Viewpoints: 'Outrageously high fee' for emergency services; Mysterious rise in autism cases

A selection of editorials and opinions on health policy from around the country.

The Los Angeles Times: The Bizarre Calculus Of Emergency Room Charges
(T)he calculus for medical charges in general is beyond comprehension, with outrageously high fees used as a starting point in a bizarre game of bargaining. Glenn Melnick, who teaches hospital finance at USC, told me it's as crazy as if he asked to buy the TV in my living room, and I gave him a price of $1 million to start the conversation. This is the kind of insanity that exists when medicine and medical insurance are about private profit rather than public health, when 50 million people are uninsured, when Medicare and Medicaid reimbursements don't always cover true costs and when polarized politics prevent the kind of reasonable discussions that could lead to solutions (Steve Lopez, 3/31).

The New York Times: The Puzzle Of More Autism Cases
The latest federal survey suggests that more than 1 percent of all children in the country have been identified as having autism or two related disorders by the age of 8, a far higher percentage than found in previous surveys. But no one knows whether the increase shows that the disorders are more common or whether it simply reflects better detection of cases that would previously have been missed. Either way, the survey by the Centers for Disease Control and Prevention suggests that more children and parents may need help in coping with these disorders in their schools and communities (4/1).

The New York Times: Pink Slime Economics
The trouble with the budget devised by Paul Ryan, the chairman of the House Budget Committee, isn't just its almost inconceivably cruel priorities, the way it slashes taxes for corporations and the rich while drastically cutting food and medical aid to the needy. Even aside from all that, the Ryan budget purports to reduce the deficit -; but the alleged deficit reduction depends on the completely unsupported assertion that trillions of dollars in revenue can be found by closing tax loopholes (Paul Krugman, 4/1).

The Wall Street Journal: Ryan Endorses Romney
Mr. Ryan's endorsement is especially notable because it also reflects the policy progress that Mr. Romney has made over the course of the campaign. The former Massachusetts Governor has embraced a modified version of Mr. Ryan's premium-support Medicare reform. ... . More recently, Mr. Romney endorsed Mr. Ryan's House budget, which the presidential candidate could have ducked. No doubt all of this influenced Mr. Ryan's thinking (Paul A. Gigot, 4/1).

Chicago Tribune: Deluding Ourselves On Medical 'Cures'
"To promote gastric bypass surgery as a quick fix for diabetes is unconscionable," said Dr. Jane L. Delgado. ... The rush to celebrate a cure du jour to medicine's most intractable problems is a result of people's deep desire for science to come up with some "solution" that will enable them to engage in pleasurable, sometimes destructive behaviors, without fear of unhappy consequences (Esther J. Cepeda, 4/2).

USA Today: Complex Health Choices Require Shared Decisions
Involving patient input in medical decisions is a concept known as shared decision-making. According to the Institute of Medicine, it is a foundation of patient-centered care, where care is "responsive to individual patient preferences, needs and values" (Kevin Pho, 4/1). 

WBUR's Common Health blog: On Being Gay In Medicine: A Leading Harvard Pediatrician's Story
I am currently serving on the new Institute of Medicine Committee on Lesbian, Gay, Bisexual and Transgender Health Issues. The public testimony has been moving. The enthusiasm that people have for the very existence of the committee and the expectations they have for our report have been humbling. Their comments have been a reminder of just how marginalized people still feel, and how alienated they feel from the clinicians whom they depend on in their time of greatest need (Dr. Mark Schuster, 3/30).