possible even harm. But what is the cause of the epidemic and what should be done about it? In the last decade, a popular narrative has emerged, claiming that the waste has obvious causes and remedies. That narrative, however, overlooks the complexities of the problem and the trade-offs and potential harms of the remedies proposed.
Our guest to discuss the “Less-Is-More” movement is Lisa Rosenbaum, MD, one of the best medical writers of our generation. Dr. Rosenbaum is a national correspondent for the New England Journal of Medicine, a cardiologist at the Brigham and Women’s Hospital, and an Assistant Professor of Medicine at Harvard Medical School.