Viewpoints: We need more 'socialism'; The IRS's 'unwelcome role'; 'Fog of Obamacare'

May 27 2013

Los Angeles Times: If This Health Plan Is 'Socialism,' We Need More Of It
So this is what socialism looks like: Private companies competing for people's business in an open marketplace. Californians got their first glimpse Thursday of what insurers plan to charge for coverage to be offered next year to about 5 million state residents who don't receive health insurance from employers (David Lazarus, 5/23).

The Washington Post: The Unwelcome Role Of The IRS In Obamacare
Thousands of new IRS agents will implement 40-odd provisions of the Patient Protection and Affordable Care Act -; the exact number is a matter of dispute since the law itself is so confusing. The largest tax law and social policy change in a generation will be imposed on a skeptical public by a government agency whose credibility is in ruins. But the IRS is not merely implementing Obamacare. It engaged in a regulatory power grab to ensure that it could implement Obamacare (Michael Gerson, 5/23).

The Washington Post: The Fog Of Obamacare
You've heard of the "fog of war." Well, now we've got the fog of Obamacare. The controversial Affordable Care Act (ACA) has so many moving parts that it's hard to know how its implementation is proceeding. In 2014, many uninsured are supposed to get coverage either through insurance exchanges, where they can buy subsidized policies if their incomes are less than four times the federal poverty line, or through an expanded Medicaid. The trouble is that 20 or more states may reject the Medicaid expansion, and the exchanges aren't yet finished. Much is unknown (Robert J. Sameulson, 5/23).

The New York Times' Economix: Debating Doctors' Compensation
Two themes run through the comments on previous blog posts that touched on the payment of the providers of health care. The first is that American doctors are paid too much. The second is that they are paid too little. Could both propositions be right? Let us explore the issue by looking at some numbers (Uwe E. Reinhardt, 5/24). 

New England Journal Of Medicine: The Gross Domestic Product And Health Care Spending
How much will the United States spend on health care during the next decade or two? The answer matters greatly to physicians, federal and state governments, businesses, and the general public. The answer will determine the type and extent of care that physicians can provide to their patients, as well as the amount of physicians' take-home pay. It will also determine how much everyone else can consume or invest in other goods and services. Unfortunately, forecasting health care spending is extremely difficult. Future spending depends in part on developments within the health care sector and in part on developments in the economy as a whole (Victor Fuchs, 5/22).

Boston Globe: Do I Miss My Breasts?
I had voluptuous breasts. I miss them, when I think about them. But I rarely think about them because I'm busy not missing my family's milestones and ordinary moments. The kind of moments that I suspect Angelina Jolie does not want to miss. Jolie and I have more in common than being mothers and having sexy husbands. I, too, carry the BRCA1 gene alteration, a mutation that raises a woman's lifetime risk of ovarian cancer to 40-60 percent and breast cancer to 50-80 percent (Ellen Roth, 5/22).

WBUR: Cognoscenti: The Power Of Knowing: A Daughter Who Chose BRCA Gene Testing, Against Her Mother's Will
When Angelina Jolie explained in The New York Times her decision to take action after discovering she carried the BRCA-1 mutation, I saw on social media so many women asking each other, Would you undergo genetic testing? Many expressed anger at Myriad (the company that owns the patent), at insurance companies (several do not cover the cost of the test), and at doctors they believe hold assumptions about organ removal. While some cited how removing one's organs could shorten or alter their lives, as could cancer itself, others judged individual preferences as "right" or "wrong" (Tracy Strauss, 5/24).

The New York Times' Doctor And Patient: Disability And Discrimination At The Doctor's Office
It's been nearly 23 years since the Americans With Disabilities Act, a federal law prohibiting discrimination against people with disabilities, went into effect. Despite its unequivocal language, studies in recent years have revealed that disabled patients tend not only to be in poorer health, but also to receive inadequate preventive care and to experience worse outcomes (Pauline W. Chen, MD, 5/23).

USA Today: Mental Illness Manual No 'Bible': Column
Unlike many other physical ailments, there are no acceptable scientific tests that can pinpoint mental disorders. A blood test won't tell doctors which of my son's diagnoses, if any, are accurate. Instead, psychiatrists must rely on a patient or family members to describe symptoms of the illness to make a diagnosis. The doctor then consults psychiatry's "bible" -; the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) -; to determine which diagnosis best fits the patient's symptoms. This process can be ripe for error, especially if a patient doesn't believe there is anything wrong, a common reaction during a psychotic break (Pete Earley, 5/23). 

The New York Times' Taking Note: Abortion After 20 Weeks
On the list of treasured Republican pastimes, trying to outlaw abortion and imposing a right-wing agenda on the District of Columbia (which is heavily Democratic and lacks any representation in Congress) both rank high. So it must have given Rep. Trent Franks of Arizona special pleasure to combine those hobbies by introducing a bill to ban abortion in D.C. after 20 weeks. But why stop there? (Andrew Rosenthal, 5/23). 

New England Journal Of Medicine: Under The Medical Tent At The Boston Marathon
Bright sunlight filtered through the awnings of the medical tent pitched in Copley Square, where I joined the many medical professionals caring for people who'd fallen ill from their 26.2-mile run. Some volunteers had been staffing the medical tent for years -; one nurse had worked at the Boston Marathon more than 25 times. Sickened and stressed runners poured into our makeshift hospital. A runner stumbled in and vomited into a bag. We helped him onto a cot, where he sat shivering. "You're OK," a nurse said gently, wiping his face. But his core temperature had dropped to 96 degrees, and he began having violent rigors. We brought him Mylar blankets and hot bouillon (Sushrut Jangi, 5/23).