Viewpoints: 'Raw judicial politics' on health law; Texas abortion trial; suicide and gender

Aug 22 2014

The New York Times: By Any Means Necessary
The Affordable Care Act -- Obamacare -- has endured so many near-death experiences that digging into the details of still another effort to demolish it is admittedly not an inviting prospect. (My own reaction, I confess, to hearing some months back about the latest legal challenge -- this one aimed at the supposed effect of a single word in the 900-page statute -- was something along the lines of "wake me when it's over.") But stay with me, because this latest round, catapulted onto the Supreme Court's docket earlier this month by the same forces that brought us the failed Commerce Clause attack two years ago, opens a window on raw judicial politics so extreme that the saga so far would be funny if the potential consequences weren't so serious (Linda Greenhouse, 8/20). 

Bloomberg: Republicans Won't Have Obamacare Forever
[Arkansas Sen. Mark] Pryor doesn't say that he helped pass "Obamacare," or even that he helped pass the "Affordable Care Act." Instead, he simply touts provisions of the law that almost certainly sound good to most people, saying that he "helped pass a law that prevents insurance companies from canceling your policy if you get sick, or deny coverage for preexisting conditions." The wrong way to think about this is to imagine that the ACA is getting more popular. It isn't .... But what this does get to is that individual provisions of the law (especially, naturally, the benefits) have always polled well, and the Republican solution -- repeal -- is even more unpopular than the law itself (Jonathan Bernstein, 8/20).

The New York Times: Quackery And Abortion Rights
The deception behind the wave of state-level abortion restrictions now threatening women's access to safe and legal abortions was strikingly revealed during a trial that ended last week in Texas (8/20). 

The New York Times' Room For Debate: When Do Doctors Have The Right To Speak?
Two federal appellate court decisions, one allowing Florida to prevent doctors from discussing gun safety with patients, the other letting California ban "gay-conversion" therapy, raise questions about health professionals' First Amendment rights. Do occupational-licensing laws trump the First Amendment? What limits, if any, does the First Amendment impose on government's ability to restrict advice? (8/20). 

The Wall Street Journal: The Golden Age Of Neuroscience Has Arrived
More than a billion people were amazed this summer when a 29-year-old paraplegic man from Brazil raised his right leg and kicked a soccer ball to ceremonially begin the World Cup. The sight of a paralyzed person whose brain directly controlled a robotic exoskeleton (designed at Duke University) was thrilling. We are now entering the golden age of neuroscience. We have learned more about the thinking brain in the last 10-15 years than in all of previous human history (Michio Kaku, 8/20). 

The Wall Street Journal: FedEx's 'Money Laundering' Scheme
According to U.S. Attorney for the Northern District of California Melinda Haag's revised indictment, FedEx engaged in a "conspiracy to launder" more than $630,000 in payments from shipping drugs sold illegally by online pharmacies. Justice accuses FedEx of conspiring to launder money because it "requested payment for providing shipping services" to such fly-by-night pharmacies via wire transfers, checks, direct debits, credit card charges and telephone. But as we wrote last week, FedEx had no way of knowing which pharmacies were violating the law by filling orders without valid prescriptions, and Justice hasn't provided FedEx with a list. Even if employees ripped open packages, they wouldn't be able to finger the contraband (8/20). 

Bloomberg: Why Do More Men Commit Suicide?
Robin Williams's death has brought welcome attention to the very real problem of suicide in the U.S. From 2000 to 2011, suicides increased to 12.3 per 100,000 people from 10.4. Deaths by suicide now exceed those from motor-vehicle accidents. This is not, as you might think, a problem occurring disproportionately among teenagers or the very old. The people most prone to taking their own lives are those 45 to 59 years old .... What puzzles researchers even more is that men commit suicide more often than women do -- about four times as often -- even though most studies find that women are twice as likely to be depressed and also more likely to have suicidal thoughts (Peter R. Orszag, 8/20).

The New England Journal Of Medicine: The Impact And Evolution Of Medicare Part D
Many ACA provisions position Medicare for major payment and delivery-system changes that are designed to improve quality and reduce spending growth. These reforms include altering provider reimbursement to encourage efficiency and improving care coordination among providers. In some ways, the Part D program, which is run by stand-alone plans that don't carry risk for total medical spending and have no financial relationships with providers, is out of sync with such changes. ... [T]he long-term success of payment and delivery-system reforms will depend in part on integrating Part D policy with broader reforms (Julie M. Donohue, 8/21).

The New England Journal Of Medicine: Did Hospital Engagement Networks Actually Improve Care?
Everyone with a role in health care wants to improve the quality and safety of our delivery system. Recently, the Centers for Medicare and Medicaid Services (CMS) released results of its Partnership for Patients Program (PPP) and celebrated large improvements in patient outcomes. But the PPP's weak study design and methods, combined with a lack of transparency and rigor in evaluation, make it difficult to determine whether the program improved care. ... [T]he failure to generate valid, reliable information hampers our ability to improve future interventions, because we are no closer to understanding how to improve care than we were before the PPP (Drs. Peter Pronovost and Ashish K. Jha, 8/21).