On the Concept of a Good Death

Martin Luther once said, “Every man must do two things alone: he must do his own believing and his own dying.” A number of profound concepts are embedded in that statement, starting with the unavoidable entanglement between beliefs and the process of dying. Also noteworthy is the explicit recognition of dying as a verb and the assertion that it is something that we do rather than something that happens to us. More

Cost Shifting and the Desert Island Paradox

In 1964, an eclectic group of seven strangers set out on what was to be a three-hour sightseeing excursion, only to become shipwrecked on a seemingly deserted island. Through syndication and reruns, the seven hapless castaways of Gilligan’s Island appear in our living rooms over 50 years later, still stranded but apparently none the worse for wear. At first glance, the passengers and crew of the SS Minnow would not appear to offer lessons related to health care pricing, but a closer... More

Kicking the Can down the Road: Musings from a Farmer’s Market

A few years ago, I ran into an old high school classmate at a Sunday farmer’s market. We were in our mid-50s at the time and he excitedly told me that he was retiring from his teaching job, adding that 30 years was long enough to work and it was time to retire. More

The Dust Has Yet to Settle on Health Care Reform

It’s the end of the world as we know it. Buckle up, this is only the beginning. Who knew health care could be so complicated? More

Why Monitor a Problem If You Don't Fix It?

When I think about how most hospitals audit their work processes, a favorite commercial comes to mind: the LifeLock™‘Bank’ TV spot. It begins with several armed robbers entering a bank filled with people. The robbers tell bank customers and employees to drop to the floor, but the security “monitor” remains standing. One of the customers looks up and whispers, “Hey, do something.” He responds, “Oh, I’m not a security guard, I’m a... More

Hamburgers and Health Care: The Power of a Brand

It’s interesting to think about the industrial engineering and almost fanatical insistence on consistency that goes into the production of something as inconsequential as a hamburger or a can of soda, and to contrast that with our tolerance for variation in the treatment of cancer or the use of high-cost imaging in the diagnosis of back pain. Two of the top five worldwide brands outside of the technology sector are McDonald’s and Coca-Cola, valued at $39 billion and $58 billion,... More

The Difficult Reality of Repealing the ACA

Repealing and replacing the Affordable Care Act (ACA) has been a unifying, and politically potent talking point for Republicans on the campaign trail, since the law was passed nearly seven years ago. Beyond the campaign, opposition to the law in Congress by the GOP has been ubiquitous. But with President Obama wielding the power of veto, there had been very few real legislative threats to the law’s underpinnings. That all changed in November.  More

RSNA 2016: Beyond Imaging - The AI Will Read Your Images Now

No two words struck more fear into the hearts of radiologists in 2016 than “artificial” and “intelligence,” unless you added “deep learning” to the mix. Some radiologists have expressed concern that big imaging data could continue feeding the deep-learning beast to the point where computing power becomes robust enough to replace the radiologist entirely. More

Penguins and Policy: Listening through the Noise

Emperor penguins congregate on desolate stretches of packed ice in colonies comprised of tens of thousands of birds – some colonies are estimated to reach 50,000 breeding adults. Before an egg hatches, a mating pair alternates between searching for food and keeping the egg off of the ice, balancing it on their feet. Upon returning from feeding, one member of the pair must find their partner, often in a blizzard, to exchange roles. Once a chick can maintain its own body temperature, both... More

5 Ways to Tame the Contract Labor Beast

In December 2014, the U.S. Department of Health and Human Services released a study stating that by 2025 the supply of registered nurses would outpace the demand by approximately 240,000 full-time equivalents. Regardless of your opinion of this analysis, I think we can all agree that as we kick off 2017, we are in the midst of a nurse staffing shortage. More