Viewpoints: Disappointing 'surprises' in health law; Cuts in graduate medical training threatens physician supply; Va. can afford Medicaid expansion

Mar 5 2013

Politico: Medicare Cuts Are A Giant Step Backward
The proposed 2.3 percent reduction in (Medicare Advantage plan) payments, which comes on top of cuts already scheduled under the Affordable Care Act, pays no mind to the potential impact on quality of care throughout the program. These cuts will apply to all plans no matter the value they bring in providing quality care to beneficiaries or offering innovative solutions that could ultimately be scaled and applied to the broader program. Blind cuts are the same as those of the impending sequester; their sole aim is to save money and they do nothing to reform the Medicare program, and may even harm it (Douglas Holtz-Eakin and Ken Thorpe, 3/4).

Los Angeles Times: It's 'I Told You So' On Obamacare
"What we've learned through the course of this program is that this is really not a sensible way for the healthcare system to be run." That was Gary Cohen, director of the Department of Health and Human Services' Center for Consumer Information and Insurance Oversight, talking. He was specifically responding to the apparently surprising need to halt enrollments in a program designed as a temporary bridge for people with preexisting conditions who couldn't wait until the Affordable Care Act (a.k.a. Obamacare) fully kicks in next year. The program was allocated $5 billion, but some estimate it will take $40 billion to fund the effort. Such surprises are becoming routine (Jonah Goldberg, 3/5).

Politico: Demand For Doctors Soaring As Cuts Loom
As House Speaker John Boehner has said, the Affordable Care Act is the "law of the land." ... Yet at the very moment we are inviting people into the health system, Congress is considering cutting the single source of training that will ensure we have the physicians we need to look after these individuals, by drastically reducing federal funding for graduate medical education (Kenneth L. Davis, 3/5).

The Wall Street Journal: The Real Promise Of 'Accountable Care'
For decades, the inexorable rise in health-care costs has been accompanied by growing evidence of large variations in care and widespread gaps in quality and efficiency. Almost daily, new developments come along that in other industries would improve quality and access -; such as Web- and phone-based services, electronic transactions and more-convenient facilities. In health care, however, innovative technologies and services seem to increase costs and complexity (Elliott Fisher, Mark McClellan and Stephen Shortell, 3/4).

Boston Globe: Mass. Needs An Obamacare Waiver For Small-Business Health Plans
Massachusetts has made a concerted effort in the last few years to rein in health care costs for small businesses. But new federal regulations written to implement the Affordable Care Act threaten to undercut those efforts -; and saddle thousands of Bay State businesses with big increases in premiums. State law currently allows insurers to consider a range of factors that often reduce premiums for small firms. But under the new federal regulations, most of those rating factors will no longer be allowed. For example, insurers won't be able to consider the risks inherent to the industry a company is in, or whether the company has a wellness program, or how many employees it has, or what percentage of them participate in its health plan (3/5).

The Washington Post: Medicare Reform's Slow Progress
As I reported in January, the publisher of the Wall Street Journal and others are suing to gain detailed access to Medicare billing records through the Freedom of Information Act. ... Doctors are fighting the lawsuit, claiming that their taxpayer-funded earnings are none of the public's business. There's still no ruling in the case, but readers I heard from unanimously backed the Journal. I didn't receive one e-mail supporting the doctors. What I did get was a flood of first-person testimony about outrageous Medicare bills (Charles Lane, 3/4).

The Washington Post: Virginia Ignores Neediest By Obstructing Medicaid Expansion
Virginia Gov. Robert M. McDonnell (R), under attack by his erstwhile conservative allies for having overseen the enactment of a desperately needed tax increase for transportation, is trying to protect his right flank by vowing not to permit any expansion of Medicaid while he is governor. We salute Mr. McDonnell for his guts on the transportation bill, but on Medicaid he is posturing. Even under the most aggressive scenario, the state would not be in a position to expand Medicaid before July 2014 -; six months after Mr. McDonnell leaves office. Still, that sluggish pace raises a broader question: Why is Virginia, one of the seven or eight richest states, one of the stingiest in providing health-care coverage for its poorest residents, including the working poor? (3/4). 

The Washington Post: C. Everett Koop, The Nation's Doctor
Koop turned his notoriety into influence, undertaking public health campaigns against smoking, domestic violence and preventable accidents. But his main contribution concerned HIV/AIDS. ... Koop was initially ordered by a superior to keep to himself any views on the topic. But Koop maneuvered to produce the "Surgeon General's Report on Acquired Immune Deficiency Syndrome," explicitly detailing the modes of HIV transmission, making clear it could not be spread by casual contact and affirming that "We are fighting a disease, not people" (Michael Gerson, 3/4).

San Francisco Chronicle: Biological-Material Laws Need Refining
It seems like the simplest thing in the world: your cells, tissues and fluids should belong to you. After all, your body belongs to you, doesn't it? It's not that simple. In fact, this question is at the heart of decades' worth of biomedical research. Though we've come a long way from the early days of research done without patient consent, there are still too many gray areas around what patients do know and what they can do with their own bodies' material. In a crucial case that shows just how murky the law is, in April the U.S. Supreme Court will hear arguments on whether Myriad Genetics and the University of Utah Research Foundation have the right to patent two human genes associated with breast and ovarian cancer (3/1).

San Francisco Chronicle: Baby's Cure Marks Milestone In AIDS War
The tantalizing and long-sought dream of an AIDS cure appears to have arrived. The almost unkillable virus, which until now could be suppressed but not eradicated, was snuffed out in a Mississippi infant infected at birth by a mother who tested positive for AIDS. The results come loaded with caveats and conditions and are tied to just one case. But the result is hugely important because 330,000 infections per year occur worldwide at childbirth, when a mother transmits the virus to a newborn (3/4).

San Jose Mercury News: Children's Health: California's Shift From Healthy Families To Medi-Cal May Harm Kids
Protecting the health of California's children is an ongoing priority, even as we deal with state budget deficits and realignment of government spending. As a cost-saving measure, state policymakers are moving 875,000 children who were receiving health coverage through the California Healthy Families Program to the Medi-Cal program. We are concerned that the state has not done all the necessary planning to ensure children's ongoing access to health care services. State and federal lawmakers have already expressed serious apprehensions about this transition and have urged the state to move slowly and cautiously to protect children's health (Shelly Kessler and Anne Wilson, 3/4).