Viewpoints: More Health Exchange Battles; What About Insurance And State Lines?
A selection of opinions on health care from around the country.
The New England Journal Of Medicine:
Trouble On The Exchanges — Does The United States Owe Billions To Health Insurers?
Yet another bruising fight has erupted over health care reform. On September 9, 2016, the Obama administration offered to open settlement negotiations with health insurers that have sued the United States to recover billions of dollars that they claim they are owed. Congressional Republicans are incensed, believing that any settlement would illegally squander taxpayer dollars in a last-gasp effort to save the Affordable Care Act. (Nicholas Bagley, 10/19)
Those Pesky Lines Around States
In the recent presidential debate, moderator Anderson Cooper asked Donald Trump how he would “make coverage accessible for people with preexisting conditions” if the Affordable Care Act (ACA) is repealed. Trump responded: “Once we break out—once we break out the lines [around the states] and allow the competition to come…when we get rid of those lines, you will have competition, and we will be able to keep preexisting, we’ll also be able to help people that can’t get—don’t have money because we are going to have people protected.” (Larry Levitt, 10/19)
Investing Wisely In Health Care Capital
Health care expenditures increase for 2 reasons: patients consume more services, and the cost of those services increases. Costs of services have 2 components: operating costs and capital costs. Capital represents the total pool of funds expended by a health care organization to build, acquire, or upgrade physical assets such as property, buildings, technology, or equipment. In 2014, US health care capital expenditures exceeded the Organisation for Economic Co-operation and Development average, totaling US $88.8 billion, about 3% of US $3 trillion spent on all health care.1,2 In the same year, Canada spent CAD $8.8 billion on health care capital, representing 4.1% of the CAD $214.9 billion spent on all health care, compared with 15% spent on physician services and 16% on drugs.3 Perhaps because they are numerically smaller, capital expenditures, while clearly noticeable, usually generate less controversy compared with the well-known public debate about drug prices or physician and hospital fees. (David J. Klein, Adalsteinn D. Brown and Allan S. Detsky, 10/18)
The New England Journal Of Medicine:
Wartime Lessons — Shaping A National Trauma Action Plan
Since the end of major combat operations in Iraq and Afghanistan, analysis of the lessons learned from those wars has focused largely on the wisdom of various foreign-policy decisions, the wars’ financial and human costs, and their repercussions for U.S. national security. Although it’s long been held that “the only victor in war is medicine,” until recently there had been little consideration of the effect of war on military and civilian trauma care. (Todd E. Rasmussen and Arthur L. Kellermann, 10/19)
The Ethics Of Behavioral Health Information Technology
A subpopulation of individuals with serious mental health conditions makes repeated and frequent visits to emergency departments and psychiatric crisis centers. These so-called super utilizers often have financial problems and present with chronic or untreated comorbid psychiatric and substance use disorders.1 These patients are often well known to clinical staff and are sometimes colloquially labeled “frequent flyers.” A pejorative branding, “frequent flyers” are often assumed to be problem patients. In psychiatric settings, these patients are sometimes said to be “borderlines,” “drug seekers,” “malingerers,” or “treatment resistant.” (Michelle Joy, Timothy Clement and Dominic Sisti,10/18)
Opioids: Can We Unlock The Potential Of Prescription Drug Monitoring Programs?
A recent report from the Substance Abuse and Mental Health Services Administration indicates that in 2015 more adults used prescription painkillers than cigarettes, cigars, and smokeless tobacco combined. Politicians, government agencies, and policymakers have touted prescription drug monitoring programs as a way to curb the over-prescription and side effects of opioids. (Jason Fodeman, 10/21)
The Washington Post:
What Could Stop Antiabortion Momentum? Trump Winning.
Things are looking good for the antiabortion movement. We have almost completed the struggle of disentangling ourselves from the toxic, simplistic, binary culture wars of the 1970s. Twenty-million Democrats identify as “pro-life.” The voices of people of color, disproportionately against abortion when compared with whites, are finally being heard by our movement. Almost every major antiabortion organization has women’s issues at the center of their concern and is being led by a woman. (Charles Camosy, 10/20)
The New York Times:
Late-Term Abortion Was The Right Choice For Me
I was 21 weeks pregnant when a doctor told my husband and me that our second little boy was missing half his heart. It had stopped growing correctly around five weeks gestation, but the abnormality was not detectable until the 20-week anatomy scan. It was very unlikely that our baby would survive delivery, and if he did, he would ultimately need a heart transplant. (Meredith Isaksen, 10/20)
Los Angeles Times:
A Yes Vote On Proposition 61 Will Send A Strong Message To Big Pharma And Washington
Prescription drug prices in the United States are the highest in the world — by far. Californians on Nov. 8 have a chance to stand up to the pharmaceutical industry’s greed and spark a national movement to end this price-gouging. Today, no laws prevent drug companies from doubling or tripling prices. So they just do it. The most recent flagrant example is the emergency allergy injection, EpiPen. Its maker, Mylan, jacked up the price of this 40-year-old medication by 461% between 2007 and 2015. During that same period, compensation for Mylan’s CEO rose 671%. And that’s just one company and one drug. (Bernie Sanders, 10/21)
My Stroke Changed Me, But I Still Fight For Illinois Families
When I first got to the Senate in 2010, the 42 steps to the door of the U.S. Capitol would have taken me about a minute to climb. I definitely would not have been nervous, excited or focused. In fact, I probably would have been on my phone and not thinking twice about them. (Mark Kirk, 10/19)
The New England Journal Of Medicine:
Effect Of Medicaid Coverage On ED Use — Further Evidence From Oregon’s Experiment
The effect of Medicaid coverage on health and the use of health care services is of first-order policy importance, particularly as policymakers consider expansions of public health insurance. Estimating the effects of expanding Medicaid is challenging, however, because Medicaid enrollees and the uninsured differ in many ways that may also affect outcomes of interest. Oregon’s 2008 expansion of Medicaid through random-lottery selection of potential enrollees from a waiting list offers the opportunity to assess Medicaid’s effects with a randomized evaluation that is not contaminated by such confounding factors. In a previous examination of the Oregon Health Insurance Experiment, we found that Medicaid coverage increased health care use across a range of settings, improved financial security, and reduced rates of depression among enrollees, but it produced no detectable changes in several measures of physical health, employment rates, or earnings. (Amy N. Finkelstein, Sarah L. Taubman, Heidi L. Allen, Bill J. Wright and Katherine Baicker, 10/20)