Viewpoints: Playing Chicken On Entitlements; 'Getting Serious' About Mental Illness

The New York Times: Playing Taxes Hold ’Em
This is no time for a Grand Bargain, because the Republican Party, as now constituted, is just not an entity with which the president can make a serious deal. If we’re going to get a grip on our nation’s problems — of which the budget deficit is a minor part — the power of the G.O.P.’s extremists, and their willingness to hold the economy hostage if they don’t get their way, needs to be broken. And somehow I don’t think that’s going to happen in the next few days (Paul Krugman, 12/20). 

The Wall Street Journal: Teetering On The Cliff
Speaker John Boehner defaulted to Plan B as a last resort after weeks of failed negotiations with the White House. ... When Mr. Boehner finally cracked on raising rates, at an income threshold of $1 million, Mr. Obama still said no. ... Flush with victory, [Obama] could have at least made a gesture on entitlements. Instead, he has treated the talks as an extension of the election campaign, traveling around the country at rally-style events at which he berates Republicans for not accepting his terms of surrender. Grant gave Lee more at Appomattox (12/20).

The New York Times: Strangers In The Night
But down the road, Obama does have a problem and, for Republicans, a vulnerability. Even if the cliff talks go his way, Obama will still face a money shortage. Entitlement costs are rising. Revenues can’t keep up. ... The Republican strategy should be obvious. Swallow hard and accept a deal. End the showdown era. ... Prepare a comprehensive tax and entitlement reform strategy for 2013. Call Obama’s bluff on health care reform. In case Obamacare doesn’t bend the cost curve, get Obama to agree to some automatic triggers — plans that will kick in and bring down health care spending (David Brooks, 12/20).

The Washington Post: Making A ‘B’ Line To The Cliff
Boehner gave on both revenue (now $1 trillion) and rates (now letting rates rise for those earning more than $1 million). The White House gave on revenue, rates and entitlements. It reduced its revenue demand to $1.2 trillion and raised the sock-it-to-me, rate-rising level to $400,000, from $250,000. It agreed — infuriating progressives — to an entirely sensible change in the inflation measurement for calculating tax brackets and cost-of-living adjustments for benefit programs. The two sides were so close it makes you want to cry, although, in a sign of the trying times, they can’t even agree on how close (Ruth Marcus, 12/20). 

The New York Times: Medicare Spending Isn't Out Of Control
Critics of Medicare — notably private health insurers — contend that the higher prices for health care paid by private insurers can be explained by a “cost shift” from government, notably Medicare, to private payers. This view reflects the idea that the providers of health care are to be “reimbursed” for whatever costs they incur in treating patients, rather than budgeting backward from whatever revenue they are “paid,” like other sellers (e.g., hotels or airlines), which can charge different prices to different customers for the same thing (Uwe E. Reinhardt, 12/21).

Los Angeles Times: Medicare: A Plan B For Part D
[The Part D prescription drug program] enables seniors and the disabled to buy taxpayer-subsidized coverage for many of the most widely prescribed medicines. When it created the costly benefit in 2003, though, Congress provided no way to pay for the subsidies, which have cost more than $300 billion so far. Worse, it barred the government from negotiating with drug makers for better prices — an extra gift to the pharmaceutical industry, which already stood to gain from the increased demand for its newly subsidized products. Now that policymakers are casting about for ways to save money on Medicare, they should allow it to take advantage of its market power (12/21). 
 
St. Louis Beacon: Don’t Weaken Medicare
Medicare gives [my mother] control over her own health-care decisions. Unlike my own "private" health insurance, Medicare lets her pick from virtually every doctor and hospital in the country. That’s the kind of choice she wants. ... When we all want the same thing, it just makes sense to provide it for everybody. That’s exactly why we should just fix the problems with Medicare (end the deductibles and co-pays; correct the inadequate physician reimbursement, etc.) and provide it to all Americans, regardless of their age. ... Instead, our precious Medicare is under attack (Dr. Ed Weisbart, 12/21).

Roll Call: Changes To Medicare Part B Pose Risk To Rural Minorities
Rural residents are more likely to be uninsured or underinsured, to develop chronic illnesses and to have trouble finding qualified doctors than residents of urban areas. Minorities in rural areas are at even greater risk. They’re more likely than their white neighbors to be obese and to have diabetes. ...  Several articles have reported that Part B cuts could be part of the fiscal cliff deal once lawmakers figure out what programs to trim. If that passes, rural Americans suffering from serious illnesses such as cancer, multiple sclerosis and rheumatoid arthritis may have to travel further or be unable to get the medical care they need (Gary Puckrein,12/20).

USA Today: Dealing With Guns And Mental Illness
According to a recent article published by Public Health Law Research, gun restrictions on people with a history of mental illness, such as background checks and waiting periods, had no significant effect on homicide rates. The restrictions, however, did reduce the suicide rate, suggesting that people with mental disorders, especially depression, are more likely to kill themselves than others. ... What troubles me is broadside finger-pointing that increases stigma against persons such as my son. He didn't ask to have a mental disorder anymore than I asked to have poor eyesight and asthma (Pete Early, 12/20). 

The Washington Post: The Roots Of Mass Murder
As a psychiatrist in Massachusetts in the 1970s, I committed people — often right out of the emergency room — as a danger to themselves or to others. I never did so lightly, but I labored under none of the crushing bureaucratic and legal constraints that make involuntary commitment infinitely more difficult today. Why do you think we have so many homeless? Destitution? Poverty has declined since the 1950s. The majority of those sleeping on grates are mentally ill. In the name of civil liberties, we let them die with their rights on (Charles Krauthammer, 12/20).

The Miami Herald: Let’s Get Serious About Mental Health
The sad truth is, in almost every tragedy like Sandy Hook, Aurora, and Virginia Tech, cries for help went unheeded or unfunded. Sometimes it’s the person with a serious mental illness (SMI) — schizophrenia, bipolar disorder, major depression — or a family member reaching out to help them. In either case, their pleas for help often fall on deaf ears or on a mental health system that is stressed with too much unmet need and too few resources. ... Due to the cost of providing treatment and shrinking government budgets, policy makers dismiss adequate mental healthcare funding as something less than a high priority (Paula Dockery, 12/20).

The New York Times: Labs, Washed Away 
When the hospitals were hit by Hurricane Sandy, hundreds of experiments were obliterated by the loss of power. Precious biological samples carefully frozen over years were destroyed. Temperature-sensitive reagents and equipment were ruined. Medications and records for patients in clinical trials were rendered inaccessible. ... For many patients, the thrum of research within a medical center is invisible. But it is an integral — and very human — part of a hospital. When a hurricane disrupts research, it is a loss that resonates well beyond the laboratories (Dr. Danielle Ofri, 12/20).

The New York Times: Where Have All the Primary Care Doctors Gone?
More and more, my family and friends are asking for my help in finding a primary care doctor. That they would be having trouble finding one doesn’t surprise me. We’ve all been reading warnings about an impending doctor shortage for several years now. What is alarming to me is that there are no sure-fire solutions in place that will bail us all out in time (Dr. Pauline Chen, 12/20).

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