Viewpoints: Two views of Medicare equipment bidding changes; High Court case may impact FDA approval process

USA Today: Medicare Bidding Competition In Danger: Our View
In 2010, Medicare spent more than $14 billion on oxygen devices, mobility scooters, diabetes test strips and other "durable medical equipment" and supplies that patients use at home. For taxpayers, and for beneficiaries with a 20% co-pay, that was about $5 billion too much. Everyone overpaid because for years, Medicare bought or rented things like this on a fee schedule set by Congress, for prices that had nothing to do with normal market competition (3/18).

USA Today: Fix The Sham Bidding Program: Opposing View
In 2003, Congress required Medicare to ensure that medical equipment and supplies used by beneficiaries at home (known as "durable medical equipment," or DME) are procured through a system that increases competition and achieves market-based prices, but doesn't diminish quality. Unfortunately, Medicare has completely mismanaged the design and implementation of its bidding program for home oxygen equipment, power wheelchairs, diabetic supplies and other critical home medical products (Tyler J. Wilson, 3/18).

The New York Times: Drugs For Early Stage Alzheimer's
The Food and Drug Administration has proposed lowering the bar for approving drugs to treat people at the earliest stages of Alzheimer's disease, before they have developed any serious impairment or overt dementia. The goal is commendable -; to find ways to prevent or slow the progression of this terrible disease before it can rob people of their mental capacities. But the proposal raises troubling questions as to whether the agency would end up approving drugs that provide little or no clinical benefit yet cause harmful side effects in people who take the medications for extended periods (3/17). 

Los Angeles Times: Battle Over 'Biosimilars'
One of the most promising frontiers in healthcare is biologic medicines -; complex substances derived from living cells that can help fight chronic diseases and cancers. To encourage investment in biologics, Congress in 2010 gave drug companies what amounts to a 12-year monopoly on the substances they developed. Now, supporters of biologics are pushing lawmakers in Sacramento and other state capitals to put new hurdles in the way of knock-off compounds, called "biosimilars" (3/17). 

Politico: Court Case Could Undermine Drug Approval Process
On Tuesday, the Supreme Court will weigh a novel legal theory being advanced by the trial bar that, if upheld, could become the torts' next big payday against drugmakers. The case could also undermine the basic tenets of the Food and Drug Administration's process for approving new medicines. For this latter reason, the trial bar finds itself on the other side of the Obama administration, which has filed an amicus brief in the case (Scott Gottlieb, 3/17).

The New York Times: The Real Spending Problem
[T]he taxes-versus-spending distinction is largely meaningless. Each year, the government doles out tax breaks worth $1.1 trillion. That is more than the cost of Medicare and Medicaid combined. ... Yet in budget talks, Republicans ignore tax entitlements, which flow mostly to high-income taxpayers, while pushing to cut Medicare, Medicaid and Social Security (3/16).

The Washington Post: America The Retirement Home
The budget debate' central reality is that federal retirement programs, led by Social Security and Medicare, are crowding out most other government spending. Until we openly recognize and discuss this, it will be impossible to have a "balanced approach" -; to use one of President Obama's favorite phrases. It's the math: In fiscal 2012, Social Security, Medicare, Medicaid and civil service and military retirement cost $1.7 trillion, about half the budget (Robert J. Samuelson, 3/17).

Reuters: 2014: The Democrats' Dilemma
Obama continues to seek a "grand bargain," reiterating his willingness to cut Medicare and Social Security in exchange for Republican acceptance of greater revenue – largely from closing loopholes. Entrenched Republican opposition to any tax increase has thus far saved the country and the president from any deal. But the president's very public pursuit makes more and more Americans aware of the proposed terms. Republicans show their base that they are standing staunch against any further tax hikes, while pushing hard to slash spending. In contrast, the president suggests to his base that he is open to abandoning the commitment to defend Social Security and Medicare if the price is right (Robert L. Borosage, 3/18).

The Medicare NewsGroup: The Potent Opposition To Medicare's Proposal For Greater Drug Rebates
One of the largest potential savings Medicare could reap is from drug costs, and that would come from asking drug companies for bigger rebates. Medicaid and the Veteran's Administration each demand steep discounts as single payers, as do most governments with national health programs. But Medicare is unlikely to get similar huge markdowns from drug companies and middlemen anytime soon because the proposal faces a torrent of opposition from the pharmaceutical lobby and legislators allied with it (John Wasik, 3/15).

The Wall Street Journal: New Medicaid's Roach Motel
The Republican Governors of Arizona, Florida and Ohio who helped lead the constitutional challenge to ObamaCare but have since decided to expand Medicaid have a problem. They need to persuade their skeptical Republican legislatures to pass bills endorsing their flips, and now they're searching for any legal alibi in a storm (3/15). 

Des Moines Register: Medicaid Expansion Is No Pot Of Gold
My personal view is that it's in the public interest to make sure everyone has access to health care at the least possible cost to taxpayers. ... If Medicaid doesn't shift to quality-based payment models and discourage patients from using the emergency room as a walk-in clinic, the state should find a way to do that. There's no free pot of gold. Taxpayers are paying for this health care out of one pocket or the other. Leaving people without insurance raises health care costs for everyone. So the argument is not really about who pays. It's about who will get health care, how much they'll get and who will manage it. Better that we recognize that and stop chasing rainbows (Kathie Obradovich, 3/16).

Kansas City Star: Renew KC's Vital Health Levy For Indigent Care
Compassionate Kansas City voters approved a property tax increase in 2005 to help provide medical care for thousands of indigent people and operate the city's ambulances. The need for those crucial health care services still exists. The Star recommends a yes vote on Question 1 on April 2, to renew that property tax through 2023. ... If Missouri legislators refuse to take hundreds of millions in federal funds for better Medicaid coverage -; an unfortunate possibility, given GOP intransigence on the matter -; Truman (Medical Center) in particular could sustain a severe financial hit. Keeping the full health levy in place would be a smart move for taxpayers and a crucial investment in better health for the entire community (3/16).

The Lund Report: Breaking Down Healthcare's Silos
I have often thought that breaking down the silos that exist in our healthcare system is an important step in transforming our fee-for-service healthcare system into one where we pay for health, quality, and cost-effectiveness. My thoughts about silos have focused on clinicians' reluctance to adapt to electronic health records (EHRs), hospitals purchasing physician practices (e.g., we must own them) and not properly incentivizing them, and health information technology vendors insisting on their form of contracts, and contending they are the platform, rather than facilitating interoperability (Paul DeMuro, 3/16).