Inside Opinion

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Tag: health care reform


Next test for Obamacare: The November election

This editorial will appear in Friday’s print edition.

The U.S. Supreme Court has settled the biggest question about Obamacare: Is it constitutional? Now comes the second question: Is it politically sustainable?

Supporters of the law have complained bitterly of the legal challenge that 26 Republican attorneys general – including Washington’s Rob McKenna – mounted against the Affordable Care Act.

But without the lawsuit, the act’s legality wouldn’t have been settled this soon. There would have been no victory in court on Thursday, and the massive law would still be dogged by the threat of unresolved constitutional issues.

As it happened,

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Doctor’s orders: Stop buying useless ‘health care’

This editorial will appear in tomorrow’s print edition.

When the doctors who make their money from delivering medical procedures say they’re delivering too many of them, it’s time to listen.

Last week, nine medical specialty groups announced an initiative against unnecessary care – for example, MRIs for ordinary backaches, EKGs when the patient has no signs of heart trouble, brain scans for common headaches and antibiotics for virus infections.

These are serious people. They include, among others, the boards of the American Academy of Family Physicians, the American College of Cardiology and the American College of Physicians.

The problem they’re addressing is just as serious. The United States spends more than $2 trillion a year on health care, with costs rapidly rising. Medicare is busting the federal budget; state governments – including Washington’s – are staggering under the weight of their own health insurance costs.

Corporations and privately insured individuals are likewise burdened. Economists are predicting that America will be spending a fifth of its gross domestic product on health care by 2020.

Yet all this spending doesn’t translate into better health. America’s vital indicators lag far behind many countries that spend far less.

A big part of the problem is that much of the treasure this country dumps into clinics, hospitals and pharmacies is simply wasted. People who study the issue commonly estimate that at least 20 percent and as much as 30 percent of the country’s medical spending is unwarranted.

A recent study in the Journal of the American Medical Association, “Eliminating Waste in U.S. Health Care,” focused on six problem areas. The authors found that the cost of overtreatment – such as unnecessary surgery or unwanted end-of-life care – ran from $158 billion to $226 billion in 2011.
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Uninsured freeloaders’ option: Stay out of the ER

This editorial will appear in tomorrow’s print edition.

There are jillions of opinions about the constitutionality of the individual health insurance mandate, but only one of them will ultimately count – the opinion signed by the majority of the justices on the U.S. Supreme Court.

So let’s leave the jurisprudence to the high court – which is hearing arguments on the mandate this week – and look at the law’s logic.

If you believe that humane societies provide medical care for their needy, there are several options. A couple of those options – such as expanding Medicare to younger Americans – are explicitly socialistic. The Democratic Congress of 2010 went for an alternative, so-called Obamacare, that preserved the private health insurance industry.

Covering everyone means covering people regardless of how sick they are. But insurers go broke if they’re required to cover only the sick – whose medical bills are bound to be much higher than their premiums – while free-riders pay nothing until they get sick themselves. To guarantee coverage for pre-existing conditions, nearly all Americans – sick and healthy – must be in the pool.

Hence the mandate to either carry medical coverage or pay a penalty. It’s pretty much where you wind up if you want universal coverage but don’t want to replace private insurance with a Medicare-style government program.
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Decide sooner, not later, on health insurance mandate

This editorial will appear in Friday’s print edition.

Well, is it or isn’t it?

The question of whether the federal health care insurance mandate is constitutional is all but certain now to go where everyone knew it would eventually – the U.S. Supreme Court.

The mandate for all Americans with taxable income to purchase at least minimal health insurance by 2014 is part of the Patient Protection and Affordable Care Act approved by Congress in 2010. It has been challenged by 26 Republican attorneys general – including Washington’s Rob McKenna.

Two federal appeals court panels have ruled on it: The 11th Circuit Court of Appeals panel (Florida, Georgia and Alabama) struck down the mandate as unconstitutional but upheld the rest of the law while the 6th Circuit panel based in Ohio upheld the law and the mandate. With two federal courts ruling in opposite ways, the mandate was going to get to the Supreme Court eventually. But separate requests from both the Obama administration and the AGs have speeded up the process. Read more »


Birth control coverage will be a boon for millions

This editorial will appear in Friday’s print edition.

Contraceptive use in the United States is an issue fraught with irony.

The women who can least afford to get pregnant – including the young, the poor and the uneducated – often have the least access to effective birth control. They may not have health insurance, but even if they do, it might be subject to a deductible or co-pay. So they’re more likely to use cheaper, less effective methods like condoms – or nothing at all.

Little wonder the United States has the highest rate of unintended pregnancies in the industrialized world. Almost half of all U.S. pregnancies are unplanned, and about 40 percent of those end in abortion. Medicaid and the Children’s Health Insurance Program alone spend more than $12 billion a year providing maternity care for low-income women and care for infants in the first year of life. Read more »


A conservative defense of the individual mandate

This editorial will appear in Sunday’s print edition.

Legally, the soft underbelly of “Obamacare” is its mandate that most Americans carry health care insurance. It got some much-needed armor last week from a federal appeals court.

Conservatives – who are otherwise big on personal responsibility – have locked onto that requirement as the most vulnerable target in the Affordable Care Act, which promises to extend health coverage to millions of uninsured Americans in 2014.

Trial judges aren’t supposed to decide cases on ideological grounds, but you’d never know it from the lawsuits against the individual mandate. According to Politico, the court decisions have split cleanly along partisan lines: Judges appointed by Republicans have all ruled against the law, and judges appointed by Democrats have all ruled for it.

That curious string of coincidences finally broke Wednesday when a respected conservative jurist – and former clerk to Supreme Court Justice Antonin Scalia – upheld the constitutionality of the maligned policy. Jeffrey Sutton of the Sixth U.S. Circuit Court of Appeals provided the pivotal vote in favor of the mandate in its first test at the appeals level.
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Repeal ‘Obamacare’? Show us the alternative

This editorial will appear in tomorrow’s print edition.

OK, Republicans, let’s see your health care bill.

The new GOP majority in the U.S. House of Representatives is poised today to repeal last year’s Affordable Care Act (or “Obamacare” – take your pick). It’s an empty gesture as far as lawmaking goes: The Democratic majority in the Senate won’t second the motion, and President Obama certainly wouldn’t sign a repeal of his signature legislation.

But Republicans hope to follow up with piecemeal attacks on the 2010 package that might eventually gut it. The fattest target is the law’s requirement that most Americans carry health insurance. It’s unpopular; it’s also a way to prevent freeloaders from buying insurance after they get sick, then dropping it as soon as they’ve had their babies or their hip replacements.

The Affordable Care Act promises to do the job of extending medical coverage to most Americans, but it is not a work of art. A repeal would be fantastic – if the law were being replaced with something better. The problem is, congressional Republicans aren’t offering a better bill. In fact, they’re offering no bill at all.
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‘Death panels’ are back, and patients will profit

This editorial will appear in tomorrow’s print edition.

President Obama appears to have slipped “death panels” back into federal health care law via executive authority. Good for him.

To paraphrase Mark Twain, there are lies, damn lies and the death panel scare. The ever-inventive Sarah Palin came up with the term last year in a drive to whip up fears about health care reform.

Section 1233 of the health care bill, she said, would allow “Obama’s death panel” to judge whether “my parents or my baby with Down Syndrome” are “worthy of health care.”

Others took up the cry – Section 1233 made a convenient target – and they were so successful that Congress eventually dropped the measure from the reform bill.

Back to the world of facts. Only a certified paranoid could have read the actual text of the section and concluded that someone was trying to pull the plug on grandma. It simply allowed Medicare funding for discussions, every five years, between doctors and patients about their end-of-life options. That’s it.

These conversations happen all the time right now. Patients dying of cancer, for example, already consult with their doctors about what treatments are available, whether they want aggressive medical intervention, what life-sustaining measures they are willing to accept, the value of advance directives and the appointment of health care “proxies” – typically family members – who can make decisions on their behalf if they are incapacitated.
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