What is Quality in Health Care ?

We argue about health care……rationing, Obamacare, socialism – creeping or otherwise – the “market”, personal responsibility, and so forth.

But there are ways to have a discussion about what we want for ourselves and – more importantly – for those we love.

So I propose we start a discussion as to the nature of quality healthcare.  If we can identify what makes delivered healthcare high quality, we can then discuss how to provide it.

Interested ?  If so please comment below.  I will respond.

I encourage disagreement.

Here is my first comment:

High quality health care has several characteristics:

1. It minimizes unwanted variation;

2. It involves patients and their families;

3. It is evidence based / best practice driven;

4. Preventable complications are driven out of the system.

Comments ?


1. Gentle Readers – A brief editorial written by colleagues and me related to the abuse of the Commons by unbridled capitalism.

Yes, we live in a capitalist country, but without proper regulation “..the weak become the meat that the strong will eat…”. And this means all of us.  All.

This is NOT Quality.


The Tragedy of the Commons – Drug Shortages and Our Patients’ Health




2. Gentle Readers – this was published this morning in the Daily Item, the paper for this area of Pennsylvania. I grant that it is not measured and without passion. But then, if you have read anything I have written, you will know that the facts are correct, but there is always passion.


Repealing the Affordable Care Act – Be Afraid

10 March, 2017

Today the Republicans and their President presented the “idea” they have to repeal and replace the Affordable Care Act (ACA), also known to many as ObamaCare.

To be perfectly transparent, I must point out that while I read the actual legislation and generally supported it, I found too many insurance company give-aways were included. The single-payer option, which would have driven costs down in a major way while focusing our quality efforts, was not allowed to see the light of day. Obama and his collaborators made the calculation that if they tried to have a single-payer option – that is, one among many – the entire plan would fail. So, they chose, instead, a complex system of Exchanges, Subsidies, Medicaid expansion and regulation to get where they wanted to go…..More follows




3. Gentle Readers – The Republican attempt to repeal – not fix, not replace – the Affordable Care Act (ObamaCare) has, for now, failed. Their plan was to turn the health system over to the private sector and eliminate the presently held access  to health car for something between 24 and 30 million of our citizens. This while sneaking in a tax cut that would have benefited the upper 0.1%. Fortunately, for now, this has failed.

This creature who calls himself a man, who presently occupies the White House, blithely would send these uninsured to their deaths, for many thousands will die if they have no ability to get heath care; all the while enriching his friends and cronies. Is this what you voted for Trump supporters ? A man who will watch you die and smile all thee way to the bank.


Repeal of the Affordable Care Act: The Issue Is Not Cost

19 March, 2017

“Those who need care most often get care least. And even when the poor do get service, it is often second rate…This situation will be corrected only when the poor have sufficient purchasing power to enter the medical marketplace on equal terms with those who are more affluent.”

Richard M. Nixon

Several versions of the Trump / Republican legislation to repeal the Affordable Care Act (ACA, “ObamaCare”) have been released. While the final legislation is not yet available, the general outlines of the Trump / Republican plans are becoming clear.

Before touching on these, it is important to point out – to look back for just a moment – that there is a history of our country trying to bring health care to her people in a manner similar to the ACA……more follows





4. Gentle Reader – A brief and rather angry ( I appear to be angry often these days) piece on the mis-named “American Health Care Act”.

“Repeal and Replace” is a Lie, it is Simply “Destroy and Enrich”


There is an old political truism that one should never impute intent on the actions of one’s opponents; that they are honorable people with whom one has, simply enough, policy disagreements. This truism does not hold with the Republican ACA replacement – the American Health Care Act (AHCA) passed by the House on Thursday.

The AHCA is not a fix for the Affordable Care Act (ACA, ObamaCare), which does need fixing. Rather, it is a destroy and enrich act – ultimately stripping access to health care from 24 to 30 millions of us, and through tax cuts for the rich, further enriching our Gilded Class. The Republicans have shown who they work for, who they are owned by: the extremely wealthy.



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