Viewpoints: Slowing health costs; possibility of Medicaid deal in virginia; a new name for brain death

Jan 8 2014

The Wall Street Journal: ObamaCare Is Slowing Health Inflation
For decades a common refrain was that the rapid rise in health spending hurt the competitiveness of American businesses and ate into workers' take-home pay. Businesses and politicians from both sides of the aisle agreed that something had to be done to slow the growth of health-care costs. New data Monday from the Centers for Medicare and Medicaid Services show that we are making important progress. From 2010 to 2012, health spending grew at an annual rate of just 1.1% in real per capita terms-;the lowest rate in the 50 years we have been collecting these data, and a small fraction of the 6% rate that inaugurated the past decade (Jason Furman, 1/6). 

The Fiscal Times: Has The U.S. Found A Cure For Rising Health Costs?
Something big has been happening in U.S. health care, and it isn't President Obama's reform law: Since 2009, health care costs have risen between 3.6 and 3.8 percent a year, the slowest rates on record. That trend continued for a fourth straight year in 2012, as spending increased a relatively modest 3.7 percent, according to a report released Monday by Medicare actuaries. For the first time since 1997, spending on health care as a share of gross domestic product edged lower, dropping to 17.2 percent from 17.3 percent in 2011. That still represents a greater share of the economy than in other developed countries, but it offers hope that the U.S. may be getting a much-needed handle on those spiraling costs (Yuval Rosenberg, 1/7).

The Washington Post's The Plum Line: The Benghazi-Fication Of Obamacare
Back in October, conservatives had convinced themselves that the law was going down in flames. But now that it looks to be basically functional (if far from perfect) conservatives are fumbling for any reason at hand to delegitimize the law. Going by past history, the answer will be to turn it into a conservative pet rock: like Benghazi and the IRS stories, an initially suspicious happening which turns out to be a non-scandal or an example of run-of-the-mill governing incompetence, but lives on forever as a Watergate level episode in the conservative fever swamps (Ryan Cooper, 1/6). 

The Washington Post: Don't Bet Against A Medicaid Deal In Richmond
Right now, the smart money in Richmond is betting that incoming governor Terry McAuliffe will fail to deliver on his campaign promise to expand Medicaid. This past weekend, Republican House Speaker Bill Howell said again that "Medicaid should not be expanded." ... Our view: Do the supposedly dumb thing and bet against the smart money (Norman Leahy and Paul Goldman, 1/7).

The Wall Street Journal: Millionaires On Medicaid
Expanding Medicaid coverage to an estimated nine million more Americans-;as mandated by the Affordable Care Act-;reinforces the idea that Medicaid only serves the poor. That perception is not accurate. And it distracts from a looming budgetary threat to the program: long-term care. More than two-thirds of annual spending on long-term care for the elderly is paid by state and federal governments, $60 billion of which flows from Medicaid. With 10,000 baby boomers reaching retirement age every day for the next 19 years, the Congressional Budget Office projects that spending on long-term care will more than double by 2050-;to 3% of GDP from 1.3% (Mark Warshawsky, 1/6). 

The Fiscal Times: The New Double Standards in Obamacare's Medicaid
This concept of forcing seniors over the age of 65 and the disabled to "spend down" their life savings to the last $2,000 for individuals and $4,000 for couples to qualify for Medicaid – or having to resort to devious methods of hiding or sheltering some of those savings from the government's eye -- always seemed a bit harsh and degrading to me. ... Still, the dreaded "spend down" rule seemed essentially fair to me. After all, why should middle-income or even wealthy seniors sitting on piles of savings and investments but receiving little in outside income be allowed to tap into a social safety net designed to assist poor children, pregnant women, disabled adults, and low-income seniors? But that was until last week, when the Obama administration launched a nationwide Medicaid expansion under the Affordable Care Act (Eric Pianin, 1/6).

USA Today: A Globetrotter's View Of Obamacare
Last month, after two weeks of trying, I signed up with my two sons for an Obamacare family health insurance plan. The achievement felt huge. I had survived a bureaucratic assault course. ... Yes, I was frustrated. But it felt like déjà vu. It was only my latest frustration in dealing with the U.S. health care system, whose complexity and lack of transparency set it apart from systems in other wealthy industrialized nations. The answer is not to change the system. The answer is to fix it (Louise Branson, 1/5). 

WBUR: Dr. Tim's 'Truth About Obamacare' Podcast: Jan. 1 As Rubicon?
What just happened? That is, Jan. 1. 2014, has long been the date most commonly mentioned as the moment when Obamacare really kicks in. So now that 2014 is launched, what has really changed? Dr. Timothy Johnson, retired medical editor for ABC News and author of "The Truth About Getting Sick in America," focuses on that question in his latest 'Truth About Obamacare' podcast, above (Carey Goldberg, 1/6). 

And on other issues -

Los Angeles Times: Boeing's Hollow Victory
The narrowly approved contract agreement between Boeing and its Washington state workforce will be hailed by some as a victory for the canny, hardball brinkmanship of Boeing's management and the knuckle-under economic pragmatism of the International Machinists Union. But the steep cutbacks in retirement and health benefits that tens of thousands of Boeing workers were forced to swallow have far larger implications for middle-class America (Hedrick Smith, 1/7). 

Los Angeles Times: Blurring The Line Between Life And Death
Brain death needs a new name, some doctors and bioethicists say. Perhaps it should be called "death via cessation of brain function." Then, perhaps, the public might better understand that it's not just a serious coma or a severe brain injury or a persistent vegetative state. It's the end of life (1/6). 

Journal of the American Medical Association: Care Partners And Online Patient Portals
Many chronically ill and older people also have loved ones who, distinct from caregivers, serve as "care partners." These care partners do not provide day-to-day care or serve as surrogate decision makers but do help navigate health care-;facilitating communication with physicians, discussing complex issues requiring shared decision making, and assisting with challenging self-management tasks. ... Health care systems today do not optimally identify or engage these individuals and frequently even push them away by creating barriers to obtaining patient information .... There is potential for improving care if care partners and families can be more effectively engaged (Dr. Urmimala Sarkar and Dr. David W. Bates, 1/6).