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Tuesday, January 22, 2013

Health Care Reform Articles - January 22, 2013


The Big Deal


By 

On the day President Obama signed the Affordable Care Act into law, an exuberant Vice President Biden famously pronounced the reform a “big something deal” — except that he didn’t use the word “something.” And he was right.
In fact, I’d suggest using this phrase to describe the Obama administration as a whole. F.D.R. had his New Deal; well, Mr. Obama has his Big Deal. He hasn’t delivered everything his supporters wanted, and at times the survival of his achievements seemed very much in doubt. But if progressives look at where we are as the second term begins, they’ll find grounds for a lot of (qualified) satisfaction.
Consider, in particular, three areas: health care, inequality and financial reform.
Health reform is, as Mr. Biden suggested, the centerpiece of the Big Deal. Progressives have been trying to get some form of universal health insurance since the days of Harry Truman; they’ve finally succeeded.
True, this wasn’t the health reform many were looking for. Rather than simply providing health insurance to everyone by extending Medicare to cover the whole population, we’ve constructed a Rube Goldberg device of regulations and subsidies that will cost more than single-payer and have many more cracks for people to fall through.
But this was what was possible given the political reality — the power of the insurance industry, the general reluctance of voters with good insurance to accept change. And experience with Romneycare in Massachusetts — hey, this is a great age for irony — shows that such a system is indeed workable, and it can provide Americans with a huge improvement in medical and financial security.
What about inequality? On that front, sad to say, the Big Deal falls very far short of the New Deal. Like F.D.R., Mr. Obama took office in a nation marked by huge disparities in income and wealth. But where the New Deal had a revolutionary impact, empowering workers and creating a middle-class society that lasted for 40 years, the Big Deal has been limited to equalizing policies at the margin.
Arizona plans hospital taxes to expand its Medicaid

Governor bucks image, party on health law

By Bob Christie

PHOENIX — Governor Jan Brewer has built a political career in standing up to the federal government over everything from immigration to health care.
So the Arizona governor surprised almost everyone when she announced last week that she not only plans to push for an expansion of the state’s Medicaid program under the federal health care law — she plans to fund it by raising taxes.
A conservative Republican, Brewer is believed to be the first governor to publicly come up with a way to fund the controversial Medicaid expansion. Not even Governor Jerry Brown of California, a Democrat in a state that largely supports the new federal health plan, has figured out how to pay for a boosted Medicaid plan.
Her proposal to add about 300,000 low-income Arizonans to her state’s Medicaid plan relies on funding from hospitals through a provider tax. The idea is already used to fund some Medicaid plans in 39 states, but none have tapped it to pay for the federal expansion and many have at least some room to expand such taxes.


A Check on Physicals

By JANE E. BRODY
"Go Beyond Your Father's Annual Physical. Live Longer, Feel Better"
This sales pitch for the Princeton Longevity Center's "comprehensive exam" promises, for $5,300, to take "your health beyond the annual physical." But it is far from certain whether this all-day checkup, and others less inclusive, make a meaningful difference to health or merely provide reassurance to the worried well.
Among physicians, researchers and insurers, there is an ongoing debate as to whether regular checkups really reduce the chances of becoming seriously ill or dying of an illness that would have been treatable had it been detected sooner.
No one questions the importance of regular exams for well babies, children and pregnant women, and the protective value of specific exams, like a Pap smear for sexually active women and a colonoscopy for people over 50. But arguments against the annual physical for all adults have been fueled by a growing number of studies that failed to find a medical benefit.
Some experts note that when something seemingly abnormal is picked up during a routine exam, the result is psychological distress for the patient, further testing that may do more harm than good, and increased medical expenses.
"Part of the problem of looking for abnormalities in perfectly well people is that rather a lot of us have them," Dr. Margaret McCartney, a Scottish physician, wrote in The Daily Mail, a British newspaper. "Most of them won't do us any harm."
She cited the medical saga of Brian Mulroney, former prime minister of Canada. A CT scan performed as part of a checkup in 2005 revealed two small lumps in Mr. Mulroney's lungs. Following surgery, he developed an inflamed pancreas, which landed him in intensive care. He spent six weeks in the hospital, then was readmitted a month later for removal of a cyst on his pancreas caused by the inflammation.
The lumps on his lungs, by the way, were benign. But what if, you may ask, Mr. Mulroney's lumps had been cancer? Might not the discovery during a routine exam have saved his life?
Logic notwithstanding, the question of benefits versus risks from routine exams can be answered only by well-designed scientific research.

Bill seeks to roll back Maine law covering insurance rate review

More bills looking to change the law passed by the Republican-led Legislature in 2011 are expected.

By Michael Shepherd mshepherd@mainetoday.com
State House Bureau
AUGUSTA – The first proposal to re-establish Maine's process of reviewing certain health-insurance rate changes is scheduled to go to a legislative committee Tuesday.

L.D. 83, sponsored by Sen. John Patrick, D-Rumford, and co-sponsored by Democratic Senate leaders, would roll back part of a law passed by the Republican-led Legislature along party lines in 2011.

It deals with "rate review," the state's ability to accept or reject rate increases for individual and small-group health insurance policies.

More bills seeking to change the law are expected, said Rep. Sharon Treat, a Democrat from Hallowell who co-chairs the Legislature's Insurance and Financial Services Committee, which will review L.D. 83.

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