Viewpoints: Opposition from the right weakening support for Ryan's budget plan; Doctors need to confront overweight patients

The Wall Street Journal: Ryan And The Right
It's no surprise that the White House has denounced Paul Ryan's new House budget as the end of welfare-state civilization. The puzzle is why some conservatives are taking shots at the best chance in decades for serious government reform (3/26).

The Wall Street Journal: Ryan For Vice President?
The news from Paul Ryan on Fox News Sunday had nothing to do with the budget. Chris Wallace asked the House Budget Committee chairman if he is open to becoming the vice presidential nominee, and Mr. Ryan didn't close the door. He also said he had given the matter no thought, but if that's true he probably should start thinking because it's possible he could be invited to join a Mitt Romney ticket. Let's ignore the 2012 electoral calculations for today and consider the choice from Mr. Ryan's point of view (Paul A. Gigot, 3/26).

The Philadelphia Inquirer: Doctors, Nurses Must Talk About Weight
The reality is that health-care providers and patients often fail to discuss excess weight and obesity when they should. If the American obesity epidemic is going to get better, it's going to have to start with improved communication. A 2009 study published in the journal Patient Education and Counseling found that patients whose health-care providers told them they were overweight or obese were almost nine times likelier to perceive their excess weight as damaging to their health (Denice Ferko-Adams, 3/27).

Minneapolis Star Tribune: Boomers Unready For Long-Term Needs
The sobering preparedness gap revealed by a new poll on long term care in Minnesota spotlighted one of the most pressing concerns of this era -- how to pay for aging baby boomers. … So far, one innovative solution -- helping Minnesotans tap into life insurance policies for long term care needs -- hasn't gotten much traction with legislators. The Dayton administration and the state Department of Human Services, however, will soon roll out an "Own Your Future" program to raise awareness and study possible solutions. The program is an important step forward, but it's just a start (3/26).

Archives of Internal Medicine: Emergency Department Care: When Needed-;Not When Better Choices Are Unavailable
The point of (emergency departments) is to rapidly triage and diagnose those with serious illnesses. However, it is clear that EDs in the United States function more as safety valves than as triage centers. They care for patients with no other place to go, no other place they can afford to go, no other place open when they are off from work, or no right place to go. ... If the United States is ever to have a system that provides high-quality care at an affordable price, we must direct patients to the right place at the right time to see the right person. The ED should not be the default option (Dr. Mitchell H. Katz, 3/27).

Archives of Internal Medicine: Does Motivational Interviewing Improve Outcomes?
Motivating behavioral change has become a core competency for clinicians and a major priority for the health care system as chronic disease management and disease prevention encompass an increasing proportion of clinical medicine. Nonadherence to treatment programs represents an important barrier to successful chronic disease management and is associated with significant morbidity, mortality, and preventable health care costs across a wide variety of conditions. Clearly, we need interventions that can successfully elicit behavior change to prevent and manage disease. But how successful are the current strategies? (Dr. Seth A. Berkowitz and Dr. Kirsten L. Johansen, 3/27).

Archives of Internal Medicine: Deferred Admission To The Intensive Care Unit: Rationing Critical Care Or Expediting Care Transitions?
There are several reasons to doubt that we can expand the supply of high-quality critical care to meet the expected surge in demand brought on by an aging population. First, critical care expenditures already strain nations' abilities to meet other socially desirable goals. Second, most critically ill patients are cared for by physicians who lack specific training in critical care medicine, a staffing model that has been associated with worse outcomes in most studies. Third, severe shortages are projected in critical care workforces. Therefore, if the capacity of critical care is relatively fixed, we must instead try to improve the efficiency of care (Dr. Jason Wagner and Dr. Scott D. Halpern, 3/27).