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It is often said that good policy makes for good politics. And we still want to believe that, despite the history of the “Cadillac tax” in the Affordable Care Act. Current law excludes employer-paid health insurance from taxation, which is how nearly half the public gets coverage. This subsidy, which costs $250 billion per year, according to the Congressional Budget Office, nevertheless promotes overutilization of health care, thus driving cost inflation. It causes “job lock” by linking work and insurance and redistributes income upward because tax breaks are worth more to higher income brackets. Nothing would improve U.S. health care more than to repeal the exclusion and use the savings to fund a more rational system. That’s politically impossible, however. So the ACA, passed in 2010, incorporated a second-best solution: a 40 percent levy on relatively plush “Cadillac” employer-paid plans (above $10,200 for individuals; $27,500 for families), effective 2018. (2/13)

We now have a government that’s doing less and costing more. By doing less, I mean that many traditional government programs — from defense to federal courts — are being slowly and systematically strangled by the costs of an older population (higher Social Security) and the related health-care spending (higher Medicare and Medicaid). How severe is the squeeze? The answer is in table S-7, buried in the back of the budget. Almost one-third of the federal budget consists of “discretionary spending,” which covers defense, courts, parks and all programs requiring annual congressional appropriations (essentially, permission to spend). Most of the rest of the budget goes to “mandatory” programs — Social Security is the biggest — for which people qualify if they meet eligibility requirements. (Robert J. Samuelson, 2/14)

Buried deep within President Obama's $4-trillion budget plan are a couple of healthcare proposals that could change everything for U.S. consumers. The fact that the drug industry wasted no time in dismissing the ideas — and that their Republican friends in Congress said they wouldn't even look at them — should tell you something big was afoot. (David Lazarus, 2/16)

Sanders’ idea of a universal, Medicare-like health system must be viewed through the prism of political reality. With Republicans incessantly attacking the Affordable Care Act, how would Sanders’ more-progressive blueprint, with a price tag in the trillions of dollars, get past their suffocating filibusters? Democrats would be nominating a man who has no chance to enact his signature plank because it would be politically unachievable. We prefer the pragmatism embraced by Clinton: to further develop the foundation of Obamacare that already is law. It has extended the security of health insurance to 17.6 million Americans and brought down to 10 percent the number of Americans without insurance, thanks in part to the law’s requirement that everyone be allowed coverage no matter what their pre-existing conditions might be. Honing the law is more achievable than starting anew with a plan that would be dead on arrival on Capitol Hill. (2/14)

By advocating “Medicare for all,” Sen. B ernie Sanders has rekindled the progressive dream of government-run health care. Yet Washington can’t even manage the health bureaucracy it already controls. Take a look at the sad circus surrounding the doctor nominated to lead the Food and Drug Administration—a qualified man whose confirmation is being blocked for political reasons. (Joel M. Zinberg and Thomas P. Stossel, 2/12)

Martin “Pharma Bro” Shkreli’s testimony – or lack thereof – at a House Oversight Committee hearing (or lack thereof) justifiably angered many people. The infamous former hedge fund CEO turned pharma executive raised the price of a generic anti-parasitic drug – Daraprim – by 5,000 percent last year simply because he could. Overnight, he became the embodiment of a pharmaceutical industry routinely accused of putting profit-seeking before patient health. But policymakers shouldn’t jump to conclusions, let alone legislation. There are many important differences between the “Pharma Nerds” developing innovative life-saving drugs – including Gilead Sciences’ Sovaldi – and the “Pharma Bros” exploiting loopholes to profit from generics like Daraprim. And addressing patient access challenges for one requires very different solutions than the other. First and foremost, it requires understanding why we make a distinction between generics and branded medicines in the first place. (Yevgeniy Feyman, 2/16)

For almost 40 years, I practiced general internal medicine and geriatrics in my own office. I had tens of thousands of face-to-face interactions with a group of folks who, with time, grew to trust me. I respected them as well; many I came to love — a term that I hesitate to use in this hypersensitive age. Given how geographically dispersed families are today, for many of my older patients I functioned as a surrogate son. There is no doubt that the kind of medicine I was fortunate to practice is disappearing. (Jerald Winakur, 2/12)

Dementia and Alzheimer’s disease are the leading fears among baby boomers, countless of whom have seen their parents’ brain health deteriorate. While many feel paralyzed when considering the possibility of developing an unhealthy brain themselves, much can and must be done to support cognitive health during every step of the aging process. Since pharmacology does not yet offer a solution to a deteriorating brain, each one of us must act before it is too late. This important subject is addressed by a symposium on Mild Cognitive Impairment in Miami this week. (Dharma Khalsa and Simran Stuelpnagel, 2/15)

It is encouraging to note data from the United Network for Organ Sharing that show more than 30,000 organ transplants were performed in the United States last year, reaching the highest total in the country’s history. Nevertheless, the supply of organs — donated by living and deceased donors — will fall short of the number of patients added last year to the transplant waiting lists. With the persistent shortage, there are those who would seek to increase the organs available for transplantation by providing financial incentives as a motivation for organ donation. These financial incentives would represent a monetary gain or “valuable consideration” and are currently prohibited by the National Organ Transplant Act of 1984 (NOTA) to buy and sell organs. (Francis Delmonico, 2/16)

There are more than 120,000 people waiting for organs in the United States. More than 100,000 of these individuals need kidneys. Kidneys are unique because most people have two, and it is possible for healthy individuals to donate one to someone in need. But there aren’t enough donated organs for everyone waiting, so clearly changes are needed. The National Kidney Foundation believes there are effective, proven methods to increase donation and transplantation that are underused, and that addressing those issues would significantly increase the number of kidney transplants. (Jennifer Martin, 2/16)

America’s drug crisis, which now kills more people each day than car crashes or gun violence, has challenged the conventional wisdom about recovery. With addiction inside the homes of families who thought themselves immune, we are starting to embrace the idea that addiction is a not a character flaw but a chronic disease requiring long-term management — the subject of last week’s Fixes column. This week, another idea whose time has come: trying to kick opioid addiction without medicines is as smart as relying on willpower to overcome diabetes or asthma. Medicines greatly increase the chance of success and reduce the risk of death. (Tina Rosenberg, 2/16)

Virginia should dismantle its mental-health system and replace it with one that serves Virginians who are sick rather than the bureaucrats who should be helping them. From 2010 to 2014, I served as Virginia’s inspector general for behavioral health and developmental services, which required me to cast a critical eye on the state’s mental-health services and recommend changes to improve the commonwealth’s system of care. I found a complex, dysfunctional and ineffective bureaucracy that was system-centered instead of person-centered. (G. Douglas Bevelacqua, 2/12)

Chuck Engholm arrived at the emergency room at Genesis Medical Center on Nov. 9, 2014, complaining of nausea. Engholm was 63 years old and a long-time resident of Davenport’s Handicapped Development Center, a group home where he was known for his love of horses and cowboys, and where he worked as a sander in the facility’s workshop. (2/14)

Governor Branstad says that privatizing Iowa’s Medicaid program will provide more doctors for Medicaid patients, but when it comes to the 37,000 kids on Hawk-I health insurance, children will have far fewer health care providers to choose from. (State Sen. Janet Petersen, 2/15)

[T]he most difficult part of caring for teenagers is not the wide range of medical and emotional issues they may have but, often, the legal limitations put on me by HIPAA. These limitations often lead to unsolvable situations. Unfortunately, in adolescent medicine, these situations are all too common and usually involve emotional or sexual health. (Rima Himelstein, 2/15)