KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Viewpoints: Sebelius Withstood Attacks, But Wasn’t ‘Warrior’ For Law; Burwell Offers GOP Chance To Focus On Law’s Problems

The New York Times: Kathleen Sebelius Was Too Cool And Too Patient
Kathleen Sebelius was known for her patience and cool under savage attack by Republicans, who treated her as a stand-in for the health law. She sat through hearings calmly reciting talking points while they fumed and fulminated for their audience. But that turned out to be one of her biggest liabilities ... What the health law needed in its first years was a cheerful, populist warrior who could laugh at the truly ridiculous distortions and lies Republicans invented about it, and roar back with the truth. Instead, she came across as a mild technocrat. She never emerged from the defensive crouch she assumed after the law’s calamitous debut (David Firestone, 4/11).

The Los Angeles Times: Obamacare And The Sebelius Legacy
A technology wonk might have had the website working better, but would have been utterly unable to navigate the ideological shoals through which Obamacare has had to sail. There probably aren't too many political figures who could have dealt with the relentless assault on the ACA with as much equanimity as Sebelius mustered. The record of the last six months suggests that even a flawless launch of HealthCare.gov would not have stemmed the attacks on the law. After all, it's operating fine now; have you heard a single Republican acknowledge that? (Michael Hiltzik, 4/11).

Bloomberg: Kathleen Sebelius's Legacy, And Obamacare's
By one crucial and fundamental measure, the law is living up to its name: More Americans now have access to affordable health care. ... This is no small achievement, and to reach it Sebelius had to overcome the law's unwieldy structure. Its combination of subsidies, penalties and inducement was the result of political bargaining with an array of powerful and stubborn constituencies. Making it all work would have been an ambitious undertaking in any environment. But Sebelius wasn't working in just any environment: Obamacare was hounded from the outset by a Republican Party that defined itself largely by its relentless opposition to the law -- in Congress, the courts and the states (4/11).

The Wall Street Journal: Advice And ObamaCare Consent
Kathleen Sebelius has been let out a rear door of the Health and Human Services Department, and her exit is an opportunity for getting some ObamaCare accountability. President Obama tapped Sylvia Mathews Burwell as her replacement on Friday. The Senate should try to use her confirmation to expose the law's continuing troubles and improve HHS transparency (4/11).

Bloomberg: What Does Washington Have To Say About Sylvia Burwell?
These days, serving as Secretary of Health and Human Services is an impossible job. President Barack Obama has selected the perfect woman for the task. Sylvia Mathews Burwell, the director of the Office of Management and Budget, has been picked as the successor to HHS Secretary Kathleen Sebelius. ... Republicans will use her confirmation hearings as a vehicle to attack Obamacare, but she will handle it almost perfectly and win confirmation with a large number of Republican votes (Albert R. Hunt, 4/11).

Bloomberg: How Republicans Should Play The Burwell Confirmation
First, Republicans should ask themselves, who pays attention to cabinet confirmation hearings, anyway? ... In reality, almost no one pays attention to these shows. The big exceptions are the inside-the-Beltway elites and, in particular, those who are especially concerned about the policy areas covered by HHS. They should be the target of Republican efforts during the Burwell confirmation. And that’s why Obamacare opponent Philip Klein’s is smart to advise Republicans use the occasion to make the case that the ACA gives the HHS secretary unusually vast powers. And, I would add, the case that the administration has exceeded those powers (Jonathan Bernstein, 4/11).

The Washington Post: Lt. Gov. Anthony Brown Shows Gall By Claiming Md. Is 'Leader' On Health-Care Reform
Maryland Lt. Gov. Anthony Brown (D) has staked an early claim to the dubious honor of making our region’s most shameless and misleading 2014 campaign boast. In a display of world-class chutzpah, Brown's Web site asserts that he "has positioned Maryland as the national leader in the implementation of the Affordable Care Act" (Robert McCartney, 4/12).

Roanoke Times: You Have Reached Your Destination
[Virginia House Republicans] haven't made a lick of progress on the budget or the Marketplace Virginia health care program, an idea by Powhatan Republican Sen. John Watkins that would enable uninsured adults to purchase private insurance and would make the state eligible for federal funding. The plan passed the Senate, but House leaders say they won't consider Marketplace Virginia until Medicaid reforms are implemented. And they continued to say that after Health Secretary Bill Hazel told them last week that the reforms they requested were indeed a reality (4/13).

Bangor Daily News: This Medicaid Expansion Episode Has Come To A Close — And Logic Didn’t Prevail
The Senate came up two votes short of overriding Gov. Paul LePage’s damaging veto of a bill to expand Medicaid coverage to thousands of low-income parents and adults without children. The Medicaid expansion plan that lawmakers voted on was itself something worth celebrating. It was a deliberate effort by Republican Sens. Roger Katz and Tom Saviello to craft a bill that included something for both sides of the aisle and that did something important for the state. It expanded Medicaid. It included measures to control costs in an often unwieldy MaineCare program ... The reasons for rejecting the expansion just don’t add up (4/12).

The Fiscal Times: We Can Find Consensus On Health Care Cost Reforms
With the Affordable Care Act's open enrollment period now closed, perhaps there is an opportunity for constructive, bipartisan policy discussion on health care reform. One thing that both Obamacare supporters and opponents can agree on is that our health care system remains inefficient. And, although health care inflation slowed in recent years, informed observers from across the political spectrum realize that population aging will produce a new bout of cost escalation – unless something else is done (Marc Joffe, 4/13).

On other health issues -

The Washington Post: A Needed Look Into The Cost Of Medicare
For the first time, the Obama administration released doctor-specific information about Medicare payments, starting with 2012 data on $64 billion worth of billings. Journalists immediately set to work analyzing the data. Among some of the key findings: Just 2 percent of the 880,000 physicians accounted for nearly a quarter of the payments; reimbursements for prescription drugs accounted for an eighth of the spending; a handful of specialties, oncologists and ophthalmologists especially, accounted for a disproportionate share of the costs. ... disclosure had been resisted by doctors, who felt it would invade their financial privacy or distort public discussion by disseminating raw, out-of-context information. The latter concern was voiced last week, yet what was striking about the data release was how carefully news organizations explained its nuances to readers (4/12).

Bloomberg: Blame Medicare For Eye-Popping Costs
Among the surprises nestled in last week's release of Medicare payment data was this head-scratcher: Of the 50 physicians who got the most Medicare money in 2012, almost half were ophthalmologists. Some of that may come from questionable billings. But it also results from Medicare doctors' perverse incentive to choose more expensive drugs than necessary (4/13).

The Wall Street Journal: Listening To Medicare's Billing Data
Robert Krughoff, president of Consumers' Checkbook, whose legal battle (joined by The Wall Street Journal's publisher) triggered this week's data dump, has cautioned that if you want to know how rich your doctor is, you'd be better off driving past his house. Fair enough. The data, however liable to be misinterpreted, do help to debunk a liberal heirloom—the claim that Medicare is more efficient than private insurers because Medicare appears to devote such a small share of its total spending to administrative overhead (Holman W. Jenkins, Jr., 4/11).

The New York Times: A Loyal Soldier Doesn't Deserve This
Iraq is but a fading memory for most Americans, and Afghanistan may soon recede as well. But for countless others like Mike and Leigh Anna, the war continues and will for decades to come. The Department of Veterans Affairs says that it has made progress in reducing its backlog in processing disability compensation claims, but critics say that is because of the way it defines the backlog — and many hundreds of thousands of veterans are still awaiting decisions. Likewise, the V.A. has improved suicide prevention work, but, by all accounts, it's not enough, so that veterans are dying unnecessarily (Nicholas Kristof, 4/12).

The New York Times: Doubly Disabled In Life
Americans with intellectual and developmental disabilities historically have been shuttled far from society’s mainstream into segregated lives and workplace serfdom, earning wages as low as pennies per hour for the most repetitive and menial jobs. The Supreme Court in 1999 pronounced this kind of treatment a civil rights violation under the Americans With Disabilities Act, but abuse and isolation from society have continued to this day. This week, Rhode Island and the Justice Department took an important step away from that pattern by reaching a comprehensive agreement to direct these people toward community living, minimum-wage guarantees and competitive opportunities (4/11). 

USA Today: Vaccine Opt-Outs Put Public Health At Risk: Our View
Measles, which once killed 450 children each year and disabled even more, was virtually eliminated in the United States 14 years ago by nearly universal use of the MMR vaccine. But the disease is making a comeback, fueled by a growing anti-vaccine movement and misinformation that is spreading like a contagious disease. Already this year, 115 measles cases have been reported in the USA, compared with 189 for all last year (4/13). 

USA Today: Leave Parents Free To Choose Vaccines: Opposing View
The public conversation about vaccine safety and choice began after Congress passed the National Childhood Vaccine Injury Act of 1986, shielding drug companies from product liability and doctors from vaccine-injury lawsuits. Under that law, $3 billion has been paid to the vaccine injured while liability-free drug companies enjoy profits from a multibillion dollar market. U.S. health officials now recommend 69 doses of 16 vaccines for every child. States mandate up to 15 of them — twice as many as 30 years ago (Barbara Loe Fisher, 4/13). 

WBUR: Boston Marathon Medical Director: Getting Back To What The Race Is About
Last April 15 at about 2:45, Dr. Aaron Baggish was enjoying the sunny spring day and, in his role as medical director of the Boston Marathon, marveling at the low volume of runners who needed his care. Then the first bomb exploded, about 15 feet away from him. It blew out his right eardrum but the crowd blocked much of the force of the blast, and within seconds he was over the barrier and starting to work on the injured. After the bombing, Dr. Baggish, who heads the Cardiovascular Performance Program at Massachusetts General Hospital, declined requests for interviews, feeling unable to speak publicly about what happened. But as Boston gears up for its next marathon on April 21 and he prepares to help oversee the race’s medical staff once again, he agreed to share some of his thoughts (Carey Goldberg, 4/11).

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