Viewpoints: Kasich on what would Reagan do about Medicaid; The need for more doctors

Jun 6 2013

USA Today: Reagan's Compassionate Medicaid Expansion
Leaders in the states that have decided against expanding (Medicaid) have often invoked Reagan conservatism as the reason to oppose extending Medicaid health care coverage to more people. After all, doesn't (Ronald) Reagan embody modern conservatism? He cut taxes, cut government red tape and fought the growth of entitlements. Yes, he did all those things. However, he also expanded Medicaid, not just once but several times (Ohio Gov. John Kasich, 6/2).

The New York Times' Taking Note: Reagan For Health Care Reform
With many right-wing politicians dead set against expanding Medicaid, the Republican governor of Ohio, John Kasich, needed cover for going along. Facts and figures and kindness surely weren't enough, what with his colleagues comparing health care reform to a "hostage" situation. But in an op-ed for USA Today he settled on a great excuse: It's what Ronald Reagan would have done (Juliet Lapidos, 6/4). 

The Washington Post Wonkbook: The Terrible Deal For States Rejecting Medicaid
Typically, in politics, there's no guarantee that winning an election will get anything big done. Politicians talk about ending wars and reforming health care, but then they take office, have one meeting with the chairman of the relevant committee, and back off. Here, however, federal law already says Americans making less than 133 percent of poverty are entitled to Medicaid coverage. All that needs to happen is for recalcitrant state governors and legislators to get out of the way. The publicity the benefit will get, the value it has to the target population, and the clear political path to getting that benefit all present an extraordinary organizing opportunity (Ezra Klein and Evan Soltas, 6/4).

The Missoulian: Medicaid Expansion: Call A Special Session
Now that the dust has settled, it's time for (Montana) Gov. Steve Bullock to call a special session of the Legislature to finish one of the most important tasks they had this year – Medicaid expansion. Medicaid expansion is a winning proposition for all of Montana. The obvious winners are those 70,000 Montanans without health insurance earning 138 percent or less of the federal poverty limit who would become eligible for Medicaid. Many of these are the working poor – a family of three making $26,344 a year. But the rest of us will also win and here is how (6/4).

Bloomberg: Why Florida Business Wants Medicaid Expansion
Florida's business community, a bastion of conservatism on most matters, was among those pushing hardest for a state measure that would have adopted a major part of President Barack Obama's federal health-care law. What made the situation unusual was that business wasn't getting its way in a state where it almost always does (Lucy Morgan, 6/3).

Bloomberg: How Michael Douglas Helps The Fight Against HPV
Michael Douglas may have done more for awareness about human papillomavirus than all the education programs health advocates have ever sponsored. The actor revealed this week that his throat cancer was caused by an HPV infection, the result of his having oral sex with an HPV-infected woman. The HPV problem can certainly use the attention. A dozen or so variants of HPV, the most common sexually transmitted disease, cause cancer. For people who don't have the virus, vaccines can prevent infection. Yet, the inoculations are underused (6/4).

St. Louis Post Dispatch: Health Care CEO Salaries Outpace Even Health Care Costs
In a way, you can argue that Steven H. Lipstein is severely underpaid. As Jim Doyle of the Post-Dispatch reported Sunday, Mr. Lipstein, the president and CEO of BJC Healthcare, got a million-dollar bump in his compensation package in 2011. He took home a total package of $3.3 million. ... Moral of the story: Don't go to med school, young people. Get a degree in hospital administration. And if you really want to get rich, get into the health insurance business (6/4).

Lund Report: Hospital-To-Hospital Clinical Integration Programs Represent Good Alternative
In many areas of the country, hospital providers are developing Centers of Excellence, Preventive Care, and Service Line Improvement models with other hospitals to provide greater quality care at lower costs. These models generally do not involve the often high costs of an acquisition and its attendant integration costs. There is a recent trend toward even greater coordination by and among non-affiliated hospitals across the board through hospital-to-hospital (H2H) clinical integration (CI). Such programs can obviate the need for hospitals "to be acquired" to compete in today's marketplace, and thus can help stem the tide of increases in healthcare costs (Paul DeMuro, 6/4). 

Sacramento Bee: State Can't Take Risks With County Public Health
Protecting public health is a basic government function. County health officers track illnesses and deaths from West Nile virus to hospital infections to food-borne contamination. They conduct vaccination campaigns and restaurant inspections. They respond to outbreaks and disasters. Unfortunately, this essential public health function is being lost in the budget battle between Gov. Jerry Brown and the counties in the jostling over preparing for the federal Affordable Care Act (6/5).

The Philadelphia Inquirer: Congress Should Address Looming Physician Shortage
That the Affordable Care Act will open the doors to consistent healthcare for more people is a good thing. But it will also make a predicted nationwide shortage of doctors even worse unless steps are taken to increase the number of physicians (Harold Jackson, 6/4).

JAMA: Examining The Health Effects Of Fructose
In the 1990s, excessive fat consumption was commonly believed to be the main cause of obesity. High sugar consumption was often considered to be innocuous and possibly protective against obesity by displacing dietary fat.1 A decade later, the American Heart Association linked intake of added sugars to weight gain and recommended substantial decreases in consumption to a daily maximum of 100 kcal for women and 150 kcal for men.2 Some experts now argue that sugar comprises the single most important cause of the worldwide epidemics of obesity and diabetes, primarily through the effects of fructose at prevailing levels of consumption (Dr. David S. Ludwig, 6/3).

JAMA: The Morality Of Using Mortality As A Financial Incentive
The strategy of using financial incentives to improve quality and lower costs is firmly embedded in the Affordable Care Act and the hospital value-based purchasing program launched nationwide in October 2012. The Affordable Care Act not only stiffens penalties for hospitals with high readmission rates but also uses risk-standardized 30-day mortality rates (RSMRs) for patients diagnosed with pneumonia, congestive heart failure, and acute myocardial infarction as a criterion for rewarding or penalizing hospitals. ... However, 2 questions are worth asking: (1) are RSMRs an appropriate measure of hospital quality; and (2) does linkage of incentives to RSMRs for the 3 highest-volume hospital conditions increase the potential for early misuse or overuse of hospice or palliative care measures for patients whose risk of death is higher than expected but by no means certain. Although RSMRs have useful purposes, they are not a consistent or reliable indicator of hospital quality (Dr. Joel M. Kupfer, 6/5).

JAMA: A View From The Safety Net
We sat huddled around the conference table at the regular monthly meeting for medical directors at our community health center. In front of us was a quality report from one of our largest health plans. Although we were hitting many of the health plan's quality targets, there was room for improvement on some of the measures. ... Situations like this arise frequently at our organization, an urban community health center that serves a safety net population. Though our clinical leadership believes strongly in quality measurement and improvement, we find that the measures by which we are judged do not always align with the services our patients most need. For many of our patients, their biggest struggles center on social and economic concerns. How they will cover next month's rent? Who will watch their children when they are at work? Will they have health insurance to cover their medications? To meet the needs of our patient population, we have had to look beyond the traditional medical model of disease to the social determinants of health (Dr. Michael E. Hochman, Alex Y. Chen and Martin Serota, 6/5).