Viewpoints: Gerson Says No Compromises Makes For 'Bad Politics;' Democrats Are Getting A Pass; Manchin Signals A Break In Democratic Ranks

The Washington Post: A Compromised Reputation Among The GOP
We are seeing that an anti-compromise ideology can make for bad politics. In our system, Obamacare will not be overturned by one house of Congress. A tea-party shutdown strategy — if implemented — would make securing the other house and the presidency less likely for Republicans. And the political energy consumed by Cruz and crew has not been available to promote incremental limits on Obamacare that might have aided GOP political prospects (Michael Gerson, 9/26).

The Wall Street Journal: Defunders Give Democrats A Pass
As Mr. McConnell said Tuesday on the Senate floor: Majority Leader Harry Reid "can only afford to lose four Democrats if he wants to restore funding for Obamacare. So, if five Senate Democrats vote against the majority leader, Obamacare will be defunded . . . The spotlight should be on them." If only it were. The tragic reality is that this vote isn't shaping up to be all that perilous for the owners of the law. Nobody is even talking about Democrats. Nobody has put an iota of pressure on them for months (Kimberley A. Strassel, 9/26).

Bloomberg: Ted Cruz Republicans Listen Only To Themselves
A recent CNBC poll asked whether the Patient Protection and Affordable Care Act should be defunded. By 44 percent to 38 percent, Americans said no. Then the pollsters asked specifically about Cruz’s plan: forcing a shutdown to defund Obamacare. The public rejected that idea 59 percent to 19 percent. But Cruz isn’t listening. Public opinion on Obamacare is complicated but generally consistent. The law is unpopular. But a solid majority wants the Republican sabotage to end (Ezra Klein, 9/26).

USA Today: House GOP Rants Its Way Past Fiscal Problem: Our View
Defunding Obamacare — for all the Tea Party hyperventilating — would not yield much savings. Next year, according to the Congressional Budget Office, it will amount to about 1.3% of federal spending. As it ramps up fully, it will grow to about 3.3%. That's a pretty small sliver of government to justify sacrificing the financial credibility of the United States. What's more, because defunding Obamacare would also defund the offices that collect the taxes that more than pay for it, the action would actually increase the deficit (9/26).

USA Today: Obamacare Is Fiscally Irresponsible: Opposing View
By Washington standards, the entitlements within Obamacare start slowly. Next year, the Medicaid expansion and exchange subsidies will cost taxpayers $48 billion. Over the next decade, however, the cost of these entitlements will balloon to $1.8 trillion. Simply put, Obamacare is incompatible with fiscal responsibility. Left in place, Americans should expect these costs to grow (Michael A. Needham, 9/26).

The Wall Street Journal: The Obamacare Phalanx Breaks
One reason Obamacare has held together despite its unpopularity is the phalanx of support from Democrats. They passed it on a partisan basis without a single Republican vote, and they're sticking to it. So it was news on Thursday when West Virginia Senator Joe Manchin became the first Democrat of note to break with one of Obamacare's core tenets. The Senator told a media breakfast that he'd vote to support a bill to fund the government that included a one-year delay in the Affordable Care Act's mandate to buy individual health insurance (9/26).

The Wall Street Journal: Manchin Breaks Ranks
Senators like Ted Cruz of Texas have been trying to repeal ObamaCare in one fell swoop. ... But other GOP lawmakers, who share the freshman senator's goal, think that his strategy is unrealistic given that Republicans control only the House and that the president is unlikely to undo his signature achievement. The better tactic is to go after portions of the law, such as the individual mandate, that are less popular and hard for Democrats to defend. In other words, pick fights that you stand a chance of winning. Mr. Manchin's change of heart suggests that this strategy even has some bipartisan support (Jason L. Riley, 9/26).

The Wall Street Journal: The Beltway Stalemate
Any clear-eyed thinking would show that Obamacare needs to be, at the least, delayed. The law has always suffered from its usurpation of the physician-patient relationship, its infringement on First Amendment freedoms of Christian businesses and entities, and its stifling of the innovation and flexibility our health-care system needs. We now see the Obama administration unilaterally delaying parts of the law, Congress working to ensure members and their staffs are not burdened by the new rules, and concerns that Obamacare computer systems will be unready for the enrollment that starts in a few days. We continue to find "glitches," price shocks and other surprises throughout the legislation and its related rules (Pete Du Pont, 9/26). 

The New York Times: Could a Republican Health Care Reform Ever Happen?
But the first moment when a Republican Congress might actually be able to pass a health care overhaul won’t arrive until February of 2017, at which point Obamacare will have been the baseline for two years — the new taxes, the subsidies, the mandates, the higher premiums, the Medicare cuts, the Medicaid expansion, all of it. And at that point, the plausible right-of-center alternatives to Obamacare will no longer look risky and disruptive relative to the status quo, because that status quo will no longer be one that Republican interests and voters are deeply invested in defending. Instead, those interests and voters will be looking for ways to limit the health care law’s impact (Ross Douthat, 9/26). 

Los Angeles Times: Dr. Seuss Goes To Washington
Sen. Ted Cruz has egg on his face. Green egg. On Tuesday, during his 21-hour marathon "filibuster" against Obamacare, he read aloud to his daughters back home the Dr. Seuss book "Green Eggs and Ham." But he clearly missed its message. In the Seuss tale, Sam-I-Am, a lover of green eggs and ham, tries to persuade a friend to try them. But the man resists. He resists so persistently and so adamantly that he ends up sounding a lot like the Republicans on Capitol Hill who are determined to defund President Obama's healthcare law. But in the Seuss story, the man is finally persuaded to try the offending eggs and ham, and, much to his surprise, he loves them. If only the GOP would take a page from that book (Peter Dreier, 9/26).

Los Angeles Times: Debt Ceiling Baloney From Republicans
The GOP's price for raising the limit is major concessions by Democrats on spending, entitlements and the 2010 healthcare law. No matter what you think about those demands, it's irresponsible to take the debt ceiling hostage, especially when the automatic across-the-board sequester spending cuts enacted in 2011 are motivating both sides to seek a broad fiscal deal (9/25).

The New York Times: A Republican Ransom Note
We’ll refrain from deliberately sabotaging the global economy, Speaker John Boehner and the other leaders said, if President Obama allows more oil drilling on federal lands. And drops regulations on greenhouse gases. And builds the Keystone XL oil pipeline. And stops paying for the Consumer Financial Protection Bureau. And makes it harder to sue for medical malpractice. And, of course, halts health care reform for a year (9/26). 

The New York Times: Is Obamacare Working?
The Obama administration this week provided the first detailed look at premiums to be charged to consumers in federally run health insurance markets, established under the Affordable Care Act. With some states already rolling out the new exchanges, are we seeing that the law is worthwhile or a problem? (9/26).

Kansas City Star: Lieutenant Governors In Missouri, Kansas Agitated Over Obamacare
The rollout of the new insurance marketplaces, courtesy of Obamacare, has rattled Republican politicians like a disturbance in the jungle. The agitation seen in Washington is just the beginning (Barbara Shelly, 9/26).

Kansas City Star: Transform Medicaid To Help More Low-Income Missourians
A hearing in Jefferson City Thursday stood out as an encouraging show of pragmatism amidst all the last-gasp frenzy about repealing Obamacare. While Republican politicians in Washington blustered about getting rid of the law — which won’t happen — legislators and experts were seeking a way to make it work better in Missouri (9/26).

Philadelphia Inquirer: Obamacare Deserves Chance
Cruz maintains that he only wants to protect Americans from Obamacare, which he says is "hurting almost every sector of the economy." That's quite an accomplishment for a program that has yet to be implemented -- and which can be revised as needed after it's been cranked up. The dangerous steps toward a shutdown that Cruz and his cabal are willing to take, either now or when the debate turns to raising the debt ceiling, have more to do with enhancing their status among the tea-party faithful than with making health care affordable and accessible (9/25).

St. Paul Pioneer Press: Patient Incentives Needed To Bring Down Health Costs
The Affordable Care Act is going into operation, at least if conservative Republicans in the House fail to repeal it. Yet regardless of that or other changes in health financing, we will continue to struggle with rising costs of care itself. The act may boost some incentives for providers to do things at less expense. … But there still will be few incentives on the patient side. Until that changes, evermore high-tech treatments and an aging population are likely to drive spending upward at a faster rate than growth of the overall economy (Edward Lotterman, 9/25).

And on other issues -

Politico: Abortion Is A Winning Issue For Wendy Davis
Along with guns and gays, abortion has long been part of the Republican red-state arsenal. But as Texas Republicans abandon suburban women to court Tea Party voters, they create opportunities for Democrats whose abortion positions appear increasingly moderate. If [State Sen. Wendy] Davis can frame [Lt. Gov. Greg] Abbott’s extreme position as restricting abortion access, then Gov. Wendy Davis might not be such a crazy idea after all (Jason Stanford, 9/26).

Tampa Bay Times: For Mentally Ill, There Must Be A Better Way
An investigation will ultimately determine whether St. Petersburg Officer Damien Schmidt acted appropriately Monday night when he shot and killed an ax-wielding young man on a downtown sidewalk. But the death of Kenneth Robert Sprankle and three other mentally ill people recently killed in confrontations with St. Petersburg police should force a serious discussion in Tallahassee about spending more on mental health services. More treatment on the front end could save lives and taxpayer money (9/25).

The Wall Street Journal: Medical Education Needs Major Surgery
The U.S. medical education system is the finest in the world, yet it is very expensive and inefficient. ... The uncomfortable truth is that medical schools today provide a preclinical education that their students neither want nor need. Students hate live classroom lectures, especially for basic content, and they know they learn better [online] on their own time at their own pace. Yet schools still rely on these educational relics. A more individualized system of self-study using the latest in digital technology, along with small study groups to integrate knowledge, would provide more effective learning. It seems wasteful to pay 170 anatomy professors to design 170 separate courses and then bill students for this privilege (Jonathan David, 9/26).

Miami Herald: Fee Changes Take A Toll On Lab Testing Industry
As the head of a clinical laboratory specializing in cancer testing for more than 20,000 patients in south and central Florida, recently proposed efforts to reduce payments for critical diagnostic lab testing that Medicare cancer patients rely on to receive life-saving treatment are deeply troubling. ... proposed cuts to payments for vital cancer tests are so severe — nearly 75 percent in some cases — it would reduce payment to below the cost of laboratories to buy necessary materials to provide these services (Dan Vanoort, 9/25).

Journal of the American Medical Association: The Future of the Medicare Home Health Program
Most older Americans want to age in place. The Medicare home health benefit is a prominent national policy supporting older Americans at home and provides for visiting nurse and therapist services from home health agencies (HHAs). In 2012, Medicare spent $18.2 billion on HHAs; 3.5 million beneficiaries received care. Home health can help struggling patients get support in the community and can enable successful transitions home from institutional care. However, numerous concerns have been raised about the home health benefit, including fraud, geographic variation in utilization, and poor coordination with primary medical care. This uncertainty is untimely, as more than 70 million adults will join Medicare between 2011 and 2030 with the hope of receiving care at home. It is time to develop a stronger home health option (Dr. Steven Landers, 9/26).

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