Viewpoints: Predicting The Fallout If The Health Law Is Undone; Variation In Medicine
A selection of opinions on health care from around the country.
The New York Times' The Upshot:
Many States Will Be Unprepared If Court Weakens Health Law
A Supreme Court ruling this spring could upend health insurance markets in at least 34 states, eliminating the federal subsidies that make coverage affordable for millions of Americans. State governments, theoretically, have ways to forestall this outcome. But few have taken action. If they wait until the court rules, it may already be too late for a state to get started on an exchange so that it is ready for 2016. (Margot Sanger-Katz, 12/11)
The New England Journal Of Medicine:
Unraveling Obamacare — Can Congress And The Supreme Court Undo Health Care Reform?
The 2014 elections altered the ACA's political environment in a way that could produce changes in the law, but its core will remain in place. Now the question is, once again, whether Obamacare will emerge intact from the Supreme Court. If the Court dramatically narrows the ACA's scope, the political calculus will change substantially in 2015 and beyond. The law's recent momentum will be reversed, the fight over Obamacare will intensify, and the future of health care reform will be highly uncertain. (Jonathan Oberlander, 12/10)
The New England Journal Of Medicine:
Predicting The Fallout From King V. Burwell — Exchanges And The ACA
The U.S. Supreme Court's surprise announcement on November 7 that it would hear King v. Burwell struck fear in the hearts of supporters of the Affordable Care Act (ACA). ... the states in question may not want to operate their own exchanges. The political climate is hostile to the ACA in nearly all of them. Just seven of them will be led by Democratic governors in 2015; ... ACA opponents' commitment to resisting the temptation of federal money should not be underestimated: witness the refusal of nearly two dozen states to expand Medicaid even though the federal government would cover almost all the costs. ACA supporters thus have good reason to worry. (Nicholas Bagley, David K. Jones and Timothy Stoltzfus Jost, 12/10)
The New England Of Medicine:
Antitrust Enforcement In Health Care — Controlling Costs, Improving Quality
The success of health care reform in the United States depends on the proper functioning of our market-based health care system. Antitrust laws play a crucial role in ensuring that consumers benefit from robust market competition. ... The FTC supports the key aims of health care reform, and we recognize that collaborative and innovative arrangements among providers can reduce costs, improve quality, and benefit consumers. But these goals are best achieved when there is healthy competition in provider markets fostering the sort of dynamic, high-quality, and innovative health care that practitioners seek and patients deserve. (Edith Ramirez, 12/11)
The New York Times:
Don’t Homogenize Health Care
IN American medicine today, “variation” has become a dirty word. Variation in the treatment of a medical condition is associated with wastefulness, lack of evidence and even capricious care. To minimize variation, insurers and medical specialty societies have banded together to produce a dizzying array of treatment guidelines for everything from asthma to diabetes, from urinary incontinence to gout. (Sandeep Jauphar, 12/10)
The New England Journal Of Medicine:
The Disease Of The Little Paper
Toward the end of his life, my father tried to engage me in conversations about our shared profession. ... “Seen any great cases?” he'd ask. This question set my teeth on edge. ... I'd explain — again — that I was a general internist, not a specialist as he had been, and derived my professional satisfaction from long and close relationships with patients and not from making obscure diagnoses. ... The reminiscence I bristled at most, though, was about ladies — always they were “ladies” — with something he called la maladie du petit papier: the disease of the little paper. They would come to his office and withdraw from their purses tiny pieces of paper that unfolded into large sheets on which they'd written long lists of medical complaints. (Dr. Suzanne Koven, 12/11)
The New England Of Medicine:
Integrating Oral And General Health Care
During World War II, the U.S. armed forces faced a surprising obstacle to recruiting sufficient field-ready personnel for the war effort: 10% of potential recruits failed service requirements related to oral health (such as having six opposing teeth), and many who met the requirements had severely compromised teeth ... So at the end of the war, “many dentists, military officers, political leaders, and others vowed to solve the Nation's rampant dental problems.” ... Of course, the ultimate goal is care, not insurance, but we know that incorporating coverage of oral health into health insurance reduces costs and improves health. (Dr. Bruce Donoff, John E. McDonough and Christine A. Riedy, 12/11)
The Washington Post:
I’m An Obama Supporter. But Obamacare Has Hurt My Family.
As it happened, the 2008 election was the first time Jim and I were bitterly divided on candidates. Jim foresaw healthcare reform as an addition to the federal deficit more worrisome than any health benefit. When I told him about Obama’s victory, he grumbled, “I guess I can’t blame Obama for breaking my heart.” But, he worried that he would eventually be able to blame the president “for keeping me from getting better.” The transition to Obamacare – at least for a 59-year-old man and a 56-year-old woman in south Orange County – wouldn’t be quite that bad. But it would be, in three big ways, far rougher and more frustrating than I’d ever dreamed. (Catherine Keefe, 12/10)
Modern Healthcare:
Who Cares What Gruber Says About Obamacare?
Before Obamacare foes made a big deal about consultant Jonathan Gruber's videotaped statement that Democrats capitalized on “the stupidity of the American voter” to win passage of the healthcare reform law, they made a big deal about his videotaped comment about who would and would not qualify for a federal premium subsidy. Much was made of the remark by the Massachusetts Institute of Technology economist that “if you're a state and you don't set up an exchange, that means your citizens don't get their tax credits.” ... Gruber said during a congressional grilling Tuesday that his statement about subsidies and exchanges was taken out of context and that he had built his economic models based on the assumption that subsidies would be available in every state. (Harris Meyer, 12/9)
The New York Times:
Heavy Lifting
One of my sharpest memories of elementary school is the way that teachers – the young, pretty, married ones – would occasionally just disappear. One day they would be in the classroom, looking as they always did, and the next day they would be gone, replaced by a substitute – in reality, the new teacher. Over the summer or during the next school year, you might catch a glimpse of the mysteriously vanished teacher at the grocery store, pushing a baby carriage. Where had the baby come from? The pattern became clear: Once a teacher even began thinking about having a baby, the classroom was no place for her – or any like-minded woman. (Linda Greenhouse, 12/10)