Viewpoints: The impact of Florida's special election; drug testing for doctors; the toll from Alzheimer's

Mar 14 2014

The Wall Street Journal: Riding The 2014 Wave
A rule of electoral politics is that when a Democratic wave is building, the media broadcast it like a foregone conclusion. When a Republican wave is building, Beltway pundits are the last to admit it. After Tuesday's GOP win in a Florida special House election, even the press corps now agrees that Republicans are poised for major gains in November, assuming the GOP has the wit to exploit it (3/12). 

The Wall Street Journal: GOP, Beware Of Tuesday's Victory
To Republicans, a word of caution over the special election in Florida's 13th congressional district: Don't uncork the champagne. David Jolly's victory on Tuesday over Democrat Alex Sink by 48.4%-46.6% is significant. President Obama won the district twice, and its changing political demographics make it Democratic-leaning-;despite being held for 42 years by C.W. "Bill" Young, a popular Republican, until his death last fall. Still, special elections don't always dictate how midterms turn out (Karl Rove, 3/12). 

The Washington Post: Midterms An Obamacare Referendum? Not So Fast.
Democrats are likely to have a lousy midterm election -; Republicans are forecast to pad their House majority by a few seats and to have a decent chance of taking control of the Senate -; but this has nothing to do with what happened in Florida on Tuesday. An NBC News-Wall Street Journal survey this week found Obama's job approval rating at a record low and an unusually high percentage of voters eager to register that dissatisfaction at the polls. But the causes of the party's difficulties this year are larger than any issue, candidate or president, and those who are casting November's vote as the Great Obamacare Referendum are almost certainly overdoing it (Dana Milbank, 3/12). 

Los Angeles Times: Obamacare And Rising Deductibles: A Dialogue
David Goldhill, whose Wall Street Journal review of Ezekiel Emanuel's book on healthcare policy was at the heart of our post this week on Obamacare's effect on rising deductibles, takes issue with my interpretation of the trends and how the Affordable Care Act will influence them in the future. Goldhill, who is president and CEO of the Game Show Network, is a serious student of the healthcare landscape. His 2013 book "Catastrophic Care: How American Health Care Killed My Father -- and How We Can Fix It" is a sober and worthwhile examination of the American healthcare system, as seen through the prism of one family's experience (Michael Hiltzik, 3/12). 

Los Angeles Times: Watch An Expert Teach A Smug U.S. Senator About Canadian Healthcare
A U.S. politician's I-don't-need-no-stinkin'-facts approach to health policy ran smack into some of those troublesome facts Tuesday at a Senate hearing on single-payer healthcare, as it's practiced in Canada and several other countries. The countries in question have successful and popular government-sponsored single-payer systems, provide universal coverage and match or outdo the United States on numerous measures of medical outcomes -- for far less money than the U.S. spends. ... By far the high point of the morning was an exchange between Sen. Richard Burr (R-N.C.) and Danielle Martin, a physician and health policy professor from Toronto. ... Martin bats down the myths and misunderstandings about the Canadian system that Burr throws at her (Michael Hiltzik, 3/12).

The Washington Post: Better Health Through Good Choices
A significant portion of America's health-care bill -; caused by violence, vehicular accidents, coronary artery disease, lung cancer, AIDS, Type 2 diabetes brought on by obesity, among other problems -; results from behavior widely known to be risky. So as we wallow waist deep in the muddy debate about health care, we should remember that the relationship between increased investment in medicine and improvements in health is complex and tenuous (George F. Will, 3/12). 

The Wall Street Journal: Sibelius Vs. Accuracy
There have been dozens of ObamaCare delays or major revisions via administrative fiat, including four so far this year, but there's one in particular that the Health and Human Services Department prefers to keep hidden: the individual mandate waivers that we exposed Wednesday. HHS Secretary Kathleen Sebelius also happened to testify Wednesday in front of the House Ways and Means Committee, and Tennessee Republican Diane Black asked about "ObamaCare's Secret Mandate Exemption" (March 12). Ms. Sebelius said she hadn't read the editorial but did call Ms. Black's gloss "not accurate"-;before going on to confirm that it was, in fact, accurate (3/12). 

Fox News: ObamaCare: The Impossible Enforcement Of An Unworkable Law
Does "ObamaCare" truly exist? Are we actually living with the law that was passed with so much fanfare four years ago? I had to ask myself that question while reviewing the New York Times list of unilateral ObamaCare changes, a list that chronicles ObamaCare's utter failure (Jay Sekulow, 3/12).

Fox News: Not Funny Or Die: Obama Gambles On Health Plan With Zach Galifianakis
I'm not one who is aghast when Barack Obama goes outside the traditional Beltway press and tries to connect through comedy. But there is a problem when the president does the web show "Funny or Die" with Zach Galifianakis. He wasn't funny. He died (Howard Kurtz, 3/12). 

The Tennessean: Time For Republicans To Explain Their Endgame On Medicaid
What is the end game on Medicaid expansion for Republicans? More importantly, what is the solution for those who will bear the consequences? Democrats have made the case for expanding Medicaid under the Affordable Care Act for two years now. We have pressed for full expansion, awaited a unique plan put forth by our governor, and recently presented a narrow expansion to avoid catastrophe. So far, Republicans have stood united in opposition to all three, but they have not had to explain their position (State Sen. Jim Kyle, 3/12).

Bangor Daily News: Maine's Medicaid Program Is In Perpetual Crisis. Don't Let Expansion Make It Worse.
Every day, state agencies make difficult decisions to manage requests for services and programs amid limited resources. This prioritization is not done in a vacuum, and funding one part of state government affects available resources in other programs. Regardless of assertions by this or any other media outlet to the contrary, we know it's true. We experience this reality with every state budget assembled in Augusta. Why, then, would anyone question whether the Medicaid expansion being debated in Augusta, which will require more than $800 million in state resources over 10 years -; according to an Alexander Group report -; will affect spending on other critical programs and services such as investments in job training, support for our children's education, or improvements in our transportation infrastructure? (Maine Department of Health and Human Services Commissioner Mary Mayhew, 3/12).

On other health care issues -

The New York Times: Why Aren't Doctors Drug Tested?
People go to hospitals to get well. We all know that medical care involves risks, but what patients don't expect is that the doctors, nurses and other staff members charged with their care may deliberately cause them harm. As an important recent case demonstrates, that's exactly what can happen without stronger controls (Daniel R. Levinson and Erika T. Broadhurst, 3/12). 

The New York Times: High Mortality From Alzheimer's Disease
A provocative new study has suggested that Alzheimer's disease causes six times as many deaths as the official statistics would indicate. The Centers for Disease Control and Prevention estimated that, in 2010, Alzheimer's caused almost 84,000 deaths in the United States, a number derived from death certificates in which Alzheimer's was listed as the main cause. But, in reality, the new study said Alzheimer's was the underlying cause in more than 500,000 deaths in 2010 that were often attributed to conditions, such as pneumonia, caused by complications of Alzheimer's. Those numbers would catapult Alzheimer's from the sixth-leading cause of death in the United States to the third, behind heart disease and cancer (3/12). 

The Washington Post: Relative-Value Health Insurance
On Monday, I posted about how new hepatitis C drugs priced as high as $1,000 per pill are a symptom of a fundamental problem with our health-care system. When most private insurance has relatively low deductibles and co-payments and covers all "medically necessary" treatments without regard to their cost (except for items that are specifically excluded by contract), patients have an incentive to demand all treatments with a positive expected benefit, no matter how small the benefit and how high the cost. As medical technology continues to improve and becomes more expensive, this "moral hazard" problem becomes more and more severe, and the price of health care spirals ever higher. The benefits might be worth the increased costs, but they might not be (Russell Korobkin, 3/12).

The New England Journal Of Medicine: The Checklist Conundrum
Assessing the outcomes of all surgical procedures performed in Ontario during 3-month periods before and after hospitals implemented a surgical safety checklist, they found no reduction in surgical mortality or complications, despite self-reported use of a checklist by 98% of hospitals. ... it is not the act of ticking off a checklist that reduces complications, but performance of the actions it calls for. ... Regulation works best when a practice of unquestioned value has become the norm. ... What should be mandated -; and nationally funded -; are large-scale state and system wide collaboratives to motivate, train, and support local efforts to implement checklists (Dr. Lucian L. Leape, 3/13).

JAMA: The Innovation Vs Consumer Protection Tug-Of-War In Health Policy
In the overheated political environment surrounding the Affordable Care Act (ACA), it's easy to miss the fact that conservative and liberal health policy proposals exist along a coherent continuum: each strikes a different balance between the desires to promote innovation and protect consumers. For convenience, let's situate the ACA at the political center (Austin Frakt, 3/12).