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As gridlock persists in our nation’s capital and good legislation continues to die in the Senate, it is clear the next president will play a key role in determining the future of Obamacare. That means candidates’ positions on the issue will be among the most important when ballots are cast next year. Obamacare’s “three-legged stool” — the subsidies, guaranteed-issue rules and individual mandate — is already collapsing under its own weight. ... I recently proposed the most substantive conservative plan to repeal and replace Obamacare presented to date. My Obamacare alternative addresses the root causes of high health-care costs, offers patients more options and strengthens the safety net for the most vulnerable Americans. (Jeb Bush, 11/10)

Until Carly Fiorina criticized Obamacare during Tuesday’s prime-time Republican debate, there hadn’t been much attention to health care in the GOP debates. During last week’s Democratic candidate forum in South Carolina, I didn’t detect a single question about health care or the Affordable Care Act. This is not a knock on hosts and moderators; debates and forums such as the Democratic meeting last week are not the best vehicles for drawing out presidential candidates on the intricacies of health policy. The result, however, is that the public is not learning much from these widely viewed events about what candidates would do regarding one of the country’s most divisive issues should he or she be elected president. (Drew Altman, 11/11)

In implementing the Affordable Care Act, the Obama administration has offered religious schools and charities that object to some birth control methods a reasonable and respectful accommodation: They need not provide or pay for contraceptive coverage for their female employees, but they must inform the government of their objections so coverage can be offered directly by an insurance company. But that compromise isn't good enough for the leaders of some of the organizations, who believe that merely signing a paper expressing their objections makes them complicit in sin because it "triggers" actions by others. (11/10)

Republican presidential candidates have spent much of their time on the campaign trail lately pledging more treatment and less punishment to deal with epidemic drug abuse, most dramatically in a viral video featuring an emotional New Jersey Gov. Chris Christie. This is a welcome development — even if the GOPers, like their Democratic counterparts, exaggerate the degree to which arrests for simple possession of drugs, as opposed to trafficking, have swollen the prison population. The more attention leaders focus on the heartbreaking rise in prescription opioid and heroin addiction, and overdose deaths the better. (11/10)

Opiate addiction is on the rise in the United States. Death rates, partly stemming from substance abuse, are increasing among middle-age white Americans. In response to what is being called a heroin epidemic, Massachusetts Gov. Charlie Baker has proposed legislation that would give hospitals the power to force treatment on drug addicts. Is this an effective approach to the problem? (11/11)

Hospitals are increasingly using so-called patient experience surveys to see how they can improve, and to establish their national rankings. .... It was those questions about the hospital’s food, parking and cleanliness that prompted Roy to call me. Those things might be important to someone else, he said, who was hospitalized briefly for a knee replacement. But not for someone like [his wife] Sheila, who was facing advanced cancer and death within a year. Roy and Sheila wanted to tell us about the adequacy of the information they received from our doctors about Sheila’s prognosis and treatment options. And they wanted to compliment the emotional and spiritual support they received from our staff. Most important, Roy said, they wanted to thank the palliative care team, which was especially helpful. (David Casarett, 11/11)

Although the percentage of adverse events associated with the use of dietary supplements is small, there are still an estimated 23,000 emergency department visits per year associated with their use. Considering the costs of emergency department visits, these types of adverse events can put a financial burden on patients, insurance companies, hospitals, and the health care system as a whole. It is unlikely that all of these emergency department visits could be prevented, but reducing the frequency of adverse events caused by dietary supplements could help to reduce the number of visits and could help to cut health care costs, as well. (Marcelo Fernandez-Vina, 11/10)

The news that mortality is increasing among middle-aged white Americans spread like wildfire last week .... Unfortunately, there are a couple of pieces of the puzzle that we think the ... study missed. By not looking at men and women separately, [the study] failed to see that rising mortality is especially pronounced among women. ... Two studies from the National Academy of Sciences (NAS) and the Institute of Medicine (one of which was directed by the first author of this post) have shown that Americans are slipping behind other high-income countries when it comes to mortality and survival, and that this “US health disadvantage” has been growing particularly among women. Another study by researchers at the University of Wisconsin–Madison shows that in the decade between 1992-96 and 2002-06, female mortality rates increased in 42.8 percent of US counties. ... By lumping women and men together, the study also missed the important point that the increases in mortality are affecting women of reproductive and childrearing ages, a finding that has huge implications for children, families, and communities. (Laudan Aron, Lisa Dubay, Elaine Waxman, and Steven Martin, 11/10)

The road to every blockbuster drug is a minefield. Drugs can end up being approved for smaller populations than expected, have nasty side effects, or run into increasingly penny pinching payers and governments, all of which can lop chunks off of rosy sales forecasts. For biotech firms with highly concentrated income streams, a big, failed acquisition is truly frightening. That's why the sort of company Amgen is reportedly seeking -- one with a late-stage drug that it can get on the market rapidly -- is in high demand. (Max Nisen, 11/10)