Viewpoints: Health overhaul doesn't necessarily help the sick; single payer doesn't mean cheaper

May 2 2014

The New York Times: The Problem With Free Health Care
Now that it's clear that Obamacare is here to stay, its supporters should focus on making the program better. Fixes are not a sign of weakness. They are a sign of responsiveness and of good management. And the Affordable Care Act does have its flaws. Here's a big one: It favors screening over diagnosis. ... In other words: A woman over 40 can have a free screening mammogram. But if she notices a breast lump and goes to her doctor to have it evaluated, she'll pay for a diagnostic mammogram. That could cost $300. So the woman at lower risk for cancer -; the one with no signs or symptoms of the disease -; has an incentive to be tested, while the woman at higher risk -; the one with the lump -; faces a disincentive (H. Gilbert Welch, 4/30). 

The Wall Street Journal: The Coming Two-Tier Health System
With the unveiling of the Affordable Care Act's website, the public experienced a painful reminder of the consequences of the government's new authority over health care. While millions signed up for insurance, millions of others abruptly lost their existing coverage and access to their doctors because that coverage didn't fit new ObamaCare definitions (Scott W. Atlas, 4/30). 

Politico: Obama At A 'Dead Point'
The president keeps saying the debate over the health care law is over. If so, he lost it -; at least the debate over whether the law is worthy of support. The March Obamacare enrollment surge hasn't brought springtime for President Barack Obama, just the soggy reality that he looks to be about as much of a drag on his party in November as anyone would have expected a few months ago (Rich Lowry, 4/30).

The Washington Post's The Plum Line: Schumer: Repeal Will Be Liability For McConnell In Kentucky'
Get this: Chuck Schumer thinks Mitch McConnell's support for repealing health insurance for 400,000 people in his home state might actually become a political liability for him. This crazy notion comes in a fundraising email that Schumer is circulating for Kentucky Senate candidate Alison Lundergan Grimes. It can't be true, of course, since it is an established fact that Obamacare can only be an enormous liability for Democrats in elections six months from now, and there can never be any pitfalls of any kind in the GOP repeal stance, no matter how many people end up enjoying the law's benefits (Greg Sargent, 4/30). 

Bloomberg: A Single-Payer System Won't Make Health Care Cheap
There are two potential outcomes for a "public option" health insurer: It could set rates high, in which case it wouldn't control costs, or it could jam them down to Medicaid levels, in which case no one but the very healthy or the very desperate would buy that insurance because it will be hard to actually use that coverage (Megan McArdle, 4/30).

Bloomberg: Is Obama A Bad Manager?
Or consider the fiasco of the October Healthcare.gov roll-out, which features prominently in many critiques of Obama's management. Is it properly viewed as a sign of presidential failure? Or is it more accurate to conclude that no president can prevent all bureaucratic snafus, and that the real test is how a president mobilizes the bureaucracy to tackle the problem? By the first standard Obama fails; by the second, he does very well. There seems to be evidence to support both (Jonathan Bernstein, 4/30).

The Washington Post: Herring Rises, McAuliffe Falls
I was out of town part of last week, but I was taken aback by a poll by Christopher Newport University showing a switch in voter attitudes about expanding Medicaid for up to 400,000 Virginians. In February, a poll by the school found that a majority of voters favored Medicaid expansion, 56 to 38 percent. By April, it had switched to 53 percent opposed and 41 percent in favor. Quentin Kidd, the CNU political scientist who oversaw the poll, says the Republicans are winning the Medicaid debate. He is likely correct, and the fault is McAuliffe's (Peter Galuszka, 4/30). 

Fort Wayne Journal Gazette: 'The Indiana Way': Hope Rises For Resolution Of Medicaid Impasse
It was, after all, only the second time an Indiana governor had visited the Neighborhood Health Clinics Inc., so the small group that awaited Mike Pence on Tuesday morning was excited about the chance to show him around. Not every community has a facility that's been providing health care to people regardless of their ability to pay for 45 years. Also auspicious on the rare bright spring morning was a sense that perhaps an impasse between Indiana and the federal government on expanding Medicaid may soon be broken. ... Pence praised NHCI and its staff and told them solving the health care challenge is on his mind every day. He said the state may be applying to the federal government within about a month for permission to pursue the expanded-HIP option in order to take care of Hoosiers "the Indiana way" (5/1).

The Fiscal Times: There's No App For That: Why We Need A Health Care Shopping Guide
When you need work done on your car or bring a contractor into your home for some work, you can expect to get an estimate on what the job will cost. Even closing on a home mortgage and sale requires a comprehensive "good-faith estimate" of expenses before you sign on the dotted line. Unless you're paying out of pocket, that's rarely the case in health care, where bills mostly come after the service is performed, long after you've had a chance to shop around. Since most Americans rarely have to worry about the full cost of their medical bills -; they are largely covered by employers -; this isn't an issue. For those with high-deductible policies, choosing elective surgery or running businesses, though, getting treatment is a different ball game -; one that requires honest and accurate upfront pricing disclosure (John F. Wasik, 4/30).

The Fiscal Times: Obama's Biggest Lie: The ACA Will Lower Health Care Spending
The economic news this week may have people wondering whether they have gone through the Looking Glass into Wonderland. The Bureau of Economic Analysis issued its advance estimate of first-quarter growth in 2014, which barely made it into the black with an annualized GDP growth rate of 0.1 percent. Even that terrible result – the worst quarter since 2012, and tied for second-worst since the start of the technical recovery in June 2009 – would have been worse without an explosion of health-care spending as Obamacare enters its first year of implementation. Not since 1980 has the American economy seen such a rapid expansion of health-care spending (Edward Morrissey, 5/1).

On other health care issues -

The New York Times' Room For Debate: Doctors In The Death Chamber
As a lethal mix of drugs left the murderer Clayton D. Lockett writhing and gasping before dying of a heart attack in the Oklahoma death chamber Tuesday night a doctor stood by to see if he had lost consciousness, and then died. Doctors have participated in lethal injections since they were first used, even injecting prisoners, despite professional guidelines that proscribe this. Should they be allowed to participate in executions without being disciplined? (4/30). 

news@JAMA: On Medicine And Money
As might have been anticipated, much of the media coverage of the release of the CMS data focused attention on health care professionals dubbed "Medicare millionaires" and their practice patterns. Tantalizing as such details might be, more profound issues were being sidestepped. In particular, little has been said with respect to the uncomfortable relationship between medicine and money. This is an unfortunate state of affairs, because the ethical and moral challenges associated with the juxtaposition of medicine and money are highly deserving of our attention (Eli Y. Adashi, 4/30).