Viewpoints: Medicaid's good deal; Medicare hospital errors; CBO on exchange coverage

Aug 14 2014

The New York Times' The Upshot: A Deal Too Good To Turn Down, Unless It's Medicaid
If the governor and the legislature refuse to accept the federal deal [for Medicaid expansion] -; as 24 states have so far -; they in effect vote against one of the most fantastic cash-flow deals ever offered them. ... And it gets worse. The state's citizens are paying taxes to the federal government to help cover the federal payments made to other states who do accept the new deal, but the state gets nothing in return. In states that accept the deal, possibly millions of poor citizens will get insurance coverage they now lack. Furthermore, doctors, hospitals and other providers of health care in the state would see their revenues increase and thus could offer more jobs to residents of the state. ... In short, this economist is puzzled by the thinking among the leaders of the 24 states who have refused to accept the highly profitable deal offered them under the Affordable Care Act (Uwe E. Reinhardt, 8/12).

Forbes: Without Oversight, Medicare Threatened By Hospital Billing Errors
Recently, in a series of back-to-back Congressional hearings on improving Medicare integrity, lawmakers sounded the alarm: Medicare is rife with waste, fraud and abuse, and it must be fixed. But in a twist, the hearings focused solely on the impact of this issue on hospitals, not patients or taxpayers. This is troubling for several reasons. According to the Centers for Medicare and Medicaid Services, Medicare lost over $36 billion to over-billings by providers in fiscal year 2013, with hospitals accounting for 88% of the waste. According to the Government Accountability Office – Congress' preeminent oversight body – these astounding losses are largely due to documentation errors, also referred to as "up-coding," in which a provider erroneously bills Medicare to recoup higher reimbursements (Becky Reeves, 8/12). 

The New Republic: Halbig Truthers Say Everyone Blew It on Obamacare. This Former Analyst Says They're Full of It.
The smartest, least dishonest argument you'll hear from Halbig Truthers goes something like this: The statutory text of the Affordable Care Act can only be read one way, and by that reading, the government isn't authorized to provide subsidies to beneficiaries in states that didn't set up their own exchanges. ... This is a stretch for a lot of reasons, starting with the assumption that the ACA can only be read one way. ... One of the central players in this drama was the Congressional Budget Office, and we know the analysts there never imagined Congress intended to condition subsidies on states setting up their own exchanges (Brian Beutler, 8/11).

Forbes: Transcending Obamacare: An Introduction To Patient-Centered, Consumer-Driven Health Reform
Today, the Manhattan Institute is publishing my 20,000-word, 68-page health reform proposal .... It represents a novel approach to health reform: neither accepting Obamacare as is, nor requiring the law's repeal to move forward. And yet its ambition is to permanently solve our health care entitlement problem, while also expanding coverage for the uninsured. ... One of the fundamental flaws in the conservative approach to health care policy is that few-;if any-;Republican leaders have articulated a vision of what a market-oriented health care system would look like. Hence, Republican proposals on health reform have often been tactical and political-;in opposition to whatever Democrats were pitching-;instead of strategic and serious. Those days must come to an end. The problems with our health care system are too great. Health care is too expensive for the government, and too expensive for average Americans (Avik Roy, 8/13).

The Milwaukee Journal Sentinel: The GOP's Perilous Way Forward On Health Care
Obamacare is a disaster, for which it increasingly appears Democrats will pay the political price in 2014. But Republicans also have to consider the possibility that voters will hold them at least partially accountable for what happens from here on out. Regardless of their merit, if court cases from the right render the ACA more of an incomprehensible patchwork of regulations, the GOP should prepare itself for making the case for an ol' switcheroo. If the public thinks the GOP broke Obamacare, the party has to be prepared to buy it. And if Obamacare in Wisconsin collapses, Republicans could use some good political -; ahem -; insurance (Christian Schneider, 8/12).

The New York Times: Perpetuating Schizophrenia's Stigma
A few months ago, a patient came to our hospital, seeking help. ... He was a college graduate in his 20s and had recently been fired from his job as a high school math teacher, because of unexpected absences. He had come to believe that government agents were conspiring against him, and he had taken to living out of a truck and sleeping in different parking lots. By the time he came to us, he was exhausted. A diagnosis became clear: he had schizophrenia. We admitted him to the hospital, and after a few days, with his symptoms under control, we released him. Unfortunately, we prescribed a medication for him that could cause significant, permanent harm, instead of an equally effective drug with milder side effects -; all because he was uninsured (Edward Larkin and Irene Hurford, 8/12).

Bloomberg: Robin Williams's Laughter Masked A Deadly Disease
When someone as sparklingly witty as Robin Williams commits suicide ... our first reaction is disbelief at the incongruity. Perhaps it shouldn't be. Psychologists believe that some styles of humor can mask a greater susceptibility to depression. In fact, a certain sense of humor may be a symptom of a widespread, often untreated disease that disables and kills (Leonid Bershidsky, 8/12).

Forbes: Robin Williams' Death Underscores Connection Between Creativity, Depression And Addiction
Williams was arguably one of the best examples of both extraordinary creativity and the darker sides of that sort of genius: Severe depression and addiction. ... So why are creativity – including comedy – and mental illness so intertwined? Like any creative profession – writer, musician, and artist – the answer may be that the comedian's brain might be wired a little bit differently to begin with (Alice G. Walton, 8/12). 

The Washington Post: It Shouldn't Be This Awful And Isolating To Have HIV In The Year 2014
I was one of 725 new patients below the age of 24 to be diagnosed with HIV in the United Kingdom that year (out of 2.5 million new infections worldwide). I know nobody else my age who is positive; naturally that left me feeling isolated, alone, and a little alien. Thanks to drug advances, there's little chance I'll develop AIDS. But I'll never have the freedom of a normal life, either. What I discovered after my diagnosis is that the shame and stigma attached to HIV is far more intense than the social anxiety attached to homosexuality (Patrick Reynolds, 8/12). 

The Wall Street Journal: Medtronic's Tax Lesson
Medtronic's pending acquisition of Covidien and adoption of Ireland as its legal headquarters teaches the economics of corporate inversion in one lesson. Here's the trade: Medtronic agrees to call Ireland its legal home, and in return it gets to bring $1 billion or more into the U.S. without penalty. That's how much cash is sitting on Covidien's books. True, it's not nearly as much as Medtronic already has sitting in its own foreign subsidiaries. The Minneapolis-based medical technology firm currently holds $13 billion in cash abroad. But this Medtronic money is all subject to extra taxation once it crosses the U.S. border, unlike the Covidien money, which can be brought to the U.S. and invested without penalty. The same penalty-free investing goes for all of Covidien's cash flow in the future (8/12).