Viewpoints: Cutting costs for patients with chronic illness; Gov. Pence's change of Heart; fix the VA

May 21 2014

The New York Times' The Upshot: Why Patients With Chronic Illnesses Should Pay Less
Most health care plans ask that you spend some money out of your pocket whenever you use the health care system. This is known as cost-sharing .... Cost-sharing works for most people, because most people are healthy. Healthy people who use health care are often doing so inefficiently. They often don't need the care they ask for, because they're well. One way we use cost-sharing poorly, though, is that we apply it to all insurance beneficiaries equivalently. We treat them all the same, no matter how sick or healthy they are(Aaron E. Carroll, 5/19). 

The Wall Street Journal: In Health Care, Sometimes It's Provider Choice Vs. Price
Some people who don't have strong ties to doctors or hospitals seem willing to accept narrower networks of providers in return for lower prices. In other words, unlimited choice of doctors and hospitals may not always be the third rail in American health care it once was. ... Many people who are uninsured or who bounce from plan to plan every year in the non-group market may never have had a regular doctor or hospital, and the uninsured may be more worried about paying for health coverage that they are now legally required to buy than about having a broad choice of providers. Often, the price difference between broad- and narrow-network plans is substantial (Drew Altman, 5/20).

The Washington Post: Indiana's Gov. Pence Taking The Obamacare Money And Running With It
For the first time since Obamacare split the country in two, the conditions for a cease-fire have begun to appear. An architect of this detente -; although he denies any such intent -; is Mike Pence, who as a conservative Republican congressman in 2010 fought bitterly against the law and who as governor of Indiana refused to implement it (Dana Milbank, 5/19). 

The Washington Post's Right Turn: Mike Pence Goes (Back) To Washington
Indiana Gov. Mike Pence is testing the proposition that the Republican Party can be the party of reform and the little guy, not the dogmatic libertarian party that treats abstract principles, rather than people, as the lodestar for politics and governance. In coming to talk today to the American Enterprise Institute -; whose president, Arthur Brooks, has been on a mission to spread the former vision -; Pence took on a knotty subject, Medicaid reform, and put his conservative reputation on the line (Jennifer Rubin, 5/19). 

Forbes: Indiana's Innovative Medicaid Expansion Idea Could Chart A Path For Major Reform Going Forward
Conservatives do need to chart a new path to Medicaid reform, and the original Healthy Indiana Plan is one of the best models. ... This deal is probably as much as Indiana could get in the short term before the existing HIP program is scheduled to expire later this year. It is extremely helpful to have working models of innovative programs as examples of consumer-centered health reform going forward. If Indiana holds the line on any further demands for changes to HIP by the Obama administration – and even demands more flexibility – then Gov. Pence could set the stage for other states to chart a different path forward to reform the flawed, fraud-ridden Medicaid program that fails so many of its enrollees (Grace-Marie Turner, 5/19).

Bangor Daily News: Medicaid Expansion Meltdowns Show Maine Made Right Decision
One of the biggest issues to consume the Maine Legislature over the 2013-14 term was whether to implement Obamacare's welfare expansion in our state.  ... Republicans in the House and Senate recalled how past expansions in Maine shattered initial cost estimates. ... Then we considered how Medicaid has been shortchanging our nursing homes and disabled people on waitlists for years, and how those who stood to benefit from Obamacare's Medicaid expansion are all able-bodied, working-age adults who are disproportionately young and male. ... The way Medicaid expansion is playing out in other states is quickly proving that Maine Republicans made the right call by sustaining the governor's vetoes of expansion (Rep. Ken Fredette, 5/19). 

The Washington Post's Volokh Conspiracy: Another 'Specious' Defense Of Obamacare
In our challenge to the ACA, we contended that the "individual responsibility requirement" enforced by a "penalty" was an unprecedented and unconstitutional expansion of the power of Congress to "regulate commerce" among the states. In his swing vote opinion, Chief Justice Roberts agreed that this would indeed be unconstitutional, but revised the statute by giving it a "saving construction" in which the "requirement" was turned into an option to buy insurance, and the "penalty" was converted from a fine to a tax. But, like others including the administration, [a recent New York Times editorial] cannot quite stick to the script here. And I don't blame it too much. I agree with the eight Justices who thought this was a requirement enforced by a penalty or fine (Randy Barnett, 5/19). 

WBUR: The Global View: Lessons For Mass. Health Care From Abroad
A study released last week found that insurance is saving lives in Massachusetts. Expanded coverage will mean 3,000 fewer deaths over the next 10 years. We have state of the art health facilities and are among the healthiest of Americans. Despite the fiasco of our failed enrollment website, the Commonwealth maintains near universal health coverage, and inspired the Affordable Care Act. Our example is heartening not just for America, but for the many low-and middle-income countries around the world working toward universal health coverage. These countries aren't just taking a page from our book, though -; they have valuable lessons for us, too (Jonathan D. Quick, 5/20). 

On other health issues --

The Washington Post: Heads Need To Roll At The VA
The VA situation, however, looks more serious day by day. If VA hospitals really are falsifying records to disguise lengthy waiting times -; and if veterans are dying as a consequence -; then President Obama needs to bring in new management to fix the problems and fast (Eugene Robinson, 5/19). 

USA Today: VA Bad Press Overshadows Our Good Work
Hearing the stories of military veterans is humbling. Veterans have given a part of their lives for the country. We, the medical team, feel we are doing a service to society by caring for them in return. Working at the Department of Veterans Affairs as a physician is like betting on the underdog team. Sometimes it seems the odds are stacked against you, but you still believe in what the team stands for. And you know that each win is a big one (Katherine Chretien, 5/19). 

The New York Times: A Cancer Treatment In Your Medicine Cabinet?
We believe that it might be possible to treat breast cancer -; the leading cause of female cancer death -; with a drug that can already be found in nearly every medicine cabinet in the world: Aspirin. In 2010, we published an observational study in The Journal of Clinical Oncology showing that women with breast cancer who took aspirin at least once a week for various reasons were 50 percent less likely to die of breast cancer. ... And yet, until now, there have been no randomized trials (the gold standard of research) of aspirin use among women with breast cancer. It's not hard to see why: Clinical trials are typically conducted on drugs developed by labs seeking huge profits (Michelle Holmes and Wendy Chen, 5/19).

The Washington Post: Love And 'The Normal Heart'
This revolution has been so long in coming -; and yet so quick in arriving. HBO on May 25 will air Larry Kramer's "The Normal Heart," a movie version of his play. It is semi-autobiographical and about the onset of the HIV-AIDS epidemic and the adamant refusal of some political leaders, most prominently President Ronald Reagan and New York Mayor Ed Koch, to even acknowledge what was happening. An epidemic was sweeping the gay community, men were dying hideously and often at a very young age -; and no one much gave a damn (Richard Cohen, 5/19). 

The Wall Street Journal's Political Diary: ObamaCare's Regional Problems
A new poll of likely voters in the states and districts with the most competitive Senate and House races brings more bad news for President Obama and his party. "In the congressional districts and states where the 2014 elections will actually be decided, likely voters said they would prefer to vote for a Republican over a Democrat by 7 points, 41 percent to 34 percent," reports Politico, which commissioned the survey by research firm GfK. "Among these critical voters, Obama's job approval is a perilous 40 percent, and nearly half say they favor outright repeal of the Affordable Care Act" (Jason L. Riley, 5/19). 

The Richmond Times-Dispatch: Virginia's Mental Health System And Its Coverage Gap
This year there have been two major health policy discussions taking place in Virginia, about how to better provide mental health services and how to provide access to health insurance for low-income, uninsured Virginias. The first was largely a result of the tragedy that took place last fall with Sen. Creigh Deeds, my friend, while the second has been a conversation that has evolved nationally over the past few years -; but both came to a head in the Virginia General Assembly this year. Though the public conversations about these issues have been largely separate, they are surprisingly similar and inherently intertwined (Ralph Northam, 5/19).