David Howard

Health economist interested in policies to better align medical practice with evidence. Emory University faculty since 2000. All opinions are entirely correct.

[David Howard @CostAnEffect]

@BouncingDeadCat @vkoganpolisci @JahangirAsgha10 I am aware of inflation. MD pay is largely keeping track with inflation according to reports I've seen (increasing in nominal terms), but it is not going down as some posts would imply.

[David Howard @CostAnEffect]

@DrDiGiorgio There are 2 applicants for every medical school slot, so the word isn't getting out.

[David Howard @CostAnEffect]

@vkoganpolisci @JahangirAsgha10 According to industry reports, MD pay is increasing. While this may reflect other factors (e.g., payments from private insurers), the situation isn't so dire as the conversion factor implies. And there are still 2 applicants for every medical school admission slot.

[David Howard @CostAnEffect]

So are we banning Kaiser Permanente?

[Elizabeth Warren @SenWarren]

Your health insurer shouldn’t own your doctor’s office, pharmacy, and the middleman who decides which prescriptions are covered and how much they cost.

That gives one corporation at least 4 ways to squeeze every penny out of you when you get sick.

Let's break up Big Medicine.

[David Howard @CostAnEffect]

@yuanyi_z Same bro. The socialization pressure is strong. I've loved my career in academia, but with some time and perspective I might have gone a different route.

[Chris Pope @CPopeHC]

Hospital Global Budgets are at the heart of Medicare For All's claimed efficiency gains.
Maryland's experiment with Global Budgets since 2014 has yielded higher prices and less treatment of seriously ill patients.
https://t.co/QM1yftm9GH

[David Howard @CostAnEffect]

@jtsemp @DrJBhattacharya FYI @NIH just released a request for input on improving the grant submission process and reducing administrative burden.

[John Cawley @cawley_john]

Call for abstracts for NBER conference, "The Economic Implications of GLP-1 Therapies" that I'm co-organizing w @KosaliSimon & @MariaAPolyakova . Submissions due Dec 15, 2026 and the conf is March 4, 2027. Details at link: https://t.co/sJC7rC1y6L

[David Howard @CostAnEffect]

@HandSurgeonMD The purpose of the Wiser demonstration is to test whether it lowers costs. Why not wait to see the results?

[David Howard @CostAnEffect]

The federal debt is 120% of GDP and trending higher due in part to Medicare. We need to give prior authorization a try.

[Andrew Yang, MD | Hand Surgeon @HandSurgeonMD]

Traditional Medicare used to skip prior auth. In 6 states, including New Jersey, a pilot called WISeR put AI-assisted prior auth back in.

On Oct 15, a CMS deputy administrator said "there are a lot of things about WISeR that are not working."

It's bad for independent practices. Hospitals can absorb the unpaid admin time. A solo office can't.

The House spending bill would cut off its funding. The Senate voted 46-50 against ending it. Current funding runs out Dec 11.

Doctors, residents, med students: ask your House member and both senators to keep the WISeR funding ban in the final bill. Template below.

[David Howard @CostAnEffect]

@PerformativeM That's the point of the Wiser demonstration: to find out if it lowers the cost.

[David Howard @CostAnEffect]

@hwxndi @mattfromcobb Yeah, every team goes through ups and downs. We'll get better again.

[David Howard @CostAnEffect]

@Hoagland_Alex Very clever idea to get at an important issue.

[David Howard @CostAnEffect]

@CPopeHC Medicare for all might be cheaper.

[David Howard @CostAnEffect]

Had a great visit to U Penn @whartonknows last week. Met with @davidjpowell24 & many others.

[David Howard @CostAnEffect]

@ScottBarkowski @instrumenthull But sign reversals in >5%? That's much larger than I would have expected.

[David Howard @CostAnEffect]

I have an old paper showing that episiotomy rates declined in response to trial results, but women treated by older obstetricians were more likely to have an episiotomy, suggesting that generational change is one mechanism by which evidence is translated into practice.

[Dr. AK 🇮🇳 @docakx]

An episiotomy is a small surgical cut in the perineum, the skin and muscle between the vagina and the anus, made to widen the opening during birth.

The idea was first described in 1742 by Sir Fielding Ould, an Irish doctor, who hoped a planned cut would be safer than a ragged tear. In the early 1900s, American obstetrician Joseph DeLee argued it should be routine, especially with forceps. By the middle of the century, many hospitals cut almost every first-time mother.

The cut is made in the last moments of pushing, after the area is numbed. It can run straight down the middle or angle to one side. The angled cut is less likely to reach the anus. After the baby and placenta are out, the cut is stitched closed.

For decades doctors believed a clean cut healed better and protected the pelvic floor. Later studies showed routine cutting did not stop severe tears and often caused more pain, bleeding, and slow healing.

Today it is used only when truly needed, such as when the baby must be born quickly, when forceps or a vacuum are used, or when a shoulder is stuck. Most births now go ahead without it.

[Rich Duszak, MD @RichDuszak]

Radiology practices with technical component ownership/billing are less likely to be consolidated than those which provide only professional services. Hot off the press with @NeimanHPI colleagues in @JACRJournal. https://t.co/zBRBBDH9Mb

[David Howard @CostAnEffect]

@paulnovosad Unfortunately, yes.