Nejm Audio Perspectives

Under the Affordable Care Act, Medicare will launch a Shared Savings Program for groups of health care providers that join forces, with or without hospitals or health plans, to form legal entities that agree to take responsibility for the quality, cost, and overall care of a population of patients. What will these accountable care organizations (ACOs) look like? Who will step forward to form them? What are the best pathways and likely hurdles to achieving ACO status? What are the risks of entering the arena, and what are the expected benefits for clinicians and patients? In a roundtable discussion moderated by Dr. Thomas Lee, experts Lawrence Casalino, Elliott Fisher, and Gail Wilensky explored these and other questions.

President Barack Obama has argued that healthcare reform is essential to the future economic health of the United States. But the economics of both healthcare and reform are daunting. Is it possible to pay for healthcare coverage for all Americans without moderating our rapidly rising healthcare costs? And what do we know about the best ways of achieving cost savings? In a roundtable discussion moderated by Dr. Atul Gawande, three experts in health economics — Drs. Elliott Fisher, Jonathan Gruber, and Meredith Rosenthal — explore the most promising ways of slowing the growth of healthcare costs, their potential effects on medical practice, and the likelihood that the current healthcare reform effort will be a step in the right direction.

President Barack Obama has placed US healthcare reform at the top of his domestic agenda, and months of legislative work on the issue have resulted in five bills — three in the House of Representatives and two in the Senate — that proponents believe will move the country in the direction of universal coverage, a fairer insurance system, and slower escalation of health care costs. In part 3 of a symposium co-sponsored by the Journal and the Harvard School of Public Health, health policy expert Mark Pauly explores the promise and limitations of the bills and the outlook for reform. The discussion is moderated by Arnold Epstein of the Journal and the Department of Health Policy and Management at HSPH. To listen to Part 1 of this discussion, click here.

President Barack Obama has placed US healthcare reform at the top of his domestic agenda, and months of legislative work on the issue have resulted in five bills — three in the House of Representatives and two in the Senate — that proponents believe will move the country in the direction of universal coverage, a fairer insurance system, and slower escalation of health care costs. In part 2 of a symposium co-sponsored by the Journal and the Harvard School of Public Health, health policy experts Katherine Baicker and Jacob Hacker explore the promise and limitations of the bills and the outlook for reform. The discussion is moderated by Arnold Epstein of the Journal and the Department of Health Policy and Management at HSPH. To listen to Part 3 of this discussion, click here.

President Barack Obama has placed US healthcare reform at the top of his domestic agenda, and months of legislative work on the issue have resulted in five bills — three in the House of Representatives and two in the Senate — that proponents believe will move the country in the direction of universal coverage, a fairer insurance system, and slower escalation of healthcare costs. In Part 1 of a symposium co-sponsored by the Journal and the Harvard School of Public Health (HSPH), health policy expert Henry Aaron explores the promise and limitations of the bills and the outlook for reform. The discussion is moderated by Arnold Epstein of the Journal and the department of health policy and management at HSPH. To listen to Part 2 of this 3-part discussion, click here.

U.S. primary care is in crisis. Primary care physicians must care for more and more patients, with more and more chronic conditions, in less and less time, for which they are compensated far less than subspecialists. They must absorb increasing volumes of medical information and complete more paperwork than ever, as they try to function in a poorly coordinated health care system. As a result, their ranks are thinning, with practicing physicians burning out and trainees shunning primary care fields. In a continuing roundtable discussion moderated by Dr. Thomas Lee, four experts in primary care and related policy - Drs. Thomas Bodenheimer, Allan Goroll, Barbara Starfield, and Katharine Treadway - explore the crisis, as well as possible solutions for training, practice, compensation, and systemic change.

The US economy has been in recession for more than a year, the unemployment rate is climbing, the ranks of the uninsured are growing rapidly, and healthcare provider organizations are feeling the squeeze. What help can the federal government offer as part of the economic stimulus package? What will the increasing pressure mean for proposed healthcare reforms? And is there any silver lining in the clouds for the future of the US healthcare system? In a roundtable discussion moderated by Dr. Thomas Lee, three experts in health policy, economics, and healthcare delivery — Drs. James Mongan, Jonathan Oberlander, and Meredith Rosenthal — explore the current and likely effects of the recession on US healthcare and the prospects for systemic change.

In this continuing roundtable discussion, moderator Dr. Atul Gawande, surgeon and associate professor at Harvard Medical School and the Harvard School of Public Health, is joined by Deborah Denno, professor of law at Fordham University; Dr. Robert Truog, professor of medical ethics, anesthesiology, and pediatrics at Harvard Medical School; and Dr. David Waisel, associate professor of anesthesia at Harvard Medical School, in a conversation about lethal injection, the current protocol, possible alternatives, and the role of healthcare professionals in putting convicted criminals to death. This is the second of a two-part discussion. To listen to Part 1, click here.

In this roundtable discussion, moderator Dr. Atul Gawande, surgeon and associate professor at Harvard Medical School and the Harvard School of Public Health, is joined by Deborah Denno, professor of law at Fordham University; Dr. Robert Truog, professor of medical ethics, anesthesiology, and pediatrics at Harvard Medical School; and Dr. David Waisel, associate professor of anesthesia at Harvard Medical School, in a conversation about lethal injection, the current protocol, possible alternatives, and the role of healthcare professionals in putting convicted criminals to death. This is the first of a two-part discussion. To listen to Part 2, click here.

US primary care is in crisis. Primary care physicians must care for more and more patients, with more and more chronic conditions, in less and less time, for which they are compensated far less than subspecialists. They must absorb increasing volumes of medical information and complete more paperwork than ever, as they try to function in a poorly coordinated health care system. As a result, their ranks are thinning, with practicing physicians burning out and trainees shunning primary care fields. In a roundtable discussion moderated by Dr. Thomas Lee, four experts in primary care and related policy — Drs. Thomas Bodenheimer, Allan Goroll, Barbara Starfield, and Katharine Treadway — explore the crisis, as well as possible solutions for training, practice, compensation, and systemic change.

In two large randomized trials, researchers examined the effect of annual prostate-specific antigen (PSA) screening on the rate of death from prostate cancer and found that it was small and was offset by false positive diagnoses. Since screening may have benefits in catching cancers early but may also carry risks including that of unnecessary treatment, professional societies have split on the question of whether to recommend regular PSA screening. In a roundtable discussion moderated by Dr. Thomas Lee, oncologist Dr. Philip Kantoff and primary care physician Dr. Mary McNaughton-Collins debate the clinical implications of the new findings and the best way to advise patients about undergoing PSA testing.

In an issue of the Journal, Boucek et al. reported on three cases of heart transplantation from infants who were pronounced dead on the basis of cardiac criteria. Moderator Atul Gawande, of Harvard Medical School; George Annas, of the Boston University School of Public Health; Arthur Caplan, of the University of Pennsylvania; and Robert Truog, of Harvard Medical School discuss key ethical aspects of organ donation after cardiac death.