Viewpoints: 'Killing' Medicaid; Medicine For Mentally Ill; 'Outrageous' Veto Of Mammogram Bill In Calif.

The New York Times: Killing Medicaid The California Way 
(E)ven as it vigorously defends the constitutionality of the individual mandate, the Obama administration may be complicit in eviscerating Medicaid — and setting back the broader goal of ensuring that all Americans have access to quality health care (Bruce C. Vladeck and Stephen I. Vladeck, 10/13).

Los Angeles Times: Medical Marijuana Guidance
The core of the problem is the same as it has always been: the interplay, and conflict, between the federal prohibition of marijuana and the state authorization of medical use under Proposition 215, passed in 1996. Any law student will tell you that federal law prevails, but that's hardly the end of the matter (10/14). 

Detroit Free Press: Michigan Can't Afford To Keep Best Medicines From Mentally Ill
Shortsighted legislation, now before the House, would further weaken and erode Michigan's anemic mental health care system by limiting access to medication for people with mental illness and epilepsy. House Bills 4733 and 4757 would strip Medicaid patients with these conditions of drug access protections. They would, in effect, reverse laws enacted in 2004 to maintain access to single-source drugs — in other words, drugs with no current generic equivalents — by requiring prior authorization for certain drugs not on the state's preferred drug lists. Getting that would require patients to have a failure period with a generic drug, a dangerous practice for people with serious mental illness (10/14).

Des Moines Register: What 'Obamacare' Critics Don't Tell You
Lose your job, lose your health insurance. Unemployed Americans have known this for many years. Since the recession began, even more have learned this painful lesson. The vast majority of Americans — about 160 million — get health insurance through their jobs. Many of us take this arrangement for granted. We may not realize our employers pick up the largest share of the cost. So what do people do when they can't find full-time work with benefits in this economy? Many piece together part-time, temporary or contract jobs — most of which do not offer health coverage (10/13).

San Jose Mercury News: Brown's Veto Of Mammogram Disclosure Is Outrageous
Gov. Jerry Brown probably made more good than bad decisions on various bills this fall. But it was infuriating to see him veto Sen. Joe Simitian's bill requiring full disclosure to women whose mammograms may be ineffective. It was so simple, so certain to save lives that we could not imagine a veto. But the medical establishment pulled out all the stops to kill it. Amy Colton persuaded Simitian to carry the bill after she was diagnosed with advanced breast cancer despite years of supposedly clear mammograms. She learned, too late, that her dense breast tissue obscured the cancer. This condition is noted in reports to doctors but not in reports sent to patients, who develop a false sense of security (10/13).

Milwaukee Journal Sentinel: Concussion Legislation Is A Win-Win
Pro wrestler Mick Foley is legendary for his memory problems. … State Rep. Jason Fields and state Sen. Alberta Darling may not have been thinking about Foley when they recently introduced concussion legislation, but they are trying to make sure what happened to him doesn't happen to young Wisconsin athletes. The bill would require coaches of athletes ages 11 to 19 to pull them immediately if they suspect a head injury. The athletes would have to be examined by a health care provider trained in the evaluation of concussions and couldn't return until that provider gave them written permission to compete again (Gary Nosacek, 10/12).

New England Journal of Medicine: The New Language of Medicine
We are in the midst of an economic crisis, and efforts to reform the health care system have centered on controlling spiraling costs. To that end, many economists and policy planners have proposed that patient care should be industrialized and standardized.2 Hospitals and clinics should run like modern factories, and archaic terms such as doctor, nurse, and patient must therefore be replaced with terminology that fits this new order. The words we use to explain our roles are powerful. They set expectations and shape behavior. This change in the language of medicine has important and deleterious consequences. The relationships between doctors, nurses, or any other medical professionals and the patients they care for are now cast primarily in terms of a commercial transaction (Dr. Pamela Hartzband and Dr. Jerome Groopman, 10/13).

New England Journal of Medicine: Rethinking Health Care Labor
Of the $2.6 trillion spent in 2010 on health care in the United States, 56% consisted of wages for health care workers. Labor is by far the largest category of expense: health care, as it is designed and delivered today, is very labor-intensive. The 16.4 million U.S. health care employees represented 11.8% of the total employed labor force in 2010. Yet unlike virtually all other sectors of the U.S. economy, health care has experienced no gains over the past 20 years in labor productivity, defined as output per worker (in health care, the “output” is the volume of activity — including all encounters, tests, treatments, and surgeries — per unit of cost). (Dr. Robert Kocher and Nikhil R. Sahni, 10/13).

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