Kaiser Health News - Public Health

Research Roundup: Getting A Critical Care Doc At Night; Poverty Among Seniors

Fri, 24 May 2013 13:16:00 GMT

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

JAMA Internal Medicine: Firearm Legislation And Firearm-Related Fatalities In The United States – Researchers analyzed 121,084 firearms deaths in the U.S., using 2007 to 2010 data from the Centers for Disease Control and Prevention: "The outcome measures were state-level firearm-related fatalities per 100 000 individuals per year overall, for suicide, and for homicide. In various models, we controlled for age, sex, race/ethnicity, poverty, unemployment, college education, population density, nonfirearm violence–related deaths, and household firearm ownership." They concluded that a "higher number of firearm laws in a state are associated with a lower rate of firearm fatalities in the state, overall and for suicides and homicides individually. As our study could not determine cause-and-effect relationships, further studies are necessary to define the nature of this association" (Fleegler et al., 5/13).

New England Journal Of Medicine: A Randomized Trial Of Nighttime Physician Staffing In An Intensive Care Unit – Previous studies suggest that the use of intensivists, doctors specifically trained in critical-care medicine, improve the outcomes of intensive care unit (ICU) patients. But studies analyzing the impact of nighttime staffing of intensivists in ICUs have shown mixed results. Researchers at the Hospital of the University of Pennsylvania compared nighttime staffing to the use of daytime intensivists who were available for phone-based consultation at night. More than 1,500 patients were included in their analyses. "We found no evidence that this staffing model, as compared with nighttime telephone availability of the daytime intensivist, had a significant effect on length of stay in the ICU or hospital, ICU or in-hospital mortality, readmission to the ICU, or the probability of discharge to home," the authors write. "In an academic medical ICU in the United States, nighttime in-hospital intensivist staffing did not improve patient outcomes" (Kerlin et al., 5/20).

Annals Of Family Medicine: Spreading A Medical Home Redesign: Effects On Emergency Department Use And Hospital Admissions – Patient centered medical homes (PCMH) emphasize long-term relationships between patients and providers as well as other attributes of primary care. This study analyzed how PCMHs in clinics owned by the Washington state insurance and health care system, Group Health Cooperative, affected health care use. The authors found that, one year after the implementation, Group Health patient visits to emergency departments significantly declined and there was a shift from face-to-face doctor/patient visits to greater use of secure messaging and telephone conversations. "Group Health's experience in spreading its PCMH model shows that achieving PCMH transformation across a diverse set of primary care clinics is possible with a clear change strategy … and sufficient resources and supports," they conclude (Reid et al., May 2013).

Health Care Cost Institute: Health Care Costs From Birth To Death -- Using commercial and Medicare health care data, the author of this report (sponsored by the Society of Actuaries) analyzed cost differences based on age, sex and health status. He reports that costs are generally high in the two years of life and then drop by age 5. They pick up again in the teen years and for women increase during the child-bearing years. Among other key findings: "An aging population is not an overwhelming driver of health care spending. ... Health costs are twice as high for people with cancer or other chronic conditions. Older men are more costly than older women" (Yamamoto, May 2013).

Kaiser Family Foundation: A State-By-State Snapshot Of Poverty Among Seniors: Findings From Analysis Of The Supplemental Poverty Measure – The authors write: "During recent deficit reduction discussions, policymakers have put forth a variety of proposals to reduce Federal spending that would affect people on Medicare, including options that would shift costs onto beneficiaries ... Based on the Census Bureau’s supplemental poverty measure, the poverty rate among people ages 65 and older is higher than is reflected in the official poverty measure, and is particularly high among seniors in some states. ... Under the supplemental poverty measure, which deducts health spending from income, poverty rates could increase if beneficiaries were required to pay higher cost sharing or premiums for Medicare. ... The supplemental measure suggests that a greater share of seniors may already be struggling financially than is conveyed by the official measure" (Levinson et al., 5/20).

Here is a selection of news coverage of other recent research:

San Francisco Chronicle: 56% Of Patients Don't Follow Prescription
It might take more than a spoonful of sugar to help the medicine go down for many Americans. In a survey of more than 1,000 adult patients who are on prescription medication for chronic illnesses, 40 percent say they haven't followed doctor's instructions or have skipped taking their meds at least once in the past year. More than a quarter said they've stopped taking medications altogether or never even filled a prescription. It's a problem known as medication nonadherence and is linked to 125,000 deaths in the United States each year (Roethel, 5/21).

Medpage Today: Medical Home Transition Long But Worth It
The path to becoming a patient-centered medical home is long, rough, and varies for each practice, but getting there is essential to providing high-quality, affordable healthcare to all Americans, researchers concluded. The Agency for Healthcare Research and Quality (AHRQ) came to that conclusion in summarizing the results of 14 grants it issued in the summer of 2010 to understand the processes and determinants of transforming primary care practices. ... The results were published Monday in a special supplement of the Annals of Family Medicine (Pittman, 5/20).

Reuters: Health Sites Too Complex, Full Of Cliches: Study
The importance of health literacy hit home for Lisa Gualtieri when a Cambodian refugee diagnosed with cancer asked her to act as a patient advocate. … A new study, published Monday in JAMA Internal Medicine, suggests one potential reason for the family's confusion: Despite good intentions, many experts may be creating educational materials that are too difficult for patients and their families to grasp (Oransky, 5/20).

Viewpoints: We Need More 'Socialism'; The IRS's 'Unwelcome Role'; 'Fog Of Obamacare'

Fri, 24 May 2013 13:11:20 GMT

Los Angeles Times: If This Health Plan Is 'Socialism,' We Need More Of It
So this is what socialism looks like: Private companies competing for people's business in an open marketplace. Californians got their first glimpse Thursday of what insurers plan to charge for coverage to be offered next year to about 5 million state residents who don't receive health insurance from employers (David Lazarus, 5/23).

The Washington Post: The Unwelcome Role Of The IRS In Obamacare
Thousands of new IRS agents will implement 40-odd provisions of the Patient Protection and Affordable Care Act — the exact number is a matter of dispute since the law itself is so confusing. The largest tax law and social policy change in a generation will be imposed on a skeptical public by a government agency whose credibility is in ruins. But the IRS is not merely implementing Obamacare. It engaged in a regulatory power grab to ensure that it could implement Obamacare (Michael Gerson, 5/23).

The Washington Post: The Fog Of Obamacare
You’ve heard of the "fog of war." Well, now we've got the fog of Obamacare. The controversial Affordable Care Act (ACA) has so many moving parts that it's hard to know how its implementation is proceeding. In 2014, many uninsured are supposed to get coverage either through insurance exchanges, where they can buy subsidized policies if their incomes are less than four times the federal poverty line, or through an expanded Medicaid. The trouble is that 20 or more states may reject the Medicaid expansion, and the exchanges aren’t yet finished. Much is unknown (Robert J. Sameulson, 5/23).

The New York Times' Economix: Debating Doctors' Compensation
Two themes run through the comments on previous blog posts that touched on the payment of the providers of health care. The first is that American doctors are paid too much. The second is that they are paid too little. Could both propositions be right? Let us explore the issue by looking at some numbers (Uwe E. Reinhardt, 5/24).

New England Journal Of Medicine: The Gross Domestic Product And Health Care Spending
How much will the United States spend on health care during the next decade or two? The answer matters greatly to physicians, federal and state governments, businesses, and the general public. The answer will determine the type and extent of care that physicians can provide to their patients, as well as the amount of physicians' take-home pay. It will also determine how much everyone else can consume or invest in other goods and services. Unfortunately, forecasting health care spending is extremely difficult. Future spending depends in part on developments within the health care sector and in part on developments in the economy as a whole (Victor Fuchs, 5/22).

Boston Globe: Do I Miss My Breasts?
I had voluptuous breasts. I miss them, when I think about them. But I rarely think about them because I’m busy not missing my family’s milestones and ordinary moments. The kind of moments that I suspect Angelina Jolie does not want to miss. Jolie and I have more in common than being mothers and having sexy husbands. I, too, carry the BRCA1 gene alteration, a mutation that raises a woman’s lifetime risk of ovarian cancer to 40-60 percent and breast cancer to 50-80 percent (Ellen Roth, 5/22).

WBUR: Cognoscenti: The Power Of Knowing: A Daughter Who Chose BRCA Gene Testing, Against Her Mother's Will
When Angelina Jolie explained in The New York Times her decision to take action after discovering she carried the BRCA-1 mutation, I saw on social media so many women asking each other, Would you undergo genetic testing? Many expressed anger at Myriad (the company that owns the patent), at insurance companies (several do not cover the cost of the test), and at doctors they believe hold assumptions about organ removal. While some cited how removing one's organs could shorten or alter their lives, as could cancer itself, others judged individual preferences as "right" or "wrong" (Tracy Strauss, 5/24).

The New York Times' Doctor And Patient: Disability And Discrimination At The Doctor's Office
It's been nearly 23 years since the Americans With Disabilities Act, a federal law prohibiting discrimination against people with disabilities, went into effect. Despite its unequivocal language, studies in recent years have revealed that disabled patients tend not only to be in poorer health, but also to receive inadequate preventive care and to experience worse outcomes (Pauline W. Chen, MD, 5/23).

USA Today: Mental Illness Manual No 'Bible': Column
Unlike many other physical ailments, there are no acceptable scientific tests that can pinpoint mental disorders. A blood test won't tell doctors which of my son's diagnoses, if any, are accurate. Instead, psychiatrists must rely on a patient or family members to describe symptoms of the illness to make a diagnosis. The doctor then consults psychiatry's "bible" — the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) — to determine which diagnosis best fits the patient's symptoms. This process can be ripe for error, especially if a patient doesn't believe there is anything wrong, a common reaction during a psychotic break (Pete Earley, 5/23).

The New York Times' Taking Note: Abortion After 20 Weeks
On the list of treasured Republican pastimes, trying to outlaw abortion and imposing a right-wing agenda on the District of Columbia (which is heavily Democratic and lacks any representation in Congress) both rank high. So it must have given Rep. Trent Franks of Arizona special pleasure to combine those hobbies by introducing a bill to ban abortion in D.C. after 20 weeks. But why stop there? (Andrew Rosenthal, 5/23).

New England Journal Of Medicine: Under The Medical Tent At The Boston Marathon
Bright sunlight filtered through the awnings of the medical tent pitched in Copley Square, where I joined the many medical professionals caring for people who'd fallen ill from their 26.2-mile run. Some volunteers had been staffing the medical tent for years — one nurse had worked at the Boston Marathon more than 25 times. Sickened and stressed runners poured into our makeshift hospital. A runner stumbled in and vomited into a bag. We helped him onto a cot, where he sat shivering. "You're OK," a nurse said gently, wiping his face. But his core temperature had dropped to 96 degrees, and he began having violent rigors. We brought him Mylar blankets and hot bouillon (Sushrut Jangi, 5/23).

Senate Immigration Bill Would Ease Restrictions On Foreign Health Workers

Thu, 23 May 2013 13:33:00 GMT

On Capitol Hill, several legislative efforts are moving forward on health issues. Among them is an effort by the Massachusetts delegation to keep bonus Medicare payments for the state's hospitals, while House Republicans are looking for another way to deal with a bill to fund high-risk insurance pools. In addition, a Senate measure is advancing that would increase scrutiny On compounding pharmacies.

Modern Healthcare: Immigration Bill Seeks To Ease Rules For Foreign Health Workers
After 30 hours of debate over a three-week period, the Senate Judiciary Committee has passed a bipartisan immigration bill that would seek to strengthen the country's healthcare workforce by making it easier for foreign health professionals to work in the U.S. The panel voted 13-5 on Tuesday to approve the sweeping Border Security, Economic Opportunity and Immigration Modernization Act (PDF) that Sen. Charles Schumer (D-N.Y.) introduced last month. In all, the committee considered 212 amendments in the bill that Senate Majority Leader Harry Reid has said he would like to bring to the floor for debate in June, "sometime soon" after Congress returns from a weeklong Memorial Day work period (Zigmond, 5/22).

Boston Globe: Mass. Tries To Retain $250 Million For Hospitals
The Massachusetts congressional delegation, after holding a rare emergency meeting Wednesday, launched what could be a final effort to preserve more than $250 million in bonus Medicare payments to the state's hospitals that critics call the "Bay State boondoggle." But the prospect of holding on to the windfall is dimming. The Democrat-controlled Senate voted earlier this year to end the payments, enacted under President Obama's health care overhaul law and which come at the expense of most other states. A similar bill was introduced in the Republican-led House this week (Jan, 5/23).

Reuters: Senate Committee Advances Drug Compounding Bill
A U.S. Senate committee on Wednesday unanimously approved legislation that would increase federal oversight for companies that compound and sell sterile drugs across state lines. The proposed legislation was introduced in response to a meningitis outbreak last fall that killed more than 50 people and sickened more than 700. The outbreak was traced to contamination found in steroid injections made by the New England Compounding Center (Dye, 5/22).

Kansas City Star: With Roberts' Backing, Bill To Reform Pharmacy Compounding Heads To Senate
A U.S. Senate committee on Wednesday passed bipartisan legislation that would fundamentally change how large-scale pharmacy compounding is practiced in this country. Also Wednesday, the Senate's Health, Education, Labor and Pensions Committee issued a report showing that poor compounding practices have persisted even since last fall, when a meningitis outbreak linked to contaminated steroid injections killed 55 people and sickened about 700 (Morris, 5/22).

CQ HealthBeat: Rejected High-Risk-Pool Bill To Get Another Chance
A month after House Republican leaders were forced to pull an unpopular health care law revision from the House floor, bill sponsor Rep. Joe Pitts said he expects to see a modified version under consideration again in "a couple of weeks." The reworked measure appears designed to mollify critics in the GOP rank and file who argued that the bill, as introduced, would have, in effect, just bolstered the president's signature health care law rather than repealed its provisions (Dumain and Ethridge, 5/22).

And, during a recent hearing -

McClatchy: Medical Company Declines To Answer Senate Questions On Medicare Billing
The president and chief executive officer of a medical equipment company invoked the Fifth Amendment at Senate hearing Wednesday, declining to answer questions about aggressive marketing tactics used to sell scooters, sleep apnea machines and other home medical supplies to Medicare recipients who may not need or want them. Jon Letko of U.S. Healthcare Supply LLC, based in Milford, N.J., exercised his constitutional right not to incriminate himself at the hearing before the Senate Subcommittee on Financial and Contracting Oversight (Wise, 5/22).

Viewpoints: Sen. Alexander Sees Reflections Of Oliver North In Sebelius' Quest To Raise Funds; Vaccine Scare's Legacy

Thu, 23 May 2013 04:00:00 GMT

The Wall Street Journal: Kathleen Sebelius, Meet Oliver North
Major news outlets in recent days have reported that U.S. Department of Health and Human Services Secretary Kathleen Sebelius is raising money from the private sector -- including from health care executives -- for use by a private entity that is helping to implement ObamaCare. ... Is Ms. Sebelius raising funds for a private entity and then coordinating with that entity to do something Congress has refused to authorize, or for which it has refused to appropriate funds? And is she raising money from organizations she regulates, in violation of ethics laws? (Sen. Lamar Alexander, R-Tenn., 5/22).

The New York Times: Aftermath Of An Unfounded Vaccine Scare
Britain is experiencing serious outbreaks of measles that look to be a delayed consequence of a failure to vaccinate infants and young children more than a decade ago. A prime cause of that failure was ill-founded fears among parents that a widely used vaccine to combat measles, mumps and rubella might cause autism. Because they shunned the vaccine, their children, now in their teens, are suffering the consequences (5/22).

Milwaukee Journal-Sentinel: Mandatory Vaccinations Deserve Vigorous Debate
The debate over the mandatory influenza vaccinations of employees is worthy of a vigorous public airing. Controversy has been growing nationwide over the plight of employees, particularly health care workers, being dismissed from jobs due to their refusal to accept this unwanted intrusion into their personal health care decisions. I fully recognize this argument pits two groups advocating against each other over a position based on rights. Employers demand flu vaccinations of employees, with extremely limited exceptions, as a fundamental right of an employer. Those who object stand on individual liberties to make their own personal health care decisions without the threat of dismissal (Jeremy Thiesfeldt, 5/22).

The New York Times: Kill Bill
According to statistics United Republic assembled, the prescription drug industry spent $116 million lobbying for legislation to prevent Medicare from bargaining down drug prices — legislation that enabled drug companies to make an additional $90 billion annually. That amounts to an extraordinary 77,500 percent return on investment. Oil companies, in turn, had a return on investment of 5,900 percent, and multinational companies, 22,000 percent (Thomas B. Edsall, 5/22).

The New England Journal of Medicine: The Gross Domestic Product And Health Care Spending
An examination of data from the past 60 years for the economy as a whole and for health care expenditures indicates that there has been a robust relationship between the two. ... Some observers place great emphasis on the particularly slow growth of national health care expenditures in 2010 and 2011. How useful is the experience of growth over a period of 2 years in predicting the growth rate over the next 20 years? The answer seems to be not at all. ... [T]he rate of growth of national health care expenditures in the past appears to have been substantially related to the growth of the GDP. There has been some slowing of the growth of health care spending relative to the GDP, but it began not just a few years ago, but in the 1990s (Victor R. Fuchs, 5/22).

Columbus Dispatch: Obamacare May Lead To 'Skinny' Policies
Would you like to have a "skinny" health-insurance policy? Probably not. But if you're employed by a large company, you may get one, thanks to Obamacare. That’s the conclusion of Wall Street Journal reporters Christopher Weaver and Anna Wilde Mathews. They report that insurance brokers are pitching and selling "low-benefit" policies across the country. You might be wondering what a "skinny" or "low-benefit" insurance plan is. The terms may vary, but the basic idea is that policies would cover preventive care, a limited number of doctor visits and perhaps generic drugs. They wouldn't cover things such as surgery, hospital stays or prenatal care (Michael Barrone, 5/23).

JAMA: Public Health Regulation As A Public Process
Media coverage of new public health regulations often seems to follow a template: The [regulatory agency]'s plan to implement [public health regulation] is causing controversy among [businesses affected] and [individuals who object]. … But there's another way to think about how policy is developed to improve health: as a dynamic process open to a range of policy alternatives (Dr. Joshua M. Sharfstein, 5/22).

JAMA: Encouraging Smokers to Talk With Their Physicians About Quitting
Over the next few months, physicians may see an increase in patients asking for help in quitting smoking. Why? The Office on Smoking and Health at the Centers for Disease Control and Prevention recently launched the second stage of its national media campaign, Tips from Former Smokers (Tips). Some of the ads include a new call to action with the message, "You can quit. Talk with your doctor for help." This "talk with your doctor" initiative provides physicians with a golden opportunity to help more patients quit smoking (Dr. Tim McAfee, 5/22).

The Lund Report: Physician, First Do No Harm -- To Yourself
Studies confirm most doctors are overworked, exhausted, or depressed. The tragedy: few seek help. I ask the group, "How many physicians have lost a colleague to suicide?" All hands are raised. "How many have considered suicide?" Except for one woman, all hands remain up -- including mine. "Physicians have the highest suicide rate of any profession," I explain. "In the United States we lose over 400 physicians per year to suicide. That's the equivalent of an entire medical school. Even that's an underestimate because many physician suicides are incorrectly identified as accidents" (Dr. Pamela Wible, 5/21).

MinnPost: Failed Virginia Bill On Miscarriages Reveals Ignorance About Women's Health
As I've written here before, the medical ignorance of some politicians -- particularly in regard to women's reproductive health -- is a continual source of astonishment. ... While searching through the legislative history of Virginia state Sen. Mark Obenshain, now running on the Republican ticket for his state's attorney general position, reporters found that he had authored a bill in 2009 that would have required all women in Virginia to report miscarriages to police or risk legal penalties, including as much as a year in jail (Susan Perry, 5/22).

Bloomberg: Better Death Records Can Lead To Longer Life
Here's a morbid thought atop a morbid thought: Two in three deaths worldwide -- some 35 million a year -- go unregistered. And in many cases when deaths are recorded, reliable information on what caused them is lacking. Why does this matter? Without such records, public-health authorities can't tell enough about what's killing people to minimize the dangers they face (5/22).

Oregonian: Portland And Its Aversion To Fluoride Reflects Oregon's Unusual Politics
In 2011, the board of the Santa Clara Valley Water District voted to begin fluoridating water for about 850,000 customers in and around San Jose. Anti-fluoride activists grumbled but realized they didn't have the resources to take their fight to the public. That's sure not what happened in Portland, which once again showed that this far northwest corner of the country is willing to go where other parts of the country rarely tread (Jeff Mapes, 5/22).

Weekend Reading: Mental Illness Stigma And Health Insurance Mazes

Thu, 23 May 2013 13:19:00 GMT

Every week reporter Ankita Rao selects interesting reading from around the Web.

The New York Times Magazine: Unexcited? There May Be A Pill For That
Linneah sat at a desk at the Center for Sexual Medicine at Sheppard Pratt in the suburbs of Baltimore and filled out a questionnaire. She read briskly, making swift checks beside her selected answers, and when she was finished, she handed the pages across the desk to Martina Miller, who gave her a round of pills. The pills were either a placebo or a new drug called Lybrido, created to stoke sexual desire in women. ... The search for a female-desire drug has been an obsession of the pharmaceutical industry for more than a decade, largely because the release of Viagra, in 1998, showed that gigantic sums of money can be made with a quick chemical solution to sexual dysfunction. But while Viagra and its competitors deal with the simple hydraulics of impotence, the most troubling difficulty for men, the psychological complexity of depleted lust has so far defeated industry giants (Daniel Bergner, 5/22).

Tampa Bay Times: Akshay Desai And The Rise And Fall Of Universal Health Care
In August, Universal Health Care Group was crumbling. Regulators circled. Bankruptcy loomed. Still, founder and CEO Akshay Desai didn't publicly hint at any problems. "As a businessman, I know all too well what it takes to make it in the private sector," he bragged at the time. It was vintage Desai — supremely confident, selective with the facts. The 55-year-old son of Indian educators built Universal on smarts and ambition (Susan Taylor Martin and Jeff Harrington, 5/13).

The New York Times Magazine: Some Of My Best Friends Are Germs
I can tell you the exact date that I began to think of myself in the first-person plural — as a superorganism, that is, rather than a plain old individual human being. ... Justin Sonnenburg, a microbiologist at Stanford, suggests that we would do well to begin regarding the human body as “an elaborate vessel optimized for the growth and spread of our microbial inhabitants.” This humbling new way of thinking about the self has large implications for human and microbial health, which turn out to be inextricably linked. Disorders in our internal ecosystem — a loss of diversity, say, or a proliferation of the “wrong” kind of microbes — may predispose us to obesity and a whole range of chronic diseases, as well as some infections (Michael Pollan, 5/22).

Slate: You Do Not Have Asperger's
The autism community is a fractious bunch. We argue over the causes of autism, the best treatments, or even if it should be treated at all. But we do share a common anxiety: the DSM-5. This latest version of the Diagnostic and Statistical Manual of Mental Disorders, released by the American Psychiatric Association this month, officially eliminates many familiar autism spectrum diagnoses. Asperger’s syndrome (typically applied to those with no intellectual disability or language deficit); pervasive developmental disorder, not otherwise specified (generally given to higher-functioning individuals who may not meet all the criteria for autism); and childhood disintegrative disorder (attached to kids who develop typically and then experience severe regression after the age of 3) are now incorporated into the single diagnosis of autism spectrum disorder. ... Yet those diagnoses had serious implications. Certain states provide services for children diagnosed with autism but not for those diagnosed with Asperger’s (Amy S.F. Lutz, 5/22).

USA Today: Glenn Close, Family Work To End Stigma Of Mental Illness
Calen Pick has schizoaffective disorder, a combination of schizophrenia and bipolar disorder. He was 15 when he realized something was wrong, 16 when he checked himself into a lockdown mental health facility, 18 when he got out and 28 when his sanity touched down on solid ground. Now 31, Pick got married last year and is working with his mother, Jessie Close, who is bipolar, and his aunt, six-time Oscar nominee Glenn Close, to help end the stigma and discrimination facing the mentally ill (Korina Lopez, 5/22).

The Nation: Cashing In On Breast Cancer Awareness
Many American women played the BRCA what-if game for the first time [last] Tuesday: what would I do if I had the mutation? Would I get a mastectomy, even though there was a chance I wouldn’t need it? ... The problem is that there is profit—a lot of profit—to be made from stoking all of this worry. The big winner on Tuesday was not women’s health; it was Myriad Genetics, the company that has held the exclusive patent on the BRCA 1 and 2 mutations since the 1990s. ... The BRCA gene speaks to the impossible dilemma of for-profit healthcare, particularly when practiced as legal monopoly: some high-risk women will be saved, but many more women will be either needlessly alarmed, financially penalized, or both, so that one corporate monopoly can make a staggering profit (Rose-Ellen Lessy, 5/16).

The New York Times: Defining My Dyslexia
I started cataloging insults in the second grade. Notable put-downs heard outside my special-ed classroom included "dimwinky," "retardochuckles" and "the meat in the sandwich of stupid." The last of which, if you think about it, is a seriously impressive use of metaphor for a 7-year-old. I learned all the jokes about dyslexia, and told them to better effect than anyone else. Making fun of myself was my best defense. The other choices — hiding from my diagnosis or accepting myself as limited — didn't appeal (Blake Charlton, 5/22).

Viewpoints: Mass. Experience May Not Be True Test For National Health Law; 'Dishonest' Campaign By Medical Device Makers

Wed, 22 May 2013 13:13:22 GMT

The New York Times: Economix: Massachusetts Employees Will Keep Their Health Plans
Massachusetts is often held up as a window into America's health insurance future, because it embarked on what came to be called the Romneycare reform six years ago. Like the Affordable Care Act provisions going into effect nationwide next year, Romneycare aimed to increase the fraction of the population with health insurance by imposing mandates on employers and employees and by subsidizing health insurance plans for middle-class families without employer plans. ... The details and dollar amounts in the Massachusetts health care law differ from the national Affordable Care Act, and for that reason alone I hesitate to infer too much from the Massachusetts experience (Casey B. Mulligan, 5/22).

The National Review: It's Not 'Universal Coverage'
This history of Obamacare's political origins makes it all the more ironic that Obamacare, from what we now know, should not be considered a "universal coverage" plan, even by the benchmark the administration was using in 2009. Estimates from the Congressional Budget Office (CBO) point to this conclusion. In its latest assessment of the law, released in conjunction with new budget projections, the CBO indicates that the number of uninsured residents in the United States will never fall below 31 million -- three million more uninsured people than was estimated for the non-mandate plan President Obama rejected -- and that the insured will never be as much as 90 percent of the population (James C. Capretta, 5/21).

The Hill: Treat Nonprofit Health Care Fairly
For decades, unions have negotiated high quality, affordable health insurance through nonprofit Taft-Hartley plans -- one of the few reliable private providers for lower income individuals. ... In addition to being a long-standing and successful provider, these plans have been models of efficiency, achieving better cost savings than for-profit insurance carriers with medical loss ratios often exceeding 90 percent. That means 90 cents out of every dollar go to patient care. ... But as currently interpreted, the ACA would block these plans from the law's benefits (such as the subsidy for lower-income individuals and families) while subjecting them to the law's penalties (like the $63 per insured person to subsidize Big Insurance). This creates unstoppable incentives for employers to reduce weekly hours for workers currently on our plans and push them onto the exchanges where many will pay higher costs for poorer insurance with a more limited network of providers (Joseph T. Hansen, 5/20).

Los Angeles Times: Why The Medical Device Tax Needs To Stay
The chief drawback of a law as complex as the Affordable Care Act, the health insurance reform measure passed in 2010, is that it provides self-interested opponents a multitude of places to stick a wedge in and hammer away. But you'd be hard-pressed to find a campaign against the ACA as narrow-minded and dishonest as the one mounted by medical device manufacturers (Michael Hiltzik, 5/21).

Fox News: 5 Reasons The Government Is Not Prepared To Handle ObamaCare
The recent turn of events with the Obama Administration and a lack of transparency are a significant red flag to the impending catastrophe of how the proposed changes under the Affordable Care Act could be the next ensuing disaster. … The emerging IRS scandals, as they pertain to the multiple crises of the Obama Administration, are an ominous sign for how these very mistakes will impact the outcome of how the Affordable Care Act is implemented, and ultimately the lives of every American consumer (Dr. Sreedhar Potarazu, 5/21).

Fox News: Americans Beware – ObamaCare Expands How The IRS Can Hurt You
Most of us interact with the Internal Revenue Service once a year at tax time. But President Obama's Affordable Care Act health law puts us under the IRS's thumb all the time. The IRS has a history of using leaks and delays to punish people based on their politics. The latest is news that the IRS delayed processing requests for tax exempt status from the Obama administration's conservative critics, and even leaked information about them to the press (Betsy McCaughey, 5/20).

Des Moines Register: Possible Medicaid Compromise Is Encouraging
(Iowa Gov. Terry) Branstad indicated he would be willing to accept a form of Medicaid expansion if it came with assurances that if the federal government reduces funding for the program in the future, Iowans would not be left picking up the cost. On Tuesday, Sen. Jack Hatch, D-Des Moines, said legislative leaders and the governor's staff have been meeting frequently and may have a deal soon. The final, compromise plan should capture the maximum amount of federal money available, insure Iowans earning up to 138 percent of poverty level and be able to gain approval by the federal government. Whether elected officials are successful remains to be seen, but there is more hope now than there was a week ago (5/21).

Des Moines Register: Broader Medicaid Wouldn't Produce A Healthier Iowa
Bluntly, expanding Medicaid coverage would only make its recipients "feel better," but not actually be better. That makes Medicaid a very expensive feel-good program. Expanding Medicaid lives up to the name of the Affordable Care Act -- it gives "affordable care," nothing more. And the financial protection afforded Medicaid recipients is most effective in protecting against "catastrophic" health expenditures (Bob Williams, 5/21).

The Washington Post: Free Genes From Patent Restrictions
Jolie's news highlights an arcane but increasingly important question of patent law. As the sequencing of the human genome has expanded the ability to test for such genetic susceptibilities, is the discovery of the gene itself a patentable invention? (Ruth Marcus, 5/21).

The Seattle Times: Is Catholic Church Taking Over Health Care In Washington
Lord knows our schools have problems. But suppose we tried to solve them by doing something radical -- say, turning the schools over to the Catholic Church. … If put to a vote, this plan would crater. Most of us aren't Catholic, so I'm guessing we'd never go along with letting the creeds of that one faith run something as universal as education. So why are we allowing it with health care? (Danny Westneat, 5/21).

Miami Herald: Stopping Medicare Fraud
Miami has long had the sorry reputation for being the nation's leader in Medicare fraud, with seemingly just about anybody -- from convicted felons to, well, actors -- allegedly cashing in on what's supposed to be a medical safety net for the country's elderly and disabled. How can this happen? And keep on happening? ... But another part of Medicare, the administration arm that certifies that care givers who tap into Medicare reimbursements are actually qualified to do so and then verifies that they actually deliver the services they vouch for, must be much more diligent. Especially so in fraud capitals like Miami where it's so easy to find an abundance of seniors, some of whom are achingly vulnerable to crooks and cons (5/19).

JAMA: Value of Unique Device Identification in the Digital Health Infrastructure
In recent years, high-profile cases of medical device failure resulting in patient harm -- such as implantable cardioverter-defibrillator leads and metal-on-metal hip implants -- have received substantial attention both in the medical literature and popular press. These examples illustrate the need for a more effective system of monitoring device performance and protecting patient safety (Drs. Natalia A. Wilson and Joseph Drozda, 5/21).

JAMA Pediatrics: Stunting The Growth Of Child Health Research
A recent comprehensive assessment concluded that "lack of research, poor research, and poorly reported research" greatly limit child health research. Children participate in medical research at rates less than one-half those of adults, perhaps attributable to inadequate opportunities, ineffective recruitment strategies, and parents' greater concerns about their children's safety than their own in research settings. Meanwhile, health care spending on children declines every year as a share of national expenditures, causing concern that investment in child health research will decline as well (Dr. Matthew M. Davis, 5/20).

JAMA Internal Medicine: Evaluating Health System Processes With Randomized Controlled Trials
Health system processes shape and define health care and the medical experience of patients, health care practitioners, and society at large. These processes range from targeted mandates, such as gown and glove precautions for patient contact or automated computer alerts, to wider choices, such as deciding how to respond to medical emergencies, how to use (or not use) performance metrics or patient satisfaction surveys, what new health care facilities to build, or even how to finance health care costs and medical insurance. Given their unquestionable importance, we contend that health system processes should be routinely evaluated with randomized controlled trials (Drs. John P. A. Ioannidis and Vinay Prasad, 5/20).

The Medicare NewsGroup: Does Medicare Overpay Private Plans? The Debate Heats Up
The debate on whether Medicare Advantage (MA) is reducing health care costs is intensifying. A recently released analysis of government data by America's Health Insurance Plans (AHIP), the main health insurance lobby, found that seniors enrolled in MA plans in California and Nevada had better health outcomes than patients enrolled in Traditional Medicare. … Given the growing toxic environment in Washington and the fact that MA has become a political football, it's unlikely that the CMS or Congress will act before the 2014 elections, delaying a closer look (John Wasik, 5/21).

Health Policy Solutions (a Colo. news service): The Year Of Mental Health At The Colorado Legislature
In addition to other health care reforms (Medicaid expansion, improved parity for behavioral health coverage) two historic pieces of behavioral health legislation moved forward this year. One deals with Colorado's civil commitment laws -- statutes long overdue for a 21st century update. The other is a bill that includes over $20 million in funding to create a statewide behavioral health crisis response system. The governor signed both bills into law at the Jefferson Center for Mental Health on May 16 (Michael Lott-Manier, 5/21).

WBUR: Cognoscenti: Your Patient Is Your Partner: Collaboration Creates The Best Medical Outcomes
In a recent interview, physician and noted social activist Dr. Paul Farmer gave this advice to graduating medical professionals: their real impact will come when they work in teams. As the co-founder of Partners in Health and a champion of improving health in underserved communities, Farmer's work is built on building partnerships and applying successes and lessons learned to new frameworks (Laurie Edwards, 5/22).

Viewpoints: Slowing Health Costs; What Causes Genetic Testing To Be So Expensive; Iowa Governor Offers Medicaid Supports A 'Glimmer Of Hope'

Tue, 21 May 2013 13:15:00 GMT

Modern Healthcare: Cost Sustainability
We have done it. We have decreased the increase in the cost of healthcare. ... Is this decline the desperately needed bend in the healthcare cost curve or just the impact of the depressed economy? ... A slower growth of healthcare cost would mean less burden on the individual family, freeing that family to invest in and live a higher quality of life. ... The good news is that it can be done. And the blueprint for eliminating waste, lowering the cost and maximizing the value is actively being considered by voices that rise above partisan bickering (Drs. Manoj Jain and Bill Frist, 5/18).

The New York Times: The Outrageous Cost Of A Gene Test
Angelina Jolie's revelation that she had had a preventive double mastectomy was eloquent and brave. She had learned that she inherited a faulty copy of a gene, BRCA1, that put her at high risk for invasive breast cancer as well as ovarian cancer. Now women everywhere are asking: Should I get the same test? What will it cost? ... Unlike routine tests for diabetes or high cholesterol, however, the BRCA gene evaluation — performed by only one company in the United States, Myriad Genetics — is phenomenally expensive, with a "list price" close to $4,000 when a related genomic-rearrangement test is included in the analysis, which oncologists typically recommend. The question is why? Today, molecular scientists like me can sequence all of an individual’s genes — at least 20,000 of them — for about $1,000. About five cents per gene (David B. Agus, 5/20).

The Wall Street Journal: Gene Patents Drive Medical Innovation
The biotech industry began in 1978 when the University of California applied for a patent on the gene for the human growth hormone. Since that filing nearly 20% of the 20,000-plus genes in our DNA have been patented. The current Supreme Court case challenging the patent on the breast cancer gene (Association for Molecular Pathology v. Myriad Genetics) could invalidate thousands of these patents, affecting hundreds of diagnostic and therapeutic products. The biotech industry saves tens of thousands of lives and creates as many jobs. However, a ruling against the patent will deep-six future life-saving technologies as investor support for such discoveries disappears (Kevin Kimberlin, 5/20).

The New York Times: New Efforts To Undercut Health Reforms
Congressional Republicans are trying to exploit two controversies bedeviling the Obama administration to undermine the health care reform law. They are using an uproar over misguided tactics by Internal Revenue Service employees to target conservative political groups seeking tax-exempt status as an excuse to prohibit the agency from playing a pivotal role in carrying out the Affordable Care Act. And they want to use a controversy over efforts by the secretary of health and human services, Kathleen Sebelius, to encourage private donations to help enroll people in new health care exchanges as a cudgel to disrupt such efforts (5/20).

Des Moines Register: Medicaid Debate Has A Glimmer Of Hope
So it's hard to know whether a glimmer of potential compromise on health care, based on Gov. Terry Branstad’s comments Monday, is genuine. It looks promising, however. Branstad hinted Monday that he might be willing to use federal Medicaid expansion dollars for a new low-income health care program in Iowa, under certain conditions (Kathie Obradovich, 5/20).

New Orleans Times Picayune: House Should Approve Medicaid Money
Lawmakers have another chance to do the right thing Tuesday (May 21) when the House of Representatives considers a bill that would allow tens of thousands of uninsured residents to use Medicaid money to buy private insurance. House Bill 233 is a response to Gov. Bobby Jindal's refusal to accept the expansion of Medicaid under the federal Affordable Care Act. The bill takes a similar approach to legislation approved in Arkansas that Gov. Mike Beebe is hopeful will get federal approval (5/21).

Kansas City Star: By Not Acting On Medicaid, Missouri Legislature Failed To Help Patients
The Missouri legislature ended its session Friday after failing to act on a rare opportunity to transform Medicaid. However, for the good of Missouri, this critically needed transformation must proceed. Missourians cannot afford a lengthy delay — 300,000 of our neighbors remain uninsured, including more than 13,000 veterans and 4,000 spouses of veterans who live below or near the federal poverty level. Unfortunately, Missourians' tax dollars now will be spent by other states on their versions of Medicaid reform as Missouri businesses and individuals pay more (Herb Kuhn, 5/19).

Lund Report: Cost Of Coverage – The Real Measure Of Health Reform Impact
Prior to actual plan pricing being available, everyone, including me, tried to predict how much the Affordable Care Act (ACA) would increase premiums. Estimates generally ranged from 25 percent to 38 percent, and I was on the high end. So we all knew premiums were most likely going to increase, we just weren’t sure how much. All these efforts to predict were generally done on a false assumption that similar plans to the new Platinum, Gold, Silver and Bronze plans were available already, and all we had to do was predict the added cost of the new 2014 ACA requirements (John Gridley, 5/20).

Bloomberg: Wildly Varying Hospital Prices Keep Health Care Expensive
If further proof were needed that price competition doesn’t exist in the expensive U.S. health-care market, it arrived this month. The Centers for Medicare and Medicaid Services published 2011 charges for medical treatments set by more than 3,000 American hospitals. … The wide -- and wild -- variation exposes a critical weakness in the national effort to control costs (5/20).

Milwaukee Journal Sentinel: Bill To Ban Mandated Flu Vaccinations An Unwise Idea
The flu season is winding down around the country, but this year — as in past years — thousands of people required a visit to the hospital after contracting the disease. That's why the Centers for Disease Control and Prevention recommends that most people get an annual flu shot. And that's why health care workers often are required by their employers to be vaccinated. But that requirement would be illegal under legislation now being drafted by a Republican legislator from Fond du Lac. State Rep. Jeremy Thiesfeldt told The Associated Press that he began drafting the bill after health care workers complained they had been fired for refusing to be vaccinated (5/20).

State Roundup: Nearly 13,000 Calif. Hospital Workers Set To Strike

Tue, 21 May 2013 13:15:00 GMT

A selection of health policy news from California, Louisiana, Vermont, Minnesota, North Carolina, Arkansas and Pennsylvania.

Los Angeles Times: Patient Care Workers Set To Start Walkout At Five UC Hospitals
Respiratory therapists, nursing aides, surgical technicians and other patient care workers plan to stage a walkout starting Tuesday morning at five University of California medical centers. More than 12,000 workers from the American Federation of State, County and Municipal Employees are expected to participate in the two-day strike over staffing, pay and pension reform, union officials said. An additional 3,400 workers from the University Professional and Technical Employees union plan a one-day sympathy strike (Gorman, 5/21).

Reuters: Health Care Workers Set To Strike California Public Hospitals
Nearly 13,000 health care employees at five University of California medical centers plan to strike on Tuesday in a move that threatens to back up emergency rooms and already has forced the postponement of elective surgeries (Cohen, 5/21).

The Associated Press: Proposals Would Limit Cuts In La. Medicaid Program
Proposals that would make it more difficult to cut the rates paid to private hospitals and nursing homes for taking care of Medicaid patients are nearing final passage in the Louisiana Legislature. Overwhelming support from lawmakers comes despite concerns the constitutional amendments would further limit budget areas available to cut when Louisiana has financial woes -- and leave public colleges more vulnerable to slashing (Deslatte, 5/20).

New Orleans Times Picayune: Louisiana Senate Panel Approves Dual Provider Rate Bills
Two pieces of legislation designed to draw down more federal Medicaid dollars for Louisiana's hospitals and nursing homes were passed by a Senate committee Monday, even as they faced opposition from the administration of Gov. Bobby Jindal and two prominent think tanks. House Bill 532, sponsored by House Speaker Chuck Kleckley, R-Lake Charles, and Speaker Pro Tem Walt Leger, D-N.O., would allow hospitals to assess a fee on themselves, which would then be placed into a state-run "Hospital Stabilization Fund." This fund would then be used to draw down matching federal Medicaid dollars. House Bill 533, sponsored by the same two representatives, would constitutionally protect provider rates already issued by nursing homes, pharmacies and intermediate care facilities used to draw down Medicaid dollars. Both bills would involve amendments to the state constitution and would go to the state's voters before final approval (McGaughy, 5/20).

The Associated Press: Vermont Is 4^th State To Legalize Assisted Suicide
After years of debate, Vermont became the fourth state in the country Monday to allow doctors to prescribe lethal doses of medicine to terminally ill patients seeking to end their lives. Gov. Peter Shumlin signed the bill into law at a Statehouse ceremony even as opponents vowed to push for its repeal (5/20).

WBUR: Vermont Legalizes Physician-Assisted Suicide
Vermont has become the third state in the country, and the first in the east to legalize physician assisted suicide. The Vermont state legislature passed a so-called death with dignity bill last week. And in so doing, it became the first state to approve such a measure through legislative efforts, rather than through a voter referendum. The bill was signed into law just moments ago by Vermont Governor Peter Shumlin (5/20).

KQED: Surgery Rates Vary Dramatically Across California: Look Up Your City
Where you live matters. And in health care, it matters in all sorts of ways you might not think of immediately. If you're having elective surgery, one of the major factors determining what kind of treatment you will receive depends on where you live, according to new research released Tuesday. In health policy, "elective" does not necessarily mean cosmetic surgery. Treatments for early stage cancers are considered "elective" because there are a range of options (Aliferis, 5/21).

The Associated Press: Bill Would Bring Sunshine To California Health Care Reform
Two lawmakers are pushing legislation to strip broad secrecy provisions from the state agency overseeing health-care reforms in California that could shield from the public how hundreds of millions of dollars are spent, officials said Monday. The bill by Republican Sen. Bill Emmerson and Democratic Sen. Mark DeSaulnier was introduced in the state Senate less than two weeks after The Associated Press reported the degree of privacy granted Covered California appears unique among states attempting to establish their own health insurance exchanges under President Barack Obama's signature law (Blood, 5/21).

The Wall Street Journal: Minnesota To Allow Home Day-Care Workers To Unionize
Minnesota is set to allow unions to organize workers who provide home day-care services and other home care, giving organized labor a rare victory at the state level. The state House, by a vote of 68 to 66, passed legislation Monday that allows unions to negotiate on behalf of providers whose clients receive government subsidies -- including through Medicaid, the federal health program for low-income and disabled people (Peters and Maher, 5/20).

North Carolina Health News: A First Look At Health Care In The Senate Budget
Senate leaders rolled out their proposed $20.58 billion budget for the coming biennium late Sunday night with a plan that increases overall state spending by 2.3 percent, including increased spending on Medicaid. But the plan also includes a lot of cuts (Hoban, 5/20).

Politico: Arkansas 12-Week Abortion Ban Blocked For Now
A federal judge has temporarily blocked an Arkansas law banning abortions after 12 weeks into pregnancy, the first legal test of state early abortion laws passed in 2013. Judge Susan Webber Wright of the U.S. District Court for the Eastern District of Arkansas on Friday granted a preliminary injunction against the law, ruling from the bench after a hearing on a challenge brought by abortion rights advocates (Smith, 5/20).

Philadelphia Inquirer: Casey Promotes Health Care Research As A Job Source
U.S. Sen. Bob Casey says he doesn't have an answer to the national need for balance in creating health-care financing solutions, but he knows that National Institutes of Health funding helps put and keep jobs in the Philadelphia region. … A Democrat from Scranton, Casey said at the Friday meeting that unlike most topics dividing Congress, funding for medical science has a "bipartisan consensus, less so on financial levels, but we're not as far apart as we are on other issues." Pennsylvania got about $1.46 billion in NIH funding in 2012. That was fourth highest among the states (Sell, 5/21).

California Healthline: Federal Ruling, State Law May Conflict
In 2011, the Legislature went along with the governor's plan to cut Medi-Cal provider rates by 10 percent. Provider groups immediately went to the courts to stop it, saying that patient access to care would be threatened by such a severe reduction. Now the final decision rests with a federal judge. A ruling is expected soon. If a federal judge signs off on the law, Medi-Cal providers in California will have rates cut by 10 percent and also will need to pay back two years' worth of that 10 percent reduction. The effect would be a 15 percent rate cut for the next four years and a 10 percent cut thereafter (Gorn, 5/20).

California Healthline: Health Care Issues High On Latino Community Agenda
Health care, traditionally a vital issue in Latino communities, is still high on the list, but the focus may be shifting, according to Latino leaders who convened for a statewide summit last week in Sacramento. … The Latino Community Foundation, a statewide philanthropy based in San Francisco, convened more than 100 leaders of California Latino organizations for a "Sacramento Summit" last week. The event launched the California Latino Agenda, a campaign to unite leadership, establish goals and lobby for policy positions (Lauer, 5/20).

Pentagon Advisor's Biotech Firm Reaps Millions For Anthrax Drug

Mon, 20 May 2013 13:34:00 GMT

Los Angeles Times: Anthrax Drug Brings $334 Million To Pentagon Advisor's Biotech Firm
Over the last decade, former Navy Secretary Richard J. Danzig, a prominent lawyer, presidential advisor and biowarfare consultant to the Pentagon and the Department of Homeland Security, has urged the government to counter what he called a major threat to national security. Terrorists, he warned, could easily engineer a devastating killer germ: a form of anthrax resistant to common antibiotics. … Danzig did this while serving as a director of a biotech startup that won $334 million in federal contracts to supply just such a drug, a Los Angeles Times investigation found (Willman, 5/19).

Viewpoints: Sebelius' 'Ethical Line'; As Tricky Phase Of Health Law Approaches, Concerns About Exchanges Opening On Time

Mon, 20 May 2013 13:32:21 GMT

The Washington Post: Kathleen Sebelius Dances On An Ethical Line
One of the biggest questions hanging over the health-care system is how many young Americans will sign up for coverage once the Affordable Care Act begins to phase in this October. If too few buy insurance on the markets that the government is creating, insurance companies would be stuck covering primarily the old and the sick. They would have to pay out more per customer. Their customers, in turn, would have to pay more to those companies for coverage. The stakes for the Health and Human Services Department, which is overseeing the transition, are tremendous. But they are not high enough to justify HHS Secretary Kathleen Sebelius dancing around serious ethical lines (5/18).

The Washington Post: Obamacare's Tricky Next Phase
Thought you had seen the last of the fighting over the Affordable Care Act, also known as Obamacare? Since its passage in 2010, after all, it has survived Supreme Court review, innumerable challenges from House Republicans and Mitt Romney’s unsuccessful campaign to evict its author from the White House. Nonetheless, with the heart of the reform set to take effect next year, its most contentious days may lie ahead (5/19).

The Wall Street Journal: Navigating The ObamaCare Maze
On Oct. 1, millions of Americans are supposed to be able to go online and acquire health insurance on electronic exchanges in the states where they live. But here is a question that is being increasingly asked by people in the insurance industry: What happens if the exchanges aren't ready on time? (John C. Goodman, 5/19).

The Washington Post: Is The Health Care Spending Slowdown For Real?
We all know that Stein's Law will someday apply to health-care spending, which has risen from 5 percent of the economy (gross domestic product) in 1960 to almost 18 percent now. What we don't know is how and when its share of the economy will stabilize. Will this result from spending controls imposed by Washington; or from delivery-system "reforms" that spontaneously cut "waste"; or from rationing, which limits spending by denying people treatment; or by some combination of these? As for when, could it be now? (Robert J. Samuelson, 5/19).

Tampa Bay Times: Paying For Benefits, Getting None
Economists like myself are accustomed to seeing politicians act in ways that don't make economic sense. That being said, the decisions many are making about health care policy are truly dumbfounding. Florida recently failed to pass a budget that included the expansion of Medicaid that is part of the Affordable Care Act (Obamacare) and will be implemented on Jan. 1, 2014. In so doing, Florida joins 24 other states that are "opting out" of expanding Medicaid. Not surprisingly, most of the South is in that group. The economic consequences of opting out are likely to be large (Alan Green, 5/19).

Austin American Statesman: A Texas Solution For The Affordable Care Act
Because the governor is hesitant to expand Medicaid, the legislature will probably adjourn without taking full advantage of the dollars available to Texas to cover the uninsured through the Affordable Care Act. Fortunately there is more than one way to skin a cat, which in this case means a way to pull down all the dollars in the affordable care act through a market solution rather than by expanding traditional Medicaid, and it can be done before the legislature meets again in 2015 (Anne Dunkelberg, 5/19).

Bloomberg: Oregon's Radical Health Overhaul Blazes New Trail
The past few years have seen two remarkable health-care experiments in the Beaver State. One is the Oregon Health Insurance Experiment, the first randomized, controlled trial comparing Medicaid -- or any kind of health insurance -- with being uninsured. The other is (Gov. John) Kitzhaber's effort to rebuild the state's Medicaid program around community health rather than individual fee-for-service treatments. The health-insurance experiment has gotten all the attention. But it's the Medicaid reforms that really matter (Ezra Klein, 5/17).

Oregonian: Getting More Doctors, Nurses Into Rural Oregon Should Win Legislature's Support
Oregonians living in rural settings can have a hard time finding adequate and prompt medical care. It's either far away, too expensive or both. Finding an available doctor or a trained nurse practitioner close to home in Grant or Tillamook counties, to name just two of more than a dozen Oregon counties rated by the U.S. government as medically underserved, could be more of a trial than the runaway fever in need of attention (5/19).

Arizona Republic: Refusing Medicaid Expansion Means Abandoning Neighbors
But when (Timothy Leffler) lost his position at the Arizona State University School of Music because of state budget cuts, he faced dire circumstances. Leffler has type 2 diabetes. As a single adult without children, he narrowly qualified for Arizona Health Care Cost Containment System coverage just before the state froze enrollment. Soon after, he was diagnosed with severe hereditary neuropathy, which started in his feet and moved to his hands and arms. It's a very painful disease with no cure. He will need medication for the rest of his life. And he will be one of 60,000 Arizonans to lose such coverage on Dec. 31, if the state Legislature refuses Medicaid restoration (John Linder and Martha Seaman, 5/19).

Star Tribune: Minnesota Program Cuts Costs For Poor -- Compassionately
Ezekiel Allen's weary voice and his long list of medical challenges -- schizophrenia, a back injury, bipolar condition, high blood pressure, brain polyps, dental troubles, migraine headaches -- make him sound far older than his 45 years. Homeless for a number of years, Allen didn't see a doctor regularly for far too long. When the pain of his conditions became overwhelming, the Minneapolis man would get medical care from one of the costliest venues — an emergency room (5/19).

The New York Times: Angelina Jolie's Disclosure
Very few women fall into such a high-risk category. But for those who do, the test may be lifesaving. ... The health care reform law requires private insurers to cover genetic counseling and, if appropriate, BRCA testing, without a co-payment, in recently issued policies. ... Generally, neither private nor public insurance will cover the tests for women whose family history does not suggest increased risk, and that makes good sense (5/17).

Los Angeles Times: Health Care For Angelina Jolie -- And Everyone Else
We applaud Times columnist Robin Abcarian for shining the light on the inequities in our healthcare system in response to Angelina Jolie’s recent announcement about her prophylactic mastectomy. When Jolie made her medical decision, she had at her disposal the resources to pay for the procedures and the best doctors; not everyone has the same ability. At the Cancer Legal Resource Center (CLRC), our attorneys hear from individuals who experience great difficulty undergoing the same procedures as Jolie because they fear discrimination based on the results of genetic tests, and because their insurance won't cover the care they need (Anya Prince and Jen Flory, 5/18).

Los Angeles Times: A Birth Control Double Standard
In the uproar about making the morning-after contraceptive known as Plan B available to our daughters, there has been no similar outcry about condoms and our sons. Anyone of any age can walk into a drugstore -- as well as most grocery and big-box stores -- and buy condoms. If you want to remain anonymous, you can pay cash; no ID is required. If you're too embarrassed to face the checkout clerk, use the self-check aisle or, for $17.97, get a box of 100 -- flavored or with "added sensations," even -- delivered to your door in a plain brown box (Meg White Clayton, 5/20).

Des Moines Register: Dental Board's Actions Protect Dentists, Not The Public
Some licensing boards are obviously important to protect public safety by ensuring workers have certain minimum education and training. Yet the licensing boards, often composed largely of industry insiders, may limit competition. ... Among the most egregious examples of this: In 2009, the Legislature approved an amendment to Iowa law that ensured only dentists can provide teeth-whitening services. ... That’s right. You can whiten your own teeth with a mouth tray and gel purchased at a drugstore. You can go online and buy exactly the same products dentists use in their offices. And if you lived in most other states, you could set up a business offering this cosmetic procedure to the public -- and many people have. But not in Iowa (5/19).

Updated Diagnostic Guidebook For Mental Disorders To Be Unveiled This Weekend

Fri, 17 May 2013 13:33:34 GMT

In advance of its release, the new edition of the Diagnostic and Statistical Manual of Mental Disorders has triggered debate and controversy surrounding the many changes included in this 947-page book.

The Washington Post: Psychiatry's Revamped DSM Guidebook Fuels Debate
For ADHD, the definition is being broadened, meaning the disorder could be diagnosed in more children. In the case of autism, the opposite is true. The new criteria are among the changes that will be released with the publication this weekend of the long-awaited guidebook that psychiatrists and other mental health clinicians use to diagnose mental disorders. It's the first major update in nearly 20 years. The 947-page tome by the American Psychiatric Association adds some new disorders, broadens criteria for existing ones and tightens them for other illnesses (5/17).

Reuters: Psychiatrists Unveil Their Long-Awaited Diagnostic 'Bible'
The long-awaited, controversial new edition of the bible of psychiatry can be characterized by many numbers: its 947 pages, its $199 price tag, its more than 300 maladies (from "dependent personality disorder" and "voyeuristic disorder" to "delayed ejaculation," "kleptomania" and "intermittent explosive disorder"), each limning the potential woes of being human. But to the psychiatrist who shepherded the tortuous creation of the "Diagnostic and Statistical Manual of Mental Disorders," perhaps the single most important number is the "5" in its title: This is the DSM-5, not the DSM-V (Begley, 5/17).

Viewpoints: Health Law's Effect On Patient Safety; Angelina Jolie's Surgery Is The Ultimate 'Choice'

Fri, 17 May 2013 13:33:02 GMT

The New York Times: Learning From Litigation
Much of the discussion over the Affordable Care Act has focused on whether it will bring down health care costs. Less attention has been paid to another goal of the act: improving patient safety. Each year tens of thousands of people die, and hundreds of thousands more are injured, as a result of medical error (Joanna C. Schwartz, 5/16).

The New York Times: The Murky World Of Hospital Prices
Last week, the federal government made public a vast trove of information on the list prices charged by hospitals for a large array of procedures commonly performed on hospitalized patients. It was a good start toward providing greater transparency in hospital billing, which has long been shrouded in secrecy. But it fell short of providing full information that patients need to make informed decisions about which hospitals to use and which insurance to buy (5/16).

The Washington Post: Bill Gates: 'Death Is Something We Really Understand Extremely Well'
"I always use this chart of childhood death," Bill Gates says. "In 1960, 25 percent of kids died before the age of 5. And now we're down below 6 percent of kids dying before the age of 5." We're sitting in a bare conference room at his foundation’s D.C. headquarters. Gates is in town to talk to members of Congress about his top priority this year: Global health -- and, in particular, the total eradication of polio. He wants to drive that 6 percent even lower, and he believes he can. Wiping out a disease like polio sounds impossible. But it's actually, Gates tells me, completely achievable (Ezra Klein, 5/17).

Reuters: A Woman's Choice
We use that word so often: choice. It has become the code word for abortion, alas, and thus a lightening rod for activists on both sides of that continuing battle. But this week Angelina Jolie redeemed the word and the idea behind it -- that a woman has a right to choose what happens to her body, however tough that choice sometimes is (Anne Taylor Fleming, 5/16).

Philadelphia Inquirer: Angelina Jolie's Lesson For Obamacare
Angelina Jolie's announcement that she underwent a double mastectomy to protect against a genetic form of breast cancer inspired widespread surprise and admiration. With her op-ed revelation in the New York Times, she put herself forward as a role model for millions of women who face a similar dilemma. Such candor and forthrightness are rare among celebrities. Yet, she is extremely fortunate in one respect. She has the financial resources to afford both the testing that found her heightened risk and the consequent surgery. As she noted in her op-ed, many women do not (Robert Field, 5/17).

Tampa Bay Times: Politics And My Double Mastectomy
During the same week that Angelina Jolie announced that she had a preventive double mastectomy as a precaution against her genetic predisposition toward breast cancer, House Republicans are likely to vote for the 37th time to repeal or replace Obamacare. These two events have more in common than you think. That's because, for everyone except the mega-wealthy like a Hollywood star, having Jolie-like health care options depends on good, affordable health insurance. And having access to that kind of coverage depends on reasonable and caring leaders in Washington -- something the Republican caucus is missing, as proved by the anticipated vote (Robyn E. Blumner, 5/16).

Fox News/Washington Examiner: ObamaCare Is About Power
Members of the House of Representatives are scheduled to vote Thursday to repeal all of ObamaCare. Given that the House voted to repeal the law last year, some commentators and observers have questioned the need for another repeal vote. However, the scandals coming to light over the last week perfectly make the case for why Congress must eradicate the law from the statute books (Jim DeMint, 5/16).

New England Journal Of Medicine: Expanding The Role Of Advanced Nurse Practitioners – Risks And Rewards
As the 2014 expansion of coverage mandated by the Affordable Care Act (ACA) looms larger, one question with no ready answer is how health care providers, policymakers, and payers will cope with an expected surge in patient demand for services. A shortage of primary care physicians to treat newly insured persons is the most immediate health workforce issue, but when added to the nation's population growth and more aging patients who require treatment, finding a practitioner may become an even more daunting challenge (John Iglehart, 5/16).

Tampa Bay Times: Hypocrisy In The House
Republican state lawmakers on Tuesday didn't want to talk about 1 million of the state's poor who don't have health insurance. Or about how Floridians and their health care system inevitably absorb the cost when the uninsured are in crisis. They tried to change the subject when asked at a Suncoast Tiger Bay meeting in St. Petersburg about news reports that juxtaposed Republican House members' generous taxpayer-covered health insurance with their votes to reject federal Medicaid expansion dollars to cover 1 million uninsured -- and pump $51 billion into the state economy. Floridians shouldn't so easily dismiss the hypocrisy (5/14).

Orlando Sentinel: Costly Expansion Wouldn't Improve Floridians' Health
The state Legislature's decision this year to reject Medicaid expansion was the correct decision for Florida. There is little evidence that growing the health care program for the poor would improve the health of state residents. A recent study in the New England Journal of Medicine is all the proof that Sunshine State legislators needed to reject Medicaid expansion. Those lamenting the failed implementation of this part of the federal Affordable Care Act in Florida can look to Oregon to see that Floridians won't be missing out on much (Bob Williams, 5/17).

Orlando Sentinel: Misrepresentations Blocked Care For A Million Floridians
Despite the support of Gov. Rick Scott and the Florida Senate, the 2013 legislative session ended with the Florida House unilaterally blocking the extension of health coverage to more than a million low-income, uninsured Floridians. Approving "Medicaid expansion" (or a comparable Senate-backed alternative) would have provided low-wage workers, parents and patients priced out of coverage with desperately needed access to care and protection from financial ruin. It would have infused $51 billion of our tax dollars into the economy, created 120,000 private-sector jobs, saved the state more than it would cost, and enabled service-sector employers to avoid hundreds of millions in penalties. In short, a "win-win-win." The only remaining impediment was purely political (Greg Willowe, 5/17).

Cincinnati Enquirer: Kentucky Expands Medicaid, Why Not Ohio?
By virtue of Kentucky’s Medicaid laws, Gov. Steve Beshear was able to expand that state's program without going through the Kentucky General Assembly. Good for him and good for Kentucky. ... But in Ohio, the Republican-controlled General Assembly is taking a lifetime to ponder the issue (5/16).

Research Roundup: Surgical Residents Not Happy With New Schedules

Fri, 17 May 2013 13:26:00 GMT

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

JAMA Surgery: Surgical Residents' Perceptions of 2011 Accreditation Council For Graduate Medical Education Duty Hour Regulations – In 2011, the organization that oversees medical student training instituted a new regimen to replace the traditional 24-hour call schedule for medical residents, to improve patient safety and the residents' health. Under this new policy, residents in their first year of post-graduate training get increased supervision and are limited to 16-hour shifts. Researchers interviewed more than 1,000 surgical residents and found nearly 66 percent of them disapproved. "Residents believe that the intended improvements in patient safety, resident quality of life, and education have not been borne out after implementation of the changes," the researchers write. "Furthermore, a concerning majority of surgical residents report noncompliance and falsification of duty hours. It may be difficult for residents, particularly in surgical fields, to learn and care for patients under the current ACGME regulations" (Drolet et al., 5/15).

JAMA Surgery: Effects Of Duty Hour Restrictions On Core Competencies, Education, Quality Of Life, And Burnout Among General Surgery Interns – Researchers aimed to measure the implications of the new work regulations by assessing the views and experiences of 213 surgical interns from 11 general surgery residency programs in July 2011 and May 2012. They found that half of the participants believed the new regulations decreased the coordination of patient care and the time they spent in the operating room while 70 percent felt it reduced their ability to achieve continuity with patients. The majority did not believe that the regulations decreased their fatigue. "The high rate of burnout among US surgeons appear to begin during residency training, even under the … reduced work hours," they conclude (Antiel et al., 5/15).

American Journal Of Public Health: The Impact Of Cigarette Excise Tax Increases On Purchasing Behaviors Among New York City Smokers – While tax increases on cigarettes have been shown to be effective in preventing and reducing smoking, many people respond to the hikes by buying their cigarettes in other jurisdictions with lower taxes, over the Internet, on the street or from Native Americans selling untaxed products. Researchers found that "Following the 2008 tax increase [in New York City], 21% of smokers reported buying more cigarettes from another person on the street. ...Tax increases should be paired with enforcement strategies that limit the flow of untaxed, cheap cigarettes into jurisdictions with high cigarette pack prices," they conclude (Coady et al., 6/2013).

Academic Emergency Medicine: National Growth In Intensive Care Unit Admissions From Emergency Departments In The United States From 2002 To 2009 – Patient admissions to intensive care units (ICUs) have been increasing with an aging population, the authors write. The authors analyzed records from more than 4,000 patients admitted to the ICU from emergency departments from 2002 to 2009. "Over the study period, ICU admissions from EDs increased from 2.79 million in 2002/2003 to 4.14 million in 2008/2009," they write. The largest growth was among visits by patients 85 years or older. Nonwhite and Medicaid-covered patients were also major contributors to higher ICU admissions. They suggest that growth trends should be considered as decisions are made in regards to ICU capacity and add that "an increased emphasis" on the link between the emergency department and intensive care unit as well as "critical care training for emergency providers may be warranted, as many patients stay in EDs for prolonged periods of time" (Mullins, Goyal and Pines, 5/2013).

Kaiser Family Foundation/Health Management Associates: Profiles Of Medicaid Outreach And Enrollment Strategies: Helping Families Maintain Coverage In Michigan – Looking ahead to the 2014 implementation of the health law, the authors write: "This brief provides insight into lessons learned from Medicaid and CHIP outreach and enrollment strategies by profiling a successful initiative of the Michigan Primary Care Association to facilitate coverage renewals through a systematic, technology-based reminder system coupled with one-on-one assistance." The authors assert that a critical challenge will be to help people stay enrolled. "Losses in coverage at renewal interfere with individuals' access to and continuity of care and create unnecessary administrative costs associated with re-enrolling eligible individuals into coverage" (Edwards, Rodin and Artiga, 5/14).

Controversy Lurks As Cloning Technique Yields Embryos For Use In Stem Cell Therapies

Thu, 16 May 2013 13:44:00 GMT

Political and ethical fights over human cloning may follow the latest stem cell therapy advance after scientists created embryos that are genetic copies of living people in an effort to treat diseases such as Alzheimer's.

Los Angeles Times: For First Time, Stem Cells Are Produced From Cloning Technique
For the first time, scientists have created human embryos that are genetic copies of living people and used them to make stem cells — a feat that paves the way for treating a range of diseases with personalized body tissues but also ignites fears of human cloning. If replicated in other labs, the methods detailed Wednesday in the journal Cell would allow researchers to fashion human embryonic stem cells that are custom-made for patients with Alzheimer's disease, diabetes and other health problems (Healy, 5/15).

NPR: Cloning, Stem Cells Long Mired In Legislative Gridlock
The news that U.S. scientists have successfully cloned a human embryo seems almost certain to rekindle a political fight that has raged, on and off, since the announcement of the creation of Dolly the sheep in 1997. "The issue of legislation on human cloning is about to get hot again," says Hank Greely, director of the Center for Law and the Biosciences at Stanford Law School (Rovner, 5/16).

Weekend Reading: Volunteers In The Battle With Heart Disease

Thu, 16 May 2013 13:39:00 GMT

Every week reporter Ankita Rao selects interesting reading from around the Web.

The Atlantic: Lost In Medication
Psychiatrists who take time with their patients are not the norm. It's not because others don't care. Rather the system rewards efficiency, not empathy ... I treated a patient who had suffered from schizophrenia for years. He had finally achieved some stability on a cocktail of antipsychotic medications as he was passed along through the clinic, year after year ... One day, though, he showed up for his appointment looking completely different. His complaints had nearly disappeared; he was cheerful, optimistic. ... Inquiring about what had changed, I found out that with the assistance of the hospital work program, he had gotten a job for the first time in nearly 30 years. … In many places psychiatry has become a biological enterprise, with some psychiatrists even introducing themselves as "psychopharmacologists." In no other specialty does a physician define themselves by the medication that they use (Sarah Mourra, 5/10).

The New Republic: My Five Obamacare Anxieties
Conservatives are talking about the implementation of Obamacare in the same thoughtful way they talked about its enactment—that is, as an impending apocalypse. It won't be, as I've noted previously. Most Americans get insurance through employers, Medicare, and Medicaid, and that will still be the case on January 1, when Obamacare's big provisions take effect. But the minority who buy insurance on their own or have no insurance will see tremendous changes. And you don't have to be Rush Limbaugh to have real concerns about how those changes will play out (Jonathan Cohn, 5/13).

The Fiscal Times: Why The IRS Scandal Could Bring Down Obamacare
The Internal Revenue Service's scandalous targeting of Tea Party-themed and other conservative groups could severely damage President Obama – but it's not necessarily because anyone close to the White House sanctioned the allegedly independent actions by the tax collection agency. ... The real fallout could be that it will impede Obamacare, ... The IRS will largely administer this attempt at providing near-universal health insurance. It is responsible for overseeing the tax credits and tax increases in the law, and—most critically—ensuring that businesses and individuals comply with the individual mandate and other major provisions. Prominent Republicans are already connecting the unpopular insurance program to the questions swirling around the IRS (Josh Boak and Eric Pianin, 5/14).

The Weekly Standard: Eggs For Sale?
If you want to know what's going to go wrong in the culture, read the professional journals. A case in point: An article in the April 10 New England Journal of Medicine called for the creation of a commodities market for "made-to-order" human embryos. The authors, I. Glenn Cohen and Eli Y. Adashi—university professors, of course—treat embryos as the equivalent of a prize cattle herd. They note that sperm and eggs are already bought and sold for in vitro fertilization (IVF) and, further, that New York legalized buying eggs for use in biotechnological research a few years ago. Hence, "it is not clear" (an oft-used phrase in bioethical advocacy that frees the author from actually having to prove a point) why we should not also allow companies to make "made-to-order embryos" for profit, since that activity would be "more similar to the sale of gametes than the sale of children" (Wesley J. Smith, 5/14).

The New York Times: Seeking Clues To Heart Disease In DNA Of An Unlucky Family
Researchers have long known that a family history of early death from heart disease doubles a person's risk independently of any other factors. Family history is defined as having a father or a brother who were given a diagnosis of heart disease before age 55 or a mother or sister before age 65. Scientists are studying the genetic makeup of each member of the Del Sontro family, searching for telltale mutations or aberrations in the long sequence of three billion chemicals that make up human DNA. Until very recently, such a project almost certainly would have been futile. Picking through DNA for tiny aberrations was so costly and time-consuming that it was impractical to take on for an entire family (Gina Kolata, 5/12).

The New Yorker: Can We Patent Life?
On April 12, 1955, Jonas Salk, who had recently invented the polio vaccine, appeared on the television news show "See It Now" to discuss its impact on American society. Before the vaccine became available, dread of polio was almost as widespread as the disease itself. Hundreds of thousands fell ill, most of them children, many of whom died or were permanently disabled. The vaccine changed all that, and Edward R. Murrow, the show's host, asked Salk what seemed to be a reasonable question about such a valuable commodity: "Who owns the patent on this vaccine?" Salk was taken aback. "Well, the people," he said. "There is no patent. Could you patent the sun?" ... It took thousands of scientists and technicians more than a decade to complete the Human Genome Project, and cost well over a billion dollars. The same work can now be carried out in a day or two, in a single laboratory, for a thousand dollars—and the costs continue to plummet. As they do, we edge closer to one of modern science's central goals: an era of personalized medicine, in which an individual’s treatment for scores of illnesses could be tailored to his specific genetic composition. That, of course, assumes that we own our own genes (Michael Specter, 4/2).

The National Journal: How Much Big Insurance Paid A Small-Business Group To Fight A Premium Tax
The nation's leading health insurance industry group gave $850,000 to a top small-business trade association as part of a campaign to repeal a key provision of President Obama’s health care law, National Journal Daily has learned (Frates, 5/14).

Viewpoints: When A Doctor Should Keep Quiet; 2 Views Of Hospital Pricing; Stem Cell 'Snake Oil'

Thu, 16 May 2013 13:31:57 GMT

Los Angeles Times: For A Dying Patient, A Prescription Of Silence
In medical school, we were taught not to withhold information from our patients or to be "paternal" in making decisions for them. We internalized the idea that fully informed patients are better equipped to make treatment decisions. And with patients likely to die of their diseases, discussing the prognosis frankly would allow them to say goodbyes, get things in order and prepare advanced directives for what kind of interventions they did and didn't want. But Pedro's wife was adamant. "He will lose his will to live if he knows he has cancer. And he will then die even sooner" (Susan Partovi, 5/16).

USA Today: Hospital Pricing Gouges Patients: Our View
Shouldn't you be able to see the price of something before you buy it, so you can shop for value or simply figure out whether you can afford it? Before you roll your eyes and say, "Of course," think about the last time you bought medical care, especially in a hospital. See any price lists on the wall? Probably not. And, if you had, you might have fainted on the spot (5/15).

USA Today: Hospital Billing Too Complex: Another View
Many parts of America's health care delivery and financing systems urgently need updating, and the matter of "charges" ranks high on the list. Today's hospital bill is a symptom of a broken payment system. Hospitals deal with more than 1,300 insurers, each having different plans with multiple requirements for hospital bills. Decades of federal regulations have made a complex billing system even more complex and frustrating for everyone involved (Rich Umbdenstock, 5/15).

USA Today: Beware Of Stem Cell Therapy Claims
A stem cell transplant can help cure patients with acute myeloid leukemia, and research has shown incredible potential, from growing teeth to mending "unhealable" bone fractures. Still, stem cells are poorly understood. Despite this, as (Ferris) Jabr writes, many cosmeticians continue to claim that stem cells are a cure-all for "everything from wrinkles to joint pain to autism." Until we understand them better, stem cells are the new snake oil peddled by 21st century charlatans. Thankfully, the Food and Drug Administration is cracking down (Alex Berezow, 5/15).

JAMA: Accountable Care Organizations: Accountable For What?
Dr Robert Potenza and Dominica Potenza, partners in life and in work, are, respectively, a cardiologist and a registered nurse who have a cardiology/internal medicine practice in the Bronx. … In theory, continuity of care should be improving at Montefiore, one of 32 Pioneer Accountable Care Organizations (ACOs) that aim to become models for improving population health while lowering costs. Montefiore has been acquiring physicians' practices to expand its primary care capacity, but the Potenzas are reluctant to join, fearing they'll lose what control they have over the personalized care they give their patients (Diana Mason, 5/15).

Columbus Dispatch: Expanding Medicaid Would Help In Fight Against Breast Cancer
As a seven-year breast-cancer survivor, I know how important annual screening can be. I was diagnosed with Stage IIa breast cancer on a routine mammogram. ... I was lucky and had very adequate health insurance, yet my personal cost remained over $6,000. While expanding Medicaid in Ohio would seem counterintuitive as a cost-saving measure, we must sometimes view Medicaid dollars spent as a long-term investment in Ohio and enable Ohioans to realize the savings. Screening to capture cancer at the earliest possible stage reduces the costs of treatment and improves mortality (Tammy Weis, 5/16).

Bloomberg: U.S. Must Fight Harder Against TB
While USAID's TB budget is being slashed, public-health spending on tuberculosis in the U.S. is also being cut. On top of belt tightening from sequestration, the administration of Barack Obama has been pillaging money from the U.S. Department of Health and Human Services’ Prevention and Public Health Fund, which goes to efforts such as immunizations, health screenings and smoking prevention. ... Almost all TB specialists in the U.S. work in public clinics and hospitals. Many patients, being either uninsured or underinsured, have nowhere else to go for their treatment. Even after the Affordable Care Act is fully in place, public TB clinics will remain important safety nets for undocumented immigrants and legal immigrants who don’t yet qualify for public services. It's safe to assume that cuts in public health funding will have the same effect we saw in the early 1990s after earlier reductions: Many patients will be inadequately treated, allowing greater transmission of TB and the emergence of multidrug-resistant strains (Celine Gounder, 5/15).

Tampa Bay Times: Fight On Prescription Drug Abuse Not Over
Once local law enforcement and the Florida Legislature finally committed to addressing prescription drug abuse, it made a difference. The welcome news that prescription drug deaths in the Tampa Bay area are down 30 percent since 2010 is surely a result of a focus on unscrupulous pain clinics and easy access to pills. But there is more work to be done, and boosting the state's still-tepid commitment to a prescription drug database is the place to start (5/14).

New England Journal Of Medicine: The Role Of The NIH In Nurturing Clinician-Scientists
The awarding of the 2012 Nobel Prize in Chemistry to Robert Lefkowitz and Brian Kobilka, both M.D.s trained in cardiology, for their work on characterizing the structure and function of beta-adrenergic receptors, should remind us of the critical role that clinician-scientists have played in formulating the seminal concepts that govern modern biomedical science. Much has been written since the 1970s about the demise of the physician-scientist -- as evidenced by the declining share of RO1 grants that the National Institutes of Health (NIH) awards to physicians -- and the economic factors that have driven physicians away from the laboratory and research clinic into more remunerative clinical practice (Dr. Michael Gottesman, 5/15).

Viewpoints: Controversy Taints IRS Efforts On Health Law; Another Chance To 'Gut' The Overhaul In The Courts; Salt Wrongly Accused

Wed, 15 May 2013 13:26:29 GMT

The Wall Street Journal: Your Next IRS Political Audit
Even as the politicized tax enforcement scandal expands, the Internal Revenue Service continues to expand its political powers thanks to the Affordable Care Act. A larger government always creates more openings for abuse, as Americans will learn when the IRS starts auditing their health care in addition to their 1040 next year (5/14).

The Washington Post's The Plum Line: Why Washington Scandal-Mania May Save Medicare And Social Security
Liberals who are dreading the scandal-mania that is taking hold should note that it contains a potential upside: It could make a Grand Bargain that includes cuts to Medicare and Social Security benefits even less likely than it already is. That's because when scandal grips Washington, a president actually needs his core supporters more than ever to ward it off, making it harder to do anything that will alienate them (Greg Sargent, 5/14).

New Republic: The Supreme Court Is About To Get Another Chance To Gut Obamacare
(Michael) Carvin's legal argument, which originated with CATO Institute economist Michael Cannon and Western Reserve law professor Jonathan Adler, is that, due to a drafting glitch in the ACA, only state-run exchanges, not federal ones, can provide tax credits and subsidies to enable lower-income individuals to afford ACA-mandated health insurance. ... So, could rejectionists have any basis for hoping to overturn Treasury's rule? Yes, they could. All the Obama administration's arguments, however well-founded, could be shoved aside, if the case reaches the Supreme Court, and the Court's conservative bloc deploys a "methodology," long touted by Justice Antonin Scalia, for interpreting statutes. Scalia's approach, which he calls "textualism," holds that judges must tease out the meaning of individual statutory words or phrases in isolation, rather than giving weight to the statute's overall structure, design, purpose, or legislative history (Simon Lazarus, 5/13).

The New York Times' Economix: Patterns Of Changes In Health Insurance
A number of industries can expect big changes in employee health insurance in the next year or two, while others will continue with business as usual (Casey B. Mulligan, 5/15).

Arizona Republic: Fiscal Risks Of Not Expanding Medicaid
Opponents of Gov. Jan Brewer's Medicaid expansion proposal are recklessly minimizing the risk to the (state) of not participating. Arizona is in an unusual position regarding this issue. Most states offer very little Medicaid coverage to childless adults. So, for them, expanding coverage to 133 percent of the federal poverty level is a very big step. And even the 10 percent of that expansion they will end up having to pay under Obamacare is a big bill (Robert Robb, 5/14).

Politico: Fixing The VA-DOD Health System Fiasco
As health care plans nationwide enter the home stretch of implementing electronic records under the framework of the Obama administration’s Affordable Care Act, and military service disability claims backlogs grow in size and attention, the Department of Veterans Affairs and the Pentagon need a much more coherent approach to modernize and deploy their electronic health record systems (Peter Levin, 5/15).

Medpage Today: Hospitals In Crisis: The Effects Of Obamacare
Under the Affordable Care Act's Hospital Readmissions Reduction Program, hospitals that readmit certain patients within 30 days of discharge could face significant penalties. Under the Affordable Care Act's Hospital Readmissions Reduction Program, hospitals that readmit certain patients within 30 days of discharge could face significant penalties. The question is whether hospitals really have that much control over factors leading to readmission and whether they are really at fault (Dr. Sreedhar Potarazu, 5/14).

The New York Times: Doubts About Restricting Salt
After years of warnings to cut sodium consumption to reduce heart attacks and strokes, it is disturbing to learn how little evidence exists that such reductions would actually be beneficial to health. There is even emerging evidence that some groups in the population could suffer harm from levels that are too low (5/14).

Los Angeles Times: Doctoring In A Family Way
New policies proposed in April by the Residency Review Committee for Family Medicine, or RRC, the group that outlines requirements for physician training programs nationwide, threaten to interfere with that comprehensive care and to decrease reproductive health access for women like Jennifer. The proposed RRC changes would eliminate the current requirement that family medicine residents learn full-scope reproductive healthcare. Instead, the decision to teach these skills would be up to the discretion of individual residency programs. Family doctors would no longer be required to learn how to prescribe birth control, place intrauterine devices or contraceptive implants, provide options counseling for women with unintended pregnancies or diagnose and manage miscarriages (Alison Block, 5/15).

USA Today: Angelina Jolie, Breast Cancer Fighter: Our View
While her message was brave and important, it's equally important to note that Jolie is among an extremely small percentage of women with an unusually high risk of breast cancer due to her family history and her gene mutation. Only about 1 percent of women test positive for mutations to the BRCA1 or BRCA2 genes that signal elevated risk for breast and ovarian cancer, and most women who develop breast cancer can be successfully treated with less radical treatment if the cancer is caught early (5/14).

Health Policy Solutions (a Colo. news service): The Ethically Slippery Slope Of Assisted Suicide
While New Mexico and other states are grappling with the question of whether to allow doctors to write prescriptions for drugs that terminally ill patients can take to commit suicide, countries such as Belgium and The Netherlands are pushing the envelope in distressing ways. For those who claim there is no evidence of a slippery slope in abuse of physician-assisted suicide once implemented, I offer several problems presented by the Belgium and Netherlands experiments. In these countries, it is legal for physicians to directly euthanize patients (Dr. Anthony Vigil, 5/14).

Health Policy Solutions (a Colo. news service): Making Sense Of Variation In Health Care Pricing
Some have been outraged by the seemingly pointless variation in charges the Medicare data shows. However, some variation in the base charges for hospital services does make sense. Facilities and providers alike need to charge differently depending on how sick and complicated their patients are, whether they have additional overhead costs because they are a teaching facility, number of patients receiving charity care, etc. The more important task, though, is to figure out where variation is not adding value and to identify opportunities to get health care spending under control (Phil Kalin, 5/15).