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Morning Briefing

Summaries of health policy coverage from major news organizations

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Tuesday, Jan 13 2015

麻豆女优 Health News Original Stories 3

  • Most Marketplace Customers Have New Filing Requirements This Tax Season
  • Skipped Care A Side Effect Of High-Deductible Health Plans
  • Payment Disparities Puzzle, Intrigue Charlotte Health Execs

Health Law 4

  • In Your Mailbox Soon: 2014 Health Insurance Tax Reporting Forms
  • Some State Marketplaces Face Bumps, Problems
  • New Ariz. Gov. Doesn't Address Medicaid Controversy
  • High Court Rejects Challenge To The Health Law's Individual Mandate

Capitol Watch 1

  • Congressional Republicans Hopeful About Replacing Obamacare -- Especially If Supreme Court Assists

Marketplace 2

  • Hospital Bond Issuances Fall To Lowest Level In At Least A Decade
  • Tenet 2014 Results Upbeat -- With Help From The Health Law

Veterans' Health Care 1

  • VA Spending On Veterans' Benefits Varies Widely

Quality 1

  • Clinic That Treated Joan Rivers Before Her Death Loses Medicare Funding

State Watch 1

  • State Highlights: Kaiser-Fresno Mental Health Workers Start 7-Day Strike; NYC's New Flu Shot Rules Stir Immunization Debate

Editorials And Opinions 1

  • Viewpoints: Medicaid's Payback; Orszag Says Brill Missed Key Point; Dems' 'Bargaining Chips'

From 麻豆女优 Health News - Latest Stories:

麻豆女优 Health News Original Stories

Most Marketplace Customers Have New Filing Requirements This Tax Season

The health law requires people to report their coverage situation. Those who get insurance through their jobs will only have to check a box on the usual return, but those without insurance or those who received subsidies will have to fill out new forms. ( Michelle Andrews , 1/13 )

Skipped Care A Side Effect Of High-Deductible Health Plans

High deductibles and other out-of-pocket costs related to health insurance have become a rising concern among consumers and health-care providers. ( Lisa Stiffler, The Seattle Times , 1/13 )

Payment Disparities Puzzle, Intrigue Charlotte Health Execs

Blue Cross and Blue Shield of North Carolina says it decided to reveal how much it pays hospitals for particular procedures to help consumers hold down costs. ( Ann Doss Helms, Charlotte Observer , 1/12 )

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Summaries Of The News:

Health Law

In Your Mailbox Soon: 2014 Health Insurance Tax Reporting Forms

The Obama administration said Monday that it has sent out the necessary forms to consumers who received financial help from the government to buy coverage under the health overhaul.

If you're among the millions of consumers who got financial help for health insurance last year under President Barack Obama's law, better keep an eye on your mailbox. The administration said Monday it has started sending out tax reporting forms that you'll need to fill out your 2014 return. Like W-2s for health care, they're for people who got health insurance tax credits provided under the law. (Alonso-Zaldivar, 1/12)

Kaiser Health News consumer columnist Michelle Andrews writes: "In addition to the normal thrills and chills of the income tax filing season, this year consumers will have the added excitement of figuring out how the health law figures in their 2014 taxes. The good news is that for most people the only change to their normal tax filing routine will be to check the box on their Form 1040 that says they had health insurance all year." (Andrews, 1/13)

Some people, though, opted against the tax credits -

Grace Brewer says she never thought she would be without health insurance at this stage of her life. "I'm a casualty of Obamacare," says Brewer, 60, a self-employed chiropractor in the Kansas City, Kansas, area. She wanted to keep the catastrophic health insurance plan she once had, which she says fit her needs. But under the Affordable Care Act, the government's health care reform law, the plan was discontinued because it did not comply with the law's requirements, and her bills doubled to more than $400 a month. "I wanted a minimal plan and I鈥檓 not allowed to have it," she says. "That seems like an encroachment on my freedom." (Leonard, 1/12)

Some State Marketplaces Face Bumps, Problems

Oregon is getting ready to lay off 61 exchange employees while officials in Minnesota and Colorado scramble to make fixes to their health insurance portals. In Maryland, a health law "navigator" company faces criticism.

The Cover Oregon health insurance exchange intends to lay off 61 people starting in March, cutting its workforce in half. A political embarrassment since failing to deliver a working enrollment-and-subsidy website last year, the exchange is expected to be dissolved as a stand-alone legal entity by the Legislature in the next few months, its remaining functions transferred to a state agency. (Budnick, 1/12)

A prob颅lem with the MNsure sys颅tem has pre颅vent颅ed about 7,500 peo颅ple from en颅rol颅ling in public health in颅sur颅ance programs, state of颅fi颅cials said Mon颅day, as they de颅scribed what ap颅pears to be the larg颅est tech颅nol颅o颅gy glitch of the cur颅rent open en颅roll颅ment pe颅riod. (Snowbeck, 1/12)

The Connect for Health Colorado board of directors agreed to spend an additional $322,000 through the end of February to try to sign up applicants stalled in the state health insurance exchange's online enrollment system. Interim chief executive Gary Drews said the emergency expenditure was needed to resolve about 1,900 outstanding reports of problems 鈥 down from as many as 4,800. (Draper, 1/12)

Cancer patients desperately in need of critical care are among those unable to get health insurance because Colorado鈥檚 sign-up system is failing to work properly, health coverage guides told state officials on Monday. (Kerwin McCrimmon, 1/12)

A Maryland company that has reaped millions of dollars in federal health-reform grants for work around the country is drawing fire for its performance in the Kansas City area. Critics say that Advanced Patient Advocacy, a privately held company, has been slow off the mark in its role as a 鈥渘avigator鈥 organization, charged with helping consumers find coverage through the health insurance marketplace established by the Affordable Care Act. (Sherry, 1/12)

New Ariz. Gov. Doesn't Address Medicaid Controversy

Gov. Doug Ducey did not tip his hand during his first State of the State speech on whether he will continue the legal defense of former Governor Jan Brewer's expansion of Medicaid. Also in the news, Idaho's governor urges the legislature to hold a hearing on a commission's report about expansion benefits, and advocacy groups in Tennessee and Missouri seek a turnaround in their states.

Arizona Gov. Doug Ducey pledged Monday to bring an era of fiscal responsibility and smaller government bureaucracy to his state, but his first speech to the Legislature never mentioned his most pressing health issue: whether to defend Medicaid expansion despite conservative fury over Obamacare. (Pradhan, 1/12)

Ducey, who took office Jan. 5, gave additional signals about how he plans to guide the state through a challenging fiscal crunch, although his remarks lacked key details. And while he devoted time to discussing tax policy, regulatory reform and even the need for a civics curriculum in schools, he was silent on border security 鈥 a major theme of his 2014 campaign 鈥 as well as higher education and whether he would continue former Gov. Jan Brewer's legal defense of her 2013 Medicaid expansion. (Nowicki, 1/12)

Gov. Butch Otter urged lawmakers to hold a hearing on the findings of his Medicaid Redesign Workgroup. Some 104,000 state residents get caught short because they fail to qualify for tax credits under the state health insurance exchange or meet the state's Medicaid eligibility requirements. (Dentzer, 1/13)

A University of Tennessee economic study commissioned by advocates for expanding Medicaid says Gov. Bill Haslam's Insure Tennessee could create 15,000 jobs and bring $1.14 billion in new spending to the state. According to the study released Monday by UT's Center for Business and Economic Research, an estimated 200,000 of the 470,000 eligible Tennesseans would participate in Haslam's proposed version of Medicaid expansion. The $1.14 billion figure comes from an estimated $5,705 in medical spending by each of those 200,000 people. (1/12)

Even as prospects appear bleak for Medicaid expansion in Missouri, a new report says the state would save $81 million right off the bat and $100 million annually later on if it expands the program. The report by the Missouri Budget Project, a nonpartisan think tank in St. Louis, says the savings would come from money the state currently spends on Medicaid services provided to pregnant women, mental health patients and prisoners in need of medical care. (Margolies, 1/12)

High Court Rejects Challenge To The Health Law's Individual Mandate

The case was led by the Association of American Physicians and Surgeons, a conservative doctors' organization, and the Alliance for Natural Health USA.

The U.S. Supreme Court on Monday declined to take up another broad challenge to President Barack Obama's signature health care law. The court rejected an appeal filed by the Association of American Physicians and Surgeons and the Alliance for Natural Health USA. The groups had challenged various aspects of the law known as Obamacare including the so-called individual mandate that requires people to obtain health insurance or pay a tax.(1/12)

The Supreme Court on Monday rejected a 2-year-old legal challenge to a central provision of Obamacare from a conservative doctors group. The case, which was led by the Association of American Physicians and Surgeons, sought to strike down the law鈥檚 individual mandate, which fines individuals who fail to purchase health insurance. (Ferris, 1/12)

Capitol Watch

Congressional Republicans Hopeful About Replacing Obamacare -- Especially If Supreme Court Assists

One GOP lawmaker said that if the high court decides that health insurance subsidies should not be available through the federal marketplaces, then the health law would unravel quickly. Sen. Ted Cruz, R-Texas, predicted doom for Republicans if they don't deliver on promises like scrapping this sweeping statute.

Congressional Republicans believe they can replace Obamacare with their own health care reforms, if the Supreme Court strikes down a key segment of the current health care law in a ruling expected in June, a senior U.S. lawmaker said on Monday. (1/12)

Republicans "will get walloped" in 2016 if they do not deliver on campaign promises, such as working to scrap the controversial national health care law and blocking President Barack Obama's immigration proposals, Sen. Ted Cruz said Monday. The freshman Texas lawmaker said fellow Republican candidates promised during last year's elections to scrap the health care law, which they call Obamacare, and to deny Obama's executive actions, which they call "amnesty." (Elliott, 1/12)

All the while, President Barack Obama and GOP leaders jockey for negotiating positions -

Several influential Republicans want to use a filibuster-proof budget procedure to overhaul the corporate tax code 鈥 rather than wield it as a weapon against Obamacare, as conservatives are demanding. The quiet push, led by South Dakota Sen. John Thune, seeks to use the potent tool known as budget reconciliation to give both the GOP and President Barack Obama the sweeping victory on tax policy that business groups want, which could include a significant cut in corporate tax rates as well as provide funding for a long-term transportation bill. In contrast, an attempt to use reconciliation to gut Obama鈥檚 health care law might showcase Republicans鈥 new strength on Capitol Hill but would inevitably end in a veto. (Raju and Everett, 1/13)

With his quick veto threats 鈥 he issued three more on Monday night 鈥 Mr. Obama signaled that he would be aggressive in rejecting legislation he sees as chipping away at his policy priorities, such as the health care law, or his presidential authority to do things like approve an oil pipeline. But by insisting that he wants to collaborate with Republicans, the president 鈥 who will host congressional leaders of both parties at the White House on Tuesday 鈥 also hinted that there is negotiating room beyond those threats. 鈥淭he president鈥檚 attitude is that we shouldn鈥檛 let our disagreements, as big as they are on some issues, prevent us from working together on the things we do agree on,鈥 said Dan Pfeiffer, a senior adviser to Mr. Obama. 鈥淚f Republicans take a similar attitude, there is an opportunity to prove people wrong and make some progress.鈥 For now, Mr. Obama and congressional Republicans are dwelling mostly on the big disagreements. (Hirschfeld Davis, 1/12)

Marketplace

Hospital Bond Issuances Fall To Lowest Level In At Least A Decade

Modern Healthcare reports that some nonprofit hospitals opted to spend money on IT systems rather than on building projects in 2014. In addition, questions about how Hepatitis C drug exclusivity deals impact physician practice and Heritage Provider Network launches a joint venture with Trinity Health.

Hospital bond issuances fell to their lowest level in more than a decade last year as not-for-profit providers scaled back their capital spending despite low interest rates and eager lenders. Instead of investing in traditional brick-and-mortar building projects, many health systems are focusing their attention on upgrading their information technology systems. These projects are not only less expensive, but they have a relatively short lifespan before providers must make the next upgrade. (Kutscher, 1/12)

Southern California-based Heritage Provider Network is forming a joint venture with the nation's second-largest nonprofit hospital system to better coordinate patient care across much of the country. The agreement announced Monday calls for Heritage and Trinity Health to build networks in different markets that focus on integrating the fragmented care many patients receive from multiple providers. Financial terms of the deal weren't disclosed. (Terhune, 1/12)

Exclusivity deals for hepatitis C drugs by pharmacy benefit managers and a major health plan have raised concerns that the decision of which drug is best for a patient is being taken away from clinicians. Last week Anthem became the first payer to announce an exclusivity deal for a hepatitis C drug. As part of the pact, beneficiaries must try Gilead Sciences' Harvoni before trying any other treatment for hepatitis C genotype 1, which accounts for up to 75% of all U.S. cases. (Dickson, 1/12)

Meanwhile, news outlets also detail changes in the marketplace from the emergence of big-box store walk-in clinics to how smartphones might聽play a role in personal health 聽-

The American health care system may finally be catching up to the rest of the 21st-century economy, in which convenience is not only expected, but demanded -- and massive retailers are driving the change. Patients suffering everyday complaints like chest colds or ankle sprains have long faced the lamentable choice between waiting days to see their family doctors or enduring time-sucking, unpleasant and expensive visits to hospital emergency rooms, especially at night and on weekends when physicians typically aren't open for business. It's one of the most annoying aspects of the way medical care is provided in the United States. (Young, 1/12)

Extracting medical care from the health care system is all too often an expensive exercise in frustration. Dr. Eric Topol says your smartphone could make it cheaper, faster, better and safer. That's the gist of his new book, The Patient Will See You Now. Lots of people are bullish on the future of mobile health to transform health care, but Topol gets extra cred because of his major medical chops: Former head of cardiology at the Cleveland Clinic and present director of the Scripps Translations Science Institute in La Jolla, Calif. (Shute, 1/13)

Tenet 2014 Results Upbeat -- With Help From The Health Law

The hospital operator reported that the Affordable Care Act helped trigger a 21 percent jump in fourth-quarter admissions. Also, Aetna announces that it will boost the wages of its lowest-paid workers.

Tenet Healthcare Corp. said Monday said that it expects 2014 results to be near the top of its previously raised range, as the hospital operator continues to benefit from the Affordable Care Act, which helped spur a 21% admissions jump in the fourth quarter. For 2014, earnings should be near the top of range of the $1.90 billion to $1.95 billion range, Tenet said. For 2015, the Dallas-based company forecast revenue ... slightly above the $17.4 billion predicted by analysts polled by Thomson Reuters. It also foresees admissions growth of 2.5% to 3.5%. (Chen, 11/12)

Amid signs of a tightening labor market, Aetna Inc. plans to boost the incomes of its lowest-paid workers by as much as a third in a bid to draw top prospects and reduce turnover. The move by the big health insurer highlights larger debates over the pace of the economic recovery and the compensation of people toward the bottom of the wage scale. Around 12% of Aetna鈥檚 domestic work force will see a raise to a floor of $16 an hour, primarily employees in customer service and billing-related jobs. Aetna, which also said it will cut health-care costs for many of the same employees next year, follows Gap Inc., Starbucks Corp. and others in raising the lower limit on workers鈥 wages. (Wilde Mathews and Francis, 1/12)

In other news -

People buy long-term care insurance as one way of financing 鈥減ersonal or custodial care鈥 in a nursing home or a community facility, according to the U.S. Department of Health and Human Services. The cost of these insurance plans is calculated based on a person鈥檚 age, how much a policy will pay per day, how many days or years a plan will pay out, among other factors. Without long-term care insurance, people often either use their own savings or Medicaid to cover long-term care. Medicare does not pay the 鈥渓argest part of long-term care services.鈥 (Santhanam, 1/9)

Veterans' Health Care

VA Spending On Veterans' Benefits Varies Widely

An NPR/public radio investigation found wide disparities, even within states, in what veterans receive. Elsewhere, VA pharmacists go unpunished for drug dispensing errors, The Washington Times reports, and House lawmakers pass a bill intended to help prevent veteran suicides.

If you're a veteran and rely on benefits from the U.S. Department of Veterans Affairs, where you live may have an effect on whether you receive the benefits you've earned...Veterans' benefits cover a wide range, including health care, monthly disability checks, home loans, life insurance, and education through the GI bill, among others. Among the states, West Virginia and Arkansas had the highest per-veteran spending in 2013 鈥 just over $7,600. Indiana, New Jersey, Delaware and Pennsylvania had the lowest 鈥 less than $5,000. Nationally, the average is just over $6,000. That's after filtering out things like costs to build and operate VA facilities. (Lawrence and Bebinger, 1/13)

Pharmacists who made serious or potentially fatal errors dispensing drugs at the VA in New Jersey kept their jobs and often weren鈥檛 even severely disciplined, according to testimony from their colleagues and other records. One chemotherapy patient died after a 2001 overdose, but the pharmacist continued working for the VA for years, according to records obtained by The Washington Times under the Freedom of Information Act. (McElhatton, 1/12)

The House on Monday passed legislation to help prevent veterans' suicides that failed to clear the last Congress due to now-retired Sen. Tom Coburn (R-Okla.). Members of both parties overwhelmingly supported the bill by a vote of 403-0. It now heads to the Senate, where it is expected to be approved easily. (Marcos, 1/12)

Quality

Clinic That Treated Joan Rivers Before Her Death Loses Medicare Funding

Medicare and Medicaid will no longer pay for services at the clinic where Joan Rivers went into cardiac arrest after it failed to fix problems with the care they give there.

The Manhattan clinic where Joan Rivers went into cardiac arrest while being treated for a voice problem has failed to correct deficiencies implicated in her death and will be prohibited from having its services paid for by Medicare and Medicaid funds, according to a letter released on Monday from the federal agency that oversees those two programs. (Hartocollis, 1/12)

In a letter sent to the clinic on Friday, the federal agency said it is terminating the Medicare agreement Jan. 31 because the clinic "no longer meets the conditions of coverage for a supplier of ambulatory surgical center services" and will no longer receive federal funds for services provided to Medicare and Medicaid beneficiaries. (Megia, 1/12)

The New York City clinic where Joan Rivers suffered a fatal complication during a medical procedure is losing its accreditation at the end of the month, a federal agency said Monday. "Yorkville Endoscopy no longer meets the conditions for a supplier of ambulatory surgical center services," the Centers for Medicare Services said in a statement. As of Jan. 31, the Manhattan medical facility will no longer be eligible to receive federal funds for services provided to Medicare and Medicaid beneficiaries. (1/12)

State Watch

State Highlights: Kaiser-Fresno Mental Health Workers Start 7-Day Strike; NYC's New Flu Shot Rules Stir Immunization Debate

A selection of health policy stories from California, New York, South Carolina, Massachusetts, Georgia, Illinois, New Jersey and North Carolina.

Kaiser Permanente-Fresno mental health and eye-care workers began a seven-day strike Monday, picketing outside the northeast Fresno hospital to protest what they say is inadequate staffing by the health system. About 15 people were on the picket line Monday morning. The Fresno hospital has about 40 mental health workers and 12 optical, workers. Statewide, about 2,600 workers have been called to strike. The workers are represented by the National Union of Healthcare Workers. (Anderson, 1/12)

A new policy requiring preschool children to receive the influenza vaccine went into effect Jan. 1 in New York City, bringing a new level of regulatory clout, as well as attention to other legislative efforts mandating immunization. (Lauer, 1/12)

A federal class action lawsuit was filed Monday against Gov. Nikki Haley and the Department of Social Services, saying a lack of heath care and other basic services is endangering children in the child welfare system. The complaint alleges Haley and DSS are responsible for drastic foster home shortages, excessive caseloads for agency workers and a failure to provide children with basic health care. The complaint further alleges that child maltreatment while in foster care goes without investigation, and inaccurate data masks a much higher rate of abuse and neglect than the state reports to the federal government. (Cahill and Self, 1/12)

A contract dispute between Blue Shield of California and Sutter Health threatens to force some 280,000 Blue Shield customers throughout Northern and Central California to switch doctors or change health plans, if they can. (Halstead, 1/12)

It owns some of the world鈥檚 most famous hospitals and one of the leading medical research engines in the United States. But when executives of Partners HealthCare System appeared before investors here Monday, they sheepishly displayed a chart showing that the health care giant last year posted its first financial loss in 15 years. (Weisman, 1/12)

Last week's budget proposal by Gov. Jerry Brown (D) didn't restore cuts from previous years -- with the exception of the already agreed-upon reversal of a 7% cut in In-Home Supportive Services hours -- and that omission was not lost on consumer health advocates. (Gorn, 1/12)

Gov. Nathan Deal ushered in his second term in office Monday with a call for Georgians to unite over common political ground and embark on consensus-driven changes rooted in his first term in office. Deal used his platform to focus on a theme of a 鈥渘ew term, a new vision, a new mandate.鈥 He made no mention of the partisan debate over President Barack Obama鈥檚 health care expansion or the brewing fight over whether to raise taxes to fund transportation improvements. (Bluestein, 1/12)

A prohibition on the use of "urgent" by urgent-care facilities in Illinois has been lifted. For years, traditional urgent-care facilities were not allowed to use the term in their titles. Illinois law allowed only emergency rooms to incorporate "urgent" or similar words in their names after some nonemergency centers were caught billing at emergency-room prices. (Hirst, 1/12)

For close to a decade, a group of Camden health-care providers has used a database of information culled from the city's three hospitals to evaluate medical costs, identify hot spots in neighborhoods, and develop outreach programs. Soon, the Camden Coalition of Healthcare Providers will also be able to look at data from the criminal justice system, housing, and other public networks - information it hopes will lead the way to root causes of recurring problems. (Steele, 1/12)

A deputy from former Attorney General Greg Abbott's office will be running the Texas Department of Insurance, Gov. Rick Perry's office announced Monday. David Mattax worked on defense and financial litigation at the attorney general's office. But he appears to just be a temporary replacement for outgoing Commissioner Julia Rathgeber, whom Perry appointed to the post in May 2013. (Satija, 1/12)

The new year brings two new challenges for North Carolina doctors who take Medicaid, as a temporary boost from the Affordable Care Act goes away and a state cut kicks in after a year鈥檚 delay. Hardest hit will be the family practitioners and pediatricians who are supposed to take the lead in providing better medical care for about 1.7 million low-income children and adults in North Carolina. (Helms, 1/12)

While hundreds of public education supporters jammed Capitol stairwells calling for more state support, New York's Republican-controlled Senate has approved eight bills intended to ensure women's rights in the workplace and housing while excluding an Assembly-backed measure to codify abortion rights. (1/12)

Editorials And Opinions

Viewpoints: Medicaid's Payback; Orszag Says Brill Missed Key Point; Dems' 'Bargaining Chips'

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

When advocates talk about the advantages of government health care, they often talk about a moral obligation to ensure equal access. Or they describe the immediate health and economic rewards of giving people a way to pay for their care. Now a novel study presents another argument for the medical safety net, at least for children: Giving them health coverage may boost their future earnings for decades. And the taxes they pay on those higher incomes may help pay the government back for some of its investment. (Margot Sanger-Katz, 1/12)

Steven Brill's new book about the process of passing the Affordable Care Act is so meticulously reported, I found myself surprised by many details of a process I myself was deeply involved in. ... A substantial amount of skepticism, perhaps even within the White House, existed about whether the health-care legislation did enough on costs. Yet the cost curve in health care is bending more drastically than even I believed possible in the fall of 2009. That鈥檚 because the collective impact of the legislation鈥檚 individual measures, along with similar changes in the private sector, has produced a shift in perspective and therefore behavior among health-care leaders. This is a significant point that Brill fails to acknowledge. (Peter R. Orszag, 1/12)

Price is the major factor that distinguishes the cost of our system from those in other developed nations. The sticker shock of some medical services and drugs is also the dimension of the health-cost problem most visible to the public. So it鈥檚 interesting that most efforts in this country to address health-care costs don鈥檛 focus on price much at all. Instead, they focus on reforming the delivery of health care and provider reimbursement to reduce the volume of health care Americans use and to weed out unnecessary procedures and hospitals days. (Drew Altman, 1/12)

[Senate Democrats] must be aware that the Supreme Court in June may invalidate the ACA's premium subsidies in 37 states. That would cripple the law unless the GOP-controlled Congress somehow agrees to restore the subsidies. Surely the Democrats also know that the Republicans would demand a very high price for doing so鈥攊f they would even consider it. So one wonders what Senate Democrats like Joe Donnelly of Indiana and Joe Manchin of West Virginia, who say they support the ACA overall, are thinking in being willing at this point to give up the 30-hour workweek rule, which might well be one of Democrats' bargaining chips. (Harris Meyer, 1/11)

Karen Kurokawa was happy to pay her husband's Kaiser Permanente bill. She just wanted to know why Kaiser had adjusted it almost $2,000 higher. The fact that the Culver City resident couldn't get a straight answer from Kaiser, even after she filed a formal grievance, highlights the challenge patients face in knowing their true healthcare costs. The episode also raises questions about Kaiser's billing system. Kurokawa said she was told by a senior company executive that "things happened that shouldn't have happened, and things that should have happened didn't." (David Lazarus, 1/12)

Given the remarkable advances that have been made in the last 50 or so years in pharmaceuticals, medical devices and surgical procedures, it鈥檚 not a surprise that people want more, and more invasive, care than they have had in the past. Just as it鈥檚 hard to do nothing when you鈥檙e ill, it鈥檚 sometimes hard to do less than the maximum when there are different treatments to choose from. (Dr. Aaron E. Carroll, 1/12)

There are roughly 11 million Americans over age 65 with diabetes. Most of them take medications to reduce their blood sugar levels. The majority reach an average blood sugar target, or 鈥渉emoglobin A1C,鈥 of less than 7 percent. Why? Early studies showed that this can reduce the risk of diabetes complications, including eye, kidney and nerve problems. As a result, for more than a decade, medical societies, pharmaceutical companies and diabetes groups have campaigned with a simple, concrete message 鈥 to get below seven. ... Doctors are often rewarded based on how many of their patients hit the target. ... But, at least for older people, there are serious problems with the below-seven paradigm. (Dr. Kasia Lipska, 1/12)

Our national debt is more than $18 trillion, and the American taxpayer is hurting. If we, as a country, have decided to spend taxpayers鈥 hard-earned dollars on funding science and research, then we need to spend wisely. ... Similarly, the National Institutes of Health has engaged in the funding of wasteful projects like $258,000 on a website for the first lady鈥檚 White House garden. These programs might sound merely frivolous, but the problem is that when the NSF or NIH funds projects of these kinds, there is less money to support good scientific research that can yield technological breakthroughs and opportunities for economic growth. Ebola-related scientific research is something that Americans want to prioritize, yet this important research is competing with wasteful grants. (Sen. Rand Paul, R-Ky., and Rep. Lamar Smith, R-Texas, 1/12)

A 1992 editorial singled out self-referral as a prime example of the 鈥済rowing encroachment of commercialism on medical practice鈥 previously characterized as the 鈥渕edical-industrial complex.鈥 Regrettably, more than 2 decades later, this observation of the failing of responsible professionalism still rings true. The recent GAO analysis reaffirms the inescapable effects of physician self-referral on increasing Medicare Part B spending. Viewed in this light, the GAO reports must be seen as nothing less than a call for action. Congress should address the relative shortcomings of the well-meaning if ineffective Stark provisions and enact simpler and enforceable ordinances in its stead. Failure to do so would constitute a costly opportunity missed. (Drs. Eli Y. Adashi and Robert P. Kocher, 1/12)

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