Viewpoints: GOP Fight With ‘Trumpian Core’; Health Bill’s Taxes Intent; CBO Could Be Wrong

The Wall Street Journal: House Republicans Repeat An Obama Error
The GOP’s first big legislative endeavor, the repeal of ObamaCare, has been understood as a classic fight between party leadership and the more conservative and libertarian wings, and there’s truth in that. I wonder if it will not also become a struggle between the leadership and the Trumpian core. (Peggy Noonan, 3/9)

The Washington Post: The Republican Health-Care Plan Isn’t About Health Care At All
Let’s abandon the pretense. Republicans’ “health care” bill is not really about health care. It’s not about improving access to health insurance, or reducing premiums, or making sure you get to keep your doctor if you like your doctor. And it’s certainly not about preventing people from dying in the streets. Instead, it’s about hundreds of billions of dollars in tax cuts — tax cuts that will quietly pave the way for more, and far larger, tax cuts. (Catherine Rampell, 3/9)

Vox: Mitt Romney’s Former Policy Director Makes The Case For The GOP’s Health Bill
The reaction to the House GOP’s health care bill — the American Health Care Act ... — was swift and severe. Liberals hated it. But so did conservative health care wonks. One exception was Hoover Institute fellow Lanhee Chen, who served as Mitt Romney’s policy director. “It is a good start and big step in the right direction,” he tweeted. So I called him to hear his case for the bill. (Ezra Klein, 3/9)

The Washington Post: The American Health Care Act Is A Good Start
The ACA was a one-size-fits-all, top-down approach to policymaking. In contrast, the AHCA moves decision-making to the grass roots by providing funding, but permitting states flexibility in how to deal with costly preexisting conditions, provide reinsurance and other stop-loss protections that permit insurers to function effectively, and trusting state insurance regulators to run their markets. Even the significant Medicaid reform needed to ensure the program’s long-term sustainability carries enormous freedom for states to tailor their programs to their populations. (Douglas Holtz-Eakin, 3/9)

The Washington Post: The GOP Health-Care Plan Would Quietly Kill The Medicaid Expansion. Here’s How.
Republican leaders in Congress have at last unveiled their proposal to overhaul the Affordable Care Act. In a nod to a growing number of Republicans concerned that a full repeal would undo coverage gains in their home states, the new plan at first glance appears to protect coverage for those insured under the ACA’s Medicaid expansion. This is a shift from prior Republican health-care legislation — including a plan from new Health and Human Services Secretary Tom Price and the 2015 ACA repeal bill passed by Congress (and vetoed by President Obama), both of which explicitly eliminated the Medicaid expansion. But the fine print of the new proposal instead takes a more insidious approach to gutting the Medicaid expansion. (Benjamin Sommers, 3/9)

Roll Call: Put Up Your Own Plan, Democrats
Democrats have a golden opportunity to save Obamacare and pick up political credibility at the same time. With House Speaker Paul Ryan’s vision for the American health care system being rejected by the left, the center and the right, Democrats should offer their own plan to bring relief to those who are paying more or getting less under President Barack Obama’s signature law. (Jonathan Allen, 3/10)

The Washington Post: The GOP Can No Longer Claim It Believes In Fiscal Responsibility
It’s time to put an end to the myth that Republicans believe in fiscal responsibility. Saving taxpayer dollars takes a back seat to the ideological imperative of blaming and shaming the poor. Witness the GOP’s long-awaited plan to replace the Affordable Care Act. House committees are moving forward on the legislation before the Congressional Budget Office has even had a chance to estimate how much the measure will cost. Why the rush? Because if the plan doesn’t snatch away health insurance coverage from millions of people — and both President Trump and House Speaker Paul D. Ryan (R-Wis.) swear it won’t — then it’s surely going to cost a ton. (Eugene Robinson, 3/9)

Bloomberg: Republicans Should Kill Obamacare Or Let It Die
Some forms of government policy are built of political concrete. Once done, they cannot be renovated, added to or even destroyed without immense cost; for that reason, they tend to go on much as they always have, for good or for ill. This was the problem that Democrats faced with Obamacare. Other countries, it was often observed, had a national guarantee of health insurance; surely, we could build a system very much like those. But the other countries had built their systems earlier, when there weren’t so many concrete towers already in the way. (Megan McArdle, 3/9)

Bloomberg: Republicans Should Kill Obamacare Or Let It Die 
We cannot simply get rid of what Democrats built, and then perhaps, at some more convenient date, start over with a sounder design. The old structures are gone, and will not spring back up of their own accord if we knock down what’s there now.  All you get from a hasty demolition is a big pile of rubble. Very expensive rubble, for Republicans, who will have to face angry voters who now have neither their old home nor the new. The base may rejoice when they hear that Obamacare has been “repealed” (sort of). But their cries of glee will be drowned out by their wailing when they find that they cannot buy individual insurance at all. (Megan McArdle, 3/9)

Los Angeles Times: Paul Ryan’s 'Trumpcare' Does Not Entirely Repeal Or Replace Obamacare
The House Republicans’ newly unveiled plan to repeal and replace Obamacare is already in political trouble because it neither repeals nor replaces. Rather than being a complete repeal, it retains some elements of Obamacare — more properly known as the Affordable Care Act. This infuriates hard-line conservative members of Congress, as well as anti-government billionaires like the Koch Brothers, because they think it maintains new and unacceptable government entitlements. At the same time, the GOP proposal is anathema to moderate Republicans and pretty much all Democrats because it does not really replace the ACA’s approach to healthcare with an improved system. Rather, it radically changes the balance in who benefits. (David Horsey, 3/9)

Bloomberg: The Case Against The CBO
Republicans fear, and Democrats hope, that the Congressional Budget Office will eventually determine that the legislation would cause 10 million to 20 million fewer people to have coverage. That may be why Republicans are holding votes before the CBO can finish its work. But the CBO has gotten its estimates badly wrong before. Before Congress enacted Obamacare, the office projected that by this year, its exchanges would enroll 23 million people. As late as June 2015, the CBO was sticking to this projection. The actual number is about nine million. (Ramesh Ponnuru, 3/9)

Arizona Republic: Are Republicans Pulling A Pelosi On Health Care?
How many times have Republicans mocked those 15 words, spoken in 2010 by then-Speaker Nancy Pelosi as Congress was moving to pass the Affordable Care Act. Seven years later, President Donald Trump and House Speaker Paul Ryan are racing to repeal and replace the despised Obamacare and it appears, oddly, that they’re determined to pass the thing before we can find out what the heck it does. (Laurie Roberts, 3/9)

Richmond Times-Dispatch: The Republican Faceplant On Obamacare
Thanks to congressional Republicans, a divided nation has come together at last. Everybody hates their health-care plan. To its credit, the bill does away with the employer and individual mandates, which compelled companies and persons to buy insurance or face federal wrath. It cuts taxes, and it also slightly relaxes rules that forbade insurers to charge older customers more than three times what they charge younger ones. ... Unfortunately, the plan’s deficiencies overwhelm its merits. (3/9)

Cincinnati Enquirer: Unintended Consequences Of Health Reform 
The advocates for the American Health Care Act argue that even if the proposed reform package needs some improvement, it is far better than doing nothing and in any case, the government can always make mid-course corrections. This is a truly costly and unnecessarily risky approach. It is a false choice because there are better alternatives for improving access, lowering costs and improving quality. (Hank Werronen, 3/9)

San Francisco Chronicle: Defunding Planned Parenthood Is Ideology, Not Health Care 
Among the ill-considered features of the emerging Republican health care plan is the wholesale effort to hobble Planned Parenthood, the national family-planning organization that, yes, also performs abortions. It’s a case of strident ideology at odds with practical goals. Planned Parenthood delivers a range of family planning and disease-prevention services, including to low-income women using federal Medicaid funds. In California, the organization serves 850,000 residents each year. (3/9)

And some opinions not related to the health law debate —

Stat: Learning How To Be A Doctor In The Shadow Of Trump's Wall
Every Wednesday, my medical school classmates and I swarm the wards and primary care clinics of nearby teaching hospitals, taking histories, fumbling through physicals, and slowly learning to practice the art of medicine. As I talk with a patient and run through my standard list of questions, there’s always one section — place of birth, nationality, and immigration — that I skip. My reasons for not gathering that information are varied: potential embarrassment for the patient, an awkwardness that could disrupt the flow of the interaction, and now the acute anxiety that asking such questions raises. (Sandhira Wijayaratne, 3/9)

The New England Journal of Medicine: Chilling Effect? Post-Election Health Care Use By Undocumented And Mixed-Status Families
Navigating the health care system is particularly difficult for people with limited English proficiency and health literacy or without health insurance or a Social Security number. Many undocumented immigrants and their families therefore go without needed care, to their detriment and sometimes that of others .... Trump administration comments and actions regarding immigration policy and enforcement will most likely further dampen health care utilization. President Donald Trump has already signed several executive orders consistent with his anti-immigrant rhetoric. (Kathleen R. Page and Sarah Polk, 3/8)

JAMA: Medicaid Block Grants and Federalism: Lessons From Canada
Republican leaders are proposing a fundamental reform in Medicaid financing—a shift to block grants. Instead of a matching subsidy and federal oversight, block grants would give states an annual lump sum with minimal conditions attached. Block granting for social and health programs has been used with varying levels of success in welfare reform and in a modified version for the Children’s Health Insurance Program (CHIP), which provides federal matching funds up to a specified cap. But for such a large state-federal health insurance program, perhaps the most useful precedent is Canada, which made a similar shift to block grants several decades ago. (Benjamin D. Sommers and C. David Naylor, 3/9)

The New England Journal of Medicine: Getting Real About Health Care Costs — A Broader Approach To Cost Stewardship In Medical Education
In recent years, a growing number of medical schools have begun to provide training in cost stewardship, as part of efforts to improve the value of health care. Yet everyday patient encounters provide sober reminders of the unintended consequences of myopic physician education about costs. (Ravi B. Parikh, Arnold Milstein and Sachin H. Jain, 3/9)

JAMA: Addressing Physician Burnout
Observational studies suggest physician burnout may have important repercussions for the US health care delivery system. Physician burnout has been linked to self-reported errors, turnover, and higher mortality ratios in hospitalized patients. Indeed, studies suggest a link between burnout and a reduction in the amount of time physicians devote to providing clinical care to patients. Given the particularly high rates of burnout in some primary care disciplines (eg, family medicine and general internal medicine), burnout could amplify workforce shortages and affect access to care. Therefore, the high rates of burnout reported in US physicians can be considered both a marker of dysfunction in the health care delivery system and a factor contributing to dysfunction. (Tait D. Shanafelt, Lotte N. Dyrbye and Colin P. West, 3/7)

San Francisco Chronicle: Help Mentally Ill With Police Training And Treatment, Not Jail 
Violent encounters between police and individuals with mental illness — Sean Moore in San Francisco and Joseph Mann in Sacramento — have highlighted the use of lethal force. In both incidents, police were summoned to address dangerous or disorderly behavior of men who suffered from mental illness; both incidents ended with officers shooting the suspects, one fatally. Public attention has focused narrowly on perceived police mismanagement of these tragic situations. Unfortunately, it may be difficult to defuse a dangerous situation especially when the officers feel that their lives are at risk or a civilian may be injured. (Matthew E. Hirschtritt and Renee L. Binder, 3/9)

Stat: I Learned Personally That Colon Cancer Is On The Rise Among Younger People
Most people think of colorectal cancer as something that affects older folks. New research — and personal experience — shows that young people are affected, too. In November of 2015, at the age of 22, I had a colonoscopy as part of an extensive workup for a pancreatic condition I had been living with for almost five years. Much to my doctor’s surprise, the procedure turned up an adenoma, a precancerous growth in the lining of my large intestine. Had it not been for the colonoscopy, it would have grown undetected for years, and almost certainly turned into colon cancer. (Maia Dolphin-Krute, 3/9)