Viewpoints: Politics Overtakes Plan B; Gingrich's Entitlement Plans; Cheeseburgers And Death

The New York Times: Politics And The Morning After Pill
Once again, the politics of birth control have trumped science and sound public policy. On Wednesday, the Obama administration overruled a carefully reasoned decision by the Food and Drug Administration to make the so-called morning-after pill available without prescription to adolescent girls below the age of 17 (12/7).

Los Angeles Times: Second-Guessing Plan B
After years of seeing their painstaking research ignored by political appointees during the George W. Bush administration, federal scientists heaved sighs of relief when newly elected President Obama vowed that science would no longer be countermanded by political ideology. On Wednesday, however, they were given reason to wonder if that was true, as U.S. Health and Human Services Secretary Kathleen Sebelius overruled the U.S. Food and Drug Administration, deciding that teenagers under age 17 would not be given over-the-counter access to the morning-after pill (12/8).

The Wall Street Journal: The Newtitlement State
Take Mr. Gingrich's 49-page manifesto on entitlement reform, which his campaign rolled out shortly before Thanksgiving. It is a fundamentally Newtonian document, both in its ambition — it promises to "reduce federal spending by half or more" — and in its lack of discipline. Oddly, Mr. Gingrich is promoting the more radical reform for the less urgent fiscal problem (Social Security) even as he hedges on what's needed to reform the main driver of spending growth (Medicare) (12/8).

Reuters: Cheeseburgers And Death: De-Socializing Health Care
Both the choice to eat too much and the choice to pay up for almost everything labeled "medical expense" are spawned by an attitude which can be called health willfulness. The United States leads the world in this attitude, but it, along with obesity and health care spending, is probably on the rise almost everywhere. It helps explain why spending on health care increased from 4 to 10 percent of GDP since 1960 for the entire OECD (Edward Hadas, 12/7).

Des Moines Register: Insurance Exchanges Are Not A Magical Solution
Last week, the secretary of the U.S. Department of Health and Human Services vowed that health insurance exchanges "will ensure for the first time that every American has access to affordable health coverage." How exactly will that happen? Nothing about exchanges — or any part of the law — alters the fundamentals of health care economics. The reality is that health care costs continue to rise unabated, which is why health insurance premiums rise equally fast. And it's those high premiums that make health insurance unaffordable for many (Brian Gillette, 12/7).

Houston Chronicle: Let's Keep Health Insurers From Gouging Policyholders
Texans who buy their own health insurance could be due an estimated $481 million in refunds over the next three years, thanks to the Affordable Care Act (ACA), the much-maligned national health reform law. Unfortunately, some Texas officials are trying to deny consumers the money they are owed — and hand most of it right back to the insurance companies. … At a time when families are tightening their belts, insurance companies should be required to do the same (Deann Friedholm, 12/7).

The Dallas Morning News: The Perils Of Drugging Foster Kids
Senators also made clear that the issue is one of child welfare, and they bored in on a new, five-state study, including Texas, showing that foster children are prescribed psychotropic drugs at rates far beyond those in the general population of Medicaid children. Much of that is attributed to trauma and behavioral difficulties that foster children cope with, but experts testified that no evidence supports the simultaneous use of five or more mind-altering drugs or prescribing even one to an infant. Both practices have persisted in Texas for years and need the closest scrutiny by state regulators (12/7).

Health Policy Solutions (A Colo. news service): Immigrants At Risk In Arcane U.S. Health Care System
Language and cultural barriers often mean that the health care needs of immigrant families remain unaddressed. Whether the problems are related to understanding and attaining health coverage or accessing services, too often immigrants suffer in silence, confused about their options and often hesitant to ask for help (Hoa Ai Tran and Susan Downs-Karkos, 12/7).

iWatch News: Rick Perry's Real Health Care Story
Dr. Michael Burgess, tweeted this directive: "Mark your calendars: Rick Perry will join Health Caucus' Thought Leaders Series next Wednesday, December 7 @ 5 p.m. ... Imagine my dismay when I learned yesterday that Perry would be sharing his thoughts behind closed doors. ... I suspect it's because Perry didn't cotton to the prospect of answering questions about two reports published this week, both of which show that, by many measures, things have gone from bad to worse since Perry became governor 11 years ago this month (Wendell Potter, 12/8).

New England Journal of Medicine: Generic Atorvastatin And Health Care Costs
If Pfizer's agreements extending Lipitor's monopoly truly result in the provision of a brand-name drug at a generic price with savings realized by patients, pharmacy-benefits management and insurance companies and employers, the only short-term losers might appear to be the competing generics firms. But ... generics companies may forgo competition, preventing the typically sharp long-term decline in generic prices and resulting in a lost opportunity for reducing systemwide spending (Cynthia A. Jackevicius, Mindy M. Chou, Dr. Joseph S. Ross, Nilay D. Shah and Dr. Harlan M. Krumholz, (12/7).

New England Journal of Medicine: Expanding Eligibility, Cutting Costs — A Medicaid Update
There is no question that Medicaid patients with the most complex conditions could gain by enrolling in well-run managed-care plans that provide more integrated, readily accessible services than the uncoordinated fee-for-service model. But getting from here to there will be one of Medicaid's greatest challenges over the next decade, and physicians will have to play a leading role. Indeed, it's nothing less than a grand social experiment that bears close watching by stakeholders of every stripe (John K. Iglehart, 12/7).

New England Journal of Medicine: Discussing Overall Prognosis With The Very Elderly
To improve the quality of decision making for the very old, we believe we should radically alter the paradigm of clinician–patient communication: offering to discuss overall prognosis with very elderly patients should be the norm, not the exception. We would suggest that clinicians should routinely offer to discuss the overall prognosis for elderly patients with a life expectancy of less than 10 years, or at least by the time a patient reaches 85 years of age. ... To make care more patient-centered, we need to start helping our very elderly patients set goals of care that take their overall prognosis into account (Drs. Alexander K. Smith, Brie A. Williams and Bernard Lo, 12/8).

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