Viewpoints: Medicaid’s Payback; Orszag Says Brill Missed Key Point; Dems’ ‘Bargaining Chips’

The New York Times' The Upshot: How Medicaid For Children Recoups Much Of Its Cost In The Long Run
When advocates talk about the advantages of government health care, they often talk about a moral obligation to ensure equal access. Or they describe the immediate health and economic rewards of giving people a way to pay for their care. Now a novel study presents another argument for the medical safety net, at least for children: Giving them health coverage may boost their future earnings for decades. And the taxes they pay on those higher incomes may help pay the government back for some of its investment. (Margot Sanger-Katz, 1/12)

Bloomberg: What Brill's 'Bitter Pill' Gets Wrong On Obamacare
Steven Brill's new book about the process of passing the Affordable Care Act is so meticulously reported, I found myself surprised by many details of a process I myself was deeply involved in. ... A substantial amount of skepticism, perhaps even within the White House, existed about whether the health-care legislation did enough on costs. Yet the cost curve in health care is bending more drastically than even I believed possible in the fall of 2009. That’s because the collective impact of the legislation’s individual measures, along with similar changes in the private sector, has produced a shift in perspective and therefore behavior among health-care leaders. This is a significant point that Brill fails to acknowledge. (Peter R. Orszag, 1/12)

The Wall Street Journal: High Health-Care Prices: More Talk Than Action
Price is the major factor that distinguishes the cost of our system from those in other developed nations. The sticker shock of some medical services and drugs is also the dimension of the health-cost problem most visible to the public. So it’s interesting that most efforts in this country to address health-care costs don’t focus on price much at all. Instead, they focus on reforming the delivery of health care and provider reimbursement to reduce the volume of health care Americans use and to weed out unnecessary procedures and hospitals days. (Drew Altman, 1/12)

Modern Healthcare: Should Dems Keep ACA Bargaining Chips In Case Supreme Court Strikes Down Subsidies?
[Senate Democrats] must be aware that the Supreme Court in June may invalidate the ACA's premium subsidies in 37 states. That would cripple the law unless the GOP-controlled Congress somehow agrees to restore the subsidies. Surely the Democrats also know that the Republicans would demand a very high price for doing so—if they would even consider it. So one wonders what Senate Democrats like Joe Donnelly of Indiana and Joe Manchin of West Virginia, who say they support the ACA overall, are thinking in being willing at this point to give up the 30-hour workweek rule, which might well be one of Democrats' bargaining chips. (Harris Meyer, 1/11)

Los Angeles Times: A Fishy Fee 'Adjustment' From Kaiser
Karen Kurokawa was happy to pay her husband's Kaiser Permanente bill. She just wanted to know why Kaiser had adjusted it almost $2,000 higher. The fact that the Culver City resident couldn't get a straight answer from Kaiser, even after she filed a formal grievance, highlights the challenge patients face in knowing their true healthcare costs. The episode also raises questions about Kaiser's billing system. Kurokawa said she was told by a senior company executive that "things happened that shouldn't have happened, and things that should have happened didn't." (David Lazarus, 1/12)

The New York Times' The Upshot: Doing More For Patients Often Does No Good
Given the remarkable advances that have been made in the last 50 or so years in pharmaceuticals, medical devices and surgical procedures, it’s not a surprise that people want more, and more invasive, care than they have had in the past. Just as it’s hard to do nothing when you’re ill, it’s sometimes hard to do less than the maximum when there are different treatments to choose from. (Dr. Aaron E. Carroll, 1/12)

The New York Times: When Diabetes Treatment Goes Too Far
There are roughly 11 million Americans over age 65 with diabetes. Most of them take medications to reduce their blood sugar levels. The majority reach an average blood sugar target, or “hemoglobin A1C,” of less than 7 percent. Why? Early studies showed that this can reduce the risk of diabetes complications, including eye, kidney and nerve problems. As a result, for more than a decade, medical societies, pharmaceutical companies and diabetes groups have campaigned with a simple, concrete message — to get below seven. ... Doctors are often rewarded based on how many of their patients hit the target. ... But, at least for older people, there are serious problems with the below-seven paradigm. (Dr. Kasia Lipska, 1/12)

Politico: No, The GOP Is Not At War With Science
Our national debt is more than $18 trillion, and the American taxpayer is hurting. If we, as a country, have decided to spend taxpayers’ hard-earned dollars on funding science and research, then we need to spend wisely. ... Similarly, the National Institutes of Health has engaged in the funding of wasteful projects like $258,000 on a website for the first lady’s White House garden. These programs might sound merely frivolous, but the problem is that when the NSF or NIH funds projects of these kinds, there is less money to support good scientific research that can yield technological breakthroughs and opportunities for economic growth. Ebola-related scientific research is something that Americans want to prioritize, yet this important research is competing with wasteful grants. (Sen. Rand Paul, R-Ky., and Rep. Lamar Smith, R-Texas, 1/12)

JAMA: Physician Self-Referral
A 1992 editorial singled out self-referral as a prime example of the “growing encroachment of commercialism on medical practice” previously characterized as the “medical-industrial complex.” Regrettably, more than 2 decades later, this observation of the failing of responsible professionalism still rings true. The recent GAO analysis reaffirms the inescapable effects of physician self-referral on increasing Medicare Part B spending. Viewed in this light, the GAO reports must be seen as nothing less than a call for action. Congress should address the relative shortcomings of the well-meaning if ineffective Stark provisions and enact simpler and enforceable ordinances in its stead. Failure to do so would constitute a costly opportunity missed. (Drs. Eli Y. Adashi and Robert P. Kocher, 1/12)