Viewpoints: Insurance and death rates; Massachusetts 'exit plan'; Obamacare premiums

May 9 2014

The New York Times: What Health Insurance Might Do
Alert (or at least health-care-obsessed) readers have no doubt been following the coverage of a new study on mortality in Massachusetts in the years following Romneycare's coverage expansion, the gist of which -; the authors found a striking, Massachusetts-specific decline in death rates for the non-elderly -; tends to confirm liberal assumptions about the benefits of health insurance, and undercut the conservative and libertarian argument that insurance doesn't have the impact on health and mortality that most people expect. The study's findings are an almost-diametrical reversal of the results from Oregon's Medicaid experiment, which were much discussed around this time last year (here's my contribution), and which seemed to strengthen the conservative critique of Obamacare's pursuit of comprehensive coverage. So now it's liberalism's turn to claim vindication, and to press Obamacare's critics to give ground in the debate (Ross Douthat, 5/7). 

The Boston Globe: Exit Plan For Health Site Mess Deserves Scrutiny Of Its Own
Having decided that fixing the current website is a lost cause, officials at the troubled Massachusetts Health Connector today will recommend buying a software product from a different vendor, hCentive. But the Connector also wants to prepare to join Healthcare.gov, the federal website, in case hCentive's "off-the-shelf" website product can't be adapted in time to let Massachusetts residents secure health plans for 2015, for which enrollment starts on Nov. 15. That course has left the state's health insurance plans deeply concerned, and understandably so: Having invested heavily to prepare for the dysfunctional website, they'll now have to prepare to work with two different websites (5/8).

The Wall Street Journal: Disconnected In Massachusetts 
The FBI is reportedly investigating criminal fraud by the architects of Oregon's ObamaCare program, but maybe the G-men should take a look on the East Coast too. Like Oregon two weeks ago, Massachusetts announced on Monday that it is dumping its dysfunctional insurance exchange and defaulting to the federal version-;though in fairness to Governor Deval Patrick, his crimes are merely against competent government (5/7).

Los Angeles Times: The Insurers Speak: Yes, People Are Paying Their Obamacare Premiums
Things continue to get tough for the Obamacare dead-enders, those increasingly lonely opponents whose only comeback against the flow of good news about the Affordable Care Act is to conjure up absurd arguments against it (I mean you, Cato's Michael Cannon) or, if all else fails, make stuff up (Michael Hiltzik, 5/7). 

The New England Journal Of Medicine: Here To Stay -; Beyond The Rough Launch Of The ACA 
Come 2017, outright repeal will remain unlikely for three reasons. First, all major parts of the ACA except the individual mandate are popular -; including the insurance-market reforms, the subsidies to make insurance affordable, closure of the drug-benefit "doughnut hole," and the incentives for most employers to provide affordable insurance as a fringe benefit. Second, lawmakers who support repeal will not want to snatch insurance coverage from an estimated 37 million people who will be insured thanks to the ACA in 2017. Third, repeal would cut into the sales and profits of health care providers and suppliers of all stripes. Although repeal of the ACA is therefore unlikely, amendments are certain (Henry J. Aaron, 5/7).

The New England Journal Of Medicine: Health Care Reform After The ACA 
The ACA creates new subsidies for insurance purchased on the exchanges and expands Medicaid eligibility, increasing the pressure from entitlements on state and federal budgets. Subsidies shift the burden but do not reduce the cost. ... If Republicans gain a Senate majority in the fall, they ... can be expected to advance targeted proposals to eliminate the ACA's most unpopular and unworkable aspects and substitute market-based alternatives. Such proposals will embrace the possibility of a more decentralized, less regulatory, and more consumer-driven model of health care. I believe that will be the direction of the next phase of health care reform in 2017, no matter who is elected President (Joseph R. Antos, 5/7).

The Washington Post: Medicaid: Will McAuliffe Play The Cuccinelli Care?
As Bill Clinton once famously said: "It depends upon what the meaning of the word is." Ain't that the truth. Last year, GOP gubernatorial candidate Ken Cuccinelli strongly opposed Democratic rival Terry McAuliffe's promise to expand Medicaid. That was a partisan difference. But earlier in 2013, Mr. Cuccinelli had occasion to address a question sitting at the heart of the Medicaid expansion debate in a nonpartisan way: Who has the legal right to expand the program? (Norman Leahy and Paul Goldman, 5/7). 

news@JAMA: Good Prospects For Reform In Long-term Care
The rollout of the Affordable Care Act (ACA) continues to dominate the noisy politics and media attention devoted to health care. But there is one important area of health system reform where there's a remarkable and growing degree of nonpartisan and constructive debate quietly focused on solving problems-;that concerns long-term care (LTC), including long-term supports and services (LTSS). True, a new LTC program was deemed unworkable and stripped from the ACA after being signed into law. And last year's Commission on Long-Term Care failed to reach agreement, spawning both official and alternative reports (Butler, 5/7).

The New England Journal Of Medicine: Vivek Murthy For Surgeon General
By obstructing the President's nomination of Vivek Murthy as surgeon general, the NRA is taking its single-issue political blackmail to a new level. With the record of past surgeons general as their guide, senators should do what is right for the health of our country by confronting the NRA and voting their own conscience. Dr. Murthy is an accomplished physician, policymaker, leader, and entrepreneur. He deserves the President's continued backing and should be confirmed (Dr. Gregory D. Curfman, Stephen Morrissey, Debra Malina and Dr. Jeffrey M. Drazen, 5/8).

The New England Journal Of Medicine: Insourcing Health Care Innovation 
Many health care professionals find it irritating when management gurus recommend solving health care's problems with approaches they would "copy and paste" from unrelated industries -; a former chief executive of a manufacturing company claims that the same simple lessons that enabled him to transform his own industry can improve value in health care, or a business-school professor offers an eight-point leadership plan that she's translated into health care as easily as if she'd translated it into French. Many people who work in health care value outside perspectives and are open to new approaches -; and yet bristle at facile recommendations emerging from these translations. ... The challenge of health care innovation lies in combining contextual understanding with fresh perspectives (Dr. David A. Asch, Christian Terwiesch, Kevin B. Mahoney and Roy Rosin, 5/8).

The New York Times' Opinionator: In Delivery Rooms, Reducing Births Of Convenience 
San Francisco General is largely a hospital for the poor. It's the city's safety net hospital, known for providing free care for all who can't afford it, and for its display -; while you wait and wait -; of the parade of humanity in all its glory. It might be surprising, then, that according to data compiled by the state it is probably the safest place in California to have a baby (Tina Rosenberg, 5/7).

The Washington Post: Pfizer's Offer To Buy AstraZeneca Shows That U.S. Needs Corporate Tax Reform 
The hot read among policy wonks these days is "Capital in the Twenty-First Century," by French economist Thomas Piketty. He warns of a long-term trend toward ever-concentrated wealth and urges a global wealth tax to prevent it. While that might be a bad idea even if it were politically feasible, there is merit to the broader notion that industrialized countries could better coordinate taxing wealth, corporate and otherwise, that flits around the world in search of the lowest rates. Case in point: U.S. drug maker Pfizer's $106 billion offer for Britain's AstraZeneca, which could enable Pfizer to flag itself as a British company and pay taxes at Britain's 20 percent rate rather than this country's 35 percent (5/7).

The Washington Post: D.C.'s Bad Mental-Health Report Card 
For the third year in a row, an assessment of children's mental health in the District of Columbia has found the city lacking in its ability to reach and help those most in need. It's long been apparent that this failure affects not only children with problems and their families but also the larger society that must contend with the costly consequences of that non-treatment. Officials need to wake up to the fact that, unless they pay better attention to the mental well-being of children, they have little chance of reducing the dropout rate, cutting juvenile crime or producing self-sufficient adults (5/7).

WBUR: Five Things Marathon Allure Can Teach Us About Improving Everyday Health
Health behavior change is hard; if it were easy, everyone would be doing it. But running a marathon is also hard, and lately it seems that just about everyone is doing it. The health care industry could learn a lot from the increasing popularity of the marathon about how to design programs that help people make positive health behavior changes (Bradley Stulberg, 5/7).

Los Angeles Times: Endorsement: David Jones For Insurance Commissioner 
Outraged by rapidly rising premiums for auto insurance, California voters passed Proposition 103 in 1988 to turn the insurance commissioner's job into an elected office with the power to reject proposed changes in the rates for property and casualty insurance. Since then, the commissioner has been arguably the most important consumer protection official in the state, overseeing more than 600 insurers that collect $123 billion in premiums for health, auto, home and other policies. This year, voters will choose among three candidates offering sharply contrasting views on how best to provide that protection, and it's a debate worth having. Nevertheless, the best candidate for the job is the one who has it already, Democrat Dave Jones (5/7).

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