Viewpoints: Save CHIP; Pharmacy Benefits Managers; Doctors’ Role In End-Of-Life Debate
A selection of opinions on health care from around the country.
The New York Times:
Save The Children’s Insurance
For the past 18 years, the Children’s Health Insurance Program has provided much-needed coverage to millions of American children. And yet, despite strong bipartisan support, we are concerned that gridlock in Washington and unrelated disputes over the Affordable Care Act could prevent an extension of the program. As parents, grandparents and former legislators, we believe that partisan politics should never stand between our kids and quality health care. (Hillary Rodham Clinton and Bill Frist, 2/12)
Los Angeles Times:
With Purchase Of EnvisionRx, Rite Aid Gets In On The Drug Intermediary Racket
John Standley, chief executive of the Rite Aid pharmacy chain, was effusive this week in describing how consumers will benefit from his company spending $2 billion to buy EnvisionRx, a firm most people likely never heard of. The deal, he said, will allow Rite Aid to expand its "health and wellness offerings" and enhance the company's ability "to provide a higher level of care to the patients and communities we serve." A great advance, in other words, for the U.S. healthcare system. Or, more accurately, yet another big business cutting itself in for a piece of your healthcare dollar with an unnecessary service that can inflate drug prices. Welcome to the world of pharmacy benefit managers. (David Lazarus, 2/12)
The New York Times' Opinionator:
Breaking Up With My Meds
My psychiatrist wheels his desk chair toward the couch to show me the graphs he’s holding: One tracks my depression over the course of a year and a half. The other tracks my anxiety over the course of a year and a half. The results are based on surveys he emails me every couple of months that ask me to rate various symptoms of my anxiety and depression on a scale of one through five. It’s November 2014. In the last year and a half, I’ve given my brain every possible rating. (Diana Spechler, 2/12)
Des Moines Register:
State Needs Action, Not Just Talk, On EMTs
[Gov. Terry] Branstad was fortunate to have fallen ill in the metro area, which is well served by several full-time, professionally staffed emergency medical services. In many areas of rural Iowa, ambulance services are struggling, and some are closing down. There are no paid, professional EMTs working for some EMS agencies, and many others can’t attract and retain enough volunteers. ... Branstad’s proposed budget for the coming fiscal year includes $200,000 to pay for two additional EMS coordinators and a contracted, part-time medical director — but much more is needed. EMS leaders throughout the state have called for mandatory background checks for EMTs and the passage of legislation that would make EMS a mandatory public service similar to police and fire protection. (2/12)
JAMA:
Law, Ethics, And Public Health In The Vaccination Debates
The measles outbreak reignited a historic controversy about the enduring values of public health, personal choice, and parental rights. ... Although vaccine policy is politically divisive, the consensus scientific view is that childhood vaccines are safe and effective, among CDC’s 10 great 20th-century achievements and a World Health Organization “best buy.” One estimate suggests that from 1924 to 2012, childhood vaccinations prevented more than 100 million cases of serious disease, with very rare adverse effects. The ethical question, then, is whether parents’ rights to raise their children justify decisions that place the community at risk. (Lawrence O. Gostin, 2/12)
The New England Journal of Medicine:
Should We Practice What We Profess? Care Near The End Of Life
[S]everal studies have revealed a disconnect between the way physicians themselves wish to die and the way the patients they care for do in fact die. ... In Dying in America: Improving Quality and Honoring Individual Preferences near the End of Life, an Institute of Medicine (IOM) committee (which we cochaired) concluded that the U.S. health care system is poorly designed to meet the needs of patients and their families at the end of life and that major changes are needed. We need to begin by fostering patients' ability to take control of their quality of life throughout their life and to choose the care they desire near the end of life. The committee recognized that these goals could be achieved only by making major changes to the education, training, and practice of health care professionals, as well as changes in health care policy and payment systems, (Philip A. Pizzo, and David M. Walker, 2/12)
The New England Journal of Medicine:
Finding The Right Words At The Right Time — High-Value Advance Care Planning
Last September, the Institute of Medicine (IOM) released a report entitled Dying in America, in which it recommends measures to improve end-of-life care through, among other strategies, better advance care planning (ACP). Specifically, it recommends the development of “standards for clinician–patient communication and advance care planning that are measurable, actionable, and evidence based” and that these standards be tied by payers and professional societies to “reimbursement, licensing, and credentialing” ... If promoting ACP discussions were as simple as asking or paying physicians to have them, Dying in America might not have been necessary. These discussions are difficult, and for multiple reasons. (Justin Sanders, 2/12)
The New England Journal of Medicine:
Breast-Density Legislation — Practical Considerations
[Connecticut] was the first to pass a law requiring physicians to offer supplemental whole-breast ultrasonography to women with dense breasts ... and mandating that insurers cover the additional screening. Since then, the number of breast-density laws in the United States has grown rapidly: as of January 2015, a total of 21 states had adopted such legislation. ... Given recent concerns raised by the U.S. Preventive Services Task Force about false positives and increased patient anxiety with routine mammography screening, it would be unwise to adopt supplemental ultrasound screening without careful consideration of the risks and benefits. ... In this era of cost containment, and given the limited data supporting screening ultrasonography, a rational and cost-effective approach to screening is needed. (Priscilla J. Slanetz, Phoebe E. Freer and Robyn L. Birdwell, 2/12)
