Viewpoints: Obama overlooking legal constraints on employer mandate delay; Bush's 'unnecessary' heart procedure; discrimination against people with mental illnesses

Aug 13 2013

The Wall Street Journal: Quote-Unquote, The Law
In his Friday remarks, Mr. Obama also claimed that he had the "executive authority" for the mandate delay. But if he really believes that, then why did he say he would normally ask for a legislative "tweak." Either the fix requires legislation or it doesn't. His comments are certainly revealing about his attitudes on Presidential power and the constraints of the U.S. Constitution. Article II, Section 3 instructs him to take care that the laws be faithfully executed, not merely what he thinks is "the essence" of laws (8/10). 

The New York Times: When A Co-Pay Gets In The Way Of Health
We want patients to receive the best care available. We also want consumers to pay less. And we don't want to bankrupt the government or private insurers. Something must give. The debate centers on how to make these trade-offs, and who gets to make them. ... What is a surprise is that amid these complex issues, one policy sidesteps these trade-offs. A few drugs -; such as beta-blockers, statins and glycogen control medications -; have proved very effective at managing hypertension, heart disease, diabetes and strokes. Most insurance plans charge something for them. Why not make drugs like these free? (Sendhil Mullainathan, 8/10).

USA Today: Contraception Mandate Applies To Business: Our View
Beginning this month, the Affordable Care Act requires that most health insurance plans give women access to FDA-approved contraception methods. ... The Institute of Medicine and common sense say contraception is basic health care for women, and the prevention of unplanned pregnancies can cut abortion rates and give women a better chance at education, work and planning family size. ... The effect of health insurance on business owners is indirect. Employees may or may not use insurance to pay for birth control, just as they may or may not use their salary to pay for something that would violate the company owners' faith. The circumstance might be discomforting. But the alternative -; granting religious exemptions to private organizations -; is more troubling. It would be open to abuse, putting the government in the position of determining which business owners were sufficiently religious (8/11).

USA Today: Religious Freedom Applies To Businesses: Opposing View
Can you make money and be religious? The Obama administration and a few courts have said no -; at least in the context of forcing business owners to violate their religion by purchasing abortion-inducing drugs for their employees. Thankfully, most courts have rejected this view, leaving individuals and their businesses free to go to work without checking their conscience at the door (Mark Rienzi, 8/11).

The New York Times: Death Panels And The Apparatchik Mindset
Aaron Carroll reads the Wall Street Journal, which is outraged, outraged, at the prospect that Oregon's Medicaid system might seek to limit spending on treatments with low effectiveness and/or patients who aren't going to live much longer in any case. Death panels! Carroll points us to the actual staff recommendation, which is far milder than the WSJ blast would have you believe. But as Carroll points out, the larger point is the absurdity of the Journal's position. On one side, it's fanatically opposed to Medicaid expansion -; that is, it's eager to make sure that millions have no health coverage at all. On the other side, it claims to be outraged at the notion of setting priorities in spending on those who do manage to qualify for Medicaid. It's OK for people to die for lack of coverage; it's an utter horror if taxpayers decline to pay for marginal care (Paul Krugman, 8/10).

Georgia Health News: Expand Medicaid To Help Local Governments
With expanded Medicaid, anyone with an income below 133 percent of the federal poverty line would become eligible under the ACA, and many more inmates (state and local) would be eligible in Georgia. Georgia would save even more if the program were emphasized and made a state and local priority, as it is in North Carolina. The ACA is lowering hospitals' governmental DSH (Disproportionate Share Hospital) reimbursements for low-income patients by $22 billion over 10 years. However, hospitals were told that these decreases were to be offset by having Medicaid cover patients who were then being served but not paid for (by private insurance, Medicaid or Medicare). When the U.S. Supreme Court ruled that states could opt out of expansion, that offset was no longer assured, but it continues to be a good idea (Jack Bernard, 8/9).

The New York Times: The Conscience Of A Liberal: The Power of Incumbency, Health Care Edition
President Obama is finally making a strong case for his own health reform, mocking Republicans for their obsession with denying insurance to 30 million Americans. It's about time; and many of us still feel that he did a remarkably bad job of explaining the reform in the past. Still, Brian Beutler has a good point here: the long delay in implementation made Obamacare hard to campaign on, because people had no experience of how it works in practice. Republicans could tell all kinds of lies, promulgate all kinds of misconceptions, and if the law's defenders tried to refute these claims, well, who was telling the truth? Remember how Medicare was going to destroy American freedom? (Paul Krugman, 8/11).

The Washington Post: President Bush's Unnecessary Heart Surgery
Former president George W. Bush, widely regarded as a model of physical fitness, received a coronary artery stent on Tuesday. Few facts are known about the case, but what is known suggests the procedure was unnecessary (Vinay Prasad and Adam Cifu, 8/9).

The New York Times: When Doctors Discriminate
If you met me, you'd never know I was mentally ill. In fact, I've gone through most of my adult life without anyone ever knowing -; except when I've had to reveal it to a doctor. And that revelation changes everything. It wipes clean the rest of my résumé, my education, my accomplishments, reduces me to a diagnosis. I was surprised when, after one of these run-ins, my psychopharmacologist said this sort of behavior was all too common. At least 14 studies have shown that patients with a serious mental illness receive worse medical care than "normal" people (Juliann Garey, 8/10). 

The New York Times: California's Continuing Prison Crisis
Over the past quarter-century, multiple lawsuits have challenged California's state prisons as dangerously overcrowded. In 2011, the United States Supreme Court found that the overcrowding had gotten so bad -; close to double the prisons' designed capacity -; that inmates' health and safety were unconstitutionally compromised (8/10). 

The New York Times: Another Twist In The Saga Of Henrietta Lacks
The enduring constant in this saga has been the cavalier treatment of the Lacks family by medical researchers. Neither [Henrietta] Lacks nor others in her family were told that extracting cells from her tumor (and later taking cells from some of her relatives) was not being done for their benefit but for the benefit of science. That condescending attitude changed last week when the National Institutes of Health announced an agreement with the Lacks family that will restrict N.I.H.-financed research on the genome of HeLa cells (not the use of HeLa cells in experiments) and place two family members on a committee to approve such research (8/11).

Los Angeles Times: With Fewer Vaccinations, Is Your Child's School Safe?
Across the country, preschools and elementary schools are declaring themselves nut free or peanut free, asking families not to pack lunch foods that could pose life-threatening dangers to highly allergic children. And the prohibitions are expanding beyond nuts. ... But the great bulk of children face a far greater risk of harm from disease. If the goal is really to protect children, I'd like to see all schools declared "unvaccinated-free zones." The law in California mandates that students in public and private schools be immunized, but it also allows easy-to-get exemptions for personal beliefs. Although some 90% of the state's kindergartners are up to date on their immunizations, it is not uncommon for individual public elementary schools to report that more than one-third of their kindergartners are not (Dr. Nina Shapiro, 8/10). 

The New York Times: Wrestling With Dying Hospitals
Think about New York City and public health, and the mind instantly goes to soda cups and cigarette bans, to Mayor Michael Bloomberg's 12-year campaign of behavioral modification to make his fellow citizens ditch their bad habits. But eating better is not the only way to a healthier city, especially when so many New Yorkers lack access to decent health care in their own neighborhoods (8/11).

The New York Times: Opinionator: Bursting The Neuro-Utopian Bubble
Critics of the Human Genome Project have voiced many concerns about genomic sequencing, most of which can also be leveled at the Brain Initiative: What happens when health insurance companies get hold of this information? Could it lead to invasions of our privacy? And, perhaps most fundamentally, aren't these scientists once again trying to play God? (Benjamin Y. Fong, 8/11).

The New York Times: Room For Debate: Deconstructing Lyme Disease
Lyme disease, which is transmitted by tick bites, is one of the most common infectious diseases in the United States. It may also be one of the most controversial. Since it was recognized in 1975, Lyme has inspired bitter disputes, including over how to treat it and whether the illness can become chronic, dividing scientists, doctors and patients. Why is it so controversial? And what are the next steps to better understanding this mysterious affliction? (8/11).

Minneapolis Star Tribune: New Minnesota Law Helps Family Caregivers
Rick Hansen was a state employee some years ago whose good health had allowed him to accrue a number of unused "sick days." But when he wanted to use that time to take his ailing mother to the doctor, his request was denied. "Sick time" was for his own medical needs or those of his dependent children -; no one else, he was told. As state Rep. Rick Hansen, DFL-South St. Paul, he set out to change that response (8/12)