calvin-hobbes-new-years-resolutions-620x469_mediumWith the implementation of the Affordable Care Act finally gaining traction, the healthcare discussions in 2014 should shift from who is covered to what is covered.  Robert Pearl, M.D. points out four medical stories that were overshadowed by the ACA in 2013, and tells us why they were important:


As a nation, we tell ourselves and the world that we are the best. For a limited number of expensive procedures, that’s true. But U.S. health care costs are the highest in the world and our results are average at best.

Who or what is to blame? Some of it stems from a medical culture that values intervention over prevention. Some of it reflects a health care pricing system that inflates costs with no strong incentive to be more efficient. Some of it is resistance to change, beginning with how we train doctors. And sometimes, it’s the patients who turn a blind eye to inconsistent costs and quality of care, or to the consequences of pharmaceutical advertising and for-profit payments to physicians.

Will the media make it a New Year’s resolution to educate all of us about these important stories in 2014?


Dr. Pearl looks at one common and expensive procedure that may be on insurers’ chopping blocks:

Cesarean birth rates in the U.S. are double the World Health Organization’s recommended rate of 15 percent. Why does that matter? Cesarean births can lead to childhood illness and complications in subsequent pregnancies.

According to the Childbirth Connection, a cesarean section (or “C-section”) is the most common operating room procedure in U.S. hospitals. It’s not only a high-cost proposition to the health care system, it’s also a high risk procedure for both the mother and child.

Elective, scheduled C-sections are important for women who are a week beyond their due date. They help the patient avoid a more dangerous set of complications. But some cesarean births are scheduled “early” – with less than 39 weeks of gestation – for the convenience of the doctor or the patient. These are unnecessary and dangerous. They are dictated by doctor preference, and contradict the best medical evidence.

In the future, we can expect insurers to heavily scrutinize such physician practices. They are likely to refuse to pay for unnecessary procedures, particularly when they add avoidable risk.


Dr. Pearl thinks a major part of the ACA — practically ignored by the media in 2013 — is its emphasis on the impact of prevention on saving lives, improving the quality of lives, and lowering health care costs:

Recognizing the value of preventive services, the government mandated through the ACA that insurance companies include preventive screenings at no cost in the future. The ACA also provided funding for over the counter medications like vitamin D for osteoporosis prevention, aspirin for patients with heart problems and fluoride to reduce tooth decay. In addition, it set aside $15 billion to fund investments in prevention over the next 10 years.

Funding through the ACA may improve overall performance. But until physicians, patients and the media value prevention as much as intervention, the problems are likely to grow worse before they become better.


Prevention is always better than intervention.  It starts today — by getting on that treadmill, eating more vegetables, drinking more water (and less sugar), quitting bad habits, making that check-up appointment you were meaning to schedule — everything on our list of New Year’s resolutions!

Time for a new beginning!

(Calvin and Hobbes — Yahoo!Images)