Viewpoints: 'Accepted wisdom' about cutting entitlements disputed; Profit motive doesn't lead to good health care

Jan 9 2013

Baltimore Sun: The Hoax Of 'Entitlement Reform'
It has become accepted economic wisdom that the only way to get control over America's looming budget deficits is to "reform entitlements." The accepted wisdom is wrong. ... Medicare and Medicaid costs are projected to soar. But here again, look closely and you'll see neither is really the problem. The underlying problem is the soaring cost of health care overall, combined with the aging of the boomer generation. The solution isn't to reduce Medicare benefits. It's for the nation to contain overall health care costs and get more for its health care dollars (Robert B. Reich, 1/9).

The New York Times' Economic Scene: Health Care And Profits, A Poor Mix
These profit-maximizing tactics point to a troubling conflict of interest that goes beyond the private delivery of health care. ... In a way, private delivery of health care misleads Americans about the financial burdens they must bear to lead an adequate existence. If they were to consider the additional private spending on health care as a form of tax -; an indispensable cost to live a healthy life -; the nation's tax bill would rise to about 31 percent from 25 percent of the nation's G.D.P. (Eduardo Porter, 1/8). 

The Washington Post: Taming The Health-Care Monster 
For years, spiraling health costs -; mainly for Medicare and Medicaid, which serve the elderly and the poor -; have consumed a growing share of the federal budget. Meanwhile, rapid increases in premiums for employer-provided insurance have squeezed take-home pay. So it's good news that, for the third straight year, health spending rose modestly in 2011. To some analysts, this signals a new era of cost-containment. Well, maybe -; and maybe not (Robert J. Samuelson, 1/8). 

Bloomberg: Smart Health-Care Strategies Hidden In 'Cliff' Deal
One little-noted provision I was encouraged to see tucked in last week's fiscal-cliff legislation is Section 601(b): an incentive for doctors to expand their use of something called clinical data registries. These registries collect information on patient characteristics, patterns of care and outcomes that can be crucial to evaluating what medical techniques and strategies work and which ones don't. Unfortunately, registries are not as widespread as they should be ... Medicare costs are driven disproportionately by a small number of very expensive patients, most of whom are heavy users of specialty treatment. So early promotion of registries in those areas could yield ideas for lowering the cost of some of the most expensive care (Peter Orszag, 1/8).

The Medicare NewsGroup: The Medicare Cost/Benefit Equation: Is The Program Worth What It Costs?
The "bundled payment" initiatives in the Affordable Care Act, including the patient-centered medical home and accountable care organizations, are designed to reward providers for high-value medical practice, not high volume. Examining the outcomes of care as closely as their cost is critical to making these new forms of medical practice pay off for those who excel at them (Michael Millenson, 1/8).

Los Angeles Times: New Study Helps Build The Case For Expanding Medi-Cal
After pushing to cut Medi-Cal spending in each of his first two years in office, Gov. Jerry Brown now has to decide whether to seek to expand it by billions of dollars -- largely, but not entirely, on Washington's dime. A new report from researchers at UCLA and UC Berkeley suggests that the expansion might actually pay for itself through higher tax revenue and lower spending in other state programs (Jon Healey, 1/8).

Sacramento Bee: Expanded Medi-Cal Will Bring Federal Money In Reform
Earlier this year, a San Bernardino doctor told a middle-aged patient named Lupe that she was facing a life-or-death situation. Her blood glucose level was alarmingly high, and she was diagnosed with diabetes. ... Today, Lupe has health care coverage through a county-based program that gives her access to a primary care physician who can manage her chronic disease. This coverage helps Lupe to continue working, avoid costly hospital stays and lead a healthier life. ... The health care coverage offered by Medi-Cal, California's Medicaid program, is much more than simply a budget obligation. The health programs offered by Medi-Cal are tailored to meet the unique needs of our diverse population (Peter Long and Dr. Robert Ross, 1/9).

Kansas City Star: Hiring More People With Disabilities Reduces Dependence
Can we afford the commitments we have made over the years to seniors, people with disabilities and government retirees? ... Last year, the Missouri legislature contemplated eliminating a health benefit for residents who are blind. Ignoring the long-held belief that taking away benefits for the disabled is a loser at the ballot box, the Missouri House budget opted to end the entitlement for 2,800 blind Missourians as a cost-saving measure. But this is the canary in a coal mine (Reinhard Mabry, 1/8).

Medpage Today: When To Use An IT Consultant, And When You May Not Need One
Should physicians use a consultant to help choose a practice management system or EHR for their practice? According to recent Medical Group Management Association surveys more than 50 percent of physicians used the services of a healthcare consultant or firm at least once in the previous 3 years. But did they have to? Was it a smart move? The Answer: It Depends. Not every practice needs a consultant's assistance when replacing and choosing a new system (Rosemarie Nelson, 1/8).