Viewpoints: Controlling long-term-care spending; march madness and health reform; hospital physicians

Apr 1 2011

The Wall Street Journal: Fiscal Health Hines On Containing Costs Of Care
Prepare to hear a lot (more) about Medicaid, the government health-insurance program for the poor. ... The U.S. government can't put itself on a sustainable fiscal course without doing something to slow health spending. It can't slow health spending costs without treating Medicaid. And it can't treat Medicaid without confronting the fact that it has become the long-term-care insurer of last resort for an aging society (David Wessel, 3/31). 

The New England Journal of Medicine: Medicaid and Access to the Courts
The Medicaid program is grounded in a statute that is one of the most complex of all federal laws. An insurer of more than 60 million people — and poised to begin serving 16 million more by 2019 — Medicaid will be reexamined this year, in all its legal complexities, by the U.S. Supreme Court, which has agreed to hear California's appeal in the case Maxwell-Jolly v. Independent Living Center of Southern California. The Court's ruling could fundamentally alter states' accountability to beneficiaries and providers when their official conduct allegedly violates Medicaid's essential federal requirements (Sara Rosenbaum, 3/30). 

Kaiser Health News: The President's Health Care Predicament
Having spent so much political capital to secure its passage, one might think that the health law would feature prominently in the president's planned reelection campaign. ... But Obama is not likely to follow that model, because ... the health law provides almost nothing that the president can claim he delivered for voters (Jim Capretta, 3/31).

Kaiser Health News: 10 Reasons To Feel Good About Health Reform Implementation
Supporters of the Affordable Care Act tend to get gloomy about the threats haunting every step along its path to implementation, seeing the negatives more clearly than they perceive the positives. As an antidote, I offer 10 reasons to be optimistic about health reform's progress and prospects. ... Can we get through the most challenging implementation of a federal law since the civil rights laws of the 1960s? Yes we can (John McDonough, 3/31).  

California Healthline: How March Madness Can Help Explain Health Reform
Like the millions drawn to the NCAA men's college basketball tournament, health policy experts have also become expert in the art of court-watching. In both cases, unexpected upsets -- whether provided by University of Richmond or Richmond-based Judge Henry Hudson -- have been eclipsed by later decisions. And inevitably, each saga has continued its march to a final court (Dan Diamond, 3/30).

The New England Journal of Medicine: Hospitals' Race to Employ Physicians — The Logic Behind A Money-Losing Proposition
If the fee-for-service system persists, large physician networks will provide hospitals with greater pricing power when they are contracting with health plans. This scenario favors greater hiring of specialists. Conversely, if payment systems move toward population health management and risk-based reimbursement, then large outpatient networks will allow a system to shift patients away from higher-cost hospital-based care and recapture lost revenues as shared savings or capitation surpluses. This scenario favors greater hiring of PCPs. A major concern in either scenario is the potential for hospitals to convert greater market power into higher prices and less competition (Dr. Robert Kocher and Nikhil R. Sahni, 3/30).

The Dallas Morning News: Texas Senate Is Pursuing More Rational Health Care Cuts
The budget bill the Texas House is considering Friday understandably is drawing fire from Texans concerned about health care, including from medical providers. The House's two-year spending plan takes a big swing at the payments made to doctors and hospitals that treat Medicaid patients. It slices and dices payments to nurses. And it eviscerates spending for nursing homes...Fortunately, the Senate is looking at more rational reductions. ... We've called for a 3 percent reduction in Medicaid spending and are sticking with that figure (3/30). 

The Miami Herald: For-Profit Government In Florida
Rick Scott is to business what a shark is to the ocean — a mindless, glassy-eyed profit eater. In a contest of trust, I'd take the shark. Florida's ethics laws are supposed to prevent him from making money on his $70 million investment in the governorship. But whether he profits now or profits later, Rick Scott's policies clearly stand to benefit his family's bottom line. At issue is Solantic, the chain of walk-in clinics Scott founded in 2001 (Joy-Ann Reid, 3/30).

The Spokesman-Review: Conscience Law Change Creates More Problems
Last year, the Idaho Legislature passed a "conscience bill" that granted health care professionals the right to abstain from doing their jobs if they morally objected to the course of treatment. The focus was on such politically charged issues as abortion, emergency contraceptives and embryonic stem-cell treatments. But along the way living wills and advanced care directives were added to the list. ... Frankly, we think the entire conscience law should be repealed because it causes patients to shop for health care providers when seeking legally available services (3/31). 

San Jose Mercury News: County Needs Full Debate On Health System Changes
Santa Clara County's Board of Supervisors made the right decision Tuesday in postponing a proposed ordinance change that would have restructured its health and hospital system. ... At minimum, Santa Clara County needs to find a way to maintain Valley Medical Center's status as the linchpin for the county's entire local hospital system. The ultimate goal should be to make the county a model for implementation of federal health care reforms (3/29). 

Star Tribune: Consider Carlson's Example On Health Care For Poor
The Senate's idea of reform is to replace Medicaid and MinnesotaCare with vouchers, so that the poor can buy health insurance in the private market. ...These bills are racing toward floor action next week. But that doesn't mean there isn't time for (former Gov. Arne) Carlson-style reform: Convene a bipartisan group of smart, serious legislators with Jesson and the best creative minds from various stakeholder groups (Lori Sturdevant, 3/30).

Chicago Tribune: Warning Flags: How Safe Is Your Hospital?
There's an important distinction between great doctoring and great safety. The U. of C. has a reputation for outstanding cancer care. That's likely the reason that Tyree, suffering from stomach cancer and pneumonia, had a relatively good prognosis when he entered the hospital and why his death so shocked his family and friends. But as a wise physician once warned, "Every hospital should have a plaque at its entrance that reads, 'There are some patients whom we cannot help; there are none whom we cannot harm'" (Michael L. Millenson, 3/31).