Viewpoints: Medicare's future finances; 'promising deal' on VA; Texas 'war on abortion'

Jul 30 2014

The New York Times' The Upshot: Good News And Gloom For Medicare, Wrapped In A Mystery
Medicare got some good news Monday, when the trustees who oversee its finances announced that the fund that pays for hospital care will remain solvent until 2030, four years longer than its forecast from last year. But that good news came wrapped up in the usual long-term bad news: The aging of baby boomers means that Medicare's long-term finances are in trouble, even if the next decade is looking much better (Margot Sanger-Katz, 7/28). 

Los Angeles Times: Good News And Warnings In The Social Security And Medicare Reports
The release of the annual trustees reports for Social Security and Medicare customarily give rise to an outburst of disinformation from the enemies of these social insurance programs -- that comes with the territory when you're putting out documents of hundreds of pages densely packed with graphs, charts and statistics. There may be less of that with the release of both reports Monday (months after the statutory deadline). That's because "the news is essentially that there is no news" in the reports, as Kathy Ruffing of the Center on Budget and Policy Priorities, a leading expert on Social Security, said during a conference call Monday on the Social Security report (Michael Hiltzik, 7/28). 

The Wall Street Journal: A Promising Deal On Reforming Veterans Affairs
Veterans across the nation are waiting too long for the care they need, and some of them are dying while awaiting treatment. Far-reaching efforts to establish public-private partnerships are needed to meet the challenges facing the Department of Veterans Affairs. On Monday, the chairmen of House and Senate committees announced a deal to provide $10 billion in emergency funding for veterans to obtain care outside the VA system. The draft bill is a step in the right direction and should be approved by the joint conference committee and passed by Congress before the August recess (Robert Morgenthau, 7/28). 

The Wall Street Journal's Political Diary: The Veterans Affairs Deal
House and Senate negotiators haven't released all the details of a plan to overhaul the Department of Veterans Affairs. But we're happy to see that a draft bill leaked over the weekend does include a provision that would allow veterans to receive care from a non-VA facility. News earlier this year that patient wait lists at VA facilities were being doctored to reflect shorter wait times and enable managers to earn performance bonuses produced a national outcry and cost Veterans Affairs Secretary Eric Shinseki his job. Never mind that at least three inspector general reports between 2005 and 2012 highlighted the very same waitlist problems, as did a Government Accountability Office report released way back in 2000 (Jason L. Riley, 7/28).

Los Angeles Times: The Genesis Of Obamacare's Disputed Provision On Insurance Subsidies
The Times ran multiple opinion pieces last week -- by me, by the editorial board and by op-ed contributors -- arguing that, contrary to what the U.S. Circuit Court of Appeals for D.C. ruled, the 2010 healthcare law makes insurance subsidies available in every state, not just the 14 that established their own insurance exchanges. To which some readers have asked, reasonably enough, why does the text of the law seem so clearly to say otherwise? For example, Michael Robertson, a tech entrepreneur who's no fan of Obamacare, asked via Twitter, "Why mention 'state exchanges' in the context of subsidies if everyone gets them? That's highly illogical" (Jon Healey, 7/28). 

Politico: The Flip-Flopping Architect Of The ACA
The administration's defenders responded to the Halbig case by insisting that Congress never intended to withhold subsidies from residents of states that did not establish exchanges. Like the Obama administration, [Jonathan] Gruber told the D.C. Circuit that this idea is "implausible." ... Gruber then became part of the story on Thursday when a video surfaced in which he espouses the very interpretation of the law he now publicly derides .... When the chief architect of the PPACA admits it withholds tax credits in uncooperative states, that establishes that the plaintiffs' interpretation of the statute in Halbig was not only plausible but that it had currency among the law's authors (Michael Cannon, 7/28).

Los Angeles Times: Here's The Single Best Analysis Of The Halbig Anti-Obamacare Ruling
Northwestern University law and political science professor Andrew Koppelman moves past the absurd legal theory underlying the Halbig ruling on the Affordable Care Act -- in which a federal appeals court invalidated subsidies provided to insurance buyers on federal, as opposed to state, insurance exchanges -- to ask why the lawsuit's backers brought the case in the first place (Michael Hiltzik, 7/28).

The Washington Post: North Carolina Republicans Put Ideology Above Lives
On July 1, the hospital in rural Belhaven, N.C., closed -; a victim, in part, of the decision by the state's governor and legislature to reject the expansion of Medicaid under Obamacare. Six days later, 48-year-old Portia Gibbs, a local resident, had a heart attack. The medevac to take her to the next-nearest hospital (as many as 84 miles away, depending on where you live) didn't get there in time (Dana Milbank, 7/28). 

The Washington Post: Texas's War On Abortion Is Shuttering Clinics Throughout The Lone Star State
Abortion remains legal in the United States, but states such as Texas are erecting legal impediments before clinics that perform the procedure. In effect, 40 years after the Supreme Court's decision in Roe v. Wade established the right to first-trimester abortion, pro-life groups and lawmakers are negating its effects. Last year, lawmakers in Texas forced through legislation that amounts to a frontal assault on the state's abortion providers. More than 40 clinics around the state performed the procedure legally and safely when the law took effect a year ago. Today fewer than half of those clinics are still in business in a state where the population has more than doubled over four decades (7/28). 

The New York Times' The Upshot: The Problem With 'Pay for Performance' In Medicine
"Pay for performance" is one of those slogans that seem to upset no one. To most people it's a no-brainer that we should pay for quality and not quantity. ... So it's no surprise that pay for performance has been an important part of recent reform efforts. But in reality we're seeing disappointingly mixed results. Sometimes it's because providers don't change the way they practice medicine; sometimes it's because even when they do, outcomes don't really improve (Aaron E. Carroll, 7/28). 

The Washington Post: Sick? Now You Can Stay Home.
Something strange is about to happen [in New York] on Thursday: Lots of workers who've never done so before are probably going to call in sick. And that's a good thing. The Big Apple, you see, is joining a handful of other trailblazing cities such as Washington, San Francisco and Newark in guaranteeing workers what Congress has not: mandatory sick days. Thursday will represent the first day that the newly covered workers can use the sick leave hours they have legally accrued (Catherine Rampell, 7/28). 

Reuters: Want To Avoid A Pandemic? Here's A Good Way To Start
Over the past two months, a series of mishaps at the CDC and NIH -; involving mishandled anthrax, mislabeled influenza and misplaced smallpox -; has alarmed the scientific community. The common theme surrounding all of them is human error. ... These mishaps show why we need to stop conducting certain types of research on strains of flu virus that could cause worldwide epidemics, or pandemics. In these types of research -; which involve live, intact viruses that can spread from person to person -; the risks outweigh the benefits (Carlos Moreno, 7/28).

Journal of the American Medical Association: Quantifying A Nonnotifiable Disease In The United States
In the United States, public health surveillance has evolved from a focus on monitoring infectious diseases to also tracking injuries, chronic diseases, birth defects, environmental and occupational exposures, and risk factors. Despite this evolution of surveillance topics, many conditions still are not notifiable to federal public health officials nor are there surveillance systems in place to capture such conditions. The lack of morbidity data for nonnotifiable conditions makes it difficult to access accurately the populations at greatest risk and the true economic and societal burden of such diseases. New approaches are needed to more accurately quantify nonnotifiable conditions of interest in the United States, such as amyotrophic lateral sclerosis (ALS) (D. Kevin Horton, Paul Mehta and Vinicius C. Antao, 7/24).