Articles: patients.
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Editorial Review
Medicare Advantage Under Fire: Public Criticism and Implications.
Congressional hearings and public reports have drawn attention to problems afflicting Medicare Advantage (MA), the privatized version of Medicare. Private plans became a staple of Medicare through the passage of the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). Congress passed this law during a furor of privatization, when think tanks and powerful financial interests emphasized the power of corporations' profit incentive to improve the efficiency and quality of social enterprise. ⋯ In total, MA plans cost the federal government 22% more per patient than if these patients in question were enrolled in traditional Medicare. Moreover, it is not clear that this additional funding is producing proportional benefits. These developments raise questions about the presence of a profit incentive in Medicare, and perhaps health care more broadly.
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Patients with rare conditions often experience substantial delays between presentation and diagnosis, and some remain undiagnosed. In this Perspective, we outline the many challenges in diagnosing rare conditions in the modern clinical context. ⋯ We present solutions currently available for clinicians to mitigate some of these problems, including facilitating deliberate reflection, utilizing a diagnostic management team, and optimizing diagnostic calibration. Finally, we speculate how technology, such as chatbots and decision support tools enhanced by artificial intelligence, may augment a clinician's ability to diagnose rare conditions in a timely and accurate manner without excessive resource use.