Longer looks: Mitt Romney's health care legacy; Closing of Philly hospitals brings 'grim consequences;' Young doctors and their apps

Oct 11 2012

Every week Shefali S. Kulkarni selects interesting reading from around the Web.

PBS Frontline: The Choice 2012
A journey into the places, people, and decisive moments that made the men who are competing for the presidency. ...As governor, Romney knew he needed what political pros called a "legacy issue" if he wanted to run for president one day. He devoted his energy towards reforming health care, an issue that Democrats had been grappling with and a problem that cost the state dearly as taxpayers bore the brunt of covering the uninsured. Romney's solution was to require that all individuals obtain health insurance, a concept known as the "individual mandate," based on a sliding scale of affordability. Over the long term, he calculated, the plan would help reduce costs. His first challenge was to get the state legislature's Democrats on board, a task he accomplished by reaching out across the aisle for cooperation (10/9).

The Atlantic: The Grim Consequences Of Closing Urban Hospitals
In 1995, Philadelphia had 19 hospitals with obstetric units, places where local women – about half of them on Medicaid – could go for prenatal care and, ultimately, to deliver their babies. … By 2005, nine of these 19 hospitals in the city had closed, a group accounting for more than 30 percent of all of the deliveries that had taken place in Philadelphia in the mid-90s. Now, some 15 years after the spate of closures started – brought on, by most accounts, because of financial pressure – we have some better sense of what this really meant for the city. A new study, published in the journal Health Services Research, concludes that Philadelphia's newborn mortality rate temporarily increased by nearly 50 percent in the first few years after the closures began (Emily Badger, 10/10).

The Miami Herald: Competition Launches Effort To Expand School Health Care In Miami Beach
Five-year-old Sydney suffers from a peanut allergy that caused her face to swell so badly when she was a toddler that her mother thought her throat would close and her heart would stop. But due to funding woes, her Miami Beach school has no nurse on staff to treat illnesses or even scrapes and bruises -; much less anaphylaxis shock. ... Though experts say the rate of disorders, allergies, diabetes and other special needs is on the rise among students, increasing the importance of school healthcare and breadth of services needed, the days when an on-campus school nurse was a given are over. In Miami-Dade County, only 157 of the county's roughly 335 public schools -; excluding charters and private schools -; has a daily on-campus healthcare professional (David Smiley, 10/5).

National Journal: Medicare: The Hard Issue Just Around The Corner
[Army veteran Herb] Randall, like many 69-year-olds, is torn between protecting a benefit he thinks he and other seniors earned -; Medicare -; and the taming of a soaring national debt that could one day cripple the government program. He's not sure which presidential candidate offers the better solution. "The Republican position is nobody is going to have it if we don't reverse the spending," he said ... But a breath later, Randall expressed just as much anxiety about the plan by GOP nominee Mitt Romney and running mate Paul Ryan to convert Medicare into a premium support program for those younger than 55. … The debate over Medicare, which simmered quietly during much of September as the campaigns focused on taxes, is about to reemerge in the presidential campaign. Earlier this week, the Obama campaign released a new ad focused on it ... The future of Medicare also will likely play a major role on Thursday night during the sole debate between Vice President Joe Biden and Ryan (Alex Roarty, 10/10).

The New York Times: Redefining Medicine With Apps And iPads
[Dr. Alvin Rajkomar] came upon a puzzling case: a frail, elderly patient with a dangerously low sodium level. ... Rajkomar had been on call for 24 hours and was exhausted, but the clinical uncertainty was "like a shot of adrenaline," he said. ... With a tap on an app called MedCalc, he had enough answers within a minute to start the saline at precisely the right rate. ... The proliferation of gadgets, apps and Web-based information has given clinicians -; especially young ones like Dr. Rajkomar, who is 28 -; a black bag of new tools: new ways to diagnose symptoms and treat patients, to obtain and share information, to think about what it means to be both a doctor and a patient. And it has created something of a generational divide. Older doctors admire, even envy, their young colleagues' ease with new technology. But they worry that the human connections that lie at the core of medical practice are at risk of being lost (Katie Hafner, 10/9).

Relate, earlier KHN coverage: FDA Seeks To Tame Exploding Medical App Market (Gold, 6/26)