Viewpoints: GOP trapped between angry base and reality of health law; small businesses 'scrambling;' competing views of Medicaid expansion in Va.

The New York Times: One Reform, Indivisible
Recent political reporting suggests that Republican leaders are in a state of high anxiety, trapped between an angry base that still views Obamacare as the moral equivalent of slavery and the reality that health reform is the law of the land and is going to happen (Paul Krugman, 8/18).

The Wall Street Journal: Will the Health-Care Law Help Small Businesses?
Change doesn't get much bigger than this. Or more contentious. President Obama's Patient Protection and Affordable Care Act has rewritten the rules on health insurance. And it has left small companies scrambling to figure out what it means for them (8/18).

Forbes: The Coming Liberation: Health Care For All Without Obamacare
Obamacare was pushed through on the promise of universal health coverage for everyone. But the CBO now scores Obamacare as leaving 30 million uninsured even 10 years after implementation! In fact, Obamacare will increase the uninsured rather than reduce them. Former CBO Chief Douglas Holtz-Eakin published a study in 2011 arguing that more than 40 million workers will lose their employer provided health insurance under the incentives of Obamacare. That is because employers can save enormous sums dropping the highly expensive, Obamacare mandated, employer health insurance (Peter Ferrara, 8/18).

The Tennessean/USA Today: Paying For Obamacare: Some Feel Singled Out
Johnny Drake's business is losing 2.3 percent of everything it makes because of the Affordable Care Act. He's the president of Pathfinder Technologies, a small company in Nashville with fewer than 20 employees, that got hit with an excise tax this year because it makes medical devices. Medical device manufacturers are among the federal health law losers, those that will have to pay up to cover the cost of implementing it (Tom Wilemon, 8/18). 

Bloomberg: On Republican Priorities, Obama May Have a Point
President Barack Obama has lost almost all credibility defending the Affordable Care Act: Hiccup after hiccup have marred its implementation, its taxes and spending will hurt economic growth, and it will raise consumer health costs. But Obama may have had a point when he charged last week that Republicans are talking about repealing the law without saying what should replace it. Republicans would be wise to debunk the president's claim head on (Lanhee Chen, 8/16).

Bloomberg: Young, Healthy And Rich Need Obamacare, Too
The trick to making any health-insurance system work is to attract enough healthy and young people into the insurance pool. ... "The whole scheme is enlisting young adults to overpay, so other people can have subsidies," Dean Clancy, vice president of public policy for FreedomWorks, told my Wonkblog colleague Sarah Kliff. "That unfairness reminded us of the military draft." Clancy is wrong: The subsidies are funded by taxes on rich people and by cuts to Medicare spending, not by the premiums paid by young people. In fact, young people are likely to be the biggest beneficiaries of the subsidies because they're more likely than any other age group to be poor and uninsured (Ezra Klein, 8/16).

Atlanta Journal-Constitution: A Republican Conversion To Obamacare
One afternoon last week, though a thousand miles apart, Newt Gingrich in Boston and Clint Murphy in Savannah came to the same conclusion about Obamacare and the GOP. Their verdict: This is not August 2010, when town hall meetings erupted in a pitchforked frenzy over the slim congressional margin that had handed Democrats their dream victory of near-universal health care coverage (Jim Galloway, 8/17).

The Richmond Times-Dispatch: Expand Medicaid? NO: It's A Question Of Care, Not Coverage
The evidence overwhelmingly shows that Medicaid expansion will mean a dramatic drop in the quality of care. The most important part of any health coverage plan is access to high-quality care and the ability to forge a one-on-one doctor-patient relationship. These are the doctors who help us most to prevent disease and sickness. These doctors are who we turn to when our kids have the chicken pox, when mom or dad has arthritic flare-ups or, God forbid, when our significant other has symptoms of cancer. They're the ones we trust. They're our first line of defense. Unfortunately, Medicaid expansion could destroy that relationship (David Schwartz, 8/18).

The Richmond Times-Dispatch: Expand Medicaid? YES: The Facts Will Speak For Themselves
In Virginia, Medicaid is well-run, with highly efficient administrators who control costs better than private insurance companies. In addition, a full accounting of the savings the state would realize from expanding Medicaid under the Affordable Care Act shows that the expansion would pay for itself. Despite claims to the contrary, Virginia can -; and should -; make this important and cost-effective service available to more people who need it. ... Critics also ignore the finding that Medicaid is an effective insurance tool. The role of insurance is to protect people from catastrophic costs, and Medicaid does this very well (Massey Whorley, 8/18).

The Columbus Dispatch: Study Boosts Medicaid Plan
Ohio lawmakers wanted more details about how expanding Medicaid could affect the state's bottom line, and now that they have them, it's good news: Enabling more poor Ohioans to have health insurance would, as previously reported, save the state money in the long term. That good news won't matter, however, unless the legislature enacts the Medicaid expansion, and so far this obviously beneficial path has been blocked by tea party Republicans for no reason other than ideological obsession (8/18).

Concord Monitor: A Moral And Financial Argument To Expand Medicaid
The economic argument for expanding Medicaid is strong. What the uninsured poor don't get is regular preventive health care that keeps them at work and out of hospitals. Instead, they get expensive treatment in emergency rooms and enormously expensive hospital stays for chronic conditions that were allowed to deteriorate. The cost of that care is shifted to employers and the insured in the form of higher health care premiums and state subsidies to hospitals. Providing health coverage increases low-income citizens' ability to exercise personal responsibility by doing more of what it takes to stay healthy and on the job instead of in a hospital or on disability payments (8/18).

Journal of the American Medical Association: Current Challenges to Academic Health Centers
Academic health centers (AHCs) have long been the exemplars of medicine in the United States. They produce "breakthrough" research, pioneer new diagnostic and therapeutic interventions, and train the best and brightest future physicians with emphasis on specialists and subspecialists. Today, they face a perilous future because the health care economic system that supports this enterprise is fading away; what [Alain] Enthoven has called "cost unconscious" third-party payment for care is being transformed into "value purchasing" (Victor R. Fuchs, 8/15).

The Washington Post: The Sequester's A Public Health Hazard
This 60th anniversary of the Clinical Center, the NIH's beating heart, is inspiriting and depressing: Public health is being enhanced -; rapidly, yet unnecessarily slowly -; by NIH-supported research here, and in hundreds of institutions across the country, into new drugs, devices and treatments. Yet much research proposed by extraordinarily talented physicians and scientists cannot proceed because the required funding is prevented by the intentional irrationality by which the sequester is administered (George F. Will, 8/16).

The New York Times: When No One Is On Call
Bedside nurses are the hospital's front line, but we can't do the first-alert part of our jobs if there aren't enough of us on the floor. More demands for paperwork, along with increasing complexity of care, means the amount of time any one nurse has for all her patients is diminishing. And as hospitals face increasing financial pressure, nurse staffing often takes a hit, because nurses make up the biggest portion of any hospital's labor costs. For patients, though, the moral calculus of the nurses-for-money exchange doesn't add up. Pioneering work done by Linda H. Aiken at the University of Pennsylvania in 2002 showed that each extra patient a nurse had above an established nurse-patient ratio made it 7 percent more likely that one of the patients would die (Theresa Brown, 8/17).

USA Today: Commend Bush's Doctors
Though I am not one of Bush's personal physicians, I have ridden mountain bikes with him recently on his ranch and personally witnessed his extreme fitness. So I was as surprised as anyone to find that he underwent a cardiac catheterization. This certainly demonstrated that we are all vulnerable to a disease that kills about 600,000 Americans every year. ... The lesson for all of us is that we could be next. If a role model for fitness in older people such Bush can have significant heart disease, so can we. In terms of treatment, stents are neither good nor bad, they are simply useful when appropriate (Dr. Marc Siegel, 8/16).

The Washington Post: In Genomics, A Need To Balance Science And Privacy
In general, in the study of human genomes, it has been common practice for scientists to share sequencing data without the identity of the person from whom it came. But an important announcement from the National Institutes of Health has cast light on the need for more debate and clarity on a subject certain to challenge both science and individual privacy in the future (8/18).