Viewpoints: 'Judicial restraint' and health law; mental health parity; perspectives from JAMA and NEJM

Aug 19 2011

Bloomberg: Health-Care Case Is A Good Moment For Judicial Restraint 
A Supreme Court decision to throw out health-care reform on Commerce Clause grounds could open up hundreds of other federal laws to legal challenge -- starting with the Civil Rights Act. It's hard to believe that this court really wants to relitigate the second half of the 20th century, but we'll have an answer soon enough. Meanwhile, let's hear a bit less about the evils of judicial activism from politicians who are eager to have judges throw out one of the most important pieces of social legislation since the civil rights era (8/17).

Politico: Is The Health Care Mandate Doomed? 
The 11th Circuit's decision shows that the constitutional issues raised by the health care law — and especially the individual mandate — are complex and serious. It also heartens those who believe that there are some things beyond the government's reach — and that the judiciary cannot abdicate its duty to hold Congress's feet to the constitutional fire (Ilya Shapiro, 8/17). 

Des Moines Register: Court Must Rule On Health Mandate
Though the Register has long supported the reform law, we have opposed forcing people to buy coverage. It's wrong. It's unnecessary. Questions about its constitutionality were destined to foul up the entire law in court challenges. That is exactly what has happened (8/17). 

Washington Examiner: Obama Concedes Health Care Law Won't Control Costs
During a rant against Republican intransigence, Obama said that he could tackle the deficit tomorrow if his opponents would agree to raise taxes and "were willing to take on some of the long-term costs that we have on health care." Sound familiar? Back in February 2009, days after signing an economic stimulus package then valued at $787 billion, Obama convened a Fiscal Responsibility Summit at the White House. At the time, the event was advertised as Obama's "pivot" to tackling the nation's debt burden, but it was really the opening pitch for imposing national health care on America (Phillip Klein, 8/17).  

(Minneapolis-St. Paul) Pioneer Press: Legislators Should Be Involved In State's Insurance Exchange
Republican legislators have taken issue with what they see as unilateral action by the governor's office. Several have argued that the Legislature should be involved in decisions about the exchange. They're right. ... For some legislators, the question isn't how to develop a health insurance exchange, but rather how to avoid participating in the federal health care reform law at all. … That said, it's responsible for the Dayton team to begin work on the health-insurance exchange (8/17). 

Kansas City Star: Brownback's Abortion Fetish Costs Taxpayers
[Gov. Sam] Brownback and the ultra-conservative Legislature have gone out of their way to pick fights with the pro-abortion forces in the state. That's going to cost taxpayers hundreds of thousands of dollars as the court cases wind their way through the courts. And rather than using state-paid lawyers already on the public dime, Brownback and Co. are funneling public dollars to private law firms to do the legal work (Yael T. Abouhalkah, 8/17). 

San Francisco Chronicle: A Dose Of Transparency For Drug Companies
Kudos to Facebook for finally requiring pharmaceutical companies to open their pages to public discussion. The fact that some drug companies responded by immediately shutting down their pages suggests that they were on Facebook to market their products, not to open a free-flowing discussion about them (8/17). 

Health Policy Solutions (Colorado health news service): Student Mental Health Critical To Academic Success
Mental health care lags behind physical health care in investment, quality, access and political will. But we can and must change this reality for the sake of our children and their futures (Jan Lewis, 8/17).

New England Journal of Medicine: The Doctor's Dilemma — What Is 'Appropriate' Care?
Most physicians want to deliver "appropriate" care. Most want to practice "ethically." But the transformation of a small-scale professional service into a technologically complex sector that consumes more than 17% of the nation's gross domestic product makes it increasingly difficult to know what is "appropriate" and what is "ethical." When escalating health care expenditures threaten the solvency of the federal government and the viability of the U.S. economy, physicians are forced to reexamine the choices they make in caring for patients (Victor R. Fuchs, 8/17).

New England Journal of Medicine: Moving beyond Parity — Mental Health and Addiction Care under the ACA
[P]arity's promise was never to cure all the system's ills. Its real contribution was to increase financial protection, particularly for people with the most severe illnesses, by removing benefit limits that restricted access and increased economic vulnerability. Its passage was an important first step. The ACA — with its emphasis on expanding coverage and improving quality through better integration — constitutes a logical next step forward (Colleen L. Barry and Haiden A. Huskamp, 8/17).

Journal of the American Medical Association (JAMA): Censorship of the Patient-Physician Relationship
In June 2011, Florida House Bill 155 (HB155)1​ became law, marking an unprecedented intrusion into the patient-physician relationship. The law states that licensed Florida health care practitioners and health care facilities "should refrain from making a written inquiry or asking questions concerning the ownership of a firearm..." Effective primary care requires asking patients about their decisions and behaviors that can place themselves and others at risk of injury or disease, like the decision to own a gun and how to store it. With this law, the Florida legislature set a dangerous precedent (Lindsey Murtagh and Dr. Matthew Miller, 8/11).

JAMA: Equality-in-Quality in the Era of the Affordable Care Act
Although efforts to improve health care quality are squarely in the sights of the ACA, disparities seem to fall in its programmatic blind spot. On both philosophical and empirical grounds, the highest-quality health care will not be realized unless inequalities are also addressed. Individuals deserve health care that is not only of high quality, but of equally high quality for all (Drs. Matthew M. Davis and Jennifer K. Walter, 8/9).

JAMA: The Hazards of Evidence-Based MedicineAssessing Variations in Care  
Patients rely on physicians and other health care professionals to deliver the most amount of information possible about treatment risks and benefits. Patients then can consider these issues in the context of their own individual preferences. Policy makers should not interfere with this process unless the evidence they use to mandate care is substantial. Because of uncertainty in the integrity of most administrative databases and registries and the inherent limitation in the amount of information they contain about patient care, policy should only rarely be made based on findings from these sources (Drs. Edward H. Livingston and Robert A. McNutt,  8/17).