Viewpoints: Ezekiel Emanuel's choice of an age to die; new enrollment numbers still confusing

Sep 22 2014

The Atlantic: Why I Hope To Die At 75
Seventy-five. That's how long I want to live: 75 years. This preference drives my daughters crazy. It drives my brothers crazy. My loving friends think I am crazy. They think that I can't mean what I say; that I haven't thought clearly about this, because there is so much in the world to see and do. To convince me of my errors, they enumerate the myriad people I know who are over 75 and doing quite well. They are certain that as I get closer to 75, I will push the desired age back to 80, then 85, maybe even 90. I am sure of my position. ... But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived (Ezekiel J. Emanuel, 9/17).

The New York Times: When Medicine Is Futile
My father would have been thrilled to read "Dying in America," a new report by the Institute of Medicine that argues that we subject dying patients to too many treatments, denying them a peaceful death. But he would have asked what took us so long. A physician from the late 1950s to the late 1990s, my dad grew increasingly angry at how patients died in this country, too often in hospitals and connected to machines and tubes he knew would not help them (Barron H. Lerner, 9/18).

Bloomberg: Obamacare Enrollees Are Paying Premiums. We Think.
Marilyn Tavenner, the head of the Centers for Medicare & Medicaid Services, just told Congress that 7.3 million people have paid premiums and are currently enrolled in exchange policies. ... The administration says that this figure only includes people who have "paid their premiums." But what does that mean? That they paid a premium at least once? Or that they are current on their premium payments? ... One thing to note is what this means for the future: The administration needs to nearly double this enrollment in order to reach the CBO's projection of 13 million exchange policies in 2015. How easy will that be? (Megan McArdle, 9/18).

The New Republic: Obamacare Critics Said Obama Was 'Cooking the Books.' New Data Shows He Wasn't.
On Thursday, HHS finally offered an official assessment [of paid enrollment]. As of August, the department says, paid enrollment was 7.3 million. That's less than 8 million, obviously, but don't take that as a sign that things have gone wrong. As Igor Volsky of ThinkProgress notes, the insurance market isn't static. Some people will change their insurance coverage during the course of a year, because they pick up or leave jobs that offer benefits. ... If you're an Obamacare dectractor, there are plenty of arguments that you can make legitimately. ... But one thing you can't say is that the enrollment numbers are bogus. They look like the real thing (Jonathan Cohn, 9/18).

The Washington Post's Plum Line: On Health Care, Obama And The ACA Can't Win No Matter What
As you know by now, almost all the news about the implementation of the Affordable Care Act has been positive. Millions of people now have coverage. The rate of uninsured is at its lowest in decades. More insurers are lining up to participate in the exchanges. Many conservative states are coming around to expanding Medicaid and insuring their poorer citizens. There's been no premium "death spiral." Growth in premiums and overall spending are slowing significantly. All terrific. Yet as we've discussed before, President Obama doesn't get much credit for these developments (Paul Waldman, 9/18). 

Los Angeles Times: Don't Turn Down A Medi-Cal Gift, Gov. Brown
The 2010 federal healthcare reform law let states expand Medicaid, the joint federal-state health insurance program for the poor, largely at federal expense. California is one of 27 states that have taken up Washington's offer, and well over 1 million newly eligible residents signed up for coverage when the expansion went into effect this year. The response has strained the system, however, causing the backlog of enrollment applications at county offices to surge to 900,000 at one point before falling to about 350,000 this month. Adding to the workload, previous years' Medi-Cal enrollees are asking the same county offices for help in filling out the new, lengthy forms required to renew their benefits (9/18).

National Review: How Avikcare Would Fix Medicaid
Medicaid is a mess, and a very expensive one at that -; the health-insurance program for low-income Americans is administered by states but has dozens of federal mandates and rules that drive up Medicaid costs. In response, the states cook up creative financing techniques to shift more costs back to the feds. The end result, among other things, is higher taxes for everyone and poorer care for Medicaid patients. In his new health-care plan, Avik Roy, a fellow at the Manhattan Institute, proposes changes to the Medicaid system that would end the state-federal finance battle, give each entity clear cut responsibilities, and improve Medicaid patients' access to quality care (Callie Gable, 9/18).

The Wall Street Journal: Low-Wage Workers Feel The Pinch On Health Insurance
We did not see big changes in employer-based coverage in the Kaiser-HRET annual Employer Health Benefit Survey released last week. Mostly this is good news, particularly on the cost side where premiums increased just 3%. But one long-term trend that is not so good is how this market works for firms with relatively large shares of lower-wage workers (which we define as firms where at least 35% of employees earn less than $23,000). These low-wage firms often do not offer health benefits at all (Drew Altman, 9/18).

The New York Times' Opinionator: A Chance To Go From Hard Lives To Healing
Like too many young men in his East Oakland neighborhood, 21-year-old Shaka Perdue spent the earlier part of his youth "living like I was becoming a statistic," as he put it. At 16, he landed in juvenile hall after robbing a pedestrian in broad daylight. Two years later a friend was shot right in front of him in a drive-by. ... Perdue still hangs out in the neighborhood -; but he now wears a stethoscope around his neck. He is one of 90 or so graduates of EMS Corps, a pioneering five-month program spearheaded by the Alameda County Health Care Services Agency that trains young men of color to be qualified emergency medical technicians (Patricia Leigh Brown, 9/18).

Los Angeles Times: To Fight Ebola, Create A Health Workforce Reserve Force
A recent projection of the West Africa Ebola outbreak is that it now may take 12 to 18 months to control and will infect 100,000 people. President Obama announced the deployment of 3,000 military troops, more than a hundred Centers for Disease Control and Prevention personnel and millions of dollars to help stem the tide. How did the outbreak get so out of control? (Michele Barry and Lawrence Gostin, 9/18).

The Washington Post: Our Excessive Tolerance Of Suicide
From Belgium comes news that a mentally disturbed prisoner is to be granted government help in committing suicide. A typically shallow ethical debate ensued -; isn't assisted suicide for a prisoner a bit too close to capital punishment? -; before the trump card of individual autonomy was played. "Regardless, he's a human being," said Jacqueline Herremans, the head of Belgium's right-to-die association, "a human being who has the right to demand euthanasia." This is the culmination of a certain line of moral reasoning: the human right to cease to be a human being (Michael Gerson, 9/18). 

The Hill: Why Won't Medicare Cover Effective Obesity Drugs?
With several drugs already on the market and others in the pipeline, we should expect access to these medications to begin reversing the alarming obesity epidemic, right? Not so fast. Last year, the American Medical Association (AMA) formally recognized obesity as a disease. Since then, many private and public health programs, including the Federal Employee Health Benefits Program (FEHBP), now offer prescription drug coverage for obesity medications. Unfortunately, patients relying on Medicare Part D don't receive the same benefits as most federal employees and those with private insurance (Jennifer Nieto Carey, 9/19).

The Atlantic: Why I'm Becoming A Primary-Care Doctor
At medical schools, general medicine is often considered unchallenging and quaint, even though primary-care doctors are what our nation needs most from its medical schools. ... Primary care is where there are the greatest gaps in public health and the most job opportunities for recent graduates. But medical students, at least the ones I know, still shun it. I am planning on applying in family medicine in the 2015 Match, the national system that pairs medical school graduates with slots in residency-training programs. As I prepare my application, I've been doing a lot of thinking about why my career choice seems so unimaginable to so many of my classmates. Why do students at elite medical schools think primary care is boring? (Mara Gordon, 9/18).