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Monday, Nov 30 2015

Full Issue

Viewpoints: Generational Disparities On Entitlements; Fears On Iowa's Medicaid Plan

A selection of opinions on health care from around the country.

An enduring puzzle of our politics is why there isn鈥檛 more generational conflict. By all rights, younger Americans should be resentful. Not only have they been tossed into the worst economy since the 1930s, but also there鈥檚 an informal consensus that the government, whatever else it does, should protect every cent of Social Security and Medicare benefits for the elderly. These priorities seem lopsided and unfair. Generational distress isn鈥檛 an abstraction; it鈥檚 repeatedly reaffirmed. (Robert J. Samuelson, 11/29)

Perhaps the most maddening aspect of Gov. Terry Branstad鈥檚 ill-conceived and poorly executed rush to privatize the Medicaid program is the manner in which he and the private contractors he has hired to take over the program dismiss the concerns of others. We understand that some people fear change, they tut. We understand some people are afraid of things that are new and different, they cluck. These reproachful, condescending responses to legitimate, justifiable concerns over the health and welfare of more than half a million low-income and disabled Medicaid beneficiaries demonstrate just how little regard the Branstad administration has for the people of Iowa, only 22 percent of whom support his privatization plan, according to an Iowa Poll in April. (11/28)

Mr. Jindal also bears responsibility for his decision to 鈥渇ight Obamacare鈥 by refusing to accept federal funds to expand Louisiana鈥檚 Medicaid program. Under the Affordable Care Act (ACA), the federal government has offered to foot practically the entire bill for increasing access to the health-coverage program to very-low-income workers. Analysis after analysis in state after state has shown that there are no good reasons, beyond anti-Obamacare demagoguery, for states to reject the Medicaid expansion. In Louisiana, 192,000 people would receive access to health-care coverage. Without the expansion, these people end up with less help than do those who earn far more. (11/26)

In just over a year, 24 states have passed right-to-try laws, including Texas, Florida and Virginia. ... California nearly became the 25th state with such a law. But on Oct. 11, less than a week after signing a right-to-die bill into law that allows terminally-ill patients to be prescribed drugs to end their lives, Gov. Jerry Brown vetoed the right-to-try bill. Gov. Brown鈥檚 reasoning? A perfect Catch 22: 鈥淧atients with life threatening conditions should be able to try experimental drugs, and the United States Food and Drug Administration鈥檚 compassionate use program allows this to happen.鈥 No, it does not. (Darcy Olsen, 11/26)

Patients seeking birth control pills today typically have to get a prescription from a doctor, but reproductive health advocates have long argued that this process is unnecessary since the pills are safe for a vast majority of women. Now two states are about to allow patients to get them from a pharmacist without seeing a doctor first. Other states should consider similar moves. (11/28)

Obamacare expanded health insurance to millions of Americans. But what good is insurance if there are no doctors available to treat them? This month, I found out, first hand. I saw a woman falling through the cracks of the new health-care system, and I tried to help her. ... Obamacare provides mental-health 鈥減arity,鈥 meaning mental health is covered as well as any other condition 鈥 in theory, an important advance. But in practice, parity was meaningless for Isabella. She is enrolled in one of the CareFirst BlueCross plans from the Obamacare exchange, but when my friend and I searched for psychiatrists within 30 miles of Washington who took her plan, the CareFirst Web site returned none. (Dana Milbank, 11/27)

Over the course of several days, I thoroughly read the list of questions, familiar terms and common abbreviations. Then I read them all again. I'm still not sure if it helped. I'm talking about the open enrollment period for my health and life insurance benefits for 2016. Several key decisions had to be made, each one with serious financial ramifications if I chose poorly or wrongly. High deductible versus low monthly premiums. Co-pay versus co-insurance. In-network versus out-of-network. Health versus sickness. Life versus death, literally. (Jerry Davich, 11/27)

When you鈥檙e sick, you expect the medicine a doctor gives you to work. But the effectiveness of one of the most important types of drugs 鈥 antibiotics 鈥 is under threat. In the United States alone, there are 2 million antibiotic resistant infections causing 23,000 deaths each year. You say that you never get sick, so this isn鈥檛 your problem. But what if I told you that antibiotics make modern medicine possible, including surgery, cancer treatment and organ transplants? Half of men and a third of women will get cancer in their lifetimes. Many treatments for cancer weaken the immune system, putting you at risk for infection. (Celine Gounder, 11/28)

I am not banking on hospice or its cousin, palliative care, to prevent suffering at the end of my life or the lives of my loved ones. Instead, I want to rely on death-with-dignity laws that allow people with terminal illnesses to receive legal prescriptions for lethal medications. Because I am an American, I guess, I want to control what I can about my own life, including how it ends. (Janice Lynch Schuster, 11/27)

In recent weeks, two major medical organizations have issued independent warnings about toxic chemicals in products all around us. Unregulated substances, they say, are sometimes linked to breast and prostate cancer, genital deformities, obesity, diabetes and infertility. 鈥淲idespread exposure to toxic environmental chemicals threatens healthy human reproduction,鈥 the International Federation of Gynecology and Obstetrics warned in a landmark statement last month. The warnings are a reminder that the chemical industry has inherited the mantle of Big Tobacco, minimizing science and resisting regulation in ways that cause devastating harm to unsuspecting citizens. (Nicholas Kristof, 11/28)

With the release of the eighth edition of the U.S. government鈥檚 Dietary Guidelines expected by year鈥檚 end, it seems reasonable to consider鈥攚ith the 鈥渙besity plague鈥 upon us and Americans arguably less healthy than ever before鈥攚hether the guidelines are to be trusted and even whether they have done more harm than good. Many Americans have lost trust in the science behind the guidelines since they seem to change dramatically every five years. (David A. McCarron, 11/27)

South Asians today account for more than half of the world鈥檚 cardiac patients. Heart disease is the leading cause of death in India, Pakistan and Bangladesh, and rates have risen over the past several decades. South Asian immigrants to the United States, like me, develop earlier and more malignant heart disease and have higher death rates than any other major ethnic group in this country. The reasons for this have not been determined. Traditional cardiac risk models, developed by studying mostly white Americans, don鈥檛 fully apply to ethnic communities. This is a knowledge gap that must be filled in the coming years. (Sandeep Jauhar, 11/28)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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