Viewpoints: Political stand-off on insurance industry safeguards; VA's problems may lie in how government works

May 28 2014

Los Angeles Times: GOP Calls Obamacare's Insurance Industry Safety Net Pure Politics
The Obama administration calls it an adjustment, Republicans call it a bailout and insurance companies call it the one thing that might keep them from raising rates and angering policyholders. The "it" in question is a quiet shift in a provision of the Affordable Care Act that makes billions of tax dollars available to insurers if they find themselves losing money on the healthcare law's new insurance exchanges. The administration felt compelled to do this because of another, more public revision of the law that was made a few months ago (David Horsey, 5/23).

The New York Times' Upshot: When Hospital Systems Buy Health Insurers
There are several reasons hospitals might want to be in the insurance business, or more closely aligned with insurers. By acting in cooperation, a unified organization might be able to better design incentives for higher-quality care. Or, by combining similar functions like human resources or tech support, the organization might cut costs. A joint provider-insurer may also be better able to adapt to -; and make more money from -; new Medicare payment models in the Affordable Care Act. ... With less competition, of course, an organization would be in a good position to raise premiums. Wary of threats to competition and the effects on consumers and patients, health economists and antitrust regulators are watching these market dynamics with a concerned eye (Austin Frakt, 5/25).

The New York Times: A Health Nominee Who Can Disarm Republicans
Now that Sylvia Mathews Burwell, President Obama's nominee to head the embattled Department of Health and Human Services, has been endorsed by a bi-partisan majority of one Senate committee and treated cordially by another, the full Senate ought to vote promptly to confirm her nomination. She is extremely well-qualified to handle the department's most pressing administrative tasks and seems able to reach consensus with, or at least disarm and charm, Republican opponents who are often adamantly opposed to cooperating in any way with the Obama administration (Philip M. Boffey, 5/23). 

The Washington Post: Talking About Race Is No Black-And-White Matter
When Sen. Jay Rockefeller (D-W.Va.) remarked last week that some of the opposition to President Obama's Affordable Care Act is "maybe he's of the wrong color," he was just saying out loud what many people believe. And no, he wasn't calling Sen. Ron Johnson (R-Wis.) a "racist." Believing that some of the Republican and tea party opposition to Obama has to do with his race is not, I repeat not, the same as saying that anyone who disagrees with the nation's first black president is racist (Eugene Robinson, 5/26).

Bloomberg: The Bright Side Of Medicaid Obstruction
Republicans in some states are softening their opposition to expanding Medicaid -- so long as the federal government grants the states increasing latitude over how to run the program. Done carefully, this could be good for everyone. Have no illusions: Some of these changes would serve no good purpose. Charging premiums for coverage only dissuades people from signing up, for example, and requiring people to look for work as a condition of getting insurance is an invitation to bureaucracy. (Pennsylvania, which proposed a work requirement, said its plan would need 723 new workers, compared with dozens in other states.) The federal government should establish minimum conditions and stand by them (5/26).

Bloomberg: Thanks, But We Still Hate Obamacare
Greg Sargent gets a great nugget from Democratic pollster Celinda Lake, who "recently conducted a statewide poll in Kentucky for an unnamed client and found that Kynect polls very positively, in contrast to Obamacare, which is underwater." Kynect is the Kentucky version of the Affordable Care Act exchange. To the extent the polling is correct, these results are another example of people loving the ACA but hating Obamacare. Which just isn't very surprising. People still don't really know what "Obamacare" is (Jonathan Bernstein, 5/23).

news@JAMA:  Will The Country Look To Massachusetts Again?
Like bad generals who are "always fighting the last war," the federal government is always fighting the last health care battle. More than 4 years after the Affordable Care Act was passed, partisan factions of Congress are acting as if they have little better to do than hold endless repeal votes and rehash old fights. In contrast, state governments do not have the luxury of inaction. Unlike the federal government, state and local governments cannot run deficits, and businesses facing high health costs in one jurisdiction can flee to another. Thus, state and local governments are forced to confront the issue of health care costs. The passion for reining in spending encompasses states as diverse as Arkansas, Maryland, Massachusetts, and Oregon (David Cutler and Steven Walsh, 5/23).

On the controversy at the Department of Veterans Affairs -

The Washington Post: The True VA Scandal Is Shared Across The Federal Government
The contours of the VA scandal, involving alleged deception about the waiting time for treatment at veterans hospitals, are depressingly familiar. Disclosure is followed by politicians' howls of outrage at perfidious civil servants, demands for firing and "accountability," more investigations and more firings, until public attention wanes. The howls are particularly screeching this time, because everyone wants to be pro-veteran, and the proposed congressional solution -; allowing any VA senior executive to be fired at will, with no due process and no protection for whistleblowers -; is particularly appalling. But the trajectory was similar when it involved the Federal Emergency Management Agency and Hurricane Katrina or the Internal Revenue Service and the tea party or the Department of Health and Human Services and HealthCare.gov (5/26).

The New York Times: Why I Blew The Whistle On The V.A.
MY decision to become a whistle-blower after 24 years as a physician in a Veterans Affairs hospital was, at first, an easy one. I knew about patients who were dying while waiting for appointments on the V.A.'s secret schedules, and I couldn't stay silent. But there was no response to the two letters I sent to the Veterans Affairs inspector general, one in late October 2013 and one in early February. Going public would damage an institution I gave more than two decades of my life to, trying to make a better place for veterans to get their care. But I had to be able to sleep at night (Sam Foote, 5/23).

The Wall Street Journal: The Scandal That Shadows Memorial Day
But there is no greater demonstration of that love in a democracy than those who freely bear arms and head into harm's way, willing to lay down their lives for the sake of their fellow citizens. For the citizens on whose behalf this sacrifice is made, there is no greater responsibility than to care for those who have returned from the fight, to help them bind up their wounds and carry on. It is therefore the height of shame and tragedy that on this Memorial Day the nation is seized with the unfolding scandal of the government's failure to meet its highest responsibility to veterans and wounded warriors (Sen. John McCain, 5/23).

On other health care issues -

The New York Times: Are We Ready For H.I.V.'s Sexual Revolution?
The F.D.A. has taken a drug -; Truvada -; that was approved for H.I.V. treatment in 2004, and approved it for prevention, a use called pre-exposure prophylaxis, or PrEP. On May 14, the Centers for Disease Control and Prevention endorsed PrEP, saying it could benefit up to 500,000 Americans. Predictably, a backlash has arisen. Some men who use it instead of condoms are called "Truvada whores." Some complain of being "slut-shamed" by their own doctors, who are reluctant to write prescriptions. Opponents said that syphilis and gonorrhea rates, already high among gay men, would worsen (Donald G. MacNeil, 5/23).

The New York Times: Diet Lures And Diet Lies
We talk a whole lot these days about the perfidies of the fast-food industry, the snack-food industry, the soft-drink industry. There are books aplenty, documentaries galore. And that's terrific. That's progress. But we should take care that our intensifying alarm over all of the aggressively marketed junk that makes us fatter doesn't crowd out a measure of sustained pique at all of the aggressively marketed pills, products and plans that fail to make us any thinner, despite their lavish promises and the money we plunk down. We should save some room for them (Frank Bruni, 5/26). 

The Detroit Free Press:  Want Fewer Abortions? Then Fund Contraception
Want to know what a failure of public policy looks like?In 2006, the State of Michigan spent $5 million to fund family planning and contraception. In 2013, it was $692,300, according to a report from the Detroit News this week. And while the state cut funding for women's health by a devastating 99%, the abortion rate in Michigan's poorest city soared to three times the state rate. If you are opposed to abortion rights, asking lawmakers to restore this funding should be your top priority. Because there is no surer way to reduce the number of abortions performed in this city, state or country than to lower the number of unwanted, unplanned pregnancies (Nancy Kaffer, 5/23).

The Denver Post:  Would You Test For Alzheimer's?
Now that researchers have discovered a simple blood test that can predict the onset of Alzheimer's disease with 90 percent accuracy, the much larger question is: Will people want to know? It's the defining question for baby boomers, who are turning 65 at the rate of 10,000 people a day. As they age, the number of seniors with Alzheimer's disease will triple, from 5 million today to about 14 million by 2050, reports the Alzheimer's Association. More than just forgetfulness or normal aging, Alzheimer's is a deadly brain disease with no remission, and no cure. It destroys thinking skills and memory, including the knowledge of how to swallow and, eventually, how to breathe (Lisa Wirthman, 5/23).

Journal of the American Medical Association: Drugs For Macular Degeneration, Price Discrimination, And Medicare's Responsibility Not To Overpay
The release of information reporting payments made by the Medicare program to individual physicians in 2012 revealed that ophthalmologists accounted for a substantial proportion of physicians who received payments exceeding $1 million.1 A major factor contributing to these high payments for some physicians was reimbursement for treatment of age-related macular degeneration (AMD) using intravitreal injections of ranibizumab, an anti–vascular endothelial growth factor (VEGF). These drugs used for treatment of AMD are controversial not only because of their expense and the substantial payments made to some physicians who administer these drugs, but also because some anti-VEGF agents are sold at markedly different prices to different customers, representing a form of price discrimination (Jonathan Silver, 5/23).