Viewpoints: United HealthCare’s Warning; BlueShield’s Promise In Calif.; Drug-Pricing ‘Takeover’

The Wall Street Journal: UnitedHealth’s ObamaCare Reckoning
Health insurance stocks took a nasty tumble last week, and maybe the markets are realizing that ObamaCare isn’t performing as well as the political class pretends. Sooner or later, reality tends to assert itself—for President Obama’s domestic legacy no less than his foreign policy. The immediate cause of the selloff was UnitedHealth Group’s shock $425 million downgrade to its earnings forecast for 2015, almost entirely driven by losses on the Affordable Care Act exchanges. UnitedHealth is the largest U.S. insurer by enrollment, and the company is warning it may withdraw from ObamaCare in 2017. The insurer has already suspended advertising for its ObamaCare coverage and stopped paying commissions to insurance brokers for signing people up. (11/22)

The Chicago Tribune: Obamacare Has a Fever Coming On
There's turmoil in the individual markets for health insurance. ... Blue Cross lost about $280 million in its exchange-based business in 2014. The consulting giant McKinsey & Co. estimated that the insurance industry lost $2.5 billion on Obamacare policies in 2014. About two of every three health care payers lost money; many of the rest eked out small profits. ... Thursday brought another thunderbolt: UnitedHealth Group, the nation's largest health insurer, warned it may bail on Obamacare in 2017 if it can't find a way to make money. ... Obamacare has a fever coming on. The Obama administration has been loath to reopen the law with Congress, given that many Republicans vow to repeal it. But the White House has to acknowledge that changes are needed now. (11/21)

The New York Times: Health Reform Lives!
Yes, Obamacare has hit a few rough patches lately. But they’re much less significant than a lot of the reporting, let alone the right-wing reaction, would have you believe. Health reform is still a huge success story. (Paul Krugman, 11/23)

Los Angeles Times: A Big Insurer Is Threatening To Pull Out Of Obamacare. What Does That Mean?
United is the nation's biggest health insurer. But that's misleading: in the individual market served by the Obamacare exchanges, it's small beer. UnitedHealth's core business is selling employer-sponsored health plans, and it hasn't been known for its familiarity with or success in the individual market, which is dominated nationwide by Blue Cross and Blue Shield plans, especially those owned by Anthem Inc. (Pre-ACA, Blues were the biggest individual insurers in 34 states.) After enactment of Obamacare, United moved only gingerly into the exchange market, participating in only five states in 2014 and 15 this year. (Michael Hiltzik, 11/19)

Real Clear Health: An ACA Provision You've Never Heard Of Could End Up Being Very Costly
One of the most consequential provisions of the Affordable Care Act (ACA) is also one of its most obscure. The “productivity adjustment factor,” inserted by the ACA into the Medicare program, is a massive spending cut, one of the largest in the program’s history. It was included to make room in the federal budget for the ACA’s expensive new health insurance subsidies. If Congress follows past practice, the ACA’s higher spending will be with us long after savings from the productivity adjustment factor have been reduced or eliminated altogether. (James C. Capretta & Joseph Antos, 11/23)

Al.com: Medicaid Expansion And Bentley's $3 Billion Blunder
For the first three years of the program, the federal government had promised to fully fund Medicaid expansion, but that was a clock that started ticking two years ago. Even if Alabama expanded Medicaid next year, it probably wouldn't be soon enough to capture the last year of that funding. About $3 billion, which could have been spent in Alabama, which could have closed that health care gap, has gone elsewhere. We might as well have put that money in a pile and set it on fire. (Kyle Whitmire, 11/20)

The New York Times: Who Turned My Blue State Red?
It is one of the central political puzzles of our time: Parts of the country that depend on the safety-net programs supported by Democrats are increasingly voting for Republicans who favor shredding that net. ... Last year, Paul R. LePage, the fiercely anti-welfare Republican governor of Maine, was re-elected despite a highly erratic first term — with strong support in struggling towns where many rely on public assistance. And earlier this month, Kentucky elected as governor a conservative Republican who had vowed to largely undo the Medicaid expansion that had given the state the country’s largest decrease in the uninsured under Obamacare, with roughly one in 10 residents gaining coverage. (Alec MacGillis, 11/20)

Los Angeles Times: Just What Did Blue Shield Promise?
To win state regulators' approval for its purchase of a rival health insurer, Blue Shield of California promised (among other things) to contribute $14 million annually for 10 years to healthcare-related charities to improve access to care. Not long after the state issued a news release trumpeting that pledge, however, Blue Shield made it clear that it was not going to contribute $14 million more per year. In fact, executives said the nonprofit already had been contributing a considerably larger amount, on average, than $14 million. The new commitment, they said, simply set a floor for future donations. Bait and switch? Not at all, the company insists. But the public could be forgiven for thinking that it's getting less than the state promised. (11/22)

The New York Times: Don’t Let Progress On Tobacco Evaporate
The Centers for Disease Control and Prevention reported this month that the adult smoking rate in the United States has fallen to a new low, a testament to the decades of education about the dangers of tobacco and measures to discourage its use. Now Republicans in the House are seeking to slash the very government programs that have helped to achieve such remarkable success. ... progress might well be slowed or reversed if Congress approves two riders attached to an appropriations bill for the 2016 fiscal year by a Republican-dominated House committee. (11/21)

The New York Times: Are Good Doctors Bad For Your Health?
We — both physicians and patients — usually think more treatment means better treatment. We often forget that every test and treatment can go wrong, produce side effects or lead to additional interventions that themselves can go wrong. We have learned this lesson with treatments like antibiotics for simple medical problems from sore throats to ear infections. Despite often repeating the mantra “First, do no harm,” doctors have difficulty with doing less — even nothing. We find it hard to refrain from trying another drug, blood test, imaging study or surgery. (Ezekiel J. Emanuel, 11/21)

The New York Times: The Politics Of Paid Time Off To Have A Baby
When Hillary Clinton was pregnant, the country didn’t even guarantee employees the ability to take unpaid time off when a new baby arrived, which meant new moms risked their jobs just to recover from birth. The Family and Medical Leave Act didn’t become law until 1993. Today, the way we see the right to time off to bond with and adjust to a new child has changed. There is perhaps no better proof than the 2016 presidential contest. For probably the first time ever, all of the current Democratic candidates openly support a national paid leave program. (Bryce Covert, 11/23)

The New York Times: End Of ‘Death Panels’ Myth Brings New End-Of-Life Challenges
With hardly a ripple of dissent, Medicare authorized payment for end-of-life discussions. Now health care professionals can punch in a code to bill Medicare for sitting down with patients to discuss end-of-life decisions. ... this modest move by Medicare could make a substantial difference. Far more important than the money — physicians aren’t going to boost their income enormously by billing $86 for a half-hour — is the message. (Paula Span, 11/20)

The Wall Street Journal: The Coming Government Takeover Of Drug Pricing
Hillary Clinton has plenty of allies as she demonizes drug-company profits and pushes for federal control over how drugs are priced. There’s a drug-pricing task force led by the White House and a similar Democrat-led effort in Congress. Many of the pharma industry’s proponents in Washington and on Wall Street dismiss this as political noise, arguing that new restrictions impeding investment and innovation are unlikely to get through a Republican Congress. But the Affordable Care Act reordered the legal framework to let a president impose price restrictions unilaterally through the Independent Payment Advisory Board and the Center for Medicare and Medicaid Innovation. These executive-branch bodies were crafted to control what procedures doctors perform, but there is reason to believe they can also control drug prices. (Scott Gottlieb, 11/22)

The Chicago Tribune: Pharmaceutical Companies Should Ignore AMA's Call For Ban On Drug Ads
You wouldn't think TV commercials for prescription drugs would boost sales. Sure, the ads draw you in with claims of curing all maladies, even ones you didn't know existed. But then — warning! — they scare you silly with an endless list of potential side effects. Car insurance ads, we understand those: Fifteen minutes will save me money. But what use is a miracle cure that will cause severe itching? And we don't want to think about certain conditions lasting four or more hours. ... The AMA is wrong to push for a ban on prescription drug ads. Consumers get the benefit of learning about potential treatments. Then, as the ads say, they can discuss the options with their doctors. That's when issues such as cost and alternate treatments can be considered. (11/20)

The Washington Post: The Dangerously Contagious Effect Of Assisted-Suicide Laws
The debate over doctor-assisted suicide is often framed as an issue of personal autonomy and privacy. Proponents argue that assisted suicide should be legalized because it affects only those individuals who — assuming they are of sound mind — are making a rational and deliberate choice to end their lives. But presenting the issue in this way ignores the wider social consequences. What if it turns out that the individuals who make this choice in fact are influencing the actions of those who follow? (Aaron Kheriaty, 11/20)

NPR: A Doctor Wrestles With Whether To Keep Wearing His White Coat
A group of doctors in the field of infectious diseases has begun to rally around a mantra of "bare below the elbows," suggesting that health professionals avoid wearing white coats altogether, as is the custom in the U.K. ... The debate over white coats has forced me to consider my own practice. In the end, I think the issue is as much about generational change as it is about infection control. I'd give up my white coat instantly if I knew it was spreading harmful bacteria. But colonization with bacteria is different from transmitting them to another person. Bacteria live on all of us, so are white coats necessarily worse than our other garments or even our own skin? (John Henning Schumann, 11/21)

Bloomberg: One Way Restaurants Can Fight Child Obesity
Until my older children tired of the ritual, I would take them to the Silver Diner in Rockville, Maryland, every Saturday morning. A few years ago, we noticed a drastic change in the menu, with more emphasis on healthy food. A new analysis of that change published in Health Affairs backs up our family's experience and suggests that it had substantial effects on the food children ordered. ... No magic silver bullet exists to reduce childhood obesity. Instead, progress will have to come from the accumulation of many small changes, like the Silver Diner’s new menu. (Peter R. Orszag, 11/20)