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    Our evolving health care system: A primer for urologists


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    Dr. Rosevear is in private practice at Pikes Peak Urology, Colorado Springs, CO.

    Urology residency is known for its long hours, quirky faculty, and challenging cases. They all fight for your attention.

    One concern I never had, even though I was a resident during one of the most severe economic downturns in our recent history, was my salary. I didn’t understand nor care how the department paid the bills. When I left residency and started private practice, I quickly learned that while striving to do the right thing when it comes to my patients is important, understanding how the business of medicine works is equally vital to the survival of a successful practice.

    But where do you start? How do you tackle a topic as broad and diverse as health care economics? My liberal arts background came to my aid when I remembered this line from Shakespeare’s “The Tempest” (Act 2 Scene 1: Antonio trying to convince Sebastian to murder his father; my emphasis added):

    “We all were sea-swallow’d, though some cast again,

    And by that destiny to perform an act

    Whereof what's past is prologue, what to come,

    In yours and my discharge.”

    With that passage in mind, I started researching the history of health care in America. My goal was to understand the economics of modern health care, how we ended up with the delivery system that we have today, and—most important—how the recent health care law will change everything. I quickly learned that understanding health care economics means understanding the health insurance industry.

    I will address this topic in two blogs. In this one, I’ll examine how America established its current health insurance system, both private and public. The second blog will summarize what the Affordable Care Act (aka Obamacare) does and how it may change the system. Neither one is meant to be an exhaustive history (for that, I recommend “The Social Transformation of American Medicine,” by Paul Starr [Basic Books 1982]) or a political commentary (which I will leave to Bill O’Reilly on the right and Rachel Maddow on the left, although my own opinion is that Jon Stewart probably speaks the truth more often).

    Continue to next page for more.

    Henry Rosevear, MD
    Dr. Rosevear, a member of the Urology Times Clinical Practice Board, is in private practice at Pikes Peak Urology, Colorado Springs, CO.


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