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The start of 2015 finds no letup in the attacks on a woman’s constitutionally protected right to make her own childbearing decisions. Republican lawmakers and organizations devoted to dismantling reproductive freedom have succeeded in shrinking the already inadequate number of abortion providers, making it exceedingly difficult, if not impossible, for women — especially young and poor women — to obtain safe and legal abortion services in large swaths Texas and other parts of the country. (1/20)

Meanwhile, the news on health reform keeps coming in, and it keeps being more favorable than even the supporters expected. We already knew that the number of Americans without insurance is dropping fast, even as the growth in health care costs moderates. Now we have evidence that the number of Americans experiencing financial distress due to medical expenses is also dropping fast. All this is utterly at odds with dire predictions that reform would lead to declining coverage and soaring costs. So will we see any of the people claiming that Obamacare is doomed to utter failure revising their position? You know the answer. (Paul Krugman, 1/19)

In pursuit of greater efficiency in the United States health system, public programs and private insurers have begun to pay some hospitals and physicians differently. These new payment models take many forms, but they all impose greater responsibility for cost control and quality improvement on providers and bear some resemblance to failed health care financing arrangements from the 1990s. However, there are some distinctions that could make all the difference. (Austin Frakt, 1/19)

The next big shift is coming in U.S. health care, and Republicans are doing their best to speed it up. What's not clear is how carefully they've thought through the consequences. A defining feature of U.S. health-care policy is that most Americans get insurance through their employers. ... But judging by the trend of the past few years, Americans with job-based coverage could soon become a minority. (Christopher Flavelle, 1/19)

It turns out that the Department of Justice lawyers who have been arguing the ACA case in the federal courts have scrupulously avoided using the language of purpose. Presumably, they are confident they can get the votes of the four Democratic appointees to the court, who are in principle at least somewhat open to the idea of legislative purpose as relevant to statutory interpretation. To win the case, however, the Department of Justice needs a fifth vote. That vote will have to come from one of the conservatives. And the Department of Justice wants that conservative, whoever it may be, to be able to argue with a straight face that his decision (it has to be a he) depends on the text of the statute and not its purpose. (Noah Feldman, 1/16)

The jury-rigged health-care program for the working poor crafted on Gov. Corbett's orders recently cleared a legal hurdle. A federal judge refused to block it despite evidence that Healthy PA, a substitute for Medicare expansion under the federal health-care reform law, needlessly reduces coverage for many of the 600,000 Pennsylvanians affected. But the program faces additional legal and practical challenges. While state officials reported this month that more than 100,000 households had applied to Healthy PA, advocates say these uninsured residents have encountered a maze of confusing and contradictory requirements to obtain the new coverage over the last six weeks. (1/18)

Virginia public opinion supports the idea of Medicaid expansion by a more than 2-to-1 margin, according to a statewide survey. The poll, conducted by Princeton Survey Research Associates International for the University of Mary Washington’s Center for Leadership and Media Studies, found overwhelming endorsement of the expansion across the state, ranging from a low of 66 percent support of those who expressed an opinion on the expansion idea in the northwest to 74 percent in Tidewater. But in a state full of gerrymandered legislative districts, delegates and senators who want another term in Richmond must focus on satisfying the more intense, ideologically extreme voters who show up for nomination contests. As a result, most Republican lawmakers are concerned primarily with what GOP voters think. (Stephen J. Farnsworth, 1/16)

Although 70% of Californians support physician-assisted suicide, it remains illegal in this state. Despite a remarkably successful 20-year-old law in Oregon that set up a process for what that state calls “death with dignity,” the Legislature in California has not introduced a bill on the subject since 2007. Before that, lawmakers tried for three years in a row with virtually identical bills and all failed. Californians should have the ability to determine their personal medical destinies. Then, in October 2014, Brittany Maynard, an articulate young Californian, brought the issue front and center with her anguishing tale: She had moved to Oregon so that she could legally end her life before her aggressive brain cancer could cause debilitating pain and seizures, and rob her of cognitive function. She died in early November by her own hand. (1/19)

Going in for therapy at a Veterans Affairs hospital is a lot like arriving at a large airport in a foreign country. You pass through a maze of confusing signage. Your documents are scrutinized. There are long lines you must stand in and a series of bureaucratic rituals that must be endured before anything resembling a human encounter occurs. In April 2013, after doing a series of intake interviews and sitting on a waiting list for three months, I had my first human encounter with my assigned therapist at the big V.A. hospital in San Diego. Little did I know that the delay in treatment would be less agonizing than the treatment itself. (David J. Morris, 1/17)

Two months ago, the British Psychological Association released a remarkable document entitled “Understanding Psychosis and Schizophrenia.” Its authors say that hearing voices and feeling paranoid are common experiences, and are often a reaction to trauma, abuse or deprivation: “Calling them symptoms of mental illness, psychosis or schizophrenia is only one way of thinking about them, with advantages and disadvantages.” ... This is a radically different vision of severe mental illness from the one held by most Americans, and indeed many American psychiatrists. Americans think of schizophrenia as a brain disorder that can be treated only with medication. Yet there is plenty of scientific evidence for the report’s claims. (T. M. Luhrmann, 1/16)

I've been lucky for the last 20 years. I could listen silently while friends complained about their medical care. My doctor was never too busy or too brusque. He always made time to listen. I never had to pay concierge fees for what I knew was uncommonly good and thorough care. But my luck ran out last summer when my doctor unexpectedly retired — pushed by some of the forces that are supposed to make patient care better and more accessible for the masses. (Sandy Banks, 1/16)

Tyrone Graham pleaded guilty to murder at age 18. Now 62, Graham suffers serious health problems, in part because of his decades of confinement. He battles renal failure and lung problems and has three weekly dialysis treatments. He takes more than a dozen medications. Yet the Maryland Parole Commission has failed to help. Graham was denied three medical parole requests. Perhaps the reason for these egregious denials is a fear that parolees will commit new crimes. However, relatively few older people on parole. (Larry Bratt, 1/16)

Responsible sharing of clinical trial data serves this public interest by strengthening the science that is the foundation of safe and effective clinical care. Sharing also fosters sound regulatory decisions, generates new research hypotheses, and increases the scientific knowledge gained from the contributions of clinical trial participants, the efforts of clinical trial investigators, and the resources of clinical trial funders. However, results from about one-third of clinical trials remain unpublished 4 years after trial completion, and much data from trials are never analyzed. (Dr. Bernard Lo, 1/16)