Medicare, Medicaid, Global Warming and Gun Control– Can Liberals and Conservatives Find Middle Ground? Should They? Part 1

 In a nation divided, “compromise” has become an extraordinarily appealing idea. Weary of the acrimony and endless wrangling, more and more Americans are asking: Why can’t conservative and liberal politicians come together and forge bipartisan solutions to the problems this nation faces?

Keep in mind that it is not only our elected representatives who are having trouble finding common ground. The Pew Research Center’s latest survey of “American Values” reveals that as voters head to the polls this November, their basic beliefs are more polarized than at any point in the past 25 years. In particular, when it comes to the question of government regulation and involvement in our lives, the average Republican has gravitated to the right. In 1987, 62% of Republicans agreed that “the government should take care of people who can’t take care of themselves.” Now just 40% support this proposition. Democrats haven’t changed their views on this issue: most continue to believe “there, but for fortune . . .”

In Congress, where polarization has led to paralysis, some argue that Republican leaders are responsible for creating gridlock by insisting on “party discipline.” But liberals in Washington also are accused of “dividing the nation.” Even President Obama, who set out to unite the country, has been described as “the most polarizing president ever.” During his third year in office, Gallup reports, “an average of 80 percent of Democrats approved of the job he was doing, as compared to 12 percent of Republicans who felt the same way. That’s a 68-point partisan gap, the highest for any president’s third year”–though this may say more about the temper of the times than the man himself. Nevertheless, many commentators believe that progressives, like conservatives, need to cede ground. The debate has become too contentious, too “political,” they say. I disagree. There are times when we cannot “split the difference.” Too much is at stake. We must weigh what would be won against what would be lost.

But reporters who have been taught that they must be “fair” and “balanced” often write as if all points of view are equally true. After all, they don’t want to be accused of “bias.” Thus they fall into the trap of what veteran Supreme Court reporter Linda Greenhouse calls “he said, she said” journalism. To them, the “middle ground” seems a safe place– a fair place– to position a story.

This may help explain why so many bloggers and newspaper reporters are calling for “bi-partisan consensus” as they comment on some of the most important issues of the day.

Global Warming

Writing about global warming, Huffington Post senior writer Tom Zeller Jr. recently declared: “Compromise is the necessary first step to tackling the problem. What ordinary Americans really want is for honest brokers on all sides to detoxify and depoliticize the global warming conversation, and then get on with the business of addressing it. That business will necessarily recognize that we all bring different values and interests to the table; that we perceive risks and rewards, costs and benefits differently; and it will identify solutions through thoughtful discussion and that crazy thing called compromise.” [ my emphasis] (Hat tip to David Roberts (Twitter’s “Dr. Grist”) for calling my attention to this post.)

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Are Doctors Prescribing Too Many Pain Medications?

In October, I was asked to speak at a Mayday Foundation meeting about blogging and using social media to spread a message. The Mayday Foundation is a global organization dedicated to pain relief.

At the meeting I met Bob Twillman, a 2011-2012 Mayday Fellow, who also is the Director of Policy and Advocacy at the American Academy of Pain Management. After the meeting he wrote a blog post for’s Congress Blog focusing on what he describes as “the much-ballyhooed issuance of three papers (including one Morbidity and Mortality Weekly Report) from CDC last week on the issue of overdoses and deaths involving prescription opiods. ”

Twillman’s essay reminds us that limiting access to pain medications is not the way to limit overuse. As regular HealthBeat readers know, I am concerned about overtreatment. But most patients who overdose get their pain medications from someone else’s medicine cabinet—not from a prescription that a doctor wrote for them. Physicians should be able to prescribe these drugs for the many patients who truly need them.

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Breast Cancer – Living with the Disease, Part 2

“The Best Care America Has To Offer”

Below, Amy Berman describes her recent journey through our health care system as “eye-opening.”  In part 1 of this post, she explained why she decided on palliative treatment for breast cancer, rejecting aggressive procedures such as mastectomy and chemo.

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The Future of Reform: Fleshing Out the Rules for Accountable Care Organizations

Today, the Obama administration released newly revised rules for “accountable care organizations” (ACOs) that are designed to persuade hospitals, doctors, and other health care workers to collaborate in providing better value for our health care dollars. In an ACO all providers involved in treating a particular patient or condition share a single flat fee. That fee will be higher if they succeed in achieving better outcomes for less, lower if they fail. In other words, providers are being asked to share in the risk that patients and payers now face when they agree to undergo treatment—or to pay for it. The lump sum payment creates an incentive for hospitals  and doctors to work together to achieve the best possible results. They will win the wager only if they co-ordinate care.

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Patients Prefer HMOs (And Other Healthcare Surprises)

The following post originally appeared on the TIME Moneyland blog.

Are health insurance plans with big brand names better than smaller insurers that most people have never heard of? “Not usually,” says Nancy Metcalf, senior program editor, at Consumer Reports. Unless, that is, the plan’s name is “Kaiser.”

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“Essential Benefits” that Insurers Must Offer Under Health Care Reform

Will Universal Coverage Mean “Medicaid for All”?

Often, I refer to the health care reform bill that President Obama signed into law in March of 2010 as “the Affordable Care Act” or ACA.  Friday,  as I read the Institute of Medicine’s (IOM’s) report on the “Essential Health Benefits” (EHB) that private insurers will be required to cover under reform, I resolved never to make that mistake again.

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Health Care Reform: The Next Stage, Part 1

Free Market Competition Cannot Make Heath Care Efficient: Why Health Care Should Be Regulated, Not By Government, but By Science

Not a few politicians and pundits continue to believe that free market competition offers the best solution to creating a health care system that offers good value for our health care dollars. House Budget Committee Chairman Paul Ryan, for one, argues that if we just give every American a tax credit, and let each person shop for his or her own insurance, consumers would pick the insurance network that offered the best care at the lowest price.

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In Survey, Doctors Report Providing “Too Much Care”

According to a new survey, nearly half of primary care physicians believe that their patients are “receiving too much care;” mostly in the form of unnecessary tests and referrals to specialists. More than one-quarter of these doctors believe that they themselves are practicing too aggressively, and they tend to blame the fear of malpractice suits for their actions. Meanwhile, when asked about their colleagues; including nurse practitioners and medical sub-specialists like cardiologists, allergists, gastroenterologists, etc., the surveyed doctors indicated that financial incentives were most likely driving over-treatment.

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