Viewpoints: Bowles urges 'deficit deal now;' A doctor's take on health law; Preparing N.Y. hospitals for future storms

Nov 9 2012

The Washington Post: Make A Deficit Deal Now
Going over the fiscal cliff would mean allowing a massive and immediate cut to nearly every major government agency and activity, including those vital to our national security or economic growth. ... What does that alternative look like? We already have the blueprints. It's the type of bipartisan package toward which the fiscal commission I co-chaired with former senator Alan Simpson, the Domenici-Rivlin group, the Senate's "Gang of Six" and the Obama-Boehner negotiations all worked. It's a package large enough to put the debt on a clear downward path, relative to the economy, and designed well enough to promote, rather than disrupt, economic growth. It's a package that includes real spending cuts and structural entitlement reforms to make Social Security solvent while slowing the growth of federal health spending while protecting vulnerable populations. And it's a package that institutes fundamental tax reform that simplifies the code and encourages economic growth by cutting spending in the tax code to reduce rates and generate additional revenue for deficit reduction (Erskine Bowles, 11/7).

The Wall Street Journal: Obama's Divided Nation
Assuming anyone could survive the GOP's clown-car selection process, one of the most attractive alternatives would have been Mr. Romney's running mate, Rep. Paul Ryan. A Ryan campaign would have consisted of a principled articulation of the case for reforming Medicare and Social Security before they collapse the national fisc, a simpler tax system and a bipartisan compromise on the deficit (Daniel Henninger, 11/7).

The New York Times: Hospital Evacuations For Future Storms
One of the big lessons of Hurricane Sandy is that New York's hospitals are not as well prepared as they need to be. ... In light of this disaster, hospital administrators clearly need to re-examine their evacuation planning and re-assess how decisions were made before the storm. Hospitals also will need to bolster their defenses (11/6).

San Diego Union Tribune: Long-Term Care A Growing Concern
San Diego is home to some of the most beautiful beaches in the nation, yet a coming wave threatens the financial security of many who live here. Four of 10 middle-aged voters say a close family member is likely to need long-term care in the next five years, yet most don't know where they will turn for help, according to a poll on long-term care by The SCAN Foundation and the UCLA Center for Health Policy Research. These findings beg for greater awareness and action by state and local policymakers (Bruce A. Chernof, 11/2).

Health Policy Solutions (a Colo. news service): VA System Inadequate To Meet Veterans' Health Needs
The sacrifices they and our family made are real, and a real testament to their commitment to our country.  As we come together to celebrate Veterans Day it is important that we consider how we might repay this commitment with a promise of our own: The promise of access to high-quality, affordable health care. Understanding the health and particularly mental health needs of our Colorado veterans is the first step toward doing that. ... A recent analysis of national data, estimates over 16 percent of all veterans report having limitations in their health such as trouble getting around and living independently, or problems with their vision or hearing (Gretchen Hammer, 11/7).

The Medicare NewsGroup: The Post-Election Climate: Common Ground On Medicare Reform
While President Obama's win won't establish a clear path forward on Medicare, it is highly unlikely to lead to a radical restructuring of the program. There is quite a bit of middle ground that policymakers, think-tank experts and academics have agreed to explore. Although they haven't yet penetrated the partisan fog on Capitol Hill, there are several ideas that may gain currency in the coming year, with some involving market-based approaches and items contained in conservative agendas. At the epicenter of a third way on Medicare reform is a growing realization that Medicare is not only part of the larger health care cost debate but that it can be reformed incrementally. Part of that strategy revolves around both a gradual departure from the fee-for-service model and a dissection on how health care is provided (John Wasik, 11/7).

Fox News: What Obama's Victory Means For Your Health Care -- A Doctor's Take
Tuesday night's win in the presidential contest for President Obama was a win for ObamaCare, the president's signature legislation from his first term. ObamaCare will now continue to be implemented. This future means that we will continue to be faced with rising insurance premiums, as our current insurance expands to cover all patients regardless of pre-existing condition, age, or how many times they've already used the policy ... Federal regulations in the form of Medicare's Independent Payment Advisory Board as well as ObamaCare's many other committees will restrict my choices for my patients. I will have more patients with more red tape and less time to spend with them. Since ObamaCare does not effectively address the doctor shortage, you will see more nurse practitioners and physicians assistants, who are quite competent, but have different training than I have treating patients (Dr. Marc Siegal, 11/7).

Baltimore Sun: The Key Role Of Nursing Homes
Many people think of nursing homes as places to go to die. But here in Maryland, skilled nursing and rehabilitation centers are in fact places people go to live. They are a big part of the solution to the state's health care challenges, providing quality and cost-effective transitional, rehab, long-term and high-acuity care to those in need. With the impending implementation of the Affordable Care Act in Maryland, we have an opportunity to identify and pilot ways in which Maryland's skilled nursing and rehabilitation centers can be essential to providing expanded care to people and families in need and deploying center‐based resources into the community for public health challenges. Nursing centers in Maryland have valuable roles to play in effectively integrating care across all settings, connecting the dots among family caregivers, primary care doctors and nurses and hospital-related care to provide better focus and integrated care to address such things as chronic heart disease, diabetes and obesity (Joe DeMattos, 11/7).

Kansas City Star: Deal With Reality: Obamacare Stays
For GOP leaders in Missouri and Kansas, the time for wishful thinking is past. Mitt Romney will not have the chance to repeal "Obamacare," as he promised in his campaign. So states must make important decisions about their participation in the Affordable Care Act. And quickly. Governors face a Nov. 16 deadline to inform the U.S. Department of Health and Human Services about their level of involvement in state-based insurance exchanges. Because of their own missteps, it is too late for Kansas and Missouri to create their own exchanges and have them operational by January 2014, as called for in the health care law. Their choice now is to partner with federal officials or accept an exchange designed by Washington (11/7).

The Wall Street Journal: Organizing to Battle Drug-Resistant TB
Extensively drug-resistant TB -- a deadlier form of the airborne disease, one that can overpower nearly all available drugs -- first emerged in South Africa in 2008. It has since been discovered in 84 countries, including the United States and much of Europe. With a concerted and coordinated response from governments, the mining industry, international development partners and civil society, we can stop this disease in its tracks. The way to start is by strengthening efforts to detect and treat TB in southern Africa's mines (The Rev. Desmond Tutu, 11/7).

New England Journal of Medicine: 'If I Had Only Known' -- On Choice and Uncertainty in the ICU
The way one views patients' initial choices to undergo advanced or high-risk interventions -- as decisive acts of buy-in or as decisions made with limited information, to be revisited and reevaluated over time -- sets the stage for one's approach to subsequent decisions regarding pursuit of life-sustaining or palliative care. For patients like ours, explicit examination of such distinctions represents an important step toward confronting and understanding the regret that can occur in the ICU (Drs. Jesse M. Raiten, and Mark D. Neuman, 11/8).

New England Journal of Medicine: Compounding Errors Compounding pharmacies are businesses that produce important products for patients. These patients, however, do not have the means to check the clinical indications for the use of the products, to ensure the accuracy of the compounding, and to verify the sterility of the delivered products. The FDA has the technical expertise and drug-evaluation experience to do so and should have this authority, and there needs to be a mechanism to ensure that the funding is in place to exercise it effectively (Drs. Jeffrey M. Drazen, Gregory D. Curfman, Lindsey R. Baden, and Stephen Morrissey, 11/7).