Today's OpEds: Medical students say don't repeal; 'Obamacare' waivers; The medical loss ratio; Medicare 'doc fix'

Health Care's Dilemma: Competition Or Collaboration? The Washington Post
Here's the dilemma: The only way for the health-care industry to move toward accountable care is to further accelerate a process of consolidation that has already reduced competition and increased market power. … In such a market, government may be required to step in with more direct regulation and competition management than traditional antitrust rules now provide (Steven Pearlstein, 11/23).

Editorial: Reform Obamacare, Don't Repeal It The Dallas Morning News 
This bill is headed toward exploding the deficit because there's no way Congress will suddenly start cutting Medicare. Instead, legislators should limit the tax subsidy that employers receive for offering coverage, especially for gold-plated plans. That move would raise enough to pay for the legislation, whose costs are largely tied up in subsidies to help working families buy insurance (11/24).

If Employers Walked Away From Health Coverage Kaiser Health News 
An inability to continue funding the industry's excesses would surely burst the health care cost bubble, unleashing a cascade of harshly chaotic consequences. Only then might we see a reform process that more rank and file Americans might appreciate and embrace (Brian Klepper and David Kibbe, 11/24).

Government By Waiver: The Breakdown Of Public Administration Forbes 
The process vividly shows how unrealistic expectations can undermine the rule of law. Waivers are by definition an exercise of administrative discretion that benefits the party who receives its special dispensation. Yet nothing in ObamaCare explains who should receive these waivers or why (Richard Epstein, 11/23).

Why The 'Doc Fix' Problem In Medicare Isn't Going Away Any Time Soon Bnet
The inconvenient truth is that most doctors and hospitals simply aren't ready to take bundled payments or form accountable care organizations. It will take most providers years to acquire the necessary health IT and infrastructure to do this — not to mention the changes in business relationships and culture that will be required. So in the meantime, the government will have to devise a bridge strategy (Ken Terry, 11/23).

'Opting Out' Of Medicaid No Real Option In Mississippi The Clarion Ledger
Almost 40 percent of Mississippi's Medicaid recipients are children, 25 percent are elderly and about 22 percent are disabled. The idea that Mississippi would somehow be better off either from a fiscal standpoint or from a public health standpoint to "opt out" of the Medicaid program is one that would be a hard sell both in the Legislature and among the state health care providers (Sid Salter, 11/24).

Sorting Out Trauma Care In NE Ohio The Cleveland Plain Dealer 
It's important that trauma care be regionalized so as to make the most of expensive resources. This discussion could have started better; it's imperative that it end well (11/23).

Medical Students To Senate Republicans: Repeal Is Not The Solution To Our Health Care Crisis The Huffington Post
An overreliance on free market ideologies through the choice and competition you champion have already driven the Norman Rockwell physician out of business. The new reforms are not changing a perfect system, they are rescuing a system on the brink of collapse (Iyah Romm, Elizabeth Wiley, Sylvia Thompson, M.D. and John Brockman, 11/23).

Medical Losers The American Spectator 
The goal of imposing a fixed medical loss ratio is to force health plans to lower prices, cut costs and provide more care. Like other aspects of Obamacare, the mandatory MLR will have the opposite effect: mandating that at least 80-85 percent of premiums be spent on medical care will lead to a rapid consolidation of health plans, reductions in physicians pay, cuts in services, and hospital closures (Robert M. Goldberg, 11/24).