Health Care Reform Articles-March 31, 2012

The court can’t stop the health-care revolution

By David Ignatius, Published: March 30

Listening to the lawyers talking nonstop last week about health care gave me a headache, so I decided to consult one of the nation’s top doctors. He offered a real-world diagnosis of what’s happening in health care — and a reminder of how much it’s changing, regardless of what the Supreme Court decides about Obamacare.

My medical guru is Delos “Toby” Cosgrove, chief executive of Cleveland Clinic, a $6 billion network that’s one of the biggest and best providers in the country. Cosgrove explained how the health system is being transformed by basic economic pressures that predated the new law and will continue, regardless.

Talking with Cosgrove, you get the sense that the political (and now, legal) version of the health-care debate is in many ways a distraction from what matters most, which is how care is actually delivered to patients. And that’s changing, inexorably, because of underlying cost pressures.

The Supremes could throw Obamacare out the window, and we’d still have a revolution in health-care delivery that promises better treatment for Americans, at lower cost. The Patient Protection and Affordable Care Act will make this revamped system accessible to more Americans, so I’m for it on equity grounds. But even if the mandate to buy insurance disappears, hospitals and docs will keep moving into the new world of care.

http://www.washingtonpost.com/opinions/the-health-care-revolution-marches-on/2012/03/30/gIQAvAQ6lS_print.html

Growth & Justice lays out its case for Minnesota single-payer health care

By Beth Hawkins | 03/29/12

The federal Affordable Care Act (ACA) is before the U.S. Supreme Court this week, while its implementation in Minnesota is tied up at the Legislature. You, John or Jane Q. Public, are probably suspecting that no matter what happens in either venue, your premiums and deductible are only headed up and your access to care down.

What if single-payer were feasible? What if it looked nothing like socialized medicine?

http://www.minnpost.com/health/2012/03/growth-justice-lays-out-its-case-minnesota-single-payer-health-care

March 30, 2012

A Health Law at Risk Gives Insurers Pause

By REED ABELSON and KATIE THOMAS

As the Supreme Court considers the constitutionality of the federal health care law, one option that had seemed unthinkable to its designers and supporters now seems at least possible: that the court could strike down the entire law.

Although it would be folly to predict what the court will conclude, policy experts, insurers, doctors and legislators are now seriously contemplating the repercussions of a complete change in course two years after the nation began to put the law into place.

Their concerns were heightened after three days of court arguments in which some justices expressed skepticism about whether the full law could stand without the individual mandate requiring almost everyone to have insurance.

“Many of us did not get the bill we wanted, but I think having to start over is worse than having to fix this,” said Robert Laszewski, a health care industry consultant and former insurance executive who opposed the bill.

Others say, however, the last two years have made it easier for Congress or the states to revisit the issue. The effort was not a waste of time, said Christine Pollack, vice president of government affairs at the Retail Industry Leaders Association, a trade group that represents large retailers and opposed the law. “There has been an important dialogue that has happened over the last three and a half years that has been a long time coming,” she said.

http://www.nytimes.com/2012/03/31/health/policy/a-health-law-at-risk-gives-insurers-pause.html?hpw=&pagewanted=print

March 30, 2012

Taking Responsibility for Death

By SUSAN JACOBY

I WAS standing by my 89-year-old mother’s hospital bed when she asked a doctor, “Is there anything you can do here to give me back the life I had last year, when I wasn’t in pain every minute?” The young medical resident, stunned by the directness of the question, blurted out, “Honestly, ma’am, no.”

And so Irma Broderick Jacoby went home and lived another year, during which she never again entered a hospital or subjected herself to an invasive, expensive medical procedure. The pain of multiple degenerative diseases was eased by prescription drugs, and she died last November after two weeks in a hospice, on terms determined by explicit legal instructions and discussions with her children — no respirators, no artificial feeding, no attempts to buy one more day for a body that would not let her turn over in bed or swallow without agony.

The hospice room and pain-relieving palliative care cost only about $400 a day, while the average hospital stay costs Medicare over $6,000 a day. Although Mom’s main concern was her comfort and dignity, she also took satisfaction in not running up Medicare payments for unwanted treatments and not leaving private medical bills for her children to pay. A third of the Medicare budget is now spent in the last year of life, and a third of that goes for care in the last month. Those figures would surely be lower if more Americans, while they were still healthy, took the initiative to spell out what treatments they do — and do not — want by writing living wills and appointing health care proxies.

http://www.nytimes.com/2012/03/31/opinion/taking-responsibility-for-death.html?ref=global-home&pagewanted=print

Could defeat for Obamacare mean victory for Obama?

By Mark Penn, Published: March 30

If the Supreme Court knocks out the guts of the Affordable Care Act — the individual mandate requiring people to purchase health insurance or pay a fine — the battle within the Obama campaign will be fierce. The president will be faced with two stark alternatives: launch the political equivalent of a drone strike on the Supreme Court and use the ruling to energize his base, or accept the decision and move on, hoping to neutralize the divisive law in the general election.

In the first scenario, President Obama would double down rather than back down. So far, he has shown no willingness to compromise on the individual mandate despite massive public opposition to the measure. In the face of a Supreme Court ruling against the law, a defiant president may seek to make an even more strident case for his vision for health care in America.

Already, the talking points for a war on the high court are being put in place by organizations such as the Center for American Progress. The story line is simple and potentially effective: From Bush v. Gore in 2000 to the Citizens United decision in 2010 to the possible Obamacare ruling, the Supreme Court puts politics above the people in the name of the Constitution.

This argument could play among an electorate predisposed to suspect the worst. A Bloomberg News survey taken shortly before the oral arguments found that 75 percent of Americans believe that politics will influence the justices’ decision on the health-care law. If the court kills the act, then Washington is reduced to a triple play of gridlock — between the president, Congress and the Supreme Court, nothing gets done.

The Obama campaign could paint the court as out of step with the modern world, in which the state needs to help redress the inadequacies of global and national markets. After all, the mandate is about everyone paying their fair share toward health care; it eliminates free-riders from the system.

http://www.washingtonpost.com/opinions/could-defeat-for-obamacare-mean-victory-for-obama/2012/03/30/gIQADM1llS_print.html

MARCH 30, 2012, 6:00 AM

The Supreme Court and the National Conversation on Health Care Reform

By UWE E. REINHARDT

Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.

Once again America is having one of its “national conversations” on health care reform. This time the buzz is over arguments before the Supreme Court on the constitutionality of certain provisions in the Affordable Care Act. The justices’ rulings will be landmark decisions, because they will indirectly go much beyond the act itself to our entire system of governance.

Today’s Economist

Perspectives from expert contributors.

A fine synopsis of the issues now before the court is provided in a report by the Henry J. Kaiser Family Foundation. The following decision tree illustrates the logical sequence of decisions.

The two major substantive decisions the Supreme Court has to make are:

1. Whether Congress has the constitutional authority to mandate every legal resident in the United States to have insurance coverage for a specified package of health benefits (hereafter the “mandate”) or whether that is an issue for the states to decide.

2. Whether Congress has the constitutional authority to expand eligibility for Medicaid benefits from the highly varied income thresholds that currently define eligibility to anyone under 133 percent of the federal poverty level (hereafter the “Medicaid expansion”).

http://economix.blogs.nytimes.com/2012/03/30/the-supreme-court-and-the-national-conversation-on-health-care-reform/?pagemode=print