News – Domestic Health Reform

  • Your Health Data Is Not Secure: What Can We Do About It? (Forbes)

    by Bill Frist

    FORBES | When it comes to protecting health data privacy, where do we find balance? Health and health-related data are fundamental to informing medical innovations and advances that save lives and better outcomes for all patients. These data include a wide range of metrics such as prescriptions, lab results, race/ethnicity, gender, and income and, more…

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  • A Road Map For Action On Health Care Spending And Value: Part IV – Value-Based Payment (Forbes)

    by Bill Frist

    FORBES | This is the fourth and final installment for my series on the Health Affairs Council on Health Care Spending and Value’s February 2023 report, “A Road Map for Action.” Each piece details one of the four priority areas within the report, which include recommendations on how the U.S. can take a more deliberate…

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  • Food-borne illness is a public health crisis: Congress must act (The Hill)

    by Bill Frist

    THE HILL | On Jan. 31, the Food and Drug Administration proposed a redesign of its human food program in response to several ongoing food crises impacting public safety and the health of millions of Americans. The redesign attempts to solve leadership and funding problems identified by an expert panel in December.  Unfortunately, the proposal does little to fix the most urgent or…

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  • A Road Map For Action On Health Care Spending And Value: Part III – Spending Growth Targets (Forbes)

    by Bill Frist

    FORBES | This is the third in a four-part series on the Health Affairs Council on Health Care Spending and Value’s newly released report, “A Road Map for Action.” Each piece details one of the four priority areas within the report, which provides recommendations on how the U.S. can take a more deliberate approach to…

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  • A Road Map For Action On Health Care Spending And Value: Part II – Price Regulation And Supports For Competition (Forbes)

    by Bill Frist

    FORBES | This is the second in a four-part series on the Health Affairs Council on Health Care Spending and Value’s February 2023 report, “A Road Map for Action.” Each piece details one of the four priority areas within the report, which include recommendations on how the US can take a more deliberate approach to…

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  • A Road Map For Action On Health Care Spending And Value: Part I – Administrative Waste And Inefficiencies (Forbes)

    by Bill Frist

    FORBES | This is the first in a four-part series on the Health Affairs Council on Health Care Spending and Value’s newly released report, “A Road Map for Action.” Each piece will detail one of the four priority areas within the report, which provides recommendations on how the U.S. can take a more deliberate approach…

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  • Recommendations On Health Care Spending And Value From 21 Experts: Why We Should Implement This Road Map For Action Now (Health Affairs)

    by Bill Frist

    HEALTH AFFAIRS | Four years ago, an ambitious group of twenty-one diverse health care experts came together at the invitation of Health Affairs to collectively develop recommendations to maximize our nation’s investment in health care. With national health care spending levels reaching nearly a fifth of our economy, it was the right time to evaluate our spending priorities and…

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  • Bringing Modernized Kidney Care To The Home: How Monogram Health Is Transforming Polychronic Care (Forbes)

    by Bill Frist

    FORBES | Nowhere has innovation been more prevalent in recent years than in healthcare – but this astounding progress has not been evenly distributed throughout all sectors of medicine, or among all Americans. Some types of care – such as cancer care – have seen a night and day difference in clinical outcomes where once…

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  • Health security is national security (The Dallas Morning News)

    by Bill Frist

    The global coronavirus pandemic compels us to rethink how we approach development assistance, cooperation, innovation and international organizations. The Dallas Morning News is publishing a multi-part series on important issues for voters to consider as they decide who to vote for president this year. This is the second installment of our What’s at Stake series,…

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  • 3 Ways Policymakers Could Help Our Nation’s Doctors And Nurses (TIME)

    by Bill Frist

    TIME | As a former heart-transplant surgeon and former U.S. Senator, I understand the frustrations many on the front lines of this pandemic are experiencing. Here are three things those doctors and nurses—dedicated but tired, anxious and feeling betrayed by government—wish policymakers would do: First, strengthen supply chains of personal protective equipment (PPE) and diagnostic tests. We are in…

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  • A Storm for Which We Were Unprepared (Claremont Institute’s The American Mind)

    by Bill Frist

    Claremont Institute’s The American Mind | Senator Bill Frist saw it coming years ago. Senator William Frist, M.D. is a nationally acclaimed heart and lung transplant surgeon and the former Majority Leader of the U.S. Senate. In 2005, during his tenure in Congress, he delivered the Marshall J. Seidman Lecture for the Department of Health Care Policy…

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  • How Changing Tobacco Laws Can Save Thousands Of Lives, Billions Of Tax Dollars (Forbes)

    by Bill Frist

    FORBES | Today we have a massive and growing public health challenge that is substantially shortening the lives of millions, negatively impacting the health of our children, and adding an astounding $170 billion in health care costs to our nation annually. Unknown to most, it has been for years the leading cause of preventable death in the United States….

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  • Most support tobacco policy changes that will save lives and tax dollars (The Tennessean)

    by Bill Frist

    THE TENNESSEAN | By Bill Frist, MD and Matthew Myers As the leading cause of preventable death in Tennessee, tobacco use is shortening the lives of millions of people, affecting the health of children and adding $2.6 billion in health care costs to the state annually.   Nearly one in four Tennesseans smoke. Centers for Disease…

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  • Understanding The Burning Platform Of Health Care Spending Growth (Health Affairs)

    by Bill Frist

    HEALTH AFFAIRS | By Bill Frist, MD and Margaret Hamburg, MD In January, we were honored to co-chair the inaugural meeting of the Health Affairs Council on Health Care Spending and Value. This diverse group of 22 health care leaders has come together to stimulate a national discussion about whether we should—and how we could—constrain what feels like runaway…

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  • Tennessee Is Home To One Of The Deadliest National Parks In The Nation: Here’s How We Change That (Forbes)

    by Bill Frist

    FORBES | In Middle Tennessee, we are known for excellence in health care services, music, and economic growth. However, one distinction we would like to relinquish is being home to the national park with the highest number of suicides in the United States. According to an analysis by Outdoor Magazine, the Natchez Trace Parkway is one…

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  • What Andy Samberg And Sandra Oh Got Right At The Golden Globes: Vaccines Are Worth Celebrating! (Forbes)

    by Bill Frist

    FORBES | Last week at the Golden Globes, hosts Andy Samberg and Sandra Oh made headlines as they tried to give out free flu shots to celebrities in the audience. This surprise stunt showed famous stars looking shocked and nervous as needle-wielding nurses descended from the stage to offer vaccinations. Samberg joked, “If you are an…

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  • Has Childhood Obesity Become A National Security Threat? (Forbes)

    by Bill Frist

    FORBES | As a physician and lawmaker, I have long argued that federal global health aid improves America’s standing in the world and makes us safer by steadying unstable nations. Countries with healthy workforces have improved economic outputs, stronger family units, and are less likely to become havens for terrorists.  But what many may not…

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  • 15 Years Later: How Well Are We Doing Addressing AIDS (Forbes)

    by Bill Frist

    FORBES | This World AIDS Day, we celebrate the astounding progress made in the past 15 years! Thanks to PEPFAR— the U.S. President’s Emergency Plan for AIDS Relief—14.6 million people living with HIV (59%) have access to antiretroviral therapy. More than 2.4 million babies have been born HIV-free. Countless lives have been saved. This progress…

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  • Reading The Healthcare Tea Leaves In The 2018 Midterm Elections (Forbes)

    by Bill Frist

    FORBES | The November elections left us with a lot to digest—it wasn’t the decisive “blue wave” that some were predicting, but the tea leaves did tell us some interesting things about what voters believe and value, particularly when it comes to healthcare. Interestingly, pollster Bill McInturff of Public Opinion Strategies found a notable phenomenon…

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  • The Latest In Blockchain In Healthcare: Top Takeaways From Distributed Health (Forbes)

    by Bill Frist

    FORBES | Last week I had the honor of kicking off the third annual Distributed Health conference in Nashville, which brought together leaders in healthcare as well as blockchain innovators from across the nation. All were united by the shared belief that blockchain has transformative potential for health and healthcare, with changes already underway. Blockchain…

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  • The Future Of Healthcare Innovation And Why Government Matters (Forbes)

    by Bill Frist

    FORBES | Why do politics matter to health? Because government, when focused, can do incredible things to move our health forward. Here are just two examples that I was directly involved with while in the United States Senate. Read more at Forbes: https://www.forbes.com/sites/billfrist/2018/11/06/the-future-of-healthcare-innovation-and-why-government-matters/#f00d712192d2

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  • Fixing the opioid crisis requires the two things Congress hates most: Bipartisanship and government spending (NBC News)

    by Bill Frist

    NBC NEWS | Practically every community in America, and most families, are facing the still-growing opioid epidemic that is tearing at the soul of our health and wellbeing. The Centers for Disease Control and Prevention estimates 115 Americans die each day from opioid-related overdoses, and research suggests that misuse of prescription opioids is a risk factor for heroinuse. It is…

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  • Rural Aging: Health and Community Policy Implications for Reversing Social Isolation (Bipartisan Policy Center)

    by Bill Frist

    BIPARTISAN POLICY CENTER | On June 7, 2018, Tivity Health’s Donato Tramuto and I convened a roundtable at the Bipartisan Policy Center to discuss challenges and potential solutions to address a little-discussed public health crisis: social isolation and our aging population. What many don’t realize is that social isolation could be an even bigger public health…

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  • A Tribute to Uwe Reinhardt: Remarks at the April 21st Memorial at Princeton University Chapel

    by Bill Frist

    For each of the last 46 years, Uwe Reinhardt touched me like a father, a brother, a son, a friend. He walked by my side on every leg of my journey and supported me at every major turning point. These are the remarks I gave at his memorial service at Princeton on April 21 and shared…

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  • Diet quality should become a core SNAP objective (The Hill)

    by Bill Frist

    THE HILL | As Congress considers reauthorizing SNAP as part of the 2018 Farm Bill, we believe it’s time to make nutrition a top priority for the program. First, we request that diet quality become a core SNAP objective. Specifically, we recommend eliminating sugar-sweetened beverages from the list of items that can be purchased with SNAP in…

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  • Updated Nutrition Labels Can Make Us Healthier Consumers (Forbes)

    by Bill Frist

    FORBES | As health-minded consumers of food, I think we all deserve to know what is in the packaged food we buy. Giving consumers information to make their own choices sounds as American as apple pie, but somehow in today’s fractured political system, it’s become a major point of contention. For the health of our…

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  • Telemedicine can improve access to quality, affordable care in Texas (Texas Tribune)

    by Bill Frist

    TEXAS TRIBUNE | If you become ill and need a doctor tonight at 11, who will you call? What will you do? Texans in Austin, Dallas, or Houston are probably surprised to learn that Texas ranks 47th in the nation in the number of active primary care physicians per capita. Among its 254 counties, 35…

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  • Less salt in foods means longer lives — Trump’s administration can fix this (The Hill)

    by Bill Frist

    THE HILL | No state is an island when it comes to our food and its impact — good or bad — on our population’s health. That’s why it’s critically important for the Food and Drug Administration (FDA) to continue its efforts to reduce sodium in our packaged and restaurant foods. In June, the FDA…

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  • New Model Can Advance Treatments, Cures For Rare Diseases (Forbes)

    by Bill Frist

    FORBES | If your child suffered from a rare and incurable disease, what would you do to find a cure? My former colleague and good friend Dr. Chip Chambers faced just such a challenge, and took the bull by the horns. Last month, Dr. Chambers organized a unique medical conference that should serve as a model…

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  • Groundbreaking 21st Century Cures Act

    by Bill Frist

    The US Senate just voted 94-5 to pass the 21st Century Cures Act. This is an historic moment for American medical innovation and the millions of patients who will benefit. The Cures Act is groundbreaking. Over the 40 years I have been in medicine, there has never been a more exciting time for medical innovation…

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  • How NashvilleHealth Is Maximizing Community Population Health (Health Affairs)

    by Bill Frist

    HEALTH AFFAIRS | How can Main Street, America, move the needle in a city’s population health and wellbeing? It begins with a solid, organizational structure built for the long term. I fondly call my hometown, Nashville, the “Silicon Valley of Health Services.” With 18 publicly traded national health care companies headquartered here with annual global health…

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  • The time to act is now: Bipartisan action will accelerate cures for Americans (The Hill)

    by Bill Frist

    THE HILL | With the election over, speculation is rampant on what this means for politics and policy in 2017.  We need to take a step back however, and realize there is critical work to be completed by Congress in 2016, to set the stage for a new generation of medical innovation, and demonstrate to the…

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  • TrumpCare: In The Beginning… (Forbes)

    by Bill Frist

    FORBES | The immediate question for those whose lives focus around lifting the health of individual Americans is, “What does Donald J. Trump’s presidency mean for health care in America?” At the heart of the answer is uncertainty. Trump is an “unknown unknown” when it comes to deep, thoughtful health policy. He has excelled in many…

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  • Our Abysmal Maternal Health Statistics And How To Improve Them (Forbes)

    by Bill Frist

    FORBES | This past year, the United States received the dubious distinction of being one of only 7 countries in the world, including Somalia and Afghanistan, which have seen an increase in maternal mortality. While countries with far fewer resources such as India and Brazil have made great strides to decrease the number of women who…

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  • The Newborn Illness That Nobody Is Talking About – And It’s Not Zika (Forbes)

    by Bill Frist

    FORBES | Nothing can prepare a mother for seeing her newborn seize multiple times an hour, refuse to eat or sleep, and shake uncontrollably. That’s what Julia found herself facing after severe chronic back pain from a car accident left her dependent on opioids. Julia had been a college student from a middle class family with…

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  • Systems Strategies for Better Health Throughout the Life Course: A Vital Direction for Health and Health Care (National Academy of Medicine)

    by Bill Frist

    NATIONAL ACADEMY OF MEDICINE | Health and health care outcomes for Americans should be better for most, and much better for some. This should be possible with currently available knowledge and resources. Capturing the potential will require adapting our strategies and approaches to the reality that health is not immutably determined at birth, but shaped by different…

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  • The right prescription for biomedical innovation (The Hill)

    by Bill Frist

    THE HILL | If you were a patient suffering from a disease, and you read about a treatment option for your illness, you would probably be eager to learn more. Imagine that the drug, device or other intervention had been on the market for several years, and studies showed that it was especially effective in some…

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  • The Food We Eat Daily That Leads To Poor Heart Health For Our Children (Forbes)

    by Bill Frist

    FORBES | Earlier this year, I called attention to the dangers added sugars pose to cardiovascular health and other health outcomes.  In the months since, many people have told me how surprised they’ve been to learn about the sugar hidden in their healthy morning yogurt or afternoon energy bar.  Frankly, I was too.  And this lack of food literacy…

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  • How Real-World Data Could Change Medicine (US News & World Report)

    by Bill Frist

    US NEWS & WORLD REPORT | With continuing advances in science and technology, the pace of medical breakthroughs is accelerating. Today, we can treat or even cure conditions that significantly shortened life just a generation ago. The exciting promises of personalized medicine are now becoming reality. Congressman Bart Gordon and I co-chair the Bipartisan Policy Center’s…

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  • From Volume To Value: Achieving Bold Change In Our Healthcare Payment Systems (Forbes)

    by Bill Frist

    FORBES | One question I hear repeatedly as I travel the country discussing healthcare is whether the transition from fee-for-service to value-based care can really be done in a way that lowers cost and improves patient care. The answer is: it can. While there isn’t a one-size-fits-all solution, successful systems change requires the collaboration and…

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  • Let’s stand with retired military leaders to get healthy school meals over the finish line (The Hill)

    by Bill Frist

    THE HILL | While headlines harp that the U.S. is a nation “hopelessly divided,” there is something lawmakers can band together on: forging a solution to our obesity epidemic.  In addition to being one of the greatest health threats our nation has ever faced, it is a terrible burden for employers, who are forced to…

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  • Tennessee Quit Week a first step to healthier Nashville (The Tennessean)

    by Bill Frist

    THE TENNESSEAN | Of the thousands of heart and lung operations I have performed, the most common cause of the underlying disease in these patients was a single voluntary behavior: smoking. That tragedy is what Tennessee Quit Week (Feb. 22-28) is all about. Smoking absolutely leads to a shorter, poorer-quality life. It more than doubles a person’s…

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  • Flint’s Water Crisis and Public Health 3.0

    by Bill Frist

    When looking at the ongoing crisis over safe drinking water in Flint one thing is abundantly clear, the decisions made–at multiple levels–were made without a comprehensive evaluation of the impact on public health. Karen DeSalvo, Acting Assistant Secretary for Health and National Coordinator for Health Information Technology, and I take a look at the public health approaches…

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  • Approve Limited-Population Antibacterial Drug Pathway (The Tennessean)

    by Bill Frist

    THE TENNESSEAN | A recent study about antibiotic resistance hit close to home for me. It projected that drug-resistant bacteria are developing at a pace that could soon threaten the lives of thousands more surgery patients each year. This study also revealed that as many as half of infections after surgery are already being caused by pathogens…

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  • The Numbers are In: The Case for NashvilleHealth

    by Bill Frist

    I like to keep an eye on my hometown’s statistics. I love seeing Nashville listed among the nation’s best cities to launch a startup, raise a family and visit for a weekend away. According to some estimates, we gain 80 new Nashvillians each day, transplants from all over, drawn to our welcoming atmosphere and our…

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  • The Superbug Fight at your Grocery Store

    by Bill Frist

    You may have heard statistics about the over-use of prescription drugs, with reports indicating that up to half of all antibiotics prescribed today are used improperly. It’s a huge problem contributing to the rising threat of antibiotic-resistant bacteria. What you may not have heard, however, is that the majority of drugs used in the U.S. aren’t even taken…

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  • Consumer Still Feeling The Pinch: The Next Big Health Care Debate (Forbes)

    by Bill Frist

    FORBES | News headlines have touted a moderation in the rise of health care costs since the economic slowdown and passage of the Affordable Care Act (ACA). But as I have traveled the country and met with health care professionals and consumers, those receiving the care have not felt any reduction in cost. In fact, many…

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  • Making Dementia Friendly Communities The New Normal (Forbes)

    by Bill Frist

    FORBES | Alzheimer’s may be one of the most frightening health challenges today. Over five million Americans—one in eight age 65 and older and one in three age 85 and older—are living with dementia and we don’t yet have a treatment that can prevent or cure the disease. But these men and women are not alone….

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  • Podcast: Medicare and Medicaid at 50

    by Bill Frist

    Fifty years after Medicare and Medicaid were created, healthcare in America is still rapidly evolving. Carefully observing where we’ve been will help inform where we are going, so in today’s special issue of the Journal of the American Medical Association (JAMA) Kaiser Family Foundation President and CEO Drew Altman and I look at the Perspectives of Beneficiaries,…

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  • Three Challenges Impacting The Future Of Obamacare (Forbes)

    by Bill Frist

    FORBES | Last week’s Supreme Court decision puts the Affordable Care Act firmly and securely into institutional and cultural permanence.  It still bears flaws due to its imperfect construction and divisive passage, but after five years, the new certainty for insurance markets will permit a maturity of risk pools, and the more direct and predictable provider…

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  • Advancing transparency in healthcare: A call to action (The Hill)

    by Bill Frist

    THE HILL | “How much does health care cost?” It isn’t an easy question to answer. Your yearly check-up, a colonoscopy, or trip to the emergency room doesn’t typically come with an obvious price tag. And it isn’t just finding out the price of a service or product that’s difficult; it’s also difficult to determine the…

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  • Why Texas is missing out on the future of medicine

    by Bill Frist

    If you’ve read much of anything here, you know that I am a big fan of health technologies to improve care and create a sustainable healthcare system. I think it’s essential that we choose the right technologies that will serve patients, and I firmly believe telemedicine is one of those solutions (so much so that…

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  • The Promises and Challenges of Precision Medicine

    by Bill Frist

    Only 15% of our health is determined by the healthcare we receive, the rest are the social determinants of health: environment, economic stability, access to care, education and community resources. Paying attention to that 85% is imperative, and precision medicine aims to take targeted genetic and molecular information and consider it in tandem with data about…

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  • A Vaccine For Future Health Crises: A Coordinated Communications Strategy Will Be The Difference (Forbes)

    by Bill Frist

    FORBES | During the Ebola epidemic this fall, I was reminded of the chaos and fear we felt in the Senate in 2001.  When the first anthrax letter was opened in the office of Majority Leader Tom Daschle, no one really even understood what anthrax was, much less how it was contracted, transmitted, or the disease’s…

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  • Telemedicine Is A Game-Changer For Patients, The System

    by Bill Frist

    The Affordable Care Act won’t address our physician shortage–a problem expected to grow to as many as 52,000 needed physicians by 2025. And for many, the ACA still isn’t providing actually affordable care. To bridge these gaps, we must find innovative ways facilitate hassle free access to a provider that is more cost-effective. There is a…

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  • Separate Health Care For Veterans Does Not Best Serve Our Vets (Forbes)

    by Bill Frist

    FORBES | I had the privilege of speaking at the Concerned Veterans for America Summit last week in Washington, D.C. I’ve written about my concern for veterans’ healthcare before (and I highlighted some of my thoughts immediately before the Summit). Our healthcare system needs a lot of work, and having served as a VA staff surgeon for nine years, the care…

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  • A bold blueprint for transforming veterans’ health care (The Washington Post)

    by Bill Frist

    THE WASHINGTON POST | Imagine how we would meet the service-related health-care needs of military veterans if we had a clean slate and were considering the question for the first time. The answer is obvious. Just as we do with veterans’ educational benefits, we would use the private sector. We would never create something like the Veterans…

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  • FDA Reform (Morning Consult)

    by Bill Frist

    MORNING CONSULT | The FDA’s warning letter Anne Wojcicki received as the CEO of 23andMe in November 2013 came as a shock to the direct-to-consumer product industry dealing in the “peri-medical” device space. The Food and Drug Administration (FDA) had not previously made such a move, and perhaps 23andMe was being used to set an example,…

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  • Save the Children’s Insurance (New York Times)

    by Bill Frist

    NEW YORK TIMES | NO child in America should be denied the chance to see a doctor when he or she needs one — but if Congress doesn’t act soon, that’s exactly what might happen. For the past 18 years, the Children’s Health Insurance Program has provided much-needed coverage to millions of American children. And yet,…

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  • New Tennessee telemedicine law grows health care access

    by Bill Frist

    I am convinced that telemedicine is a crucial part of the solution for delivery of healthcare in the United States–care that isn’t yet affordable or accessible for all. Tennessee has made important steps toward ensuring telemedicine is an option for our citizens, but there’s more to do. Telemedicine is in its infancy in Tennessee. Specialists…

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  • We Must All Play a Role in Ending Childhood Obesity (Robert Wood Johnson Foundation)

    by Bill Frist

    ROBERT WOOD JOHNSON FOUNDATION | We all want our kids and grandkids to grow up happier and healthier than we did. Instead, today’s children are the first generation of young Americans to face the prospect of living their entire lives in poorer health and dying younger than previous generations. The reason is no mystery. Too many…

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  • Bill Frist supports Haslam’s Insure Tennessee plan (The Tennessean)

    by Bill Frist

    THE TENNESSEAN | Medicaid expansion has been a contentious topic since the Supreme Court’s 2012 decision holding mandatory state participation was unduly coercive. And the arguments against expansion are well-founded: Does the federal government really have enough money to fund this? What happens if the money runs out? We have tried this before and it was…

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  • The Cadillac Tax: Implications and a Potential Silver Lining?

    by Bill Frist

    (Forbes, February 26, 2014 ) Like much of the Affordable Care Act, the Cadillac tax—Obamacare’s solution to a tax subsidy created during World War II—offers a solution to an important problem, but is fraught with unintended consequences. Ideally, the tax would prompt employers to offer more cost-effective plans, with some shift of risk to employees…

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  • Connected Health and the Rise of the Patient Consumer

    by Bill Frist

    (Health Affairs, February 2014) How to achieve better care at a lower cost? Two powerful new forces may hold the answer. America’s health care delivery sector stands at a tipping point—a convergence of a growing, graying, and highly consumptive population with increasingly limited financial and human capital resources. Policy makers naturally gravitate toward government to…

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  • Notes from the Road: Global South Summit 2013

    by Bill Frist

    NASHVILLE | At the Global South Summit last week, I moderated a panel on one of my favorite topics: transforming healthcare into health. There is much discussion about how the current model of healthcare is “broken.” But the fact is, the system is producing exactly what it was designed to produce. The problem is that…

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  • End-of-life care plan can ensure wishes are respected

    by Bill Frist

    (The Tennessean, November 4, 2013) By Sen. Bill Frist, M.D. and Manoj Jain, M.D Fifth of six parts that will appear this fall “I would never have my mother, who has cancer, go through this,” a hospital case manager in her 50s says. “I would never have her be strapped to the bed. Never have a…

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  • Health care group a guide in time of change

    by Bill Frist

    (The Tennessean, September 15, 2013) By Larry Van Horn, Ph.d., and Sen. Bill Frist, M.D. October 2014 is a month that our nation has eyed for more than four years. We will take a historic step to revamp our health care system by enrolling millions of Americans in federally mandated health insurance coverage. At the…

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