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I expected Supreme Court Justice Anthony Kennedy to vote to toss the individual mandate. I had no doubt the other three conservative justices would want the whole of the Affordable Care Act thrown out. I also expected the four liberal justices to support both the individual mandate as well as the entire law. About everyone expected Roberts and Kennedy to vote alike. If Roberts had gone with

Conservatives wanted the Supreme Court to do the work of killing the Affordable Care Act (ACA) for them. They didn’t get their wish but the Court may have put conservatives into a political corner they will find very uncomfortable. Under the new health law, the Medicaid program will be substantially expanded. Those making up to 133% of the federal poverty level (about $30,000 in annual income

In the immortal words of Rosane Rosana Dana, "Never mind."From the SCOTUS blog live in the court room: "Chief Justice Roberts' vote saved the ACA."On to the elections.

That will be the big question on Thursday if the Court throws out the mandate and the parallel insurance reforms that would require health plans to take all comers without regard to their health status and require insurers to cover pre-existing conditions. But before we get to that scenario, let’s look at another possibility. The Court Overturns Both the Individual Mandate and the Insurance

In 1998 I launched a website called " Medical Informatics and Leadership of Clinical Computing " (now entitled " Contemporary Issues in Medical Informatics- Common Examples of Healthcare Information Technology Difficulties " at this link ). Its theme was that leadership of IT in healthcare was severely lacking in the formal competencies needed to reach any measure of success, and in fact the lack of informatics competencies in the usual IT actors was causing wasted resources and patient harm. I had also commented that the term "Medical Informatics" itself was being misappropriated by anyone claiming to do anything with computers in medicine, even the creation of trivial and/or low-value programs. Sadly, little has changed in that regard since 1998; in fact things are much worse.  The meaning of the term "Medical Informatics" itself has become severely blurred, and job listings that use the term are largely misguided.  They often seek a nurse (mos...

There they, the management of University of California - Davis, go again. The Wilkes and Hoffman Op-Ed Questioning A University Sponsored Aggressive Prostate Cancer Screening Program According to the Los Angeles Times , and a post in Inside Higher Ed , the trouble began when Dr Michael Wilkes, a professor of medicine at University of California - Davis, and Jerome Hoffman, a professor of emergency medicine, wrote an op-ed in the San Francisco Chronicle in 2010 questioning the wisdom of a program run by UC-Davis promoting aggressive screening for prostate cancer with the PSA test.  They brought up problems with using PSA for screeninf that have been known for a while, including the poor ability of the test to detect cancer, the inability of the test or of prostate biopsy performed in response to the test to differentiate aggressive prostate cancer from cancer that will not progress, which is more common, the risks of such biopsies, and the poor effectiveness of available prostate c...

The following press release is very welcome, and speaks for itself.  There is a responsible voice in the government wilderness.  It is perhaps no surprise it comes from a Congresswoman who is also a registered nurse: Ellmers Calls on Sebelius to Address Health IT Safety Concerns 06/12/12 Safety Risks and Health IT-Related Errors Cited in IOM Recommendations WASHINGTON – House Small Business Subcommittee on Healthcare and Technology Chairwoman Renee Ellmers (R-NC) today sent a letter to Kathleen Sebelius , Secretary of Health and Human Services (HHS), inquiring about whether the Department has adopted the  Institute of Medicine’s (IOM) recommendations for improving the safety of health information technology (IT). The report, issued in November, recommended several steps to be taken by HHS and called for greater oversight by the public and private sectors. The Secretary was called upon by the IOM to issue a plan within 12 months to minimize pa...

Despite the trillions of dollars flowing through the US health care systems, prominent not-for-profit health care organizations seem to be complaining more often that the money going to them is not enough.  The Lay-Offs and Research Cutbacks Recently, for example, the University of Miami announced that its medical center would have to tighten its belt.  In April, according to the Miami Herald, University of Miami President Donna Shalala announced Tuesday that the medical school will take 'difficult and painful but necessary steps' next month to reduce costs, including staff cuts .In a letter to employees, she called the cuts 'significant' but provided no details about how many employees might be laid off. 'The process will take place in stages, and affected employees will be notified during the month of May,' Shalala wrote. 'Reductions will not impact clinical care or our patients and will primarily focus on unfunded research and administrative areas.' ...