Viewpoints: Health Law Is Here To Stay; Problems For Obamacare Go Beyond Website; Future 'Doc Shock'

The New York Times' The Conscience of a Liberal:  On The Right, It Will Always Be October
For almost two months, the debacle of healthcare.gov allowed conservatives to live the life they always wanted. Health reform was a dismal failure; Obama would go down in history as a laughingstock; government can’t do anything; viva Ayn Rand! ... while things are far from completely fixed, the crisis is clearly over. Obamacare will have millions of beneficiaries by the time open enrollment ends; it will add many more in the 2015 cycle. Health reform is pretty much irreversible at this point (Paul Krugman, 12/5).

The Washington Post's Right Turn: Price Of Health Care
Obamacare’s problems haven’t gone away. (“The administration has received strong criticism for failing to disclose the error rate for forms known as 834s, which send information about ObamaCare enrollees to health insurers.") ... 

The refusal of young people to do as they are told — sign up in large numbers in the exchanges — remains an potentially fatal flaw in the whole shebang. ... They didn’t understand “hope and change” meant buying something you didn’t want and/or couldn’t afford (Jennifer Rubin, 12/5).

Bloomberg: ‘Doc Shock’ On Deck In Obamacare Wars
Come January, when some number of Americans have bought insurance on the new health exchanges and are starting to use the services, you can expect another controversy to arise when many of them find out just how few doctors and hospitals they have access to. Call it “doc shock,” though the biggest outcry will not come when people try to schedule an appointment with their physician, but when someone gets sick and they learn they cannot go to whatever top-notch hospital they want, only to the hospital that is included in their plan (Megan McArdle, 12/5).

New England Journal of Medicine: The Road toward Fully Transparent Medical Records 
[N]early 2 million Americans already have access to notes, and we anticipate that open records will become the standard of care, ... Given that more than half the patients we surveyed wanted to add comments to their doctors' notes and approximately a third wanted to approve what was written, we expect that patients will soon share in generating content ... Indeed, we believe that ultimately notes will be signed by both patients and providers, as they become the foundations for planning care, monitoring the course of health and illness, and evaluating care (Jan Walker, Drs. Jonathan D. Darer, Joann G. Elmore and Tom Delbanco, 12/4).

Health Affairs: A Promising Approach For Emergency Departments To Care For Patients With Substance Use And Behavioral Disorders
Millions of patients visit US emergency departments (EDs) each year because of substance use and behavioral disorders. ... A growing body of evidence suggests that screening, providing a brief intervention, and referring these patients to treatment—an approach known as SBIRT—can be effective in the ED. Typically requiring just five to ten minutes, SBIRT incorporates principles of motivational interviewing, an evidence-based counseling technique ... [This] article recommends adopting SBIRT broadly to help EDs become a coordinated part of the health care system (Steven L. Bernstein and Gail D'Onofrio, 12/4).

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