Viewpoints: Arizona's waiver; next gen's 'different' Medicare?; individual mandate's constitutionality

Feb 17 2011

The Arizona Republic: We Can Cut AHCCCS, But We Shouldn't
There may be no federal obstacles to cutting 250,000 people out of AHCCCS, part of Gov. Jan Brewer's budget proposal. But there are compelling reasons to avoid such a drastic step if at all possible. And it's possible. The Arizona Hospital and Healthcare Association has proposed a one-year "health-care assessment," to be paid by its members, that would still bring in the federal matching money. It would be structured to reimburse their outlay, although they would still bear some costs in putting the money up front (2/17). 

The New York Times: Out Of Control In The House
Are there any adults in charge of the House? Watching this week's frenzied slash-and-burn budget contest, we had to conclude the answer to that is no. … Now some members want to go still further. On Tuesday, the House began debating the list of proposed cuts, and more than 500 amendments were filed, mostly from Republicans trying to cut still more out of — or end — programs they dislike. ... Others would cut all financing for the health care reform law, or Planned Parenthood, or any foreign aid to a country that regularly disagrees with the United States at the United Nations. If the Republicans got their way, it would wreak havoc on Americans' lives and national security. This blood sport also has nothing to do with the programs that are driving up the long-term deficit: Medicare, Medicaid and, to a lesser extent, Social Security (2/16).

Los Angeles Times: Debt And A Tough-Talking Governor 
[L]ast week, one potential Republican presidential candidate took the brave step of proposing major changes in both Social Security and Medicare. ... [Indiana Gov. Mitch] Daniels proposed focusing on the biggest components of future deficits, including defense spending and entitlements for seniors. He said it was time to "sunset" the current versions of Social Security and Medicare, maintaining them for current recipients and soon-to-be recipients but designing wholly new insurance plans for the generation that follows (Doyle McManus, 2/17).

The Washington Post: Mitch Daniels's Case For A Less Strident Conservatism
Focusing on earmarks (a "pernicious practice" but a "trifle") and "waste, fraud and abuse," says Daniels, trivializes the task of administering "bariatric surgery" to a "morbidly obese" government. ... the big twofold task is to reform entitlements and produce economic growth -- "a long boom of almost unprecedented duration." Americans must say "an affectionate thank-you" to the last century's major social welfare programs -- then sunset them. ... Medicare 2.0 should respect Americans' dignity and competence by empowering them to make "their own decisions" by delivering its dollars directly to individuals and expecting them to "pay for more of their routine care like the discerning, autonomous customers we know them to be" (George F. Will, 2/17).

The Philadelphia Inquirer/McClatchy: Reading The Judges On Health Care: What Is, And Isn't, Clear
The next challenges will go to the U.S. Courts of Appeals, and then to the U.S. Supreme Court. And unfortunately, most observers, including me, think we can accurately predict how eight of the nine justices will rule. That health care is constitutional: Justices Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan, and Sonia Sotomayor. That health care is unconstitutional: Justices Antonin Scalia, Clarence Thomas, John Roberts, and Samuel Alito. Which leaves Justice Kennedy. ... the issue here is whether the refusal of someone to participate in national health care could have an impact on interstate commerce  (Michael Smerconish, 2/16). 

New England Journal Of Medicine: Under Siege — The Individual Mandate For Health Insurance And Its Alternatives
What reformers may need even more than a policy alternative to the mandate is an alternative rationale, especially since any provision meant to ensure broad participation in insurance pools must include financial penalties. The mandate's defenders could again invoke the rhetoric of personal responsibility. Or they could emphasize that the mandate makes possible the insurance reforms that guarantee the availability of coverage to sick people. Alternatively, reformers could appeal to the mandate's communitarian foundations, arguing that there are some public programs — such as Social Security and Medicare — that produce invaluable social benefits and that succeed because everyone participates in them. Ultimately, the furor over the mandate underscores the reality that solidarity remains elusive in U.S. health policy (Jonathan Oberlander, 2/16).

New England Journal Of Medicine: Can Congress Regulate "Inactivity"(And Make Americans Buy Health Insurance)?
Judge Vinson believes that the federal government is far too powerful and that he has discovered a limiting principle. But the line he draws is not grounded in, and ignores the reasoning of, governing Supreme Court precedent. Courts, like doctors, must make judgments on a case-by-case basis. In law, as in medical diagnosis and treatment, simple rules are often misleading and inappropriate. That does not mean that there are no rules. It simply means that the governing rules are complicated and contextual (Timothy Stoltzfus Jost, 2/16).

The Des Moines Register: More Pandering From Health Reform Critics
The health reform law will do many things, including getting millions of Americans insured and protecting people from losing coverage when they get sick. What reform will not do: Provide federal money to pay for abortions. But some Republicans continue to introduce bills with names like "No Taxpayer Funding for Abortion Act." It's unnecessary. It's pandering. It's dishonest. To understand why, it's worth taking a moment for a quick refresher on how health insurance works in this country -- and how it will work under the new reform law (2/17). 

The Seattle Times: Keep Health Care A Cut Above The Rest
Many [International Community Health Services] patients are seniors who are affected by cutbacks in Medicaid and Medicare. ... community clinics, by law, can't turn anyone away regardless of their ability to pay. ... State government is tied in knots. Voters rejected new revenue sources last November and restricted state options, but there is room to clarify our vision in the federal budget. We could spend less on defense and close some tax loopholes for a start (Jerry Large, 2/16). 

Milwaukee Journal Sentinel: A Sham Of A Law
Now, without much trouble, a car buyer can discover what the dealer paid for those new cars -- and negotiate up from that point. Advantage: the consumer. That was supposed to be the point of a new law that took effect Jan. 1. The Health Care Transparency Law was touted as a way to give consumers some idea of what hospitals and doctors charged for services. Instead, the law isn't giving consumers anything they can use. And it doesn't provide accurate information on physicians' fees (2/16).

The Arizona Republic: 'Death Panels' The New SB 1070?
For now, Arizona is the only state in the union with an elected "death panel." Our governor and Legislature have decided to offer businesses hundreds of millions in tax cuts rather than save the lives of needy citizens. They say the tax cuts will encourage companies to relocate to Arizona, proving to them that this is a great place to live. And it is, as long as you never get sick (E. J. Montini, 2/17).

The Chicago Tribune: This Perk Has To Go
One excellent budget-saving idea we didn't hear Gov. Pat Quinn mention Wednesday: Make state retirees pay something for their health care insurance. ... This isn't an effort to punish retirees. It's an effort to save the state money and create a level playing field. It's an acknowledgement that many state workers took advantage of pension rules that allowed them to retire at a relatively young age, keep their health benefits, collect pension benefits and launch a second career (2/16).

Milwaukee Journal Sentinel: State's Battle Lines: Want Fairness? Enact Health Care Reform
Wisconsin's public employees and its taxpayers are picking up the tab for employers who don't provide adequate coverage. If [Gov.] Walker really values fairness, he ought to turn to small business owners and tell them to get into line with other employers; he should insist that they contribute to their workers' health insurance or bill them for the cost of covering their low- and middle-income workers through BadgerCare and the other costs shifted to employer-sponsored insurance plans. ... If Walker genuinely wants to "restore fiscal sanity" and reduce government spending over the long term, he needs to implement national health care reform, not support its repeal (Thomas R. Oliver, 2/16).

USA Today: In Treating Breast Cancer, Less Can Be Better
For more than a century, doctors have routinely removed lymph nodes from the armpits of breast cancer patients for the most logical of reasons. ... Or so most everyone thought until last week, when a study published in the Journal of the American Medical Association turned the conventional wisdom inside out. ... you would hope that in an age when medical breakthroughs are widely reported and researchers' presentations can be found on the Internet, oncologists and surgeons everywhere would be aware and adaptable. The history of breast cancer treatment suggests that's not the case (2/16).