Viewpoints: Obamacare Meltdowns And Fixes; And What’s Your Personal Health-Risk Score

The Wall Street Journal: ObamaCare’s Meltdown Has Arrived
Tennessee is ground zero for ObamaCare’s nationwide implosion. Late last month the state insurance commissioner, Julie Mix McPeak, approved premium increases of up to 62% in a bid to save the exchange set up under the Affordable Care Act. “I would characterize the exchange market in Tennessee as very near collapse,” she said. (Andrew Ogles and Luke Hilgemann, 10/5)

Los Angeles Times: Bill Clinton Was Right That Obamacare Needs Improvement — But We Knew That Already
My quiet afternoon was interrupted Tuesday by an outburst of blather on CNN about a gaffe that Bill Clinton had uttered, supposedly calling the Affordable Care Act “the craziest thing in the world.” There followed lots of speculation about how Hillary Clinton would tamp down the controversy, lots of chortling over whether the time had come to put a leash on the ex-president lest he embarrass his wife again, etc., etc. You know the drill. (Michael Hiltzik, 10/5)

Houston Chronicle:  The ACA Started With A False Policy Premise, And It's Failing 
The Obamacare experiment has left consumers with fewer health insurance options, narrower provider networks and higher premiums. United Healthcare and Aetna - two of the nation's largest insurers - have withdrawn from most of the health exchanges established under the Affordable Care Act. And they're not the first. Years of losses on the exchanges have led many insurers to drop out. (Nina Owcharenko, 10/5)

Houston Chronicle:  ACA Isn't Perfect, But Let's Fix It, Not Kill It 
Three years after its enactment, the Patient Protection and Affordable Care Act (ACA, or "Obamacare") remains the subject of intense debates driven by politics, not facts. What's inescapable is this: The ACA accomplished several important objectives, most significantly, cutting the rate of uninsured Americans from 18 percent to 11 percent. That's 20 million people who now have been able to obtain insurance. (Hagop M. Kantarjian, 10/5)

JAMA Forum: How To Get Public Option Benefits Without A Public Option
The public option debate, in hibernation since a public option was removed from health reform legislation in 2009, has reawakened. In July, Hillary Clinton and the Democratic party endorsed the idea of a launching a government-run plan to exert competitive pressure on private plans offered in Affordable Care Act (ACA) marketplaces. A nearly identical arrangement exists in Medicare—with a little-known twist that might be the key to getting most of the public option’s benefits, with fewer of its political risks. (Austin Frakt, 10/5)

The Fiscal Times: White House To Americans: Pay Astronomical Deductibles -- Or Else
HHS has floated a new attempt to drive fixed-benefit plans out of the market, this time by forcing insurers to pay the exact same dollar amount for any payable event. In other words, whatever payment the insurer provides for a day in the hospital would have to equal what they pay for a doctor visit, and vice-versa. Not only is this irrational, but it also has no precedent in insurance or any other form of commerce. Rather than make fixed-benefit plans less confusing – the ostensible rationale for the Obama administration’s hostility toward such offerings – it makes them almost incomprehensible and completely unmanageable. (Edward Morrissey, 10/6)

Bloomberg: We Already Have Health-Risk Scores. Now Let's Use Them.
Most Americans know they have a personal credit score, and many know where to find it. Few know they also have a personal health-risk score. If these were better known, and better constructed, health insurance markets in the U.S. would work more smoothly. Commercial health insurance plans, as well as Medicare, Medicaid and other government programs, generate risk scores every year for most of the people they cover. These scores are estimates of each person’s cost of care, compared with the average costs in a large population. And they play a big role in health insurance; they’re often used, for example, to determine how much more insurers are paid for sicker beneficiaries. (Peter R. Orszag and Timothy G. Ferris, 10/6)

JAMA: Will Precision Medicine Improve Population Health?
Announcement of the precision medicine initiative has led to a variety of responses, ranging from enthusiastic expectations1 to explicit skepticism,2 about potential health benefits, limitations, and return on investment. This Viewpoint discusses whether precision medicine is unlikely or likely to improve population health, aiming to forge a consensus that bridges disparate perspectives on the issue. The potential of precision medicine to improve the health of individuals or small groups of individuals is not addressed here because it involves a different question with different metrics. (Muin J. Khoury and Sandro Galea, 10/4)

Stat: It's Not Just Apps. Health Care Innovation Requires True Communication
Health care, like many industries, places great emphasis on innovation. In just the past decade, we have moved rapidly from paper medical records to electronic ones and web portals that let information pass seamlessly between health systems and patients at the touch of a finger. Smartphone apps, wearables, medical devices, and other gadgets that promise to improve health are being developed at an ever faster pace...Although it is essential to welcome ideas and creative solutions from diverse sources, many of these “innovations” aren’t solving well-defined problems in health care or they don’t easily fit into current systems that deliver care to patients. (Karen DaSilva, 10/6)

Stat: Do Ethics Fall To The Wayside When Doctors Become Pundits?
[Dr. Mehmet] Oz’s recent foray into political journalism is yet another example of the emerging physician-pundit. In some cases, their contributions come in the form of relatively objective explanatory articles unpacking the significance of Hillary Clinton’s recent pneumonia diagnosis or interpreting Trump’s widely publicized “medical reports.” But others editorialize science and manipulate political debate under the objective veneer of medicine. (Vishal Khetpal, 10/5)

The Washington Post: Does Lack Of HHS Controls Contribute To Personal-Care Abuse Of The Elderly And Disabled?
There’s a decent chance that sooner or later, you or a loved one will need a personal-care attendant. I’ve already been there, having to arrange personal in-home care for my mother before she died. Fortunately, most of the attendants we hired were good. That’s not the case with the miscreants described in a report released Tuesday by the Department of Health and Human Services’ Office of Inspector General (OIG). (Joe Davidson, 10/5)

The Washington Post: A Mega-Case Puts Opioids On Trial
Nearly 19,000 people lost their lives to opioid overdoses in 2014, a quadrupling of these deaths in just 15 years. The devastation wrought by the prescription opioid crisis, and the subsequent related epidemic of addiction to chemically similar heroin, is spreading anguish across America. Government’s response so far consists mainly of damage control — more drug treatment, distributing overdose antidotes to first responders. (Charles Lane, 10/5)

JAMA: Changing The Language Of Addiction
Words matter. In the scientific arena, the routine vocabulary of health care professionals and researchers frames illness and shapes medical judgments. When these terms then enter the public arena, they convey social norms and attitudes. As part of their professional duty, clinicians strive to use language that accurately reflects science, promotes evidence-based treatment, and demonstrates respect for patients. (Michael P. Botticelli and Howard K. Koh, 10/4)

RealClear Health: Counterfeits Kill: Stronger Law Enforcement Needed
When one thinks of counterfeit goods, it can conjure up images of customers being duped into buying inferior quality designer bags or other fashion knockoffs. However, when it comes to the manufacturing, distribution and sale of counterfeit medications, the outcomes can be much more serious and life threatening. (Steve Pociask, 10/6)

Stat: Cheap EpiPen Alternative Risks Patients’ Lives, And I’ve Seen It Myself
A mistake I made as an intern more than 20 years ago still haunts me. It’s one that doctors continue to make today, even though a simple solution — affordable EpiPens for emergency departments — could make these errors a thing of the past. ... For someone having a potentially deadly anaphylactic reaction, a small dose of epinephrine (0.3 milligrams) can help reverse the rash, wheezing, swelling of the throat, and other symptoms. It should be injected into the muscle or under the skin so it doesn’t get into the bloodstream too fast, which can dangerously stress the heart. By comparison, a larger dose (1 milligram) is injected into the bloodstream to try to restart the heart when the heart stops during a “code blue.” (Jennifer Brokaw, 10/5)

Los Angeles Times: Why Won't UC Health Centers Provide Birth Control Without A Prescription?
On Aug. 6, 2013, just weeks after Janet Napolitano was named the first woman president of the University of California, the institution offered its complete support for a bill, SB 493, known as the “pharmacist protocol.” After unanimous legislative approval, Gov. Jerry Brown signed the bill into law, which permits pharmacists to furnish self-administered hormonal contraceptives (birth control) to women without a prescription from a physician. The law also outlines training standards to make implementation as practicable as possible. (Olivia Weber, Ali Chabot and Laura Lively, 10/5)

The New York Times: Can Women Be Trusted On Abortion? Two Men Weigh In
Well, that was painful. What with the cross talk, interruptions, insults, sneers and overly rehearsed zingers, the vice-presidential debate on Tuesday surely bewildered more voters than it enlightened. There was one area, though, in which both Senator Tim Kaine and Gov. Mike Pence were crystal-clear and decidedly different: abortion rights. (Katha Pollitt, 10/5)

The Mercury News: Make End Of Life Options Real With Palliative Care
While controversy remains about California’s recently passed End of Life Option Act, we need to accept that aid-in-dying is now legal and that the state needs to support additional real options for patients—especially good palliative care with its focus on the whole-person and pain management. Alarmingly, California falls woefully short in providing universal access to palliative care.  Community-based palliative care is currently unavailable in 22 of our 58 counties; there are no inpatient services in 19 counties. Specialists in palliative care are in short supply and reliable funding is nonexistent. Most rural communities in the state have limited, or no, access to this vital service. (Margaret R. McLean, 10/5)

Milwaukee Journal Sentinel: The Public Health Crisis In Mental Illness
From a personal standpoint, I am all too familiar with the use of solitary confinement. My father, a Vietnam veteran has bipolar disorder and has spent over 15 years in and out of our state correctional facilities. Most solitary confinements occurred when he would have a medication adjustment and mania, a symptom of his illness, would ensue. (Heidi Plach, 10/5)

Arizona Republic: Is It Time To Give Up On The Phoenix VA?
It apparently wasn’t enough of a wake-up call more than two years ago, when the Phoenix VA Health Care System was at the center of a national scandal over the unbelievable -- and sometimes fatal -- amount of time veterans were expected to wait before getting medical care. It apparently wasn’t enough that the Phoenix VA has endured seven directors since then. The latest one started this week, a career bureaucrat who has the distinction of having run the worst VA hospital in the country before being packed off to a tiny clinic in the Philippines. (Laurie Roberts, 10/5)