Viewpoints: Does 'fiscal cliff' end justify the means?; A shrinking government under any plan; Wrongly confusing Asperger's with mental illness

Journal of the AMA: Poised On Edge Of The Fiscal Cliff
It is the third week of December, and all of Washington is focused on whether the country will fall off the "fiscal cliff" it has built for itself. ... As of January 1, physicians' fees for treating Medicare patients are scheduled for an across-the-board reduction of about 27% in addition to the 2% reduction for all services relating to Medicare under sequestration. ... At some point, the Congress is going to stop kicking the can down the road and decide how it is going to resolve the sustainable growth rate dilemma it has created for itself-;but there is no indication that it is yet ready to do so. I have written so many times about my frustration with the failure of Congress to directly confront this issue, including several times in this forum, that I am beginning to feel like a broken record (Gail Wilensky, 12/18).

The New York Times: The Deal Dilemma
First things first: cutting Social Security benefits is a cruel, stupid policy -- just not nearly as cruel and stupid as raising the Medicare eligibility age. But sometimes you have to accept bad things in pursuit of a larger goal: health reform should have included a public option -- heck, it should have gone straight to single-payer -- but a flawed route to universal coverage was better than none at all. The question about this looming deal is whether the end justifies the means (Paul Krugman, 12/18).

The Wall Street Journal: A Bad Budget Deal
It's clear by now that the budget talks are drifting in a drearily familiar Washington direction: Tax and spending increases now, in return for the promise of spending cuts and tax and entitlement reform later. ... Even if Mr. Obama agrees to income-testing for affluent Medicare recipients, this means another tax increase if it comes in the form of premium increases. None of this is anywhere close to the reforms that might slow the pace of health-care spending, which everyone agrees is the biggest fiscal problem (12/18).

The New York Times: Goodbye, Government, Under Either Fiscal Plan
The truth is that both the president and House Republicans have agreed to shrink a critical part of the government to its smallest in at least half a century. ... Loath to raise taxes on the middle class yet unwilling to cut deeply into the budgets for Social Security or Medicare, the president and his advisers proposed cutting the discretionary part of the budget devoted to everything except defense and other security agencies to 1.7 percent of economic output by 2022, down from 3.1 percent last year (Eduardo Porter, 12/18).

The Washington Post: Confusing Asperger's With Mental Illness, And Mental Illness With Evil
Our still underinformed, over-anxious understanding of mental illness -- or of any cognitive or neurological difference, for that matter -- suggests that we haven't come very far ... A well person doesn't shoot a bunch of 6-year-olds, though, and while I believe in evil, from a Christian perspective, sin involves free will, which I'm just not sure someone who acted as Lanza did was in any shape to exercise. Saying so is seen as "excusing" such horrific acts, but calling illness by its modern name is important. We have so much hard work to do, and on multiple fronts (Melinda Henneberger, 12/18).

CNN: Get Serious About Mental Health Care
We should be careful not to blame the mentally ill for all crimes. But we should also be prepared to accept that we might be able to prevent some tragedies if we did a better job of caring for them. ... Studies show that more than 10 percent of children in the United States might benefit from some sort of mental health treatment. Most don't get it. ... There is a shortage of resources and services available to serve children. Furthermore, even when those resources exist, a lack of coordination often prevents they're being used effectively (Aaron E. Carroll, 12/18).

Reuters: Of States And Health Insurance Exchanges
Reuters reports ["No sign Congress meant to limit health exchange subsidy: CBO," Dec. 6] that a recent Congressional Budget Office letter "could complicate" efforts to stop the Internal Revenue Service from imposing "Obamacare's" employer mandate in states that refuse to implement a health insurance "exchange." In fact, the CBO's letter devastates the IRS's already weak case (Michael F. Cannon, 12/18).

The New York Times Opinionator blog: Dietary Seat Belts
Forget the fiscal cliff: we've long since fallen off the public health cliff. We need consistent policies that benefit a majority of our citizens, even if it costs corporations money. And guns are just the bloodiest public health menace to go virtually unregulated. Preventable, chronic disease -- to a large extent brought about by diet -- is now the biggest killer on the planet. Soda kills more people than guns -- more people than car wrecks -- only less dramatically. What we need is the equivalent of a dietary seat belt (Mark Bittman, 12/18).

Kansas City Star: The Best Medicine For Healing KC's Wellness Plan
The sickness that plagued Kansas City's employee wellness program allegedly was spread not just by a few people but by hundreds of city workers. That appalling possibility indicates City Hall contains a large number of people who tried to game the Blue Cross and Blue Shield of Kansas City system to make some easy money for themselves -- without doing the work needed to get healthier and truly earn those rewards (12/18).

The Lund Report: Making Sense Out Of Drug Prices
I take a generic drug, a little yellow pill that's been produced for decades, to control blood pressure. I started taking it long before the day I turned 65 that happened to coincide with the beginnings of the great recession that effectively reduced the value of our savings and our house. ... in all the upheaval, I still had my little yellow pill to quell the violence of a blood pressure that was simply responding in kind to the events of the day. Some stability existed after all in $4 a month yellow pills. Then one day last year I went as usual to pick up my 90 day supply and was told the pharmacy didn't have it. Say what? How could you not? (Bertha Cooper, 12/18).