Editorials, Opinion Pieces Address Issues Related to Overhauling U.S. Health Care System

Summaries of several recent editorials and opinion pieces that address issues related to health care reform appear below.

Editorials

• Baltimore Sun: "While a lively debate is expected in coming months over the mechanisms of [health care] reform, the most important goals seem clear," a Sun editorial states. "Health coverage for all," a "[r]eorganization of the delivery of care," reforms to "the payment system" and "[g]overnment leadership" in efforts to "help develop national aims for health system performance, set priorities for improvement and create a system for monitoring performance" are among those goals, according the Sun. The editorial concludes, "It's time for Americans to come together and fix our broken health care system" (Baltimore Sun, 12/26/08).
  
  
• Philadelphia Inquirer: "So far, [President-elect Barack] Obama is making all the right moves" on his "campaign pledge" to enact health care reform, an Inquirer editorial states. Obama's "strategy to expand government coverage by creating a Medicare-like option that typically uninsured younger workers could afford would make sense," the Inquirer states, adding, "To control costs, [HHS Secretary-nominee Tom] Daschle's concept of Federal Reserve-style oversight is promising." The editorial continues, "Any plan, of course, should require everyone to buy insurance, as long as subsidies are made available to those who cannot afford it," while "private insurers already have advanced the effort by pledging not to turn away customers because of chronic health conditions." The editorial concludes, "The details are tricky" but "a can-do spirit and sense of urgency from a president-elect who wants 'change' are the best things America's uninsured have going for them" (Philadelphia Inquirer, 12/29/08).
  
  
• Wall Street Journal: "[W]hen the expensive realities of 'universal' coverage somehow intrude, taxpayers can't afford to let those moments disappear down the Beltway memory hole," a Journal editorial states. According to the Journal, Democrats' preparations for health care reform amount to an "arms race to promise the most while disguising the costs." However, the Congressional Budget Office last month released "two important reports on health care financing that should hit Democrats like a cinderblock." According to the editorial, the "executive summary" of the reports "is that liberal health reforms will be extremely costly, while measures intended to 'save' money won't even come close to the promises." Although Democrats maintain that "covering everyone under a government plan will reduce costs through efficiency," CBO notes that there are "'difficult trade-offs between the objectives of expanding insurance coverage and controlling both federal and total costs for health care.'" The editorial continues, "Many Democrats (and a few Republicans) are glad that" CBO Director Peter Orszag, who has been named director of the White House Office of Management and Budget in the Obama administration, "is departing and are searching for a CBO replacement who will 'score' their bills more favorably." The editorial concludes, "The best outcome would be if Mr. Orszag manages to introduce some health care sobriety to the Obama White House" (Wall Street Journal, 12/29/08).

Opinion Pieces

• Michael Cannon, Washington Times: "The leading Democratic plans" for health care reform "include radical changes that would tax and disrupt the health care of millions," Cannon, director of health policy studies at the Cato Institute, writes in a Washington Times opinion piece. "With a minimum price tag of $120 billion, universal health insurance coverage will require taxing the middle class during a recession, further expanding a $1 trillion deficit, or having the government deny medical care to patients." According to Cannon, an "estimated 30 million Americans would lose their current coverage under Barack Obama's plan." In addition, Cannon writes, "Millions could lose established relationships with their doctors." He continues, "The leading plans would cost lives by effectively nationalizing health insurance and impeding innovations that make medicine better, cheaper and safer." According to Cannon, "Republicans, centrist Democrats and independents must protect Americans from the worst elements of those proposals." Cannon writes, "Any proposal that crosses one of the following lines" -- government-run health care for the middle class, mandates or price controls -- "should be stopped. Not watered down. Not enacted and fixed later. Killed" (Cannon, Washington Times, 12/28/08).
  
  
• Victor Dzau, Raleigh News & Observer: "As the public health care reform conversation resumes, it is critically important to realize that proposed solutions must go beyond the oft-discussed goals of affordability and insurance coverage," Dzau, president and CEO of the Duke University Health System and chancellor for health affairs at Duke University, writes in a News & Observer opinion piece. According to Dzau, "While there is no question that these are important and fundamental objectives, it would be a mistake to open the health care system floodgates without first addressing the most important infrastructure barriers to reform -- the need to strengthen the primary care delivery system, and the dwindling supply of primary care physicians." He continues, "An immediate and serious commitment must be made to actively explore pioneering new patient-centered models of primary care that more effectively apply the skills of 'extenders' -- nurse practitioners, physician assistants, care managers and even health coaches -- as part of integrated, physician-directed care teams." Dzau notes, "Without serious reform of the care delivery models and primary care infrastructure, it will become impossible to provide high-quality care to the millions of people who will be entering the health care system," adding, "It is imperative that we quickly move from the theoretical to the practical in addressing this issue." Savings in health spending and access "will no doubt be the headline issues in the health care reform debate," but "neither will be effectively achieved or realized without ensuring that there will be a system in which there are doctors and strategies that allow patients to be seen," Dzau concludes (Dzau, Raleigh News & Observer, 12/28/08).
  
  
• Alain Enthoven, New York Times: Obama "has proposed some good ideas for cutting health care costs, but his proposals will not create the savings we need," Enthoven, a professor of management at Stanford University, writes in a New York Times opinion piece. According to Enthoven, "The only truly promising way to save money is to change the way health care is organized and delivered." He writes, "Some American medical practices do emphasize economy" as they "work together to improve quality and keep costs low," adding, "Their doctors share values and cultures of teamwork" by employing electronic medical records, sharing information and emphasizing prevention and disease management. According to Enthoven, "Efficient, organized medical systems need to be able to compete with -- and ultimately replace -- the fee-for-service model." Enthoven states that Obama should work with Congress to "establish a national health insurance exchange, through which people can choose among several competing health plans, including those affiliated with organized systems of care." He writes, "By combining organized systems of medical care with the competition created by a health insurance exchange, Mr. Obama could achieve large savings." After "10 years, costs could be reduced by 30%, saving more than $700 billion a year -- all driven by incentives and voluntary actions," Enthoven concludes (Enthoven, New York Times, 12/28/08).
  
  
• Phil Kerpen, Washington Times: President-elect Barack Obama "swept large Democratic majorities into both houses of Congress in large part by promising that he would not raise taxes on any Americans making less than $200,000 per year, and would provide most Americans with tax cuts," Kerpen, director of policy for Americans for Prosperity, writes in a Washington Times opinion piece. However, according to Kerpen, "there are rumblings that one of the first orders of business for the expanded Democratic majorities in Congress will be to raise taxes on millions of Americans nowhere near being rich" by increasing the federal cigarette tax to help fund an SCHIP reauthorization bill. He continues that increasing the federal cigarette tax "would signal that Democrats are still the party of higher taxes -- and not just for the rich," as the increase "would wallop the poor." A "dramatic expansion of SCHIP is a bad idea, regardless of how it's funded," as it would be "a big step toward universal government children's coverage which could, in combination with other program expansions, lead to a universal government-run health insurance system," he writes. According to Kerpen, "Such a system would be rife with long waiting lines and substandard quality of care -- judging by international experience" (Kerpen, Washington Times, 1/2).
  
  
• Morton Kondracke, Roll Call: President-elect Barack Obama "has plenty of serious problems on his agenda, but here's another worthy one: a war on obesity," Roll Call Executive Editor Kondracke writes. According to Kondracke, "Fatness is killing Americans by the millions," is "driving up health costs and damaging the national economy" and is "also aesthetically disgusting." He continues, "Obama is singularly positioned to lead the charge against overweightness" because he is "lean, he exercises and he can set a great example for getting the nation fit again," adding, "He's also smart enough to figure out how to do it -- which is probably to mention the obesity problem in his health care reform speeches and assign his yet-to-be-named surgeon general to mount a campaign of exhortation and scolding." Kondracke writes, "Trimming down America probably is going to be harder during a deep recession than at other times," adding, "There's a socioeconomic correlation to obesity -- it's more prevalent among poor people than wealthier folks." He concludes that "it's going to be tough right now for Obama to get people to eat less and exercise more," but "it can be done and it's definitely worth the try" (Kondracke, Roll Call, 12/29/08).
  
  
• Sally Pipes, Wall Street Journal: Now that Obama has nominated Daschle as HHS secretary, "[t]he prognosis is not good for patients, physicians or taxpayers," Pipes, president and CEO of the Pacific Research Institute, writes in a Journal opinion piece. Pipes continues, "Americans can expect a quick, hard push to build more federal bureaucracy, impose price controls, restrict medicines and technology, boost taxes, mandate the purchase of health insurance, and expand government health care." According to Pipes, Daschle "proposes nothing less than a giant HMO with a federal bureaucracy setting the benefit plan," adding that his "model is Massachusetts." She writes, "Massachusetts's plan is an unfolding disaster and demonstrates how Mr. Daschle's private/public model is merely a stalking horse for government-dominated health care." The "only way the Massachusetts plan will survive is with continued and increasing federal subsidies" or "tax revenue from the residents of other states," Pipes writes, adding, "The only way Mr. Daschle's proposed plan would survive is with massive deficit spending" or "with taxpayer money from future Americans, many of whom are not yet born." She concludes, "Americans could easily find that Mr. Obama's 100-day honeymoon ends with a whole new health care regime they hadn't quite bargained for" (Pipes, Wall Street Journal, 12/30/08).
  
  
• George Will, Washington Post: As HHS Secretary Mike Leavitt's tenure comes to an end, "he offers this attention-arresting arithmetic: Absent fundamental reforms, over the next two decades, the average American household's health care spending, including the portion of its taxes that pays for Medicare and Medicaid, will go from 23% to 41% of average household income," Post columnist Will writes. Leavitt says it is "'predictable' that today's traumatizing economic turbulence, by heightening Americans' insecurity, will complicate reforming entitlements," Will continues, adding, "This, too, is predictable: By curtailing revenue, today's recession will bring closer the projected exhaustion of the Medicare Part A trust fund, from early 2019 to perhaps 2016. That should get the president-elect's attention." Will writes, "Leavitt says that until health care recipients of common procedures can get, upfront, prices they can understand and compare, there will be little accountability or discipline in the system." According to Leavitt, Medicaid could become an even bigger unfunded liability than Medicare. Will writes that this is "partly because of the cost of long-term care for the indigent elderly, some of whom shed assets to meet Medicaid's eligibility standard -- sometimes as high as income under 200% of the federal poverty level." In addition, "many states, eager to expand the ranks of the dependent with the help of federal Medicaid money, use 'income disregards' to make poverty an elastic concept," Will writes. He concludes, "Governments with powerful political incentives to behave this way will play an increasingly large role in health care. As is said, if you think health care is expensive now, just wait until it is free" (Will, Washington Post, 1/1).