Viewpoints: Medicare no longer 'busting' the budget; a 'nightmare' trying to get coverage in D.C.

The New York Times' The Upshot: Medicare: Not Such A Budget-Buster Anymore
You're looking at the biggest story involving the federal budget and a crucial one for the future of the American economy. Every year for the last six years in a row, the Congressional Budget Office has reduced its estimate for how much the federal government will need to spend on Medicare in coming years. The latest reduction came in a report from the budget office on Wednesday morning. The changes are big. The difference between the current estimate for Medicare's 2019 budget and the estimate for the 2019 budget four years ago is about $95 billion (Margo Sanger-Katz and Kevin Quely, 8/27). 

The Washington Post's Plum Line: Yes, Obamacare Is Cutting The Deficit
Today the Congressional Budget Office released its latest economic and fiscal projections, and guess what: The news is pretty good. In fact, all the "deficit hawks" out there who are deeply concerned about too much borrowing and the terrible choices our grandchildren will confront might want to write a letter of thanks to one Barack Hussein Obama. To start things off, the CBO says the deficit this year will be $506 billion, or 2.9 percent of GDP. In 2013 it was $680 billion, so that's a pretty steep drop. And in terms of GDP, not only is that slightly lower than the average deficit of the last 40 years (3.1 percent), it's also a 70 percent decline from Obama's first year in office, where because of the Great Recession, which brought both the need for more spending and a plunge in tax revenues, the deficit peaked at 9.8 percent of GDP (Paul Waldman, 8/27). 

The Washington Post's Plum Line: On Obamacare, Democrats Should Attack, Not Defend
Yesterday, state treasurer Doug Ducey won the GOP nomination for governor to replace Jan Brewer in Arizona. Brewer was one of eight GOP governors who accepted the expansion of Medicaid, something Ducey had opposed. Ducey's comments on the subject are vague ... when asked whether he'd repeal the expansion, he bobs and weaves. And it isn't hard to understand why. Looking at this race in combination with other close races, you see that the politics of health care have shifted profoundly in recent months. As Democrats are stroking their chins wondering whether they can turn the Affordable Care Act into a winning issue this fall, and if so how to do it, the answer is simple: Don't defend, attack (Paul Waldman, 8/27).

The Washington Post: Even A Harvard-Educated Lawyer Has 'Nightmare' With D.C. Health Insurance Site
Diana Daniels's experience with the District's health insurance Web site is the sort that gives government bureaucracy -; and Obamacare -; a bad reputation. The Northwest Washington mom filed her online application for medical coverage for her two teenage daughters on June 4. The process supposedly requires three weeks at most. No coverage materialized for nearly three months, despite Daniels's numerous calls to D.C. Health Link trying to sort things out (Robert McCartney, 8/27). 

The Washington Post: Early Tax Planning May Be Needed Because Of The Affordable Care Act
Having gone through tax season not that long ago, you may not want to face any issues related to your tax situation until next year. But some of you may need to do some tax planning now nonetheless. It has to do with the Affordable Care Act (Michelle Singletary, 8/26).

The Wall Street Journal: An $8.3 Billion Rebuke To The FDA
Amid this summer's M&A fever, Roche's agreement Monday to buy the San Francisco biotech InterMune deserves special notice. The tie-up is an $8.3 billion guided missile into the fortified bunker that is the Food and Drug Administration. InterMune has never turned a profit in 16 years of existence and other than its clinical expertise the company holds a single asset: an idea for treating a lethal lung disorder called idiopathic pulmonary fibrosis with no known cause, cure or approved therapy-;at least in the U.S. An InterMune drug called pirfenidone that slows the progression of irreversible lung scarring is on the market in Europe, Japan, Canada and even China (8/27). 

The New England Journal Of Medicine: A VA Exit Strategy
The VHA's [Veterans Health Administration] current crisis provides an opportunity to dramatically rethink the role that the agency plays in improving access to high-quality, high-value care for its service population. To simply go on doing more of the same is to fail to recognize the challenge that the VHA's cost and population structure pose in the longer run. Just as they plan for new roles for the federal government as part of an exit strategy from a war that is winding down, politicians with longer-term views might envision a new way for the VHA to work with other federal departments and the private sector to reduce its overall and per capita costs, shed costly and unproductive assets, save taxpayers money, reduce veterans' health care expenditures, and improve veterans' outcomes (Dr. William B. Weeks and David Auerbach, 8/28).

The New England Journal Of Medicine: Updating Cost-Effectiveness -; The Curious Resilience Of The $50,000-per-QALY Threshold
For more than two decades, the ratio of $50,000 per quality-adjusted life-year (QALY) gained by using a given health care intervention has played an important if enigmatic role in health policy circles as a benchmark for the value of care. Researchers have summoned this cost-effectiveness ratio in order to champion or denounce particular investments in medical technologies and health programs. ... Invoking thresholds, however, means acknowledging limits ... It also suggests that more of our spending should focus on underutilized interventions with ratios below the threshold; substituting more cost-effective interventions for less cost-effective ones could improve health outcomes and save money (Peter J. Neumann, Joshua T. Cohen and Milton C. Weinstein, 8/28).

JAMA: Legalizing Medical Marijuana May Reduce Opioid Deaths
Opioid-overdose deaths increased in states across the country between 1999 and 2010, but states that legalized medical marijuana saw less-steep increases than those without, according to a study published in JAMA Internal Medicine this week. Growing use of prescription opioids over the past 2 decades to treat chronic pain has helped drive increasing rates of opioid overdoses. ... Marcus A. Bachhuber, MD, a Robert Wood Johnson Foundation Clinical Scholar at the Philadelphia Veterans Affairs Medical Center, and his colleagues analyzed opioid overdose rates in states with or without legalized medical marijuana (Bridget Kuehn, 8/26). 

JAMA: What Near-Death Experience Can Tell Us About Medical Care
In 2005, a survey was conducted examining how aggressively physicians treat patients near the end of life. Some 1500 primary care physicians and cardiologists were presented a scenario describing an 85-year-old man with severe congestive heart failure. ... Recently, the responses to this survey were analyzed by me, Ariel Stern, PhD; Jonathan Skinner, PhD; David Wennberg, MD, MPH. Although the data are nearly a decade old, there is no reason to think that answers today would be any different. Our analysis of these responses reveals the troubled state of American health care-;as well as the possibilities ... No one is trying to do the wrong thing, but the consequences of unstandardized and often excessive care is wasted money and unnecessary pain. Establishing the right systems, realigning payments, and pushing for the right care can accomplish far more than many think is possible (David Cutler, 8/27).