Viewpoints: Debating P4P; ‘Tactical retreat' by GOP; The virtues of across-the-board spending cuts

Jan 28 2013

The New York Times: Paying For Performance
Instead of granting automatic pay increases, [N.Y. City's public hospital system] will pay them based on how well they reduce costs, increase patient satisfaction and improve the quality of care. The Health and Hospitals Corporation, which runs the city's 11 public hospitals, deserves praise for an ambitious proposal that will need to be refined as it is put into practice. ... The doctor's union is still seeking a wage increase or at least a guarantee of part of the bonus. ... Such issues must not be allowed to disrupt this important move to pay doctors based on how well they perform (1/27).

The New York Times: Carrots For Doctors
Pay for performance, or P4P in the jargon, is embraced by right and left. It has long been the favorite egghead prescription for our absurdly overpriced, underperforming health care system. ... In practice, pay for performance does little to improve outcomes or to control costs. But if you look hard enough at why this common-sense approach doesn't deliver, you find some clues to what might. ... The first problem with P4P is that it does not address the biggest problem (Bill Keller, 1/27).

The Wall Street Journal: The Case For Across-The-Board Spending Cuts
Targeted reductions would be welcome, but the current federal budget didn't drop from the sky. Every program in the budget-;from defense to food stamps, agriculture, Medicare and beyond-;is in place for a reason: It has advocates in Congress and a constituency in the country. ... Whatever carefully targeted budget cuts might animate our dreams, the actual world of divided government suggests only one realistic way to achieve real spending reductions. It is not a meat ax. A scalpel that shaves a bit off all programs equally would work just fine (Jeff Bergner, 1/27).

Los Angeles Times: The GOP's Tactical Retreat
Polls also show that when voters are presented specific options for shrinking the deficit, they recoil from domestic spending cuts, especially in Medicare and Social Security. The most popular ways to cut the deficit turn out to be Democratic policies: higher taxes on the wealthy and cuts in military spending. And as the price for tea party support, Boehner promised conservatives a gift he may come to rue. He directed Ryan, the chairman of the House Budget Committee, to draw up a new federal budget that eliminates the deficit within 10 years through spending cuts alone -; no new taxes allowed (Doyle McManus, 1/27).

The Washington Post: Obama's Daring Liberal Agenda Is Neither Daring Nor Liberal. Discuss.
Opinion polls show that on almost all of the major positions Obama espoused in his speech -; entitlements, immigration, climate change and same-sex marriage -; a majority of Americans agree with him. ... the central mechanism of Obamacare -; the individual mandate, which Republicans blasted as a massive liberal exercise of power -; began as a conservative idea. ... Looking at this history and today's opinion polls, it would seem pretty easy to find consensus in America on a lot of big issues -; not just "liberal" or "conservative" solutions (Zachary A. Goldfarb, 1/25).

The Fiscal Times: Why Government Spending Is Not Out of Control
We are much closer to fiscal sustainability than even most economists realize. Relatively small adjustments to the growth path of federal revenues and Medicare would be sufficient to eliminate the primary deficit. Taking a meat ax to every federal program, as Republicans demand, is neither necessary nor desirable (Bruce Bartlett, 1/28).

The Hill: With State of the Union, Obama Will Take Case To The People
In this year's State of the Union, scheduled for February 12, the President opens a prime-time window of about 100 days to make significant headway on his second term agenda. ... Top White House aides tell me the President now has "clear-eyes" about Congressional politics. ... on poverty programs, look for the President to shift the GOP focus on deficit reductions to discussions of how seniors and the poor will be hurt by big cuts to entitlement programs such as Medicare (Juan Williams, 1/28).

MinnPost: New Regulations Of Compounded Medicines Mean Fewer Options At Higher Prices
Today, there are three injectable medications available for the treatment of macular degeneration with enormous benefits for a patient's vision. The three medicines are similar in safety, efficacy, and dosing; however, there is a shocking difference in cost: Avastin costs $50 per dose, while Lucentis and Eylea each cost $2,000. Unfortunately, the option to use Avastin has been restricted by the debate on how to regulate medicine from compounding pharmacies (Dr. Geoffrey Emerson, 1/28).

The Oregonian: Dentists' Concerns Must Be Addressed To Hasten Health Care Overhaul
It was inevitable that one group of providers would feel Oregon's health care transformation was happening way too fast. It's the dentists. Not all of them, but a few significant players. ... it's time for collaboration and negotiation rather than legislation. An intervention by the Legislature at this point to protect one class of caregiver against the sheer forces of change would set the wrong precedent, if not be fatal to the overhaul effort (1/26).

Sacramento Bee: Amgen Uses Its Clout To Boost Costs Of Health Care For Millions
California's own biomedical giant, Amgen, appears to have received an especially sweet deal as Congress rushed to avoid the automatic tax hikes and spending cuts of the so-called "fiscal cliff." ... As detailed by the New York Times last Sunday, senators, Democrats and Republicans alike, approved obscure language that appears to benefit Amgen – although the company says patients with end-stage kidney disease are the ones who truly will be helped (1/27).

Kansas City Star: Keep The Health Care Promises
The 2003 sale of the former Health Midwest hospital network to the out-of-town Hospital Corp. of America was a drawn-out, contentious process. Thirteen hospitals in the Kansas City region were involved, and people understandably worried that the transfer of nonprofit community assets to a for-profit owner would result in weakened connections and diminished charity care. ... We are likely to see more mergers and sales in which large, out-of-town corporate entities gain control over what are intended to be community assets. Sound agreements, and the sort of vigilance that the Health Care Foundation has provided, are essential going forward (1/27).

Baltimore Sun: Safe, Legal Abortion For 40 Years
[A] majority of Americans still agree with the high court that personal health care decisions should be left up to a woman. ... the way people identify with the issue has shifted over the years. No longer do labels like "pro-choice" and "pro-life" reflect the way people think about abortion. The fact is, generations of Americans -; across party lines -; understand that it's just not that simple. The decision to obtain an abortion is deeply personal and complex. It's not something that can be put squarely in a "pro" or "anti" box (Jenny Black, 1/27).

WBUR: Cognoscenti: Your Personal Health Information Isn't As Safe As You Think
Using a computer, an Internet connection and information available publicly online, researchers from the Whitehead Institute at MIT were able to figure out the identities of nearly 50 people who had submitted personal genetic information for a research study ... the National Institutes of Health has taken steps to make re-identifying research subjects harder to do. ... Will it work? Will these new protections be strong enough? I hope so. But frankly, I doubt it (Judy Foreman, 1/28).

Georgia Health News: Don't Make Scapegoats Of People With Mental Illness What needs to be done to prevent violence should not, therefore, be linked to national databases of people with mental illnesses. ... There is no evidence that such a database would effectively control or limit violent behavior. ... The problem with our mental health system is not that we fail to hospitalize people with acute mental health conditions. Rather, it is that we fail to take reasonable steps to prevent those conditions from occurring (Ellyn Jeager, 1/26).

Boston Globe: Patients, Doctors, And The Power Of Religious Faith
Several surveys show that over 90 percent of Americans believe in God. It's not surprising, then, that religion plays an important role in medical care. Just as there are no atheists in foxholes, a nonbeliever might reconsider while being rolled into the operating room or waiting for a biopsy result. The clinical efficacy of prayer is difficult to measure, though researchers have tried (Dr. Suzanne Koven, 1/28).

Health Policy Solutions (a Colo. news service): Colorado's Health Insurance Exchange On Track For October Launch
Colorado's exchange, like those in other states, will be funded with federal grants through 2015 as long as certain benchmarks are met along the way. ... Colorado is ahead of the game, however, because lawmakers passed a bipartisan bill in 2011 that created the exchange. That bill was supported by a broad-based coalition of business groups, health plans and consumer groups that favored creation of a state-based exchange (Bob Serno, 1/25).