Viewpoints: Michelle Obama and school lunches; more about the VA health system 'scandal'; context and caution on Medicare's physician data release

May 30 2014

The New York Times: The Campaign For Junk Food 
When we began our Let's Move! initiative four years ago, we set one simple but ambitious goal: to end the epidemic of childhood obesity in a generation so that kids born today will grow up healthy. To achieve this goal, we have adhered to one clear standard: what works. The initiatives we undertake are evidence-based, and we rely on the most current science. Research indicated that kids needed less sugar, salt and fat in their diets, so we revamped school lunch menus accordingly (Michelle Obama, 5/28).

Bloomberg: Congress Flunks Lunch
New federal standards for school lunches, phased in over the last two years, set a calorie cap for meals, encourage kids to eat whole grains and require them to put a fruit or vegetable on their plate. (No, they don't have to eat it.) This is too much for some House Republicans, who have taken up the cause of finicky eaters with a zeal once reserved for Soviet dissidents or Mitt Romney. ... To be clear, no one is forcing anyone to eat anything. Unlike some other congressional debates, this is not about the use of force. The issue is how best to fight obesity, which has more than doubled in children and quadrupled in adolescents in the U.S. in the last 30 years. Better school lunches won't reduce obesity all by themselves. But the obesity problem cannot be addressed without changing how children eat in school, where they consume half their calories. In the age-old battle between grown-ups and kids about eating better, schools and parents need to work together (5/29).

Los Angeles Times: Do People Really Overuse Healthcare When It Is Free?
Call it the "skin-in-the-game" argument: the notion that people will use medical care more sparingly -- and presumably more prudently -- if they have to pay a larger share of the costs out of their own pockets (Michael Hiltzik, 5/28).

The Washington Post: Ben Carson, Doctor Of Division
In the 16 months since his speech to the National Prayer Breakfast made him an instant conservative celebrity, he has drawn a parallel between same-sex marriage, and pedophilia and bestiality; he has declared the United States "very much like Nazi Germany"; he has likened Obamacare to slavery; and he has called the veterans' health-care scandal, in which some died while on waiting lists for medical appointments, "a gift from God" because it shows the ills of government health care. Along the way, Carson has exhibited the demagogue's belief that those who don't agree with him aren't just wrong: They are un-American and dangerous (Dana Milbank, 5/28).

Bloomberg: Republican Candidates Blur the Lines On Obamacare
The Affordable Care Act is creating as many problems as opportunities for Republican Senate candidates in the November midterm elections, an indication of the futility of the party's effort to significantly change, much less repeal, the law. A number of Republican candidates, while they still assail Obamacare, are modifying their positions; others are stumbling over the issue. The most prominent misstep was by Senate Minority Leader Mitch McConnell (Albert R. Hunt, 5/29).

Bloomberg: Obamacare's Muffled Midterm Effect
Most people, in most elections, don't vote directly on policy issues. So the fact that "Obamacare" in general is unpopular doesn't necessarily mean anything. Most people vote based on party. And in House and Senate elections, they may base their votes on what they know about the candidates, especially if there's a big gap between them.1 That suggests Obamacare could hurt some Democrats on the margins, if a candidate's support of something people don't like is one of the main things they know about that candidate. It also suggests the ACA could hurt some Republicans on the margins, if a candidate's support for repeal of a popular item is something people know about the candidate (Jonathan Bernstein, 5/28).

The New York Times' Taking Note: How Big A V.A. Scandal?
The inspector general of the Department of Veterans Affairs has confirmed allegations that the agency's medical center in Phoenix kept veterans waiting unconscionably long times to see a doctor and hid the fact by creating fictitious wait lists. However, the report issued today did not address the most explosive charges -; that veterans have died because of delays in getting treatment and that hidden delays are endemic throughout the Veterans health care system (Phillip M. Boffey, 5/28).

USA Today: VA Secretary: I'm Committed To Restoring Integrity
The findings of the interim report of VA's Office of Inspector General on the Phoenix VA Health Care System are reprehensible to me and to this department, and we are not waiting to set things straight. I immediately directed the Veterans Health Administration (VHA) to contact each of the 1,700 veterans in Phoenix waiting for primary care appointments in order to bring them the care they need and deserve (Eric K. Shinseki, 5/28).

USA Today: VA Scandal Defies Quick Cures: Our View
With a scandal exploding around them, President Obama and Veterans Affairs Secretary Eric Shinseki have insisted on getting to the bottom of what happened before starting the cleanup. Well, the first results arrived Wednesday, and they confirmed the need for a whole lot of mops (5/28).

The Denver Post: VA Secretary Shinseki Isn't Up To The Task 
An inspector general's finding of a "systemic" practice of delaying care and manipulating records at Veterans Affairs facilities is a dismaying development in a growing scandal. Though others surely bear blame, it has become clear that VA Secretary Eric Shinseki must go. He has been at the helm of this sprawling bureacracy for five years -; enough time to tackle the long-known problem of treatment backlogs (5/28).

The New England Journal Of Medicine: The Medicare Physician-Data Release -; Context And Rationale 
On April 9, the Centers for Medicare and Medicaid Services (CMS) released detailed information on utilization by more than 880,000 physicians and other health care providers who care for Medicare beneficiaries. This data release was unprecedented in its size and scope: it included nearly 10 million records ... Although this data release has, in general, been viewed positively, we are aware of the concerns of certain stakeholders, particularly physicians, regarding the accuracy or meaning of the data. ... CMS is committed to producing and releasing high-quality data ... We believe that transparency will drive health system improvement. (Niall Brennan, Patrick H. Conway and Marilyn Tavenner, 5/28).

The New England Journal Of Medicine: Caution Advised: Medicare's Physician-Payment Data Release
On April 9, 2014, Health and Human Services Secretary Kathleen Sebelius announced the release of privacy-protected data concerning services provided to beneficiaries enrolled in the fee-for-service Medicare program in 2012 ... Processes for the use of these data for research and policymaking would clearly be strengthened by efforts to ensure their validity and to account for patients' disease complexity and risk level. Insights gleaned from linking these data to quality measures and health outcomes would inform conversations regarding the value proposition to which we all aspire. One critical next step will be the proactive engagement of informed patients in discussions about their care, including its cost when appropriate (Patrick T. O'Gara, 5/28).

JAMA Forum: On Its Merits, ACA Should Be As Popular As Medicare Rx Drug Program 
In the past decade, 2 new, large federal health insurance programs have been implemented: Medicare's prescription drug program (Part D) and the Affordable Care Act's (ACA's) coverage expansion. These programs have some similarities, but have received very different public and political treatment. Although both were controversial at time of passage, only the ACA remains as controversial, if not more so, than it was on the day it was signed into law. Is this disparate treatment warranted by the evidence on the merits of the 2 programs? (Austin Frakt, 5/28).

USA Today: Right To Try Experimental Drugs: Column
This year, more than 5,000 Americans will lose their battle with ALS, commonly known as Lou Gehrig's disease. What begins as a muscle twitch will give way to joint deformation and paralysis. No medicine on the market meaningfully improves the quality of life, or extends the lives, of ALS patients. But there is a promising new treatment in a Food and Drug Administration clinical trial (Darcy Olsen and Richard Garr, 5/28).

Los Angeles Times: You Say Gun Control Doesn't Work. Fine. Let's Ban Them All Together.
In a post Tuesday, I listed the mass shootings since January 2013 in which at least three people were killed. It's an agonizingly, depressingly long list, and I cited it as the prime reason we need meaningful gun control. The post received the usual blowback from gun owners, most of whom skipped over the scope of gun deaths in this country to look more myopically at last week's tragic events at Isla Vista. ... But we do know that guns are often used by angry men to kill their wives and kids; the mentally ill to act out whatever pain they are suffering; violent criminals; the suicidal (who may kill themselves anyway by other means, but ready access to a gun makes it easier); or children who find guns kept by "properly trained" owners and accidentally shoot themselves or others. In fact, two-thirds of homicides in the U.S. involve guns, according to the CDC. And yes, we need to have stronger, better programs and laws to help the mentally ill, but in the end, it's their access to weapons that have caused so much mayhem at such a big scale. Mental illness is a factor in some of the violence, but guns are part of most of the killings (Scott Martelle, 5/28).