Viewpoints: Fears of health law's adverse selection; GOP's 'fundamental miscalculation;' special deal for Congress keeps dissent low

Aug 9 2013

The New York Times: For Obamacare, Some Hurdles Still Ahead
Yet despite the care the administration took in establishing incentives and safeguards, even some of Obamacare's most committed backers are wondering whether the experiment will work as advertised -; or, like Harvard's P.P.O., go off the rails along the way. Adverse selection is perhaps the direst threat. ... Healthier Americans will probably flock to cheaper bronze plans. And insurers will vie to enroll the healthy. In some states, big insurers have chosen not to participate in exchanges to avoid their strictures. On the outside, they could still sell cheap plans to skim off the healthy and avoid a rule that insurers on the exchanges must also offer more generous silver and gold plans (Eduardo Porter, 8/7).

Reuters: The Never-Ending War On Obamacare
Obamacare's opponents appear to be under the illusion that if they will something hard enough it will disappear, like a Las Vegas magic act. So what's their game? Are they simply in denial? No. This is internal Republican politics at work. Obamacare is the perfect vehicle for rallying dissent against big government and the president. The visceral hatred of Barack Obama for who he is and what he looks like, just as much as what he has achieved and what he stands for, is directed at the president's signature legacy achievement (Nicholas Wapshott, 8/7).

The Washington Post's The Plum Line: The Morning Plum: The GOP's Fundamental Miscalculation On Obamacare
What if Republicans -; in their drive to repeal and even defund Obamacare -; are making the same mistake they made in 2012 about the economy? ... For a long time now, the polling on Obamacare has shown a pattern. Disapproval of the law runs high, and polls that offer respondents a straight choice between repeal and keeping the law as is find high support for repeal. But polls that offer a more nuanced range of options -; such as changing the law or repealing parts of it -; find only minority support for the GOP position of full repeal. This pattern has been clear for years now. Meanwhile, polls that ask directly whether Republicans should keep blocking the law find majority opposition to that. It seems reasonable to surmise that dissatisfaction with the law may not necessarily translate into broad support for getting rid of it entirely (let alone replacing it with nothing) (Greg Sargent, 8/7).

The Wall Street Journal: Members Only
The White House on Wednesday released the legal details behind its ObamaCare bailout for Members of Congress and their staffs, and if anything this rescue is worse than last week's leaks suggested: Illegal dispensations for the ruling class, different rules for the hoi polloi. Thanks to an amendment from Iowa Senator Chuck Grassley that Democrats enacted in 2010, the Affordable Care Act says that "the only health plans that the Federal Government may make available" to Congress are the ones offered on the ObamaCare insurance exchanges. But Members and many aides have been flipping out because they won't qualify for ObamaCare subsidies and they'll lose employer contributions they now receive under the Federal Employees Health Benefits Program, or FEHBP, which picks up about three-quarters of the average premium (8/7). 

The New York Times: Economix: The Economics Of The Affordable Care Act
Will the Affordable Care Act help or hurt the economy? At a time when economic growth remains mild and the employment outlook is mixed, answering this question is of fundamental importance (David M. Cutler, 8/7).

The Washington Post: The Health Spending Mystery
In today's contentious political climate, when hardly anyone agrees on anything, here's a rare subject of consensus: Health spending is slowing, and almost everyone thinks that's a good thing. Aside from relieving pressures on federal and state budgets, it could help reverse stagnant wages by moderating the cost of employer-paid insurance. Compensation would shift from insurance to wages. What the experts don't agree on is who (or what) caused the slowdown and whether it will continue (Robert J. Samuelson, 8/7).

The Sacramento Bee: Health Care Companies Need To Focus On Driving Down Costs
Health care in this nation is at a critical inflection point. All across the country, people are asking three important questions about their health care and the industry that provides it: Why does it cost so much? Why does the price keep going up so fast? And why haven't we been able to rein in the costs? (Bernard J. Tyson, 8/7).

The New England Journal of Medicine: Payer Agnosticism
Regardless of one's views on a single-payer national health care system, most observers would agree that such a system could simplify processes for health care providers and organizations. ... we believe there are opportunities to reap some of the benefits of standardization by reforming the existing system. To this end, our organization -; a multisite, federally qualified health center with an independent practice association and contracted independent providers -; recently implemented a "payer-agnostic" strategy for delivering care to help us balance the competing demands of our third-party payers. ... If insurers and provider groups can make the leap together, it may be possible to reap some of the benefits of single-payer health care within the existing multipayer system (Drs. Michael E. Hochman, Alex Y. Chen and Martin Serota, 8/7).

The New York Times: Crazy Pills
Since Lariam was approved in 1989, it has been clear that a small number of people who take it develop psychiatric symptoms like amnesia, hallucinations, aggression and paranoia, or neurological problems like the loss of balance, dizziness or ringing in the ears. F. Hoffmann LaRoche, the pharmaceutical company that marketed the drug, said only about 1 in 10,000 people were estimated to experience the worst side effects. But in 2001, a randomized double-blind study done in the Netherlands was published, showing that 67 percent of people who took the drug experienced one or more adverse effects, and 6 percent had side effects so severe they required medical attention. Last week, the Food and Drug Administration finally acknowledged the severity of the neurological and psychiatric side effects and required that mefloquine's label carry a "black box" warning of them. But this is too little, too late (David Stuart MacLean, 8/7).

JAMA: Conflicts Of Interest In The Regulation Of Food Safety
Although conflicts created by financial relationships with drug and device companies have been a source of concern for decades, concerns about the effects of food company sponsorship on nutrition research, practice, and policy are more recent. Nevertheless, financial ties with food and beverage companies are now recognized as influences on federal dietary guidelines, opinions of nutrition professionals, and the interpretation of nutrition studies. Investigators have demonstrated impressive similarities between the actions of cigarette companies and food companies in promoting and protecting product sales (Marion Nestle, 8/7).

JAMA Psychiatry: Firearm Injuries And Death: The Cost Of Shooting In The Dark  
In 1983, I joined the Centers for Disease Control (CDC) in Atlanta, Georgia, to help start a program to use scientific research to understand gun violence as a public health problem. In the 1990s, the National Rifle Association (NRA) killed that program. ... Firearm-related deaths number more than 30,000 each year, and two-thirds of these deaths are suicides. ... After the child massacre in Newtown, President Obama ordered the CDC to get back to work on firearm injury research. ... like the solutions to motor vehicle crash–related injuries, no single approach will address the whole problem. Solutions will be multiple and incremental. Our research must simultaneously meet 2 objectives. The first is to reduce firearm deaths and injuries; the second is to preserve the rights of legitimate gun owners (Dr. Mark L. Rosenberg, 8/7).

Bloomberg: Will Medicare Fixes Lead To Hospital Mergers
Improving the U.S. health-care system requires encouraging low-value doctors and hospitals to practice as well as high-value ones do. The gap between the two is wide, but that only shows how much room we have for improvement.  Costs vary wildly across regions, among hospitals within a region, and even among doctors within a given hospital. Because this variation doesn't appear to be reliably correlated with differences in quality, value seems to be much higher in some settings than in others. What is causing this, and what might we do about it? (Peter Orszag, 8/7).

The Boston Globe: The Concierge Doctor Is In
After some soul-searching, [my internist Dr. Edward] Legare decided to join a high-end "oncierge"practice a few years ago, and asked his patients to pay an extra $1,500 for his services. I declined. His group practice shunted me to another talented young internist, Dr. Eric Serrano. Then -; poof! He's gone concierge, too. ... I'm paying about $10,000 a year for a family health plan, and, like most Americans, I see my doctor about twice a year. Harvard Pilgrim Health Care can't keep decent doctors around for me to consult with? What's going on here? (Alex Beam, 8/8).

The Sacramento Bee: State Should Make Dental Care A Priority
A major aim of the nation's Affordable Care Act is to increase access to affordable dental coverage for children starting in January 2014. Not surprisingly, children whose families don't have health insurance are more likely to have severe and untreated tooth decay, which the California Dental Association notes with understatement hinders a child's "ability to eat well, sleep well and function well at home and at school&quot (8/8).

San Francisco Chronicle: Nation's 'Wellness' Promotion Is Misguided
The American Medical Association declared obesity a disease in June. Last month, the U.S. Department of Agriculture finalized Smart Snacks in School, a set of strict nutritional standards for school cafeterias. President Obama also announced that his favorite food was, unbelievably, broccoli at a Let's Move healthy lunch event hosted by first lady Michelle Obama. "Health" is a loose term, a muddy mix of morals and science. How can we teach what is healthy to our children when we can't understand it ourselves? And how can we, in good conscience, denounce bad foods and claim we don't discriminate against the bad bodies of the obese? We can't advocate for "wellness" without privileging some people and discriminating against others (Adrienne Rose Johnson, 8/8).