Viewpoints: End-of-life discussions; seniors missing their vaccinations; health law's new political calculations

The New York Times: Encouraging End-Of-Life Talks
There is reason to hope that a degree of sanity may be returning to the touchy issue of advance planning for medical care at the end of life. Just five years ago, Republican politicians, Sarah Palin prominent among them, were falsely charging that President Obama's health care reforms would create "death panels" that could cut off care for the critically ill to save money on health care costs. Since then, that claim has been thoroughly debunked .... Now, with little fanfare, some private and public insurers have begun paying doctors to have end-of-life discussions with their patients (9/4).

Bloomberg: A Vaccine Mystery Hits Older Americans
People who remember the scourge of polio and who themselves may have suffered through such "childhood diseases" as mumps are, not surprisingly, more likely to want vaccines required for kids. But when it comes to their own health, they aren't as enthusiastic about a shot of prevention. It's been eight years since the Food and Drug Administration approved Merck's Zostavax shingles vaccine for people over 60. ... Yet only about 20 percent of Americans over 60 have had the vaccine (Virginia Postrel, 9/4).

Los Angeles Times: Women's Health Laws? No, They're Actually Antiabortion Laws
Many of the regulations on abortion now cropping up in states across the country are being passed off as attempts to protect women's health. But what they are really intended to do is to continue the long-running war on women's reproductive rights that unfortunately did not end with Roe vs. Wade 40 years ago. In fact, these new laws could actually harm women's health by delaying their access to a legal, safe procedure (9/4).

The New York Times' Taking Note: 'Obamacare' Challengers Lose Again
On Thursday morning, as almost everyone predicted it would, the federal appeals court in Washington, D.C., voted to toss out a three-judge panel's ruling upholding the latest attempt to kill "Obamacare." The full 11-member court is scheduled to rehear the case on Dec. 17. The claim this time was that subsidies for the health exchanges that are at the heart of the law are available only to those exchanges "established by the State." In other words, not available in the three dozen states where the federal government has set up an exchange because the state refused to. This would result in the denial of coverage to an estimated 4.7 million Americans (Jesse Wegman, 9/4).

The Wall Street Journal's Washington Wire: How Politics and Policy Could Accelerate Health Spending
Medicare actuaries' annual projections of health expenditures for the next decade emphasized that health spending will rise modestly in the coming years. However, decisions by the administration and Congress to undo future spending reductions could change that picture (Chris Jacobs, 9/4).

The Wall Street Journal: A Perilous Gap In Health Insurance Literacy
It's not a news flash that health insurance can be complex and confusing. But the health insurance maze can be a problem, especially if you have never had health insurance before or have not had it for a long time. That's the case for about half of the uninsured and for many people enrolling in the new insurance marketplaces set up under the Affordable Care Act (Drew Altman, 9/4).

Bloomberg: Catch Of The Day: Obamacare's Vagueness As A Political Issue
Essentially, we now have a campaign based on the Obamacare/Affordable Care Act split: Republicans run ads bashing Obamacare but duck all the details (such as whether they support or oppose Medicaid expansion). Or in some cases they support the provisions of Obamacare while bashing the law. Democrats, on the other hand, are beginning to refer vaguely to having supported "a law" (which they don't name) that does all kinds of popular things, such as requiring coverage for pre-existing conditions (Jonathan Bernstein, 9/4).

The Washington Post: Yes, The Politics Of Obamacare Are Shifting. Here's How.
It's now clear that the cooling passions over the issue are allowing Democrats more leeway to engage in debates over what is actually in the law, if not in debates over whether that thing called "Obamacare" is good or bad. ... Mark Pryor is not campaigning on "Obamacare" in deep red Arkansas. But he now feels safer to engage a debate over its individual provisions, as a way to explain and mitigate the damage from his vote, than he would have a few months ago .... the point is that the politics have changed enough to allow Dems to challenge GOP depictions of it more directly, even as Republicans are still required to campaign against the same fantasy Obamacare that once was certain to deliver them the Senate, before the facts on the grounds changed (Greg Sargent, 9/4).

Bloomberg: North Carolina Tries To Shake Off Obama
[Sen. Kay Hagan] shares a problem with other Democrats in defending their vote for the Affordable Care Act. The program is popular in her state, where the sign-up rate is one of the highest in the country. It might win her the votes of the happily enrolled, if only she could risk reminding them that the health benefits they enjoy are, in fact, Obamacare. [Her Republican challenger, Thom] Tillis did the reminding for her, calling her out for breaking the promise to North Carolinians that if you liked your health insurance, you could keep your health insurance. She countered that she is working to fix the law and not repeal it, as Tillis would, throwing consumers back to the bad old days (Margaret Carlson, 9/4).

Journal of the American Medical Association: A To-Do List For The New CEO Of The Federal Health Insurance Marketplace
Last week, the Obama Administration announced the appointment of a new chief executive officer (CEO) for the federal health insurance marketplace under the Affordable Care Act (ACA). ... Calling this position a CEO represents semantic gymnastics of a sort. That's because CEOs generally have near-total autonomy to manage an organization, reporting only to a board of directors. Nothing like that really exists in government. ... But there is a sense in which the CEO title sends an important signal: there is now one person who goes to sleep every night and gets up every morning thinking about how to make the health insurance marketplaces work well (Larry Levitt, 9/3).