Viewpoints: Health costs crushing Detroit; Military care still faces funding issues; Romneycare scores

Mar 16 2012

The Wall Street Journal: The Message Of Motown
Legacy costs are bankrupting Detroit just as they crushed its automakers. Firefighters can retire at 55 and earn 70% of their highest salary plus a 2.25% annual cost-of-living inflator in perpetuity. The result? Employee benefits alone now make up about half of the city's general fund. Health costs have grown by more than 60% since 2008 while the city's pension bill has quadrupled to $200 million (3/14).

The Washington Post: Military, Heal Thyself – Health Programs Still A Challenge
The Pentagon health program's budget issues are well known, the overall costs having more than doubled in the past 10 years and expected to continue to shoot up unless tough changes are made. The health-care headquarters staff has already been cut by 440 employees from 2011, and aligning its reimbursement rates for outpatient services with Medicare rates will save $900 million annually (Walter Pincus, 3/14). 

Boston Globe: Attacks On Romneycare Come Even As Costs Turn The Corner
Just as the Massachusetts system of delivering health care is under attack from Republicans across the country, along comes more evidence of its success -- this time, in helping to create more affordable options for individuals and small businesses. The cost savings are important because both "Romneycare'" and its famous offspring, President Obama's health care overhaul, were branded mainly as ways to decrease the number of uninsured people, partly through the much-demonized requirement that individuals who can afford insurance must buy it, and the mandate on some employers to provide insurance, as well. But those mandates also served to bring together larger groups of customers, giving insurers greater incentive to provide competitive rates (3/14). 

The New York Times: Hospitals Aren't Hotels
For several years now, hospitals around the country have been independently collecting data in different categories of patient satisfaction. More recently, the Centers for Medicare and Medicaid Services developed the Hospital Consumer Assessment of Healthcare Providers and Systems survey and announced that by October 2012, Medicare reimbursements and bonuses were going to be linked in part to scores on the survey. ... But implied in the proposal is a troubling misapprehension of how unpleasant a lot of actual health care is (Theresa Brown, 3/14). 

USA Today: Challenge For Our (Ripe Old) Age
Longer lives ... and smaller families ... are aging society. ... They also create challenges science cannot solve. One of the most worrying is that soon, people will routinely reach old age with very few, if any, immediate family members. Humankind has marshaled every intelligence to achieve long life, and now we need to be just as smart as we try to make the most of it (Ted C. Fishman, 3/14). 

Roll Call: Give Young Adults Needed Privacy For Health
Under the 2010 health care overhaul, millions of young adults in the United States can access health care on a parent's health insurance policy. That's a good thing because it means they are more likely to get preventive care that can keep them from getting sick in the first place. Yet a glitch in the system means that young adults might forgo treatment for conditions they don't want their parents to know about -; such as sexually transmitted diseases. These young people are afraid, and rightly so, that an insurance company will send an explanation of benefits home to the parent who holds the health insurance policy (Denise Chrysler and Robyn Rontal, 3/15).

The Fiscal Times: A Bold New Attack on the Alzheimer's Scourge
Dr. [Peter] Piot, who served as executive director of the United Nation's UNAIDS organization and now serves at Imperial College in London, delivered an impassioned call to action before some 1500 scientists, patients, caregivers, advocate, and health officials who gathered from every corner of the globe. According to Piot, we need a global political movement to fund cures and preventions as the global aging phenomenon will give rise to unprecedented rates of Alzheimer's. In short, we need to rally against Alzheimer's exactly as we did with HIV/AIDS in order to make a difference (Michael W. Hodin, 3/14).

McClatchy: Colon Tests Save Lives, Study Shows
There wasn't much doubt about the value of colonoscopies, the rather invasive screening tests for colorectal cancer. Now there should be none. These screenings, unpleasant as they are, do indeed save lives. The New England Journal of Medicine recently reported that in patients tracked for as long as 20 years, the death rate from colorectal cancer was cut by 53 percent in those who had the test and had precancerous polyps removed.  … While there is always a small chance of complications, most people come out of the examination saying, "It wasn't nearly as bad as I feared" (3/14).

Health Policy Solutions (a Colorado news service): Obamacare's Medicaid Mandates Are Unconstitutional
For split sovereignty to work, both the states and the feds must be able to make independent decisions within their respective spheres. The federal government must be free from state coercion, and the states must be free from federal coercion. ... Obamacare attempts to crack the constitution by directing and empowering administrators in the U.S. Department of Health and Human Services (HHS) to effectively bankrupt any state that makes Medicaid decisions different from those approved by Obamacare (Rob Natelson, 3/14) 

New England Journal of Medicine: Warning: Contraceptive Drugs May Cause Political Headaches
Americans don't usually succeed in claims that the use of their funds in contravention of their religious views violates their constitutional or statutory rights: tax resisters, for instance, have been swatted down by the courts, even when they were objecting to state-ordered killing in the form of capital punishment or war. ... This debate deserves more than partisan sound bites and slogans (R. Alta Charo, 3/21).

New England Journal of Medicine: The Severability Of The Individual Mandate
In our view, however, only a functional, not a structural, relationship exists between the mandate and both insurance-market reforms, and a clean conceptual line can be drawn between the mandate and everything else in the ACA. ... If the Supreme Court holds the mandate unconstitutional, it should therefore leave the rest of health care reform on the books (Drs. Samuel Y. Sessions and Allan S. Detsky, 3/14).

New England Journal of Medicine: A Successful And Sustainable Health System -; How To Get There From Here 
A successful and sustainable health system will not be achieved by supporting prevention, it will not be achieved by championing competition, it will not be achieved by comparing the effectiveness of different practices, it will not be achieved by striking commercial influence from professional decision making, it will not be achieved by changing the way we pay doctors, and it will not be achieved by just reengineering the system. It requires all these changes and more (Dr. Harvey V. Fineberg, 3/14).

Journal of the American Medical Association: Eliminating Waste In US Health Care
The need is urgent to bring US health care costs into a sustainable range for both public and private payers. Commonly, programs to contain costs use cuts, such as reductions in payment levels, benefit structures, and eligibility. A less harmful strategy would reduce waste, not value-added care. The opportunity is immense (Dr. Donald M. Berwick and Andrew D. Hackbarth, 3/14).