Viewpoints: McConnell says spending cuts are coming; Plea to Kan. governor to rethink insurance exchange

Jan 4 2013

Yahoo: Fiscal Cliff Deal Not Great, But It Shields Americans From Tax Hike
Predictably, the President is already claiming that his tax hike on the "rich" isn't enough. I have news for him: the moment that he and virtually every elected Democrat in Washington signed off on the terms of the current arrangement, it was the last word on taxes. That debate is over. Now the conversation turns to cutting spending on the government programs that are the real source of the nation's fiscal imbalance. And the upcoming debate on the debt limit is the perfect time to have that discussion. ... While most Washington Democrats may want to deny it, the truth is, the only thing we can do to solve the nation's fiscal problem is to tackle government spending head on -; and particularly, spending on health care programs, which appear to take off like a fighter jet on every chart available that details current trends in federal spending (Sen. Mitch McConnell, R-Ky., 1/3).

Bloomberg: When Governing Means Lurching Between Phony Crises
The tax cuts passed under President George W. Bush show what happens when reforms lack broad support. They were pushed through in 2001 and 2003 against solid Democratic opposition. For more than a decade, the overriding aim of Democratic politics has been to (partially) reverse them. Mission accomplished -- for now. A similar fate might be in store for health-care reform. With uncertain support from the public, the Affordable Care Act faces the skepticism of Republican governors and the outright hostility of a Republican-controlled House of Representatives. The policy may be the law of the land, but without a firmer base of support it will remain in jeopardy. Expect the pattern to repeat during the next phase of budgetary dysfunction (Clive Crook, 1/2).

Baltimore Sun: Budget Deal Won't Fix Unemployment
Friday, forecasters expect the Labor Department to report the economy added 155,000 jobs in December -; substantially less than is needed to pull unemployment down to acceptable levels. ... However, on the supply side, increased business regulations, rising health care costs and mandates imposed by Obamacare -; and now higher taxes on small businesses -; discourage investments that raise productivity and competitiveness and create jobs (Peter Morici, 1/2).

Kansas City Star: Political Posturing On Health Care Hurts The Uninsured
In my last year of medical school I was part of a surgical team and met Tom, a 54-year-old farmhand. ... After a thorough assessment and numerous tests the team found that Tom had a mass in his bladder. ... The advanced stage of his cancer meant that he needed surgery and radiation to even have a chance at cure. However, he was uninsured, and his medical bills were already in the tens of thousands of dollars from this admission alone. Tom was left with two options: bankruptcy or death. ... Tom, along with tens of millions of Americans, will benefit from the insurance expansions in the new health reform law, popularly known as "Obamacare," once it is enacted in 2014. However, with Kansas and many other states dragging their feet, millions will continue to die, suffer and be bankrupted (Branden Comfort, 1/2).

The New York Times: Our Absurd Fear Of Fat
The meta-analysis, published this week in The Journal of the American Medical Association, reviewed data from nearly a hundred large epidemiological studies to determine the correlation between body mass and mortality risk. The results ought to stun anyone who assumes the definition of "normal" or "healthy" weight used by our public health authorities is actually supported by the medical literature (Paul Campos, 1/2).

The New England Journal of Medicine: Shared Decision Making To Improve Care And Reduce Costs
For many health situations in which there's not one clearly superior course of treatment, shared decision making can ensure that medical care better aligns with patients' preferences and values. ... However, more than 2 years after enactment of the ACA, little has been done to promote shared decision making. We believe that the Centers for Medicare and Medicaid Services (CMS) should begin certifying and implementing patient decision aids, aiming to achieve three important goals: promote an ideal approach to clinician–patient decision making, improve the quality of medical decisions, and reduce costs (Emily Oshima Lee and Dr. Ezekiel J. Emanuel, 1/3).

The New England Journal of Medicine: Using Shared Savings To Foster Coordinated Care For Dual Eligibles
There are 9.2 million people who are eligible for both Medicare and Medicaid. ... New federal policy initiatives are promoting organizations that integrate and coordinate care to meet the complex needs of this vulnerable population. The hope is that if beneficiaries are encouraged to enter into such arrangements, costs will fall and quality of care will improve. ... It is important to advance program designs that have the potential to improve care and save money, but we need to do so in a way that promotes self-determination and the exercise of real options (Richard G. Frank, 1/2).

The New England Journal of Medicine: The Bystander Effect In Medical Care
When nine different specialty teams are called in to help diagnose a perplexing condition in an ICU patient, chaos and inaction result, with all participants assuming passive roles, expecting another physician to bear the burden of authority and responsibility. ... promoting the use of mechanisms that encourage healthy and collegial interactions between specialty and primary care teams may empower individual clinicians to participate more meaningfully in the care of shared patients. The recent TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) initiative developed by the U.S. Agency for Healthcare Research and Quality, which aims to improve communication and team-based skills among health care professionals, is an important step in this direction (Drs. Robert R. Stavert and Jason P. Lott, 1/3).