Viewpoints: Another troubled website rollout; insurers fight consumer measures in Calif.

The New York Times' The Upshot: Another Government Website Rollout That Is Found Wanting
If the federal government's new Open Payments website were a consumer product, it would be returned to the manufacturer for a full refund. Open Payments is the government's site for publishing payments made to doctors and teaching hospitals by drug and medical device manufacturers. It includes 4.4 million payments, worth $3.5 billion, to more than half a million doctors and almost 1,360 teaching hospitals (Charles Ornstein, 10/1). 

The New York Times: More Hurdles For Home Care Unions
In an attempt to build on a recent antiunion victory in the Supreme Court, the National Right to Work Legal Defense Foundation has filed another antiunion lawsuit in federal court in Minnesota. The suit seeks to weaken a new union of 27,000 home care workers there and, in the process, to undermine union rights more broadly (10/1). 

Los Angeles Times: Prop. 46 Is On The Ballot To Pick Up Legislature's Slack
The heated issue that Prop. 46 addresses -; medical malpractice payouts -; should have been resolved by the governor and Legislature. But moneyed interests -; the big-time campaign contributors -; pretty much rule the roost in Sacramento, or any capital. These power brokers, euphemistically known as "stakeholders," usually decide whether there's to be any compromising. And, if so, they do the compromising themselves (George Skelton, 10/1). 

Los Angeles Times: Health Insurers Spending Millions To Beat Pro-Consumer Ballot Measures
The latest campaign spending figures on California's two big healthcare ballot initiatives are just in, courtesy of the watchdog group MapLight, and they're mind-boggling. If you're curious about one significant driver of healthcare costs, here it is: Health insurance companies have so far contributed more than $88 million to defeat two plainly pro-consumer measures (Michael Hiltzik, 10/1).

The Wall Street Journal: ObamaCare's Anti-Innovation Effect
Of the many unintended consequences of the Affordable Care Act, perhaps the least noticed is its threat to innovation. Although most discussions center on the law's more immediate effects on hiring, insurance rates and access to doctors and care, attention should also be paid to its impact on U.S. research and development and health-care technology (Scott W. Atlas, 10/1). 

The Wall Street Journal: How Senate Republicans Can Close The Sale
Thursday morning, Republican National Committee Chairman Reince Priebus is delivering a speech at George Washington University titled "Principles for American Renewal." … The findings provide insights into how to talk about the economy, the budget and debt, national security and other issues. For example, the surveys suggest that the most powerful way for Republicans to begin any discussion of ObamaCare is to say that they believe "health-care decisions should be made by patients and their doctors, not Washington." Simple, but helpful to know (Karl Rove, 10/1). 

The Wall Street Journal: Obamacare's Wonderland
One of the four major legal challenges to ObamaCare advanced in Oklahoma on Tuesday, as a federal district court struck down the federal subsidies that are nowhere authorized in the Affordable Care Act. The order is stayed pending appeal to the Tenth Circuit Court of Appeals, so all the more reason for the Supreme Court to resolve the legal turbulence posthaste (10/1). 

The Wall Street Journal's Washington Wire: Obamacare Enrollment And Low Expectations
The infamous bungled launch of HealthCare.gov came exactly a year ago. While this year's open enrollment doesn't start until Nov. 15, administration officials, mindful of last year's "debacle," are already working to lower expectations (Chris Jacobs, 10/1). 

USA Today: The Ebola Code Of Silence
Even after the arrival of Ebola in Texas, the national dialogue in the United States remains naive, overly optimistic and full of misleading assurances from elected officials and public health experts. What the public needs to know and understand is this: Ebola is a deadly virus and like all viruses it can and will mutate and change (David J. Dausey, 10/1). 

Dallas Mornings News: Abbott's, Davis' Contrasting Visions Inch Into View
The second and last debate between the major candidates for governor gave Texas voters a clearer image of their choices ahead -; even with the unanswered questions on public education and ethics. … Contrasts, there were many, such as their positions on whether to expand Medicaid coverage under Obamacare (her, yes; him, no); tighter abortion restrictions (her, no; him, yes), and whether they would veto a bill rescinding in-state college tuition for Texas high school graduates in the country illegally (her, yes; him, no). This newspaper would side with Davis on all three (Dallas Morning News, 10/1).

Bloomberg: Congress Gets Its Hands On Insurer Incentives
The Government Accounting Office says that the Barack Obama administration's subsidy system for money-losing health insurers is legal -- for now. But depending on what Congress does with 2015 appropriations, it might not be legal next year (Megan McArdle, 10/1).

The New England Journal Of Medicine: Time After Time -; Health Policy Implications Of A Three-Generation Case Study
Conventional wisdom holds that the redesign of health care requires stepping back from the issues of individual patients and analyzing patterns of outcomes and costs for large patient populations. As practicing primary care physicians, we think a useful, complementary perspective might result from doing the opposite: ... This three-generation case study shows the intertwined effects of poverty, depression, alcoholism, drug addiction, unemployment, domestic violence, and occasionally incarceration on individual family members and the family as a whole. ... We cannot think of health care redesign without thinking of the activities that will influence the social factors that are intertwined with health -; and that thus affect health care spending. The approach we're advocating isn't charity; it's strategy (Caroline Sayer and Dr. Thomas H. Lee, 10/2). 

The New England Journal Of Medicine: Rethinking The Social History
Physicians often see patients with complex social situations as a burden -; requiring extra work that is neither reimbursable nor central to our core clinical expertise. ... Since social problems affect patients' health and treatment effectiveness, however, we cannot afford to ignore them in assessments and treatment plans if we hope to improve outcomes, reduce costs, and improve patient satisfaction. Moreover, clinicians' simple acknowledgment of social forces can strengthen their therapeutic alliance with patients. ... Adopting the social medicine framework, we revised our list of social history topics in an effort to strengthen our therapeutic alliances, better contextualize patients' diagnostic and treatment plans, and improve health outcomes (Drs. Heidi L. Behforouz, Paul K. Drain and Joseph J. Rhatigan, 10/2). 

The New England Journal Of Medicine: Swimming Against The Current -; What Might Work To Reduce Low-Value Care?
Efforts to reduce overuse of health care services run counter to the dominant financial incentives in our fee-for-service system, challenge the cultural assumption that more is better, and raise concerns about stinting on necessary care. Given the evidence that as much as one third of U.S. health care spending is wasteful, however, health care organizations are now embracing explicit consideration of value and turning their attention to overuse. ... But we need to determine whether current policy tools -; which were designed to address underuse -; will work to reduce overuse. ... the combination of shared risk and efforts such as Choosing Wisely may prove catalytic. The combination of labeling low-value care and beginning to align incentives with value may present the most promising near-term opportunity to accelerate the reduction of use of low-value care (Carrie H. Colla, 10/2).