David Williams

Patients are often confused by the medical bills they receive from providers and have difficulty matching them up with the so-called Explanation of Benefits (EOB) forms they get from health plans.

In Europe, reimbursement decisions for drugs often include explicit consideration of cost effectiveness and a comparison of the efficacy of the new drug with products that are already available.

The Affordable Care Act (aka ObamaCare) requires health plans to spend at least 80 or 85 percent of premiums on medical expenses and quality improvement - 80 percent for small groups and individuals and 85 percent for large groups.

I think everyone believes that Texas Governor Rick Perry is sincere in his opposition to the Affordable Care Act (ACA aka ObamaCare). But this still doesn’t explain why he’s refusing the expansion of Medicaid that the law brings.

Scott Gottlieb’s opinion piece in the Wall Street Journal argues that ObamaCare is making independent physician practices obsolete by forcing physicians to work for big hospitals. Although I mainly agree with Gottlieb’s observations, I’m more optimistic than he is, and less eager to point the finger at ObamaCare.

Now that consumers have identified the issue and the Boston Globe has focused attention on it, I’ll be interested to see what health plans do.

A new study purports to demonstrate that primary care physician offices in Ontario discriminate against the poor by being less likely to offer them appointments.

Concerns are emerging that the adoption of electronic health records is leading to inappropriate increases in billings to payers, including Medicare, and that these higher billings could undermine or even overwhelm any cost savings generated by the digitization of providers.

States that continue to resist the Affordable Care Act (ACA) are finding themselves in a tougher and tougher spot. The Medicaid expansion is an even tougher issue. From where I sit, states that refuse to accept the expansion of federally funded Medicaid are essentially putting through an increase in their state minimum wage.

I was only a little bit surprised to read The Doctor’s Office as Union Shop, which blames the Affordable Care Act (ACA) for ushering in “a potentially radical factor in the transformation of health care –the doctor as union worker.”