Viewpoints: Shifting Health Care Costs; What About New Payment Systems?
A selection of opinions on health care from around the country.
Health Insurers Shift More Costs To Taxpayers In Obamacare Exchanges
America’s health insurers are undergoing a crisis of consensus with respect to their engagement with Obamacare. Between 2010 (when the Affordable Care Act was signed) and 2014 (the first year of taxpayer-subsidized coverage in the health insurance exchanges), it was widely understood that health insurers had scored a big win. After all, which other industry could get the federal government to pass a law mandating individuals purchase its product or service as a condition of residency in the United States? (John Graham, 5/4)
The New England Journal Of Medicine:
When New Medicare Payment Systems Collide
Since 2012, the Center for Medicare and Medicaid Services (CMS) has introduced more than a dozen new Medicare payment models. Most of them emanate from the Center for Medicare and Medicaid Innovation (CMMI), whose strategy is to launch various initiatives, evaluate them rapidly, and expand those that reduce spending without harming quality of care. (Robert E. Mechanic, 5/5)
JAMA Forum: The Cost of Medicare Advantage
The Medicare Advantage program, which offers private plan alternatives to traditional Medicare, is surging in popularity among Medicare beneficiaries. More than 30% of about 55 million beneficiaries are enrolled in a Medicare Advantage plan, up from 16% a decade ago. Yet among policy experts it remains as controversial as ever. At issue: do Medicare Advantage plans cost more or less than traditional Medicare? (Austin Frakt, 5/4)
The Philadelphia Inquirer:
Health Care Costs And The ACO Delusion
Accountable care organizations (ACO’s) promise to save us. Dreamed up by Dartmouth’s Eliot Fisher in 2006, and signed into law as a part of the Affordable Care Act (ACA) in 2010, we have been sold on the idea that this particular incarnation of the HMO/Managed Care will save the government, save physicians and save patients all at the same time. I dare say that Brahma, Vishnu and Shiva together would struggle to accomplish those lofty goals. Regardless of the daunting task in front of them, the brave policy gods who see patients about as often as they see pink unicorns, chose to release the Kraken – I mean the ACO – onto an unsuspecting public based on the assumption that anything was better than letting those big, bad, test ordering, hospital admitting, brand name prescribing physicians from running a muck. (Dr. Anish Koka, 5/4)
Undertrained Doctors, Overprescribed Drugs
When doctors prescribe medicine, more than just their patients count on them to get it right. Society as a whole has an interest in keeping certain drugs under control -- and the evidence shows that when it comes to opioid pain relievers and antibiotics, some doctors are failing to do so. (5/4)
High Patient Cost-Sharing Is The Elephant In The Room During Election
It's not exactly breaking news. But two new reports highlight how Americans are struggling with high out-of-pocket medical costs even as most of the presidential candidates slog through their epic, insult-laden primary election battles hardly talking about the issue. The findings suggest there will be strong public pressure for a solution no matter who wins the November election. (Harris Meyer, 5/4)
The New England Journal Of Medicine:
Decriminalizing Mental Illness — The Miami Model
U.S. correctional institutions, local courts, and police officers frequently encounter people with untreated or undertreated serious mental illnesses, often coupled with substance-use disorders. These encounters usually stem from the alleged commission of a misdemeanor — trespassing, panhandling, petty theft — or a minor, nonviolent felony. Each year, about 11.4 million people are booked into local U.S. jails, where on any given day, 745,000 of them are held. An estimated 16.9% of jail detainees have a serious mental illness,1 which means that nearly 2 million people with such illnesses are arrested each year. (John K. Iglehart, 5/5)
Lexington Herald Leader:
Open Records In OxyContin Case
There’s no doubt that the public has a deep interest in understanding the origins of the opioid abuse epidemic that continues to spiral out of control and has harmed so many people, especially in Kentucky. Pike Circuit Judge Steven Combs can shed light on a critical public-health issue and preserve the openness of Kentucky’s courts and public agencies by unsealing court records in the state’s case against Purdue Pharma, the company whose criminally misleading marketing of the painkiller OxyContin has contributed to so much addiction, crime and social dysfunction. (5/4)
The Washington Post:
My Mom ODed On Painkillers. I Miss Her Every Day.
On March 2, 2002, I was playing with toys that fart in a Spencer Gifts when my mom called me. She just wanted to say hi and tell me she loved me. At the time, we’d been fighting quite a bit. I was 14, and she was addicted to prescription painkillers. Both of us were hard to deal with. She claimed to be sober but wasn’t. The summer before, when I’d broken my foot, she stole my Vicodin. She said she wanted to keep it safe so I wouldn’t take too much and become an addict like her. But I didn’t believe her. I counted how many were in the bottle when she took it away, and then counted again several hours later. Four were missing. Duh. But I didn’t confront her. I didn’t know how to. (Mollie Kotzen, 5/5)
The New York Times' Room For Debate:
Should Opioid Training For Doctors Be Mandatory?
As police continue to investigate the role prescription narcotics may have played in the death of the musician Prince, a group of advisers to the Food and Drug Administration recommended mandatory training for doctors who prescribe these powerful painkillers. The hope is that this initiative will help stem what some are calling an epidemic of overdose deaths involving opioids. The F.D.A. is not required to follow advice such as this, though it often does. (5/5)
The Baltimore Sun:
Md. Sets Health Care Example
We know that people who have access to quality health coverage are more secure, have better health outcomes and don't have to worry that one illness or injury will put them and their family in a downward spiral. This is particularly true for the formerly incarcerated who, after serving their time, might not have access to the health coverage that will help them get back on their feet. (Vincent DeMarco, 5/4)
The Baltimore Sun:
While Maryland Dallies On Medical Marijuana, Children Suffer
Parents helplessly watch the open, vacant unseeing eyes of their child, knowing inside their kid's brain an electrical firestorm rages. The seizure passes, and the immediate parental relief is tempered by hard experience: This is just a break until it happens again — and it always, always happens again. (Jennifer and Chuck Porcari, 5/4)
The Des Moines Register:
What'S So Funny About Obesity?
Fat jokes: Criticism comes with being a columnist. It’s only fair. This newspaper gives me a lot of space to share my opinions. It’s reasonable some people will disagree, even vehemently so. But there’s one trend I notice in negative responses I receive that I struggle to understand. (Daniel Finney, 5/4)
The Des Moines Register:
Why Flint Couldn't Happen Here
This year’s Drinking Water Week, May 1-7, serves to remind all of us that safe drinking water doesn’t just happen. A case in point is the recent public outrage and questions regarding the safety of tap water as a result of toxic lead levels in Flint, Mich. During past year, the serious consequences of improperly treated water have affected thousands of Flint residents, most of whom had implicitly trusted the quality and safety of their water. As the story of Flint with its political ramifications and alleged malfeasance by water regulators and city officials unfolded, media and community advocates began to call into question the integrity of all water utilities and regulators. If it can happen in Flint, could it happen here? (5/4)