Viewpoints: Calif. health exchange off to good start; Fay Vincent on access problems for disabled; How 'upcoding' increases health costs

A selection of editorials and opinions on health care from around the country.

Los Angeles Times: A Healthy Healthcare Exchange
The California Health Benefits Exchange, established under the Patient Protection and Affordable Care Act to offer subsidized private coverage to most of the uninsured, represents an excellent opportunity to improve the quality and cost of healthcare in this state. The exchange, which expects to start enrolling Californians in October 2013 with coverage to take effect in January 2014, creates a market in which informed consumers can choose the healthcare system that suits them best, and in which competing health plans have a strong incentive to improve value for money spent by consumers (Alain Enthoven, 8/17).

The Wall Street Journal: Where The Disabled Aren't Welcome
Recently I met with the speakers committee of a prominent Manhattan men's club to discuss giving a talk to the members. As we concluded a pleasant lunch, I raised the delicate subject of whether the club had a bathroom I could use in my wheelchair. I explained that I would need a toilet with bars to permit me to lift myself and a water closet that would permit access in a wheelchair. My hosts looked at one another and then, with some embarrassment, told me there was no such bathroom in their building (Fay Vincent, 8/16).

The Fiscal Times:  Incentives Spike Fee-For-Service Health Costs
Add "upcoding" to the long list of perverse incentives created by fee-for-service medicine that are undermining efforts at controlling health care costs in this country.  The latest example came to light this week in a front page New York Times exposé of billing practices at HCA, the Florida-based chain of 163 for-profit hospitals. In 2008, the company introduced a new coding and billing system that over the two years that tripled the share of emergency room visits that received the two highest reimbursement rates paid by Medicare.  In other words, almost overnight, people visiting its emergency rooms got a lot sicker (Merrill Goozner, 8/17).

Modern Healthcare: Fee-For-Service: A Rash That Just Won't Go Away
Pay doctors to churn through patients, procedures and tests, and they will. As a business model, "do more, earn more" has been singled out by policymakers and the industry as deeply flawed and one reason the U.S. spends so much on healthcare. But, as two health policy experts point out in the Aug. 8 Journal of the American Medical Association, efforts to find another way-;including accountable care-;have so far produced little change (Melanie Evans, 8/16).

New England Journal of Medicine: Unfinished Journey -; A Century Of Health Care Reform In The United States
In 1915, reformers issued the first major proposal for national health insurance in the United States. They believed that America should follow European countries such as Germany and England in securing access to medical care for workers and protecting them against the economic burdens of illness. The leadership of the American Medical Association (AMA) initially agreed, and the prospects for reform appeared promising. Yet by 1920, the health care reform campaign had failed. ... Nearly 100 years after that first proposal, Americans are still debating health care reform, the perils of "socialized medicine," and the tensions between individual liberty and government aid (Jonathan Oberlander, 8/16).

The Arizona Republic: State Should Get Ready Now
Advisers to Gov. Jan Brewer are joining with a still-forming health-care coalition to prepare for expanding the Medicaid rolls in Arizona, a key part of the new national health-care law. At first blush, it sounds like a fool's errand. There is no certainty that Brewer wants to erect the local framework for the Affordable Care Act that could add 300,000 Arizonans to Medicaid (8/17).

New England Journal of Medicine: Epidemic Pertussis in 2012 -; The Resurgence of a Vaccine-Preventable Disease
According to the Centers for Disease Control and Prevention, the United States is currently experiencing what may turn out to be the largest outbreak of reported pertussis (whooping cough) in 50 years. Why has this theoretically vaccine-preventable disease been on the upswing (James D. Cherry, 8/15)?