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In April 2016 the federal Medicare program began an experiment to save money on the half-million hip and knee replacements it pays for each year. In 67 cities, Medicare capped the payments it makes to hospitals for joint surgeries and the months of follow-up care they require. ... The idea is to lower costs over time by giving hospitals incentives to be more efficient, which would ultimately boost their bottom lines. ... Now, the new payment arrangement will be optional for hospitals in half of the cities where it previously was mandatory. That change will increase Medicare costs by $90 million over the next three years, according to the agency. (John Tozzi, 10/5)

Obamacare is still with us. The latest Republican repeal effort has failed, and the enrollment period begins Nov. 1. A bipartisan Senate bill to address its problems could be voted on sometime this fall. Meanwhile, many Democrats are embracing a single-payer “Medicare for all” system as the next step in healthcare reform. But making single-payer the top priority now could jeopardize the gains made since passage of the Affordable Care Act, which is still being sabotaged by the Trump administration. (Tom Epstein, 10/5)

Republicans on the national level will continue their egregious attack on women’s health, making the political resistance by states more important than ever. Barriers to birth control disproportionately hurt the poor, and it’s up to Massachusetts lawmakers to pass legislation like the ACCESS bill to protect them. (10/6)

The 18-year-old high school student didn’t need to hear the fetal heartbeat. She had heard enough about the challenges of becoming a teen mom from her own mother. She didn’t need to see the sonogram or to be asked again about it. She didn’t need more adoption-promotion literature or warnings of potential psychological downsides to abortions. She was determined to make a better life for herself than her mother had been able to. And after waiting four days for the appointment, she wanted to get on with the abortion. But on May 5, the long arm of the state of Iowa reached out to block her. On that day, former Gov. Terry Branstad signed a law, effective immediately, requiring anyone seeking an abortion to wait three more days and make more than two clinic trips to get one. (Rekha Basu, 10/5)

This week it’s guns, with at least 59 people dead and hundreds injured after the worst mass shooting in modern U.S. history. But the focus just as easily could be on cigarettes, or junk food, or sugary beverages. No reasonable person disputes that all these products can be dangerous, whether we’re talking about firearm casualties, lung cancer, diabetes or heart disease. The issue is how, or if, the makers of these products should be held accountable for the trouble they cause. (David Lazarus, 10/6)

“He was a sick man, a demented man,” said President Trump, trying to explain the latest mass shooting in the United States. We hear this view expressed routinely, after every new incident. But it is a dodge, a distortion of the facts and a cop-out as to the necessary response. There is no evidence that the Las Vegas shooter was insane. (I prefer not to use his name and give him publicity, even posthumously.) He did not have a history of mental illness that we know of, nor had he been reported for behavior that would suggest any such condition. (Fareed Zakaria, 10/5)

There is rising concern in the state about the growing number of persons with mental health and substance abuse issues. And while we remain concerned, our response appears fragmented and not focused. (Earl Kelly and Donner Dewdney, 10/5)

[M]any people think the United States health care system has a lot of problems. So it seems reasonable to think of policy changes that make things better, not worse. Making it harder for immigrants to come here to practice medicine would fail that test. The American system relies to a surprising extent on foreign medical graduates, most of whom are citizens of other countries when they arrive. (Aaron E. Carroll, 10/6)

The aftermath of Hurricane Irma has sparked many conversations about senior health and disaster preparation, and whether skilled nursing facilities should be prioritized when it comes to restoration of power and recovery efforts. ... If we are to ask skilled nursing facilities to adopt these hospital best practices for staffing during times of natural disaster, then skilled nursing facilities should also be categorized as top priority when it comes to restoration of power and recovery efforts. With more complex patients in our care that may be unable to evacuate, it is crucial – lifesaving even – that we be designated as “critical facilities”, immediately after hospitals, in restoration efforts. (Elaine Bloom, 10/6)

The Republican-controlled Iowa Legislature cut funding for direct-care workforce programs from about $500,000 to $188,000 for the current fiscal year. More than $100,000 was slashed for Iowa CareGivers, a nonprofit organization dedicated to cultivating a quality, caregiver workforce in this state. The money previously appropriated was used for mentoring programs, partnerships with community colleges, workforce training, stakeholder forums, public awareness and other efforts to recruit and retain direct-care workers. (10/5)

In the latest science shocker, researchers discovered that a number of people around the world are eating foods such as cheese, butter and full-fat yogurt without doing deadly harm to their bodies. This was treated as health heresy, yet this study’s findings weren’t all that out of line with previous research on moderate consumption of so-called saturated fats, found primarily in animal products. (Faye Flam, 10/4)

At Nobel Prize time, journalists tend to celebrate the ingenuity of scientists. This year, let’s show some appreciation for the ingenuity of evolution and the human body instead. The 2017 Nobel for medicine went to three researchers who uncovered the workings of tiny clocks inside your cells -- clocks that tell you when to eat, when to stop eating, and when to shut off that computer and get some sleep. The prize-winning work was done on fruit flies, but its findings are relevant to us humans, since once evolution invents something useful, it often spreads far and wide. (Faye Flam, 10/5)