Daily Rounds: Obamacare Attack Ads; Mental Health Data Privacy; Tragedy Of Health Care Commons

Distaste for health care law reflects spending on ads (The New York Times) - "In all, about $235 million has been spent on ads attacking the law since its passage in March 2010, according to a recent survey by Kantar Media’s Campaign Media Analysis Group. Only $69 million has been spent on advertising supporting it. Just $700,000 of that comes from the Obama campaign, and none of its ads mentioning the law are currently being broadcast, said Elizabeth Wilner, vice president of the Campaign Media Analysis Group. 'It explains, in a nutshell, why polling shows attitudes about the law to be at best mixed,' she said."

As records go online, clash over mental care privacy (The Boston Globe) - "At her weekly therapy sessions, Julie revealed her most uncomfortable secrets: depression, debt, childhood sexual abuse. Her psychiatrist at Massachusetts General Hospital would then type a summary into Julie’s computerized medical record. With that, more than 200 pages of sensitive notes became available to any doctor who cared for her within the sprawling Partners HealthCare system. She discovered this only when one doctor later referenced the notes. Julie, a 43-year-old lawyer, was unnerved, then angry. “The details are really nobody’s business,” she said. But Partners disagrees. Doctors must have a complete picture to make accurate diagnoses, the organization argues. And having different rules for psychiatric records contributes to the stigma of mental illness."

Getting past health care's individual mandate (Theda Skocpol and Lawrence R. Jacobs in The Los Angeles Times) "So what does the Patient Protection and Affordable Care Act do apart from the individual mandate? Three big things. First, private insurance companies will be required not to deny or revoke insurance because of preexisting conditions. They can still make good profits, but not by dumping sick people or avoiding people who might become sick. Second, Medicaid will be expanded to cover about 16 million additional low-income people, and generous tax credits will be provided to help businesses and middle-class Americans afford private health insurance plans. Third, the law requires each state to establish an exchange, or virtual marketplace, where people and businesses can comparison shop for health plans and find out which tax credits they can use to help pay for a plan of their choice."

In Elinor Ostrom's legacy, a lesson for Beacon Hill (Don Berwick In The Boston Globe) - "The proposal now for limits, best represented by the House version that calls for a rate of growth for health care costs 0.5 percent slower than the growth of the economy, is a chance for us to act as Ostrom would counsel us to: as a community, with respect for the commons, with rules that share the burden, with transparency about how we are doing, and with consequences for defection. Most payment incentives still favor increase without limits, and so it is no surprise that many Massachusetts physicians and hospitals are opposing the discipline of the House bill. They are making a mistake in doing so. They are trapping themselves and the rest of us in Hardin’s gloomy scenario, instead of following Elinor Ostrom’s way out."