Viewpoints: Holtz-Eakin and Roy offer prescription to fix health law; Iowa lawmakers opposed to Medicaid expansion should give up their coverage

Feb 22 2013

Reuters: The Future Of Free-Market Healthcare
Over nearly a century, progressives have pressed for a national, single-payer healthcare system. When it comes to health reform, what have conservatives stood for? For far too long, conservatives have failed to coalesce around a long-term vision of what a free-market healthcare system should look like. ... Obamacare is the logical byproduct of this conservative policy neglect. ... The great irony of Obama's triumph, however, is that it can pave the way for Republicans to adopt a comprehensive, market-oriented healthcare agenda. ... conservatives can use Obamacare's important concession to the private sector -; its establishment of subsidized insurance marketplaces -; as a vehicle for broader entitlement reforms (Douglas Holtz-Eakin and Avik Roy, 2/20).

The Washington Post: Health Premiums For Smokers Should Be Tweaked
When venerable anti-tobacco groups such as the American Cancer Society and cigarette makers such as Altria align in opposition to a policy, it's got to be pretty bad, right? But, when it comes to whether health-insurance companies can charge higher premiums from smokers, the fact that these mortal enemies oppose the idea doesn't mean policymakers should throw it out (2/20).

Des Moines Register: There's Irony In Lawmakers' Medicaid View
The Republicans continue to complain about a supposed "government takeover" of health care. Iowa House Speaker Kraig Paulsen, R-Hiawatha, told The Des Moines Register editorial board last week that he has no plans to pursue a Medicaid expansion. There's a troubling irony here. Last year, Paulsen gladly allowed Iowa taxpayers to pay the entire cost of his health insurance. He was enrolled in a plan offered to full-time state government employees and to members of the Legislature, although they work only parttime during the year. It cost taxpayers $13,000 for the state to insure Paulsen and his family. The amount he contributed to the premiums: $0. ... Perhaps it is time for members of Iowa's Legislature to walk in the shoes of tens of thousands of other citizens who don't qualify for any benefits from their part-time jobs. Lawmakers should give up their taxpayer-financed insurance benefits (2/20).

The New England Journal of Medicine: Routine HIV Testing, Public Health, and the USPSTF -; An End to the Debate 
The U.S. Preventive Services Task Force (USPSTF) is poised to release recommendations on screening for human immunodeficiency virus (HIV) infection that will endorse the routine testing of adults and adolescents. ... They will also carry important policy implications, since the Affordable Care Act (ACA) mandates that all public and private health plans provide coverage for USPSTF-recommended preventive services without patient copayments (Ronald Bayer and Gerald M. Oppenheimer, 2/20).

The New England Journal of Medicine: Updating the HIV-Testing Guidelines -; A Modest Change With Major Consequences 
The rationale for a grade A recommendation from the USPSTF is that there is "high certainty that the net benefit is substantial." In the case of HIV screening, that benefit can be achieved only if people identified as HIV-infected are effectively linked to and retained in HIV care and are supported in adhering to an effective antiretroviral regimen. The proposed USPSTF recommendations may remove financial barriers to routine HIV screening, but that is only the first step in ensuring that all HIV-infected Americans have access to the full continuum of care (Erika G. Martin and Bruce R. Schackman, 2/21).

The New York Times' Opinionator: Our MIA Surgeon General
But (Surgeon General Regina Benjamin's) most public work, the 2010 document called "The Surgeon General's Vision for a Healthy and Fit Nation," has a decidedly mild Michelle Obama-ish tone. In discussing the obesity crisis, it lays the blame squarely at the feet of … the victims: "In addition to consuming too many calories and not getting enough physical activity, genes, metabolism, behavior, environment, and culture can also play a role in causing people to be overweight and obese" (Mark Bittman, 2/20).

Los Angeles Times: Breast Practices: The Mammogram Dilemma
There is growing evidence that screening mammograms aren't all they've been cracked up to be. This month it was "More mammograms, more problems" -; a study showing that screening every year (instead of every other) didn't produce any benefit but did produce twice as many false alarms and twice as many biopsies. A few weeks earlier, another study (which I coauthored) suggested that roughly one-third of breast cancers diagnosed under current screening guidelines would never cause problems and didn't actually need to be diagnosed (H. Gilbert Welch, 2/21).

The New England Journal of Medicine: Medicare's Transitional Care Payment -; A Step Toward The Medical Home
In adopting the transitional care payment policy, CMS has begun shifting more financial resources toward primary care. ... Using the fee schedule to expand the delivery of advanced primary care services might well benefit the Medicare population, but such payments might also provide an incentive for visits that won't yield the anticipated benefits of higher quality and lower costs. CMS aims to formulate policy on the basis of [Center for Medicare and Medicaid Innovation] studies, but at some point it will need to take the leap to something better. The 2013 physician-payment rule suggests that day is coming soon (Dr. Andrew B. Bindman, Jonathan D. Blum and Richard Kronick 2/21).