Viewpoints: Health Law’s Worth; States Lack Plans On Subsidies; Spending Again Rising
A selection of opinions on health care from around the country.
The New York Times' Room for Debate:
Has The Affordable Care Act Proved Its Worth?
As the Supreme Court prepares a ruling that could knock out one of the pillars of the Affordable Care Act — subsidies for federal insurance exchanges — President Obama said that three years of experience have shown that the law works, and helps people. But given what we know now about its implementation, should it be supported? Or would a ruling that jeopardizes existence be for the best? (6/11)
The Washington Post:
States Have ‘No B Plan’ If The Supreme Court Scraps Health-Care Subsidies
Any day now, the Supreme Court will announce its decision in King v. Burwell, the latest high-stakes fight over the Affordable Care Act. If the government loses, more than 6 million residents of the 34 states that declined to establish their own health-care exchanges could lose subsidies that help them purchase insurance. ... Given the potential need for swift action, do the states have contingency plans in place? Could they move quickly in the wake of an adverse decision? To investigate these questions, we undertook, with financial support from the Commonwealth Fund, a study of five states that could lose tax credits: Florida, Michigan, New Hampshire, North Carolina and Utah. (David K. Jones and Nicholas Bagley, 6/11)
The Washington Post:
The Supreme Court Would Help Democrats By Killing Obamacare
Maybe the pending King v. Burwell decision will finally put Obamacare out of its misery. No matter what President Obama or Health and Human Services secretary Sylvia Burwell say, the truth is Obamacare is just limping along as another misguided, over-priced and underperforming government program. In practice, it’s not doing anything like what was promised. ... So if Obamacare is brought down in the Supreme Court, it could actually help Obama and the Democrats save face. And it would keep Hillary Clinton from being distracted in 2016 by having to defend Obamacare as premiums continue to rise, overall healthcare costs keep going up and the program stagnates. (Ed Rogers, 6/11)
The New York Times:
On Health Care Reform, Nothing To Fear But The Scaremongers
A linchpin of the Affordable Care Act is that mid-sized and large employers must either provide health coverage for employees who work at least 30 hours a week, or pay a penalty. As with every other part of the law, Republican opponents concocted a scare story around that provision, saying that employers would cut workers’ hours in order to avoid the law’s requirements.
As with other health-care scare stories, facts have trumped the scaremongering. (Teresa Tritch, 6/11)
Los Angeles Times:
Obama Isn't Bullying The Supreme Court On Healthcare
The Hill newspaper reports that “President Obama’s impassioned defense of the Affordable Care Act is riling opponents of the law and drawing accusations he’s trying to bully the Supreme Court.” It’s a bum rap. ... presidential lobbying of the court is no big deal. The justices are all big boys and girls. Like all federal judges, they have lifetime appointments and ought to be able to withstand pressure from the president, the press or the demonstrators who often congregate near the court building. (Michael McGough, 6/11)
The Wall Street Journal:
CBO Dynamic Scoring: How Obamacare’s ‘Poverty Trap’ Impedes Economic Growth
Congressional Budget Office Director Keith Hall testified before the House Budget Committee last week about how dynamic scoring–considering macroeconomic effects of legislative proposals–affects the agency’s work. It could have a major effect on entitlement spending proposals. ... Dr. Hall’s testimony highlighted ... the way that means-tested government programs lower economic growth by effectively raising marginal tax rates. ... CBO has conducted two analyses related to Obamacare that showed that the health law would exacerbate this—discouraging work and reducing the size of the labor force. The first analysis, released in August 2010, found that the law would reduce the U.S. work force by about half of one percentage point–the equivalent of approximately 800,000 workers by 2021. The second, released in February 2014, roughly tripled that estimate to 1.5% to 2% of the labor force, or about 2.3 million workers in 2021. (Chris Jacobs, 6/11)
The Wall Street Journal:
New Evidence Health Spending Is Growing Faster Again
Like Californians waiting for the record drought to lift, health cost watchers like me have been waiting for health spending to begin to grow more rapidly again as the economy strengthens. It looks like that may now be beginning to occur. The U.S. Census Bureau has published new estimates of health spending based on their somewhat obscure but important Quarterly Services Survey. Analysis of the survey data shows that health spending was 7.3% higher in the first quarter of 2015 than in the first quarter of last year. Hospital spending increased 9.2%. Greater use of health services as well as more people covered by the ACA appear to be responsible for most of the increase. (Drew Altman, 6/11)
Politico:
Why Health Care IT Is Still On Life Support
With the best of intentions, the Obama administration six years ago launched the HITECH Act, a $30 billion program to put electronic health records (EHR) in every hospital and doctors’ office. It offered incentives for docs who bought and “meaningfully used” the technology, and penalties—which start to kick in this year—for those who failed to adopt the new technology quickly enough. The goal was to get doctors to store patient data and share it electronically with the patients, other physicians, public health agencies, laboratories and other players in the vast health care enterprise that accounts for one-fifth of our economy. There was just one problem: Medicine may have been in dire need of a high-tech revolution, but the Obama administration did not think hard enough about whether the technology was ready for medicine. (Arthur Allen, 6/11)
The New York Times:
A Pill To Boost Female Libido
A federal advisory panel has recommended that the Food and Drug Administration approve the first drug to treat a lack of sexual desire in otherwise healthy women. Some women’s groups are hailing this as a breakthrough in gender equality, a start to closing the gap between men, who have numerous drugs to treat sexual dysfunction, and women, who have none. But the panel’s recommendation was laced with so many caveats that it seems clear that this particular drug — flibanserin — is only marginally effective and carries some risk of serious adverse effects. (6/12)
The Washington Post:
A Texas-Size Injustice On Abortion
If a federal appeals court ruling issued Tuesday stands, states will be able to all but deny access to abortion on a phony pretext of concern for women’s health. The impact on poor women will be particularly severe. The Supreme Court cannot allow this to be the last word on a constitutional guarantee. (6/11)
news@JAMA:
Back To The Future: Volume As A Quality Metric
Recently, a group of leading academic institutions asked all hospitals to pledge to minimize the number of patients who undergo certain surgeries performed by surgeons and hospitals who seldom do those procedures. The “Take the Volume Pledge” campaign, initiated by 2 of the most respected experts on quality and safety in the nation, John Birkmeyer, MD, of Dartmouth-Hitchcock health system, and Peter Pronovost, MD, PhD, of Johns Hopkins Medicine, makes a lot of clinical sense. We know that when patients receive these surgeries at low-volume institutions or in the hands of low-volume surgeons, they tend to fare worse. (Ashish K. Jha, 6/11)
JAMA:
Evaluation Of Wellness Determinants And Interventions By Citizen Scientists
Most medical research focuses on disease rather than health. Yet people are interested predominantly in health and wellness. Wellness refers to diverse and interconnected dimensions of physical, mental, and social well-being that extend beyond the traditional definition of health. It includes choices and activities aimed at achieving physical vitality, mental alacrity, social satisfaction, a sense of accomplishment, and personal fulfillment. ... Disease is incompatible with health, but not with wellness. For example, a dying patient who has led a rewarding life and is surrounded by a loving family and friends may still enjoy high wellness. ... For too long, the research enterprise has not adequately reflected the preferences and values of people, widening the gap between the interests of researchers and study participants. Encouraging motivated people participating in high-quality cohorts to contribute to the design and conduct of simple trials could align the interests of investigators and citizen scientists interested in wellness. (Huseyin Naci and John P. A. Ioannidis, 6/11)