Viewpoints: Texas' indifference to health needs for the poor; Sen. Grassley says IRS is too busy to deal with health law

The New York Times: The Rush To Abandon The Poor
The state with the country's worst health care record just happens to have a governor who has been the loudest voice against national efforts to improve it. A quarter of the residents of Texas, 6.3 million people, are uninsured, by far the highest percentage in the country. ... Yet Gov. Rick Perry -; strangely puffed up as he was so often in his presidential bid -; recently told the Obama administration that he would proudly refuse a huge infusion of Medicaid money that would significantly reduce those shameful statistics and cover 1.7 million more people (7/17). 

Los Angeles Times: Rational Healthcare, Not Rationing
The Affordable Care Act remains in Republican cross hairs and very much in the news. In recent days, several patients have asked me what the law will mean for them. Many of the people I care for are incurably ill and need expensive medical care to stay alive. They've heard politicians say "Obamacare" will take away their choices, rob them of hope for living longer and cast their fate to "death panels" of faceless bureaucrats. Fortunately, none of this is true (Dr. Ira Byock, 7/18).  

Los Angeles Times: GOP 'Obamacare' Jihad Takes On Subsidies For Working Poor
Congressional Republicans are so obsessed with the idea of repealing any or all of "Obamacare," they don't seem to care about the potential harm that might inflict on their constituents. The latest example comes from Tennessee Republican Reps. Phil Roe and Scott DesJarlais (both of them physicians), who introduced a resolution aimed at denying lower-income Americans in more than two dozen states, including their own, the subsidies the bill provides for health insurance (Jon Healey, 7/17).

Des Moines Register: Health Law "Taxes" The IRS
Notwithstanding the considerable issues of individual liberty, freedom of religion and free enterprise, the [Supreme Court] ruling triggers all kinds of administrative nightmares. By any measure, the Internal Revenue Service already has its hands full administering an exceedingly complex federal tax code. … The IRS has enough on its plate to properly and effectively carry out its primary mission: enforcement of the nation's revenue laws. That's why during Senate debate on the health care law I raised concerns about giving the IRS more responsibility than it could chew (Sen. Chuck Grassley, 7/17).

The New York Times: Some Legal Clarity On Generic Drugs
A federal appeals court in Philadelphia has brought some welcome common sense to the thorny question of how to judge patent cases in which brand-name drug companies pay substantial sums to generic competitors who then delay bringing their drug to market. A three judge-panel of the United States Court of Appeals for the Third Circuit ruled on Monday that, absent clear evidence to the contrary, such payments should be viewed as "prima facie evidence of an unreasonable restraint of trade" (7/17).

Reuters: Stockton Wants To End Generous Healthcare Benefits For Its Retirees
Some residents of Stockton, California are upset over the city's decision to eliminate free healthcare benefits for public retirees. Michael Fitzgerald, a columnist for the Record, Stockton's newspaper, wrote last week about the policy change: "The lavish perk that did the most to bankrupt Stockton is free lifetime medical care for some retired city employees and spouses. Now retirees are suing to keep it free" (Cate Long, 7/17).

Archives of Internal Medicine: A Call to Our Hospitals: Please Hold the Salt!
Two decades ago, several US hospitals took steps to ban smoking on their premises. ... Hospitals again have the opportunity to take the lead and to create food environments that are consistent with their mission to cure the sick and to promote health. Through the simple act of serving food that meets national nutritional standards, our hospitals will act in the best health interests of their patients, and their staff and will undoubtedly again be leaders in our ongoing dialogue on how to improve our food supply, which in turn will improve the health of us all (Dr. Kirsten Bibbins-Domingo, 7/17).

Archives of Surgery: Putting Our Own House in Order
The expert panel ... provides an extraordinarily well-organized and thoughtful approach to the prevention, identification, and management of problem behavior in surgical residents. ... Unfortunately, the authors provide only passing mention of the importance of the hidden curriculum and the potential impact of faculty behaving badly as a source of professional role modeling. Surgeons have been clearly identified as the group of physicians at highest risk for disruptive behaviors; consequently, surgical trainees are more likely to have poor role models for professional behavior (Dr. Amalia Cochran, 7/17).

Journal of the American Medical Association: Marshaling Leadership For High-Value Health Care
The math is simple: too much is spent on health care without concomitant returns in quality. The path to a better health care system must rectify these issues. However challenging, quality of care must be improved with a simultaneous reduction in costs and elimination of waste from the system. Consumers of health care understand this imperative. Public and private payers have begun to leverage their purchasing power to demand higher-value care-;care that achieves better outcomes at lower costs (Dr. Patricia Gabow, George Halvorson and Dr. Gary Kaplan, 7/18)

Journal of the American Medical Association: Understanding Health Care As A Complex System
The US health care system will need to continue to depart from a mechanical, regulatory approach to health care policy and move toward a complex systems approach that permits creative self-organization. This may be accomplished by removing structural boundaries between health care professionals, aligning their goals, enabling experimentation, and establishing simple rules to help limit costs (Dr. Lewis A. Lipsitz, 7/18).