Viewpoints: Veterans Day Thoughts On Vets’ Health Care; GOP’s Tax-Reform Secret: Success Is Tied To Medicare Cuts
A selection of opinions on health care from around the country.
USA Today:
On Veterans Day, A VA Doctor Shares Praise And Hope
Perhaps this is the inevitable conclusion for someone only reading news headlines about the Department of Veterans Affairs, but I am honored to be a VA doctor. The other day, I was in a Lyft car (I am writing from San Francisco, after all.) chatting with the driver when I mentioned I work at the VA. He immediately opened up and shared that he was an Iraq War veteran and told me all about his primary care doctor at the VA and the support he received as he transitioned back to civilian life. He thanked me for my service to the veterans. I thanked him for his service to our country. This is the VA that I know, the VA that our country should be proud of. (Megha Garg, 11/10)
JAMA:
Transforming The Military Health System
The Military Health System (MHS) is one of the largest health systems in the United States, delivering health services to 9.4 million eligible patients in nearly 700 military hospitals and clinics around the world as well as through the TRICARE health plan. ... The National Defense Authorization Act for Fiscal Year 2017 directs changes to existing management structures, enabling the MHS to collectively transform into an integrated system of readiness and health. ... This Viewpoint describes the strategic logic of a transformation that Sen John McCain (R, Arizona) stated was the “Most sweeping overhaul of the [MHS] in a generation.” (David J. Smith, Raquel C. Bono and Bryce J. Slinger, 11/9)
Reuters:
For U.S. Republicans, Tax Reform Math Hinges On Cutting Medicare
A 2018 budget blueprint approved by Congress late last month would reduce Medicare spending by $473 billion over 10 years compared with the current baseline projection, and proposes $1.3 trillion in cuts to Medicaid, various Affordable Care Act (ACA) tax credits and cost sharing subsidies and other health spending. Republicans need the spending reductions to make room for $1.5 trillion in tax cuts, mostly for corporations and wealthy households. The budget plan does not include the specifics on how these cuts will be achieved. (Mark Miller, 11/9)
The New England Journal Of Medicine:
Explaining Sluggish Savings Under Accountable Care
Despite aggressive targets set by Medicare for the spread of value-based payment arrangements and widespread agreement on the importance of delivery-system reform, progress toward lower spending growth and a transformed delivery system has been slow. Accountable care organizations (ACOs) are a prime example: nearly 1000 organizations operate as ACOs, but they have generated limited savings. Even in the third year of Medicare ACO contracts, fewer than half of ACOs received a bonus for reducing spending. To guide policy and help providers succeed, it would be useful to understand why so few ACOs are achieving savings. Data-driven empirical work on ACO performance has yielded few insights into the specific characteristics of ACOs that lead to success. We believe it would be helpful to consider how economic and organizational theories might explain early results from the ACO experiment. (Valerie A. Lewis, Elliott S. Fisher and Carrie H. Colla, 11/8)
Axios:
How The Elections Could Put The Brakes On Anti-ACA Plans
The most important issue in an election is sometimes, but seldom, the factor that actually determines the outcome of the election. That's what we saw happen in Virginia this week. Health was the top issue in the Virginia race, according to exit polls, but it was only one of many factors that drove the election. The bottom line: The election may have been more of a referendum on President Trump than health care — but the results in Virginia and in the Maine referendum on Medicaid expansion will still have a practical impact on what happens next, including the appetite for Affordable Care Act repeal and for cutting Medicaid to pay for tax cuts. (Drew Altman, 11/10)
The New York Times:
Medicaid Is Great, but Rural Maine Needs Hospitals, Too
This week Maine voted to become the 32nd state to expand Medicaid despite opposition by Gov. Paul LePage, who had vetoed five previous expansion bills passed by the state legislature and has now threatened to block the results of the ballot initiative. Unless Mr. LePage succeeds, about 80,000 more Mainers will be eligible for coverage, a victory in an unsettling year for health care in America. With the Affordable Care Act under constant threat from the Trump administration and out-of-pocket costs rising faster than wages, health care topped the list of the most important issues facing Americans this year. (Zak Ringelstein, 11/9)
Lexington Herald Leader:
Em’s Dead. Read This And You Won’t Feel So Hot Either.
But he eventually succumbed to that final straw that broke his back. Em was dead. And when I gave my best friend his last good-bye and spoke his eulogy, we all missed those days of doing what a patient needed, rather than what a bureaucrat wanted. We knew, if Em could speak, he might regret that phrase.“Joe, that’s just the way life is.” Em died. We lost him in a blizzard of records, finances, trivialities, computerized slowdowns with decreased productivity, and the fact that our patient/friends had now just become patients. For Em, you see, was the first letter of my beloved . . . Medicine. (Joseph P. Bark, 11/10)
The New England Journal Of Medicine:
Health Care Professionals And Law Enforcement
Health care professionals generally have a respectful, sometimes even friendly, attitude toward law enforcement. We may feel we’re on the same team as the police when we’re treating victims of crime, and police may be called to protect us from people who seek to harm us in the hospital. Some health care professionals in emergency departments or intensive care units may have frequent interactions with police officers who are investigating alleged crimes. But the relationship may be profoundly tested when health care professionals refuse demands from law enforcement that conflict with what we understand to be our professional obligations. These conflicts may arise when law-enforcement officers prevent clinicians from having confidential discussions with patients, demand inappropriate restraints for patients that severely impede examination and treatment, or demand that health care personnel draw specimens from patients or retrieve evidence in an invasive manner from those who refuse or are unable to consent because they lack decision-making capacity due to delirium, confusion, or unconsciousness. (Arthur R. Derse, 11/8)
The Des Moines Register:
After Four DUIs And Two Prison Stays, Now-Sober Lawyer Fights For Her Practice
As a student in the 1980s, Sandra Suarez was president of the Brody Middle School “Just Say No” club. It was named for former First Lady Nancy Reagan’s admonition to reject drugs and alcohol. It made perfect sense to the young Cuban-American girl, who had an alcoholic father and had witnessed what she calls “some of the ugliest things that no child should have to see.” She was so keen to get far away that she chose a college in Washington state. Her father stopped drinking after she left. Rekha Basu, 11/9)
The New York Times:
Facebook Is Ignoring Anti-Abortion Fake News
Last year, just weeks before the election, an article from a site called Mad World News began circulating around Facebook. The headline read “Before Applauding Hillary’s Abortion Remarks, Know the One Fact She Ignored.” In the article, the writer says she wants to expose Hillary Clinton’s lies about late-term abortions. She argues that a baby never needs to be aborted to save a mother’s life but doesn’t cite any sources or studies, and presents anecdotes and opinion as fact. Midway through the story, she shares an illustration of what she calls a “Partial-Birth Procedure” — a procedure banned in the United States. In it, she describes how a doctor “jams scissors into the baby’s skull” and how “the child’s brains are sucked out.” (Rossalyn Warren, 11/10)
The New England Journal Of Medicine:
The Promise, Growth, And Reality Of Mobile Health — Another Data-Free Zone
The use of mobile communication technologies to improve the health of individuals and populations — dubbed “mobile health,” or “mHealth” — has grown dramatically since 2008, when the term mHealth became widely used. The excitement over the use of mHealth technology especially in low- and middle-income countries (LMICs) stems from the recognition that mobile phones have penetrated the market like no other technology. There are more than 5 billion wireless communication subscribers, and more than 70% of them are in LMICs1 (though the subscription rate in low-income countries is 60% overall, and much lower in rural areas). Moreover, commercial wireless signals reach 85% or more of the world’s population, extending much farther than the electrical grid. (Amira Roess, 11/8)
