Viewpoints: Democrats turn tail; amending ACA is tough; Belgium takes hard stance on dying kids

Feb 21 2014

The Wall Street Journal: The Medicare Advantage Democrats
Democrats in competitive races seem to have gotten hall passes to try to dissociate themselves from ObamaCare heading into the midterm elections, but the White House must be ruing some of the liberties their party comrades are taking with this new political independence. Witness the parade of Democrats pleading for more money for that great liberal anathema, Medicare Advantage (2/19). 

The Wall Street Journal: Democrats Change Their Obamacare Strategy
Just a few months ago Senate Majority Leader Harry Reid said ObamaCare "will be a net positive" for Democratic candidates in 2014. Former House Speaker Nancy Pelosi proclaimed "Democrats stand tall in support of the Affordable Care Act." ... That was then. Now Democrats are circulating a new strategy memo (obtained by Politico) advising candidates to distance themselves from the law (Karl Rove, 2/19). 

The Fiscal Times: CBO Shoots An Arrow In The Heart Of Obamanomics
Live by the CBO, die by the CBO.  For the second time this month, the independent economic analysts in the legislative branch have delivered a body blow to the Obama administration's key domestic policies. First, the Congressional Budget Office – often cited by the White House for its more sympathetic analyses of the Affordable Care Act – concluded the law would result in the net loss of the equivalent of 2.5 million full-time workers, setting up the US for slower growth even as Obamacare and other entitlement programs need more workers producing more income to survive. Republicans on the Senate Budget Committee pointed out that it would cut one trillion dollars in compensation from the economy over the next decade  (Edward Morrissey, 2/20).

JAMA: How to Fix The Affordable Care Act
Like almost every major piece of legislation, the Affordable Care Act (ACA) needed fixing virtually before the statute's ink was dry. Any bill designed to transform one-sixth of the economy was bound to have-;let us say-;a few rough edges. As legislation rolls out, it's common to make adjustments. But amending the ACA poses enormous challenges (Stuart Butler, 2/19).

Los Angeles Times: Belgium's Humane Stance On Dying Kids
It's an idea that, in the death-squeamish U.S., is probably too disturbing for the edgiest TV hospital drama, let alone real life and real legislation. Last week, the Belgian Parliament passed a law allowing terminally ill children to request aid in dying. Adults there have been able to do that since 2002, and a few other European countries have similar measures. But last Thursday's action, which is expected to be signed into law by King Philippe, will make Belgium the first to extend the right to minors faced with "constant and unbearable suffering" (Meghan Daum, 2/20).

The Fiscal Times: AOL's Tim Armstrong Missed The Real Message On Health Care Costs
When AOL chief executive Tim Armstrong blundered in blaming his company's 401(k) cutbacks on "two distressed babies" recently, he missed an epic opportunity to identify the bete noire of employer-sponsored U.S. health care. Employers who have health coverage for their employees are relying upon a flawed, unsustainable model that's slowly imploding. Although Armstrong later walked back his comments, he could have articulated why this model is a yoke for employers -; and employees -; that will eventually become a financial burden that's too heavy to bear (John F. Wasik, 2/19).

The Richmond Times-Dispatch: Stevens: Improving Newborn Screening Saves Lives
One year ago this month, my life changed forever. My husband and I became parents as our beautiful daughter came into the world. But our joy was equally mixed with fear, because she came too early. Born at only 28 weeks gestation and weighing 1 pound, 8 ounces, her very survival was uncertain. I'm embarrassed to admit that, in the blur of those first weeks, I forgot all about the two newborn screening samples that were collected during her 67-day stay in the Neonatal Intensive Care Unit (NICU). She had so many pressing health needs that it was easy to overlook another blood draw (Michelle Stevens, 2/19).

The New England Journal of Medicine: Post-Acute Care Reform -; Beyond The ACA
Patients' discharge plans are often made for financial rather than clinical reasons, which contributes to the inefficient use of post-acute care and the high rate of readmissions. ... Demonstrations currently being evaluated under the Affordable Care Act (ACA) incentivize a more efficient mix of acute and post-acute care services. For example, under a bundled-payment system, hospitals and post-acute care providers are paid for a fixed "bundle" of services around a hospital episode, including post-hospitalization care. In an accountable care organization (ACO) with risk-based payment, networks of providers can share in savings if they reduce the total cost of care .... Under both approaches, provider systems have incentives to deliver cost-effective acute and post-acute care services and prevent costly readmissions. Although these payment reforms have promise, substantial regulatory and operational barriers remain (Dr. D. Clay Ackerly and David C. Grabowski, 2/20).

The New England Journal Of Medicine: Post-Acute Care -; The Next Frontier For Controlling Medicare Spending
Most acute care hospitals and physicians pay little attention to post-acute care. Patients are typically discharged to a post-acute care facility or home health care with little coordination or follow-up, reappearing on the acute care provider's radar screen only if they return to the hospital in an ambulance. Under fee-for-service reimbursement, acute care providers have had little financial incentive to invest in systems to ensure effective transitions to post-acute care or to support post-acute care providers when recently hospitalized patients have complications. Medicare's recent readmission penalties have begun focusing hospitals' attention on these issues. But Medicare's new bundled-payment and shared-savings programs provide much stronger incentives to integrate acute and post-acute care (Robert Mechanic, 2/20).

The New England Journal of Medicine: The Hospital-Dependent Patient
Hospital-dependent patients differ from those with chronic critical illness, many of whom require ventilators to sustain life, in that they may be precariously and transiently compensated while hospitalized. They are often comfortable and may have an acceptable quality of life (e.g., interactions with family and friends) in the hospital when supported and comforted .... Yet they are unable to make it outside the hospital setting when the response is not quick enough or the necessary treatments are not available. ...These patients' readmissions are counted in readmission rates, and their cases may erroneously be considered to represent failures of the transition process. However, the underlying causes of these readmissions are not failed transitions and the approaches to their management must be tailored accordingly (Drs. David B. Reuben and Mary E. Tinetti, 2/20).