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Health Policy and Reform
Election 2012
(DOI: 10.1056/NEJMp1210265)
Republican presidential nominee Mitt Romney says he’d repeal much of the Affordable Care Act. Other policy aims would shift growing Medicare costs to beneficiaries, curtail Medicaid’s benefits and shrink its enrollment, and reduce all federal health spending.
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President Barack Obama says that Obamacare is moving America toward greater health security. In his second term, he would follow through with implementation and aim to fix Medicare’s payment formula, support life-sciences research, and keep Medicare and Medicaid strong.
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(DOI: 10.1056/NEJMp1210763)
Since the Affordable Care Act ignores the structural problems in the organization and reimbursement of care, even if it succeeds in providing insurance coverage to more Americans, it won’t solve the problems of unaffordable health care costs and inadequate quality of care.
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Governor Mitt Romney says he would repeal Obamacare and replace it with common-sense, patient-centered reforms suited to the challenges we face. In the health care system he envisions, choice and competition would result in better quality at lower cost.
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(DOI: 10.1056/NEJMsr1211472)
Examination of 37 telephone polls offers insight into the U.S. public perceptions of the political environment surrounding health care, the role of health care as a voting issue, and the importance of specific health policy issues to voters’ choices for President.
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(DOI: 10.1056/NEJMp1211277)
After weighing the risks and benefits, the FDA recently approved two new drugs as adjuncts to a reduced-calorie diet and increased physical activity for chronic weight management in obese or overweight adults with at least one weight-related coexisting condition.
In 2008, CMS discontinued additional payments for hospital-acquired central catheter–associated infections and catheter-associated UTIs. In this national study, the rates of these preventable infections did not decrease after implementation of the nonpayment policy.
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A store’s placement of foods in prominent locations increases their rate of purchase, and consumption of foods high in sugar, fat, and salt increases risks of chronic diseases. Such placement should thus be treated as a risk factor, and steps should be taken to mitigate that risk.
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The New York City Department of Health proposes to prohibit restaurants, movie theaters, and mobile food vendors from selling sugar-sweetened beverages in containers larger than 16 oz. Does government have the authority to regulate food-industry conduct in this way?
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Original Article
Sugar-Sweetened Beverages and Genetic Risk of Obesity
Obesity has become a major threat to public health throughout the world. The dramatic changes in diet and lifestyle during the past three decades are believed to have played a key role in triggering the obesity epidemic. In the past several years, large-scale genomewide association studies have…
- CME
Clinical Decisions
Regulation of Sugar-Sweetened Beverages
Case Vignette. Mr. and Mrs. Landon take their 12-year-old daughter, Meredith, to her pediatrician for an annual wellness visit. Meredith has no history of medical illness, and she has received all the age-appropriate vaccinations. Meredith enjoys reading books, watching television, and playing…
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Perspective
Candy at the Cash Register — A Risk Factor for Obesity and Chronic Disease
A basic misconception has stymied our response to the obesity epidemic: the belief that food-related decisions are consciously and deliberately made. Our reluctance to interfere with or regulate the food environment is a direct consequence of the belief that people's food choices reflect their true…
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Perspective
Portion Sizes and Beyond — Government's Legal Authority to Regulate Food-Industry Practices
The importance of obesity as a public health problem has led to a number of proposed policy solutions, some of which — such as taxes on sugar-sweetened beverages — are highly controversial and have been opposed strongly by the food industry. One such measure is the proposal by the New York City…
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Perspective
Election 2012: Securing the Future of American Health Care
The editors asked the Democratic and Republican presidential nominees, President Barack Obama and former Massachusetts Governor Mitt Romney, to describe their health care platforms and their visions for the future of American health care. Their statements follow. From the moment I took office, the…
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Editorial
Calories from Soft Drinks — Do They Matter?
Obesity has emerged as one of the greatest global health challenges of the 21st century. Its increase among children and adolescents is particularly frightening, given the associated metabolic and cardiovascular complications. Studies from developing countries with populations that are undergoing…
Original Article
A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children
The increased prevalence of obesity in children, a major health problem,, has coincided with a large increase in the consumption of sugar-sweetened beverages. These beverages are considered to be more fattening than solid foods because they do not lead to a sense of satiety. Thus, children who…
Special Article
Effect of Nonpayment for Preventable Infections in U.S. Hospitals
Financial incentives that reward providers with additional payments for achieving certain quality goals, broadly known as pay for performance, have become ubiquitous. However, the effect of these programs on patient outcomes has been mixed, with a few studies showing modest gains and most reporting…
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Perspective
Election 2012: Replacing Obamacare with Real Health Care Reform
The editors asked the Democratic and Republican presidential nominees, President Barack Obama and former Massachusetts Governor Mitt Romney, to describe their health care platforms and their visions for the future of American health care. Their statements follow. Health care is at once among our…
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Original Article
A Randomized Trial of Sugar-Sweetened Beverages and Adolescent Body Weight
The consumption of sugar-sweetened beverages among adolescents has increased in tandem with the prevalence of pediatric obesity in the United States, suggesting a causal relationship. At present, a substantial proportion of high-school students habitually consume sugar-sweetened beverages,…
Perspective
The FDA's Assessment of Two Drugs for Chronic Weight Management
Owing to a complex interplay among genetic, environmental, and cultural factors, obesity has reached epidemic proportions in the United States. The adverse health consequences of obesity are manifold, potentially involving all major organ systems and contributing to reduced quality of life. The…
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Perspective
The Shortfalls of “Obamacare”
U.S. health care suffers from three major problems: millions of people go without insurance, health care costs are rising at unaffordable rates, and the quality of care is not what it should be. The Affordable Care Act (ACA) primarily addresses the first — and easiest — of these problems by…
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Perspective
Health Care Policy under President Romney
When Mitt Romney campaigned in 2002 to become governor of Massachusetts, he offered no hint that he would lead the enactment of the most consequential state health care reform law in U.S. history. Yet as early as February 2003, Governor Romney began to intimate his intention to engineer the law…
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Special Report
Understanding Health Care in the 2012 Election
The outcome of the 2012 election will have far-reaching ramifications for the future of U.S. health care. Rarely in a national election have the two major candidates' views about health care been so diametrically opposed. The views of President Barack Obama and Republican presidential nominee Mitt…
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Perspective
User Fees and Beyond — The FDA Safety and Innovation Act of 2012
President Barack Obama recently signed into law the Food and Drug Administration (FDA) Safety and Innovation Act (FDASIA), ending a long discussion among regulators, industry representatives, legislators, and patient advocates. The driving force behind the legislation was the need to reauthorize…
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Perspective
France's New Framework for Regulating Off-Label Drug Use
Off-label use of drugs is relatively common in medical practice, even if it's often not supported by strong scientific evidence. Studies in the United States have shown that off-label use may account for approximately 20% of prescriptions, or 150 million prescriptions per year. In addition to its…
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Perspective
Unpredictable and Difficult to Control — The Adolescence of West Nile Virus
Disturbingly unpredictable, disagreeable, and difficult to control — West Nile virus, first identified in the United States in 1999, has entered adolescence. In this year's tally, 3142 cases of West Nile virus disease in humans in 45 states had been reported to the Centers for Disease Control and…
Perspective
Cutting Family Planning in Texas
Four fundamental principles drive public funding for family planning. First, unintended pregnancy is associated with negative health consequences, including reduced use of prenatal care, lower breast-feeding rates, and poor maternal and neonatal outcomes. Second, governments realize substantial…
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Perspective
Health Care Reform and the Dynamics of Insurance Coverage — Lessons from Massachusetts
As the blueprint for the Affordable Care Act (ACA), the 2006 Massachusetts health care reforms are useful for projecting the potential effect of national health care reform on insurance coverage throughout the United States. In Massachusetts, reforms have yielded gains in insurance coverage. It is…
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Perspective
What's Preventing Us from Preventing Type 2 Diabetes?
The Diabetes Prevention Program (DPP) clinical trial and its 10-year outcomes study (DPPOS), both sponsored by the National Institutes of Health (NIH), showed that certain interventions could prevent or substantially delay the onset of type 2 diabetes both safely and cost-effectively. Yet diabetes…
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