Viewpoints: Republicans reject their own market-based ideas; Analyzing entitlement spending; Access to after-hours care reduces ER visits

Jan 2 2013

The Washington Post: Republicans Rejecting Their Own Ideas
It's harder and harder for politicians on the right to think straight about health care. Conservatives once genuinely interested in finding market-based ways for the government to expand health insurance coverage have, since the rise of Obamacare, made choices that are dysfunctional, even from their own perspective. Start with the decision of the vast majority of Republican governors to refuse to set up the state insurance exchanges required under the law (E.J. Dionne Jr. 12/26). 

The New York Times: Another Fiscal Flop
Over the course of the 20th century, America built its welfare state. It was, by and large, a great achievement, expanding opportunity and security for millions. Unfortunately, as the population aged and health care costs surged, it became unaffordable. ... By 2025, entitlement spending and debt payments are projected to suck up all federal revenue. Obligations to the elderly are already squeezing programs for the young and the needy. Those obligations will lead to gigantic living standard declines for future generations (David Brooks, 12/31).

Bloomberg: Focus On Health-Care Costs Causes More Spending
In 1983, the Ronald Reagan administration enacted one of the most significant cost reforms in Medicare's history. The prospective payment system switched inpatient hospital reimbursement from open-ended fee-for-service to fixed fees paid per diagnosis. In theory, this would give hospitals the incentive to treat patients as quickly and economically as possible. The new rules did drive big changes. Since 1983, the total number of days spent by Medicare patients in hospitals has fallen 40 percent, even as the number of Medicare enrollees has risen 60 percent. The average inpatient stay is now just over five days, down from 10...The prospective payment system is only one obvious example of a long trend. Most of major developments in health care ... could be described as increasing health care's productivity. None of these achievements has lowered prices (David Goldhill, 1/1).

JAMA: The Era Of Delivery Reform Begins
Health care reform evolves in distinct phases. Insurance reform, the critical first step, gained a foothold through the 2010 Affordable Care Act. The nation now enters the midst of payment reform, a second chapter motivated by the need to slow health care spending. Payers across the country are increasingly putting health care on a budget, moving from fee-for-service to lump-sum payments for bundles of services or populations of patients. Hospitals, health care centers, and physicians in turn are consolidating into accountable care organizations (ACOs) to address these new payment contracts, which reward lower spending and higher quality (Zirui Song and Thomas Lee, 1/2).

The New York Times: The Gift Of After-Hours Medical Care
A new study shows that people who have after-hours access to their doctor use the emergency room less. Published online in the journal Health Affairs, the study found that one in five people who attempted after-hours contact with their primary care doctor reported it was "very difficult" or "somewhat difficult" to do so. But those who reported less difficulty contacting a doctor after hours, say on nights and weekends, had fewer emergency room visits than people who experienced more difficulty. I can relate at least one experience in which our pediatrician's evening hours saved us an emergency room visit (Ann Carrns, 12/26). 

The Boston Globe: Making The Most Of Bedside Manner
One busy call night, while handling multiple admissions from our emergency room, I received a page notifying me that a new patient, Mr. T, had just arrived on the hospital floor. I looked up his medical record number, but no records were found in our computer system. I rushed to his room, expecting the worst. When I arrived, he appeared remarkably stable. The chart at his bedside provided a working diagnosis for Mr. T's primary complaint, shortness of breath, but I wanted to hear directly from him about his condition. After reviewing his vital signs, I put down my notes, pulled a chair up, and began taking his history (Kiran Gupta, 12/31). 

The New York Times: Approaching Illness As A Team
The Cleveland Clinic, long considered a premier medical system, is gaining new renown for innovation in improving the quality of care while holding down costs. In its most fundamental reform, the clinic in the past five years has created 18 "institutes" that use multidisciplinary teams to treat diseases or problems involving a particular organ system, say the heart or the brain, instead of having patients bounce from one specialist to another on their own. ... This team approach can improve the quality of care because all the experts are involved in deciding the best treatment option, which can save time and money (12/24). 

The New York Times: Republicans Must Support Public Financing For Contraception
Two weeks ago, Gov. Bobby Jindal of Louisiana, a potential Republican presidential candidate in 2016, proposed making oral contraceptives available "over the counter." This was a remarkable -; and wholly positive -; postelection development. It is just the sort of bold thinking the Republican Party needs to overcome its reputation for being unsympathetic to women's concerns (Juleanna Glover, 12/27).

Los Angeles Times: Individual Mandate In Healthcare Was Year's Top Consumer Story
This was the year of the healthcare mandate. No other consumer story of 2012 comes close. In a split decision, with Chief Justice John G. Roberts Jr. casting the deciding vote, the U.S. Supreme Court upheld the cornerstone of President Obama's healthcare reform law, the most sweeping overhaul of our dysfunctional medical system in decades. The so-called individual mandate requires that most people have health insurance. It's the trade-off for the insurance industry's agreement to stop denying coverage to people with preexisting conditions and to stop charging higher rates if you get sick (David Lazarus, 12/30).

(St. Paul) Pioneer Press: How To Ensure Children's Mental Health
As a pediatric surgeon, I have spent my career giving children a chance to become healthy adults. When children are struck by serious medical conditions, their loved ones and doctors wrestle to understand what happened and how we can make it better. We use every advantage -- research, technology, our understanding of the human body -- to help children heal and secure a chance to live out their full potential (Kurt Newman, 1/2).

Kansas City Star: In Missouri, The Smoking Addiction Lingers On
Tobacco is still a big part of international efforts to keep people smoking. The same holds true in Missouri, nearly a Third World state compared with others. At 17 cents a pack, Missouri has the lowest cigarette tax in the nation. Instead of raising the tax to 90 cents to slow sales, reduce health care costs and increase longevity, Missourians in November voted it down. The low tax encourages smokers, and a lot of people seem proud of that. The Republican-dominated state legislature appears to not care much about health. Smoking is good for business (Lewis Diuguid, 12/30). 

Kansas City Star: Health Care Expansion A Midwest Mystery Train
Often, donor-state status is unavoidable, an accident of geography: We get more in farm supports because we have more farms. But sometimes states and cities choose to become tax donors. ... Which is important to keep in mind in 2013 as legislatures in Kansas and Missouri discuss expanding Medicaid, the health insurance program for the poor. Republican lawmakers in both states have said the expansion may be too expensive, or would help implement what they call Obamacare, which they detest. Both are defensible positions. But rejecting millions in Medicaid subsidies will unquestionably turn taxpayers in both states into health care donors -; Kansas and Missouri tax money will be spent on health care for the poor in California and New York. And we would be donors by choice, not geography
(Dave Helling, 1/1). 

JAMA: How And Why US Health Care Differs From That In Other OECD Countries
United States health care, often hailed as "the best health care system in the world," is also faulted for being too costly, leaving many millions of individuals uninsured, and having avoidable lapses in quality. Criticism often draws on comparisons with other countries of the Organization for Economic Co-operation and Development (OECD). This Viewpoint also makes such comparisons, over a broad range of variables, and reaches one inescapable conclusion-;US health care is very different from health care in other countries. Potential reasons for the differences are discussed, leading to the conclusion that future efforts to control cost, provide universal coverage, and improve health outcomes will have to consider the United States' particular history, values, and political system (Victor Fuchs, 1/2). 

Health Policy Solutions (a Colo. news service): Easier To Buy A Gun Than To Access Mental Health Care In Colorado
Preventing gun violence means requiring a comprehensive and universal background check of both the buyer and seller in every single gun purchase in America. Preventing mass killings also means addressing the prevalence of semi-automatic assault weapons. In Colorado it is easier to purchase an AR-15 assault rifle, the one used by the shooter in Newtown, than it is to access high-quality, affordable mental health and substance use disorder treatment in the community. … It is essential that we have the resources to get individuals appropriate and affordable mental health care when and where they need it. Colorado ranks near the bottom on per capita mental health funding (Moe Keller, 12/31).