Viewpoints: Obama needs to offer plan on entitlements and spending; Assessing the paycheck crimp from health costs

Feb 19 2013

The New York Times: How To Unparalyze Us
(President Barack Obama) owes it to himself and to the country to make one more good shot at a Grand Bargain on spending, investment and tax reform before he opts for a strategy of trying to pummel the Republican Party. ... He has to lead with his chin and put a concrete, comprehensive package on the table, encompassing three areas. First, new investments that would combine immediate jobs in infrastructure with some long-term growth-enablers like a massive build-out in the nation's high-speed broadband capabilities. That would have to be married with a long-term fiscal restructuring, written into law, that slows the growth of both Social Security and Medicare entitlements (Thomas L. Friedman, 2/16). 

The Washington Post: A Permanent Financial Fix
Now, not later, is the time to put the debt on a downward trajectory. The sudden, blunt-force spending shrinkage embodied in the "sequester" scheduled to take effect on March 1 might do more harm than good. What's needed instead is a serious, sustained effort to reform the entitlements that increasingly dominate the federal budget: especially Medicare and Social Security, including the latter's fast-growing disability program (2/16).

The Washington Post: Americans' Mental Health
With the Sandy Hook shootings still in the public mind, it seems as though every legislator, from the NRA-friendly to the anti-gun, is paying attention to mental health care in America. But lawmakers must also keep an eye on the bigger transformation of the country's mental health system that is already in the works. According to a 2011 study from the Kaiser Commission on Medicaid and the Uninsured, 60 percent of Americans and 70 percent of U.S. children suffering from mental illness aren't getting treatment. One reason, no doubt, is stigma associated with seeking help for mental rather than physical problems. Another is that out-of-pocket costs and a shortage of mental health professionals limit access (2/16).

The New York Times: The Health Benefits That Cut Your Pay
The Affordable Care Act does require employers, beginning this year, to note on W-2's how much both the employee and the employer contributed to health care costs. Maybe that will help diminish the ignorance regarding true health care costs. But even with greater awareness, many Americans still might not understand that the largest effect of the cost of our health care system is to reduce the amount of money they actually take home (David Goodhill, 2/16). 

The New York Times: Finding Out Who Pays Your Doctor
The Obama administration issued a new rule this month that requires the makers of prescription drugs and other medical products to disclose what they pay doctors for various purposes, like consulting or speaking on behalf of the manufacturer. This overdue rule adds much-needed weight to previous, more limited disclosure requirements (2/18). 

USA Today: How ObamaCare Can Improve For States
As the key months for implementing the Affordable Care Act begin, 30 governors are resisting key provisions of the law. But these leaders don't need to act just as a phalanx of opposition; if they work with President Obama and Obama works with them, they can change the law's future for the better (Peter Nelson and Josh Archambault, 2/17).

USA Today: Affordable Care Act Will Work If We Embrace It
President Obama mentioned the Affordable Care Act only once during his 2013 State of the Union address, a startling oversight considering the paradigmatic shift his landmark reforms will require of the U.S. health care system in the coming year. At first glance, the future of the U.S. health care system looks bleak, and many in the medical community are complaining about the extra pressures that the ACA will put on the system. The president missed an important opportunity to explain how the reforms will make the system better from the ground up (Peter Anderson, 2/17). 

Des Moines Register: Expanding Medicaid Is The Right Thing To Do
Providing health insurance to poor people isn't a political issue. It's the morally right thing to do. It's the financially smart thing to do -; for patients, state and local governments, businesses, hospitals and doctors. Supporters have come out of the woodwork to make their case. The opponents have yet to materialize. It's time for them to stand up in a public meeting at the state Capitol and explain why providing poor, uninsured Iowans with something as basic as access to health care is a bad idea. They should also outline a viable alternative that costs less than what Washington is offering or tell their own personal stories about how being uninsured works so great for them (2/16).

The Seattle Times: Ensure Washington State Medicaid Expansion
The operative phrase is "newly eligible." Expansion of the state Medicaid program via the federal Affordable Care Act will extend health insurance to legions of people. Among those who would have access to medical care are single men earning less than $14,850 a year. Another current gap in coverage hits a swath of adults ages 50 to 64 (2/18).

The Wall Street Journal: Should Healthy People Have Their Genomes Sequenced At This Time?
Decoding a genetic sequence can be very useful for a patient with symptoms doctors can't interpret, or for couples with troubling family medical histories who are thinking of having children. But what if a person is healthy? Is there a compelling reason to know if your genes make you susceptible to a specific disease or condition? Or are there some things you're better off not knowing (Atul J. Butte and Robert Green, 2/16).

Los Angeles Times: Medicare Says Drug Refills Shouldn't Be Done Without Patient's OK
Medicare called Friday for administrators of its Part D prescription-drug program to ensure that drugstores refill prescriptions only after receiving patient approval. The move follows a series of columns in the Los Angeles Times revealing how CVS and other drugstore chains were routinely refilling prescriptions and billing insurers, including Medicare, without authorization (David Lazarus, 2/15).

Boston Globe: Medicine By Metrics
Having spent decades in search of the next wonder drug, American medicine has started to think about improving the way care is actually delivered, and has begun to dig deeply into the processes of health care. The science of operational improvement is on the rise. There's been an explosion of interest in measurement, metrics, and analytics, as researchers try to figure out how best to improve the quality of care. The pursuit of quality is powerfully enabled by the emerging "digital health" sector, which develops the tools and technologies that enable improved health data collection and sophisticated analysis, and permits us to contemplate the transition of medicine from an episodic, symptom-driven practice to a more holistic vision focused on presymptomatic care and a more continuous assessment of health (David Shaywitz and Dennis Ausiello, 2/19).

Boston Globe: Encouraging Patients To Discuss End-Of-Life Wishes
While many elderly and chronically ill patients designate an official health care proxy, few discuss their specific wishes should they later face life-threatening illness. As a result, when patients become too ill to make decisions for themselves, health care proxies are often overwhelmed by the tremendous responsibility suddenly placed in their hands. Ideally, these conversations should take place prior to the onset of severe illness (Kiran Gupta, 2/18).

Health Policy Solutions (a Colo. news service): Physician-Assisted Suicide A Slippery Slope
None of us is competent to make the decision when to end life.  We just don't, and never will, have all the data.  Since we cannot see into the mind or the heart, we cannot weigh all the factors that may be going into a patient's decision to end  life.  Patients are not obligated to fully disclose everything. We have no idea what is going on in the conscious or unconscious of a person during the last moments. When we artificially bring them to the last moment, we are interfering with that process (Dr. Anthony Vigil, 2/18).

St. Paul Pioneer Press: Nurse Ratios Are For Hospitals, Not Legislators, To Decide
They couldn't make headway on hospital staffing standards at the bargaining table, so Minnesota nurses again are taking their cause to the Legislature. With all due respect to these dedicated health professionals, that's misguided. What do legislators know about running a hospital and caring for patients? Generally speaking, nothing (2/16).

Georgia Health News: Georgia Has A 'Dental Desert,' But Hygienists Want It To Bloom
Looking at the lush greenery of the Georgia mountains or the enticing beaches and barrier islands along the Georgia coast, few people would describe the state as a desert, except for the thousands of Georgians who lack dental insurance or funds for basic preventive dental care. … Georgia ranks among the top 10 states both in current population and rate of population growth. But with just one dental school, Georgia is ranked 46th among states for its number of dentists per capita. This means that too many people in Georgia don't have access to dental care (Suzanne Newkirk and Lynne Slim, 2/17).