Viewpoints: Time to focus on health care prices; Entitlement programs and generational warfare; Cigarette tax hikes and smoking cessation

Mar 30 2013

The New York Times: U.S. Health Care Prices Are The Elephant In The Room
Traditionally, the theory driving discussions on the high cost of health care in the United States has been that there is enormous waste in the system, taking the form of excess utilization of care. From that theory it follows that methods of controlling the growth of health spending should focus on ways to reduce the use of unnecessary or only marginally beneficial health care. Largely overlooked in these discussions has been the elephant in the room: the extraordinarily high prices Americans pay for health care (Uwe E. Reinhardt, 3/29).

Bloomberg: How To Make The Health-Care Market Work Better
How could government help the health-care market work better? Here's an idea so obvious it's shocking it hasn't already been done: Let's require large hospitals and medical providers who receive dollars from Medicare, Medicaid or federal research grants to collect and publish basic price data (Evan Soltas, 3/28).

JAMA: Will The Evaluation Of The ACA Be Health Services Research's Finest Hour?
The Affordable Care Act (ACA) provides an unprecedented opportunity to expand insurance coverage and to reform the health care delivery system in the United States. The political debate about its merits and shortcomings has been highly partisan and unrelenting and not particularly evidence-based (Andrew Bindman, 3/28).

The New York Times: Cheating Our Children
So talk of a fiscal crisis has subsided. Yet the deficit scolds haven't given up on their determination to bully the nation into slashing Social Security and Medicare. So they have a new line: We must bring down the deficit right away because it's "generational warfare," imposing a crippling burden on the next generation. What's wrong with this argument? For one thing, it involves a fundamental misunderstanding of what debt does to the economy (Paul Krugman, 3/28).

Los Angeles Times: Remove Medicare's Straitjacket
The bipartisan deal that kept the federal government from hurtling over the "fiscal cliff" on Jan. 2 actually increased Medicare spending. At the last minute, a powerful bipartisan group of senators inserted a provision into the bill that blocked Medicare, for two years, from getting a better price on an expensive drug used by kidney dialysis patients. This was in addition to a previous two-year extension obtained by Amgen, the drug's manufacturer. The move saddled Medicare with roughly $500 million in added costs over the next two years and generated a windfall for Amgen. This is but one example of how Congress publicly criticizes growth of Medicare costs while privately restraining the Centers for Medicare and Medicaid Services, or CMS, from getting a better deal for Medicare patients and U.S. taxpayers (Dr. Art Kellerman, 3/29). 

Raleigh News and Observer: NC Faces A 'Sophie's Choice' On Medicaid Expansion
North Carolina policymakers faced what I've termed a "Sophie's Choice" on Medicaid expansion. Agreeing to the expansion might well have helped some uninsured North Carolinians, but it also would have hurt many others who either have or could have obtained private health insurance coverage. The correct path is not nearly as simple as expansion advocates might make it seem. I don't know what our state ultimately will decide about this in the years ahead. The best solution, now being worked out in states such as Arkansas and Ohio, might be one in which those on Medicaid are allowed to enroll in private health insurance on the exchange (Christopher Conover, 3/27).

The Washington Post: 'I Thought I Knew What Being Disabled Meant, And I Don't'
Over the weekend, "This American Life" and "Planet Money" ran a story by Chana Joffe-Walt looking at the extraordinary growth of America's disability insurance system. Joffe-Walt visited Hale County, Ala., where one-in-four residents is on disability, looked at the lawyers who specialized in winning disability cases against the government (and getting paid by taxpayers for it), and spent time with a young child whose disability check has become the key to his family's survival. The result is a detailed, nuanced, and discomfiting look at a social insurance program that has become a catch-all for the failures of both our economy and our safety net. It's worth reading, or listening to, in full. I spoke with Joffe-Walt on Wednesday. A lightly edited transcript of our conversation follows (Klein, 3/28).

USA Today: Raise Cigarette Prices To Snuff Teen Smoking: Our View
The nation's decades-long battle against smoking has been remarkably successful, especially among teens. In 1997, 36% of high school students smoked. Today, half as many do. That's quite an accomplishment, particularly because all but 10% of smokers take up the habit during their teens. But the decline has slowed, and the youth smoking rate is still far too high. These young recruits will be tomorrow's addicts, and many will become victims of lung cancer and heart disease in coming decades. ... but the most effective tool for curbing teen smoking is also one of the simplest: Raise cigarette taxes (3/28).

USA Today: Cigarette Tax Hikes Don't Help: Opposing View
We all support reducing underage use of tobacco products, and proven methods are in place -; such as retailer training programs, federal regulation and underage possession laws -; to help achieve this goal. ... Attempts to further this progress through excise tax increases, however, have had negative effects on both tobacco control efforts and responsible retailers. There is a direct correlation between increased excise taxes and black market sales. The numbers are not small (Lyle Beckwith, 3/28). 

Richmond Times-Dispatch: Covering Abortion
Supporters of abortion rights are furious at Gov. Bob McDonnell over amendments he has made to two health care measures. But they have few principled grounds on which to object – and are distorting the truth in the process. The legislation would help establish the insurance exchanges required under the federal Affordable Care Act, or Obamacare. Individuals who don't get health insurance through their employers will be required to buy insurance through the exchanges. McDonnell's amendment prohibits buying insurance plans that cover abortion (3/29). 

Arizona Republic: Medicaid Expansion Plan Stinks But Better Than Alternative
Gov. Jan Brewer's proposal for Medicaid expansion absolutely stinks. It puts Arizona in a position of supporting "Obamacare." The governor wants us to take $3 billion of federal dollars that we all know just adds to the deficit and national debt. It doesn't matter that Obamacare may not be going away because Republicans lost the last presidential election. Heck, some Republicans chose Barack Obama and Obamacare in 2008 over John McCain by staying home. Apparently John McCain wasn't conservative enough for some (Hugh Hallman, 3/28).