Viewpoints: Fight Homelessness And Help Medicaid; Anthem’s Obamacare Breakup Threat

Bloomberg: Help Medicaid By Tackling Homelessness 
In a growing number of states, Medicaid directors have come to believe they could save money by housing the homeless. The federal government is providing money to find out if they're right. There's good reason to think this is an experiment worth trying. The idea arose from two developments. First, Obamacare's drastic expansion of eligibility for Medicaid coverage has raised the number of homeless people who sign up. These beneficiaries often suffer from unmanaged illnesses, which lead to higher health-care costs and put a strain on Medicaid budgets. Second, in recent years, policy makers have come to better understand how the way people live affects their medical needs. (11/3)

Bloomberg: Anthem Threat Highlights Obamacare’s Big Test
Anthem Inc. is threatening to leave the Obamacare exchanges. But in fact, this is huge news, because Anthem runs the Blue Cross/Blue Shield organizations in 14 states. And though Anthem doesn't appear to be the sole company offering exchange coverage in any of those states, the Blues are generally the backbone of the exchanges. Where others have quailed, the Blues have by and large stuck with Obamacare. If they pull out, then it’s likely that we’ll see more counties, and possibly entire states, with no Obamacare policies on offer. (Megan McArdle, 11/3)

The New England Journal Of Medicine: The Paradox Of Authority — Transformation Of The USPSTF Under The Affordable Care Act
In early 2009, the drafters of the Affordable Care Act (ACA) agreed that as part of their insurance coverage Americans should have access to clinical preventive services without cost sharing. To avert demands for services of unclear effectiveness, they proposed that health plans should, at minimum, cover services with an A or B grade from the U.S. Preventive Services Task Force (USPSTF), a federally sponsored expert panel known for making careful assessments grounded in rigorous scientific analysis. For advocates of evidence-based medicine, this provision represented a singular achievement. But the USPSTF’s transition from arbiter of evidence to full-fledged policy authority has provoked sharp debate. (David Merritt Johns and Ronald Bayer, 11/3)

Des Moines Register: One Medicaid Complaint Branstad Hears: Insurers'
Gov. Terry Branstad’s unpopular privatization of Medicaid is turning out to be an even bigger train wreck than anticipated. Since he handed over administration of the government program to for-profit insurers on April 1, numerous Iowans have been denied health services, providers have closed their doors and seniors have lost in-home care. The governor has ignored or dismissed these complaints. Yet when the managed care companies collecting hundreds of millions of public dollars for “administration” started grumbling, Branstad snapped to attention. (11/3)

RealClear Health: Repeal Medicare Demonstration To Protect Home Health For Seniors
The Centers for Medicare and Medicaid Services (CMS) efforts to eliminate fraud and abuse are necessary to protect program integrity, which is the practice of a majority of caregivers in our industry. Florida –– more specifically, South Florida –– is the epicenter of home health fraud. To combat this, CMS in 2013 imposed a three-year moratorium on new Medicare agencies in Miami-Dade County, a two-year moratorium in Broward County (Fort Lauderdale), and a six-month moratorium statewide. As a result, honest providers cannot currently expand their home health businesses across our ever-growing state, and beneficiaries have fewer choices as to which agency cares for them. (Kyle Simon, 11/4)

The New England Journal Of Medicine: Tolerating Uncertainty — The Next Medical Revolution?
Although physicians are rationally aware when uncertainty exists, the culture of medicine evinces a deep-rooted unwillingness to acknowledge and embrace it. Embodied in our teaching, our case-based learning curricula, and our research is the notion that we must unify a constellation of signs, symptoms, and test results into a solution. ... The unintended consequence — an obsession with finding the right answer, at the risk of oversimplifying the richly iterative and evolutionary nature of clinical reasoning — is the very antithesis of humanistic, individualized patient-centered care. (Arabella L. Simpkin and Richard M. Schwartzstein, 11/3)

The New England Journal Of Medicine: Extreme Home Makeover — The Role Of Intensive Home Health Care
In 2010, the department of health in Victoria, Australia, announced the construction of a 500-bed hospital without bricks and mortar. This “virtual hospital” has 33,000 admissions each year, accounting for almost 5% of all acute care bed-days in the state of Victoria and adding much-needed hospital-bed capacity. The Australian health system has since expanded this program to reduce the strain on available hospital beds in other regions as well, while avoiding capital expenditures and preserving the quality of care. What incredible technological advance permitted achievement of these impressive results? Home visits. Intensive home health care services as an alternative to hospitalization are becoming a standard option in many health systems around the world. (Luis Ticona and Kevin A. Schulman, 11/3)

Bloomberg: Patient Zero, Typhoid Mary And Blaming The Sick
Last week, DNA sleuthing disproved a widely held belief about the HIV/AIDS epidemic: that one person single-handedly brought the illness across the Atlantic to North America. That man, a gay flight attendant named Gaetan Dugas, was mistakenly identified as “Patient Zero” by journalists in the 1980s. Not long after his name became public, the crisis had a villain: In a screaming headline, the New York Post called Dugas “The Man Who Gave Us AIDS,” while the National Review deemed him “the Columbus of AIDS.” ... The scientific findings, published last Wednesday in the journal Nature, went beyond the clearing of one person’s reputation. They also shed light on society’s often irrational way of blaming people for getting sick. (Faye Flam, 11/3)

The New England Journal Of Medicine: Safety Lessons From The NIH Clinical Center
The National Institutes of Health Clinical Center (NIHCC) has a long and storied list of accomplishments. Many practices begun at the NIHCC on the basis of NIH research have become the standard of care worldwide, and in many ways, it’s a hospital like no other. Like other hospitals, however, it is susceptible to competing priorities that can lead to lapses that compromise patient safety. Recent events at the center provide important lessons for health professionals and leaders everywhere. (Tejal K. Gandhi, 11/3)

Sacramento Bee: School Should Start Later To Allow Children Enough Sleep 
Impeccable research has proved that because children’s circadian rhythms are much different than those of adults, having them go to school so early each morning – some as early as 7 a.m. – damages their ability to learn. Yes, in theory, they could have gone to bed earlier and thus gotten enough sleep. But the research also shows that it’s difficult for children, especially teenagers, to fall asleep before 11 p.m. (Dan Walters, 11/3)

Los Angeles Times: If You Think Legalizing Marijuana Is No Big Deal, Think Again
If California approves Proposition 64 next week, it is likely to create significant momentum toward legalizing marijuana throughout the U.S. and beyond. The results of the election may signal the birth of a massive new “vice” industry along the lines of the tobacco and alcohol behemoths. (Robert MacCoun, 11/3)

The Washington Post: Aging Alone: If You’re A Single, Childless Senior Who Has Your Back?
Even if you have enough money for retirement, who will help you manage your finances when you can’t? Who can you count on to be a caregiver? Don’t have an answer to those questions? You are not alone. (MIchelle Singletary, 11/3)

Boston Globe: Appalling To Canadians, Routine In The US 
Last week, the UN special rapporteur on torture, Juan E. Méndez, published a report that compared the use of solitary confinement in 26 countries and eight US states. It found that by almost every measure, the United States imposes the most punitive regime of solitary confinement in the world. No one knows for sure how many people are being held in solitary confinement at any one time, but it is estimated to be between 80,000 and 100,000 in the United States. There are no effective limits on how long someone can be locked up like this. (Scott Gilmore, 11/3)