Viewpoints: Budget woes leave Democrats with painful choices; David Kessler on health hazards of antibiotics in meat; the pros and cons of not hiring smokers

USA Today: Entitlements Or Investment? Democrats Must Pick
Democrats therefore face a fundamental and inescapable choice: they can support funding current consumption, especially by older Americans who are not working, or future investment, particularly in scientific research and innovation. The main cause of this conflict between goals is the fact that one half of the Democratic coin, entitlements (Social Security, Medicare and Medicaid), has become an uncontrollable monolith eating up more and more of the federal budget, while growth-inducing investments get left behind (Robert Atkinson, 3/27). 

The Wall Street Journal: Obama's Incredible Shrinking Clout
This year, Republicans will block any new taxes or mandatory spending. Democrats are likely to oppose any significant entitlement savings. There is little chance of a "grand bargain" of tax increases, spending restraint and entitlement reform without serious presidential leadership. In any case that would require trust, something Mr. Obama has not done much to create and a lot to destroy. ... The budget drama reveals a more important phenomenon-;that Mr. Obama has become a minor actor on Capitol Hill (Karl Rove, 3/27).

Roll Call: Striking The Right Balance When Controlling Health Care Costs
The president recently met with about a dozen GOP leaders to try to find some common ground on deficit reduction policy. The session was closed door. But as the congressional budget war begins, there are serious indicators that if there is a "grand bargain" on fiscal reform it will include changes to Medicare. This makes sense. Medicare is a big part of the debt problem. What's disturbing, however, is that some in Congress want to aim their cuts at the one part of the program that's been exceptionally effective at containing costs: the Medicare Part D drug benefit (Joan Koerber-Walker, 3/27).

The Fiscal Times: The Cost Explosion Of Obamacare Begins To Hit Home
When Democrats insisted on turning their attention to the health-system overhaul in 2009 rather than the jobs crisis, they argued that the rapid increase in health-care costs kept American businesses from creating employment opportunities.  Barack Obama insisted that greater government control over insurance plans, including a first-ever mandate for citizens to buy insurance, would "bend the cost curve downward" (Edward Morrissey, 3/28).

Bloomberg: The Battle Over Obamacare Moves To States
President Barack Obama's Patient Protection and Affordable Care Act celebrated its third birthday last weekend. This particular anniversary was a big deal, because it was often unclear whether the law would reach it. ... Republicans, however, haven't quite given up. Their slogan, "repeal and replace," has given way to "resist and annoy." ... At the state level, most Republican governors have refused to set up insurance exchanges, and many have refused to expand Medicaid, which is the primary vehicle for insuring those currently uninsured. The question, though, is whether governors who purposefully do a very bad job implementing Obamacare will hurt the law or hurt themselves and their states (Ezra Klein, 3/27).

The New York Times: Antibiotics And The Meat We Eat
Scientists at the Food and Drug Administration systematically monitor the meat and poultry sold in supermarkets around the country for the presence of disease-causing bacteria that are resistant to antibiotics. These food products are bellwethers that tell us how bad the crisis of antibiotic resistance is getting. And they're telling us it's getting worse. But this is only part of the story. While the F.D.A. can see what kinds of antibiotic-resistant bacteria are coming out of livestock facilities, the agency doesn't know enough about the antibiotics that are being fed to these animals. This is a major public health problem, because giving healthy livestock these drugs breeds superbugs that can infect people (David A. Kessler, 3/27). 

The New York Times: Is Abortion Heading Back To The Supreme Court?
Forty years after the Roe v. Wade decision made abortion legal and recognized a woman's right to control her body and her life, the issue may well be headed back to the Supreme Court. Opponents of abortion rights have been patiently and methodically chipping away at the 1973 decision, getting laws passed that restrict the circumstances under which women can exercise their right to have a legal abortion, and making it harder for doctors to provide abortions or even abortion counseling. Republican governors and legislatures in several states, notably Texas, have made an even broader assault on women's health by trying to close clinics that provide birth control counseling, breast cancer screening and other important services. The movement has accelerated dramatically in recent weeks with the passage of new anti-abortion laws in Arkansas and North Dakota (Andrew Rosenthal, 3/27).  

The New England Journal of Medicine: The Ethics of Not Hiring Smokers
Finding employment is becoming increasingly difficult for smokers. Twenty-nine U.S. states have passed legislation prohibiting employers from refusing to hire job candidates because they smoke, but 21 states have no such restrictions. Many health care organizations, such as the Cleveland Clinic and Baylor Health Care System, and some large non–health care employers, including Scotts Miracle-Gro, Union Pacific Railroad, and Alaska Airlines, now have a policy of not hiring smokers -; a practice opposed by 65% of Americans, according to a 2012 poll by Harris International. We agree with those polled, believing that categorically refusing to hire smokers is unethical (Harald Schmidt, Kristin Voigt and Ezekiel J. Emanuel, 3/28).

The New England Journal of Medicine: Conflicts And Compromises In Not Hiring Smokers
A small but increasing number of employers -; including health care systems such as the Cleveland Clinic, Geisinger, Baylor, and the University of Pennsylvania Health System -; have established policies of no longer hiring tobacco users. ... These policies engender controversy, and we recognize that they risk creating or perpetuating injustices. ... However, these policies may also save lives, directly and through their potential effects on social norms, and these same disadvantaged populations are at greatest risk for smoking-related harms and ensuing disparities in health (David A. Asch, Ralph W. Muller and Kevin G. Volpp, 3/28).

The New York Times: Down Syndrome And A Death
A grand jury in Frederick County, Md., decided last week not to bring criminal charges in the death of Robert Ethan Saylor, a 26-year-old man with Down syndrome who was killed in a struggle with three off-duty county sheriff's deputies at a movie theater in January. Advocates for people with intellectual disabilities are bewildered and furious, and it is easy to see why (3/27).

The Seattle Times: Get Kids Mental-Health Care Instead Of Sending Them To Juvenile Courts
Imagine you have a 14-year-old daughter named Carla with a mental-health disorder. Carla is at the mall with friends when she begins to experience an unusual burst of energy and a feeling of being indestructible. She starts climbing on counters and knocks down a display of baseball caps. ... Engrossed Substitute House Bill 1524, which has already passed the state House of Representatives, would expand the list of facilities where law-enforcement officials can take nonviolent youth they believe are suffering from mental disorders (Mary Helen Roberts and Eric Trupin, 3/28).