Viewpoints: Adding a middle man to Medicare; Circumcision wars; Who is an extremist on abortion?

The New York Times: Voucherizing Medicare
Bear in mind that health expenses will still have to be mainly paid for by some kind of insurance; that's in the nature of medical care, with its high but unpredictable cost. So what we're doing here is replacing government insurance with a program that gives people money to buy private insurance -; that is, adding an extra layer of middlemen. Why would this save money? I guess the answer is supposed to be the magic of the marketplace -; but we have the experience of Medicare Advantage, plus studies of Medicaid versus private insurance, plus the raw fact that America relies more on private insurance than any other nation and also has by far the highest costs. Nothing, absolutely nothing, in the record suggests that this will do anything other than make health care less efficient (Paul Krugman, 8/27).

The Washington Post: Republicans Steal Medicare From The Democrats
At a breakfast hosted by Bloomberg News on Monday morning, Mitt Romney's campaign brain trust claimed to welcome a fight with President Obama over the future of Medicare. I say "claimed" because the Romney team surely recognizes that putting Rep. Paul Ryan (R-Wis.) on the ticket means not being able to run away from Ryan's plan -; endorsed by House Republicans -; to transform Medicare into a voucher program (Eugene Robinson, 8/27).

The New York Times: 'Warning: Smoking Can Kill You'
The new warnings were carefully chosen to replace text-only warnings that had become ineffective -; "unnoticed and stale," the Institute of Medicine reported -; in the face of the tobacco companies' long history of deceptive advertising. The United States Court of Appeals for the District of Columbia … struck down the new warnings on the grounds that they violated the First Amendment rights of the tobacco companies. It ruled that the government failed to provide evidence that the warnings would reduce smoking rates, and therefore could not justify what it called a restraint on corporate free speech. But this view ignores that these companies have spent billions of dollars over many decades misleading consumers about smoking's terrible consequences. …. As Judge Judith Rogers noted in dissent, there is good evidence that bolder warnings will "alleviate" some of the harm (8/27).

Los Angeles Times: Circumcision Wars: The Other Side Weighs In
Maybe up there with abortion and healthcare reform, circumcision of male babies and children is shaping up to be one of the hottest issues in the sociomedical world over the next few years. Once uniformly regarded as kooks by nearly everyone, people who vow to outlaw circumcision are now only regarded as kooks by the majority of people. They managed to get a measure on the San Francisco ballot last year. The California Legislature quickly intervened, passing a law that made it (rightly) clear that the state is in charge of determining medical law, not individual cities, which ended that as well as any talk of measures elsewhere in the state (Karin Klein, 8/27).

Los Angeles Times: Can Abortion Extremists Attack Other Extremists For Being Extreme?
Can you accuse someone of having "extreme" views on abortion without implicitly endorsing a middle-of-the-road position yourself? Strictly speaking, yes. If I am an extremist on the right side of the spectrum -- the Todd Akin/Paul Ryan position of no abortions even in cases of rape or incest -- I can accurately observe that someone at the left end of the spectrum -- abortion should be legal in every circumstance, even late in pregnancy -- is also an extremist. Yet there is something intellectually dishonest about bewailing extremism in the other camp -- in the hopes of appealing to "moderates" -- when you espouse an equally extreme position on the other side (Michael McGough, 8/27).

The Seattle Times: Lawsuit Victory For Treatment Of Autism
Group Health Cooperative has settled a class-action lawsuit by agreeing to cover behavioral-health treatment for autism, an important moment and model for other Washington insurers. Indeed, the state Health Care Authority followed with its partial settlement of a class-action lawsuit, agreeing to cover intensive early-intervention behavior therapy for children with autism-spectrum disorders whose parents have health insurance through the state's Uniform Medical Plan. Coverage for Medicaid patients is also close to an agreement…. Early investment in these therapies make a big difference for a lifetime (8/27).

Medpage Today: How To Replace The AMA
The divide between physicians who think that the AMA should fight for them and those who think that the AMA should fight for the health of the people seems too large to bridge in 2012. When you add to that the often expressed belief that the AMA fails on both fronts, it really becomes unsalvageable. … I see only three ways to rescue the AMA. Membership in the AMA, state, and county medical association could be made a legal condition for state medical licensure, or a national medical license. Or, the AMA could change its key objective. It could either become a lobbying organization representing all physicians with group bargaining, to the fullest extent of the law, or a new law that allows collective bargaining. Or, it could follow its current key objective and truly "promote the art and science of medicine and the betterment of public health" and stop also trying to represent the financial interests of its members (Dr. George Lundberg, 8/27).