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On Labor Day, we offer our annual tribute to America’s working men and women, who put in more time on the job than their counterparts in the world’s largest economies and generally are more productive. And as we salute those who are working hard, we’ll also offer a Bronx cheer (pfffft!) to those who are hardly working: our members of Congress. They went on vacation without bothering to act on President Obama’s request for money to fight Zika and refused entreaties to come back to work when the viral infection expanded across South Florida. (9/4)

During the debate over Obamacare, both supporters and opponents assumed the giant law would transform the American health care system. The supporters argued that the system would help Americans purchase health insurance through carefully regulated state exchanges. President Obama envisioned a day when consumers could shop for health coverage “the same way you’d shop for a plane ticket on Kayak or a TV on Amazon.” In 2010, the Congressional Budget Office estimated there would be 21 million Americans using the exchanges by now. Many supporters argued that the exchanges would eventually replace the current dominant employer-based system. (David Brooks, 9/6)

After a while, it becomes white noise; just big insurance company names in the news scrolling across our TV screens, phones and tablets, all void of the true impact these seemingly small but ever-piling-up events will ultimately have on so many. The premiums that were promised to decrease have skyrocketed, the plans we were promised we could keep have or will be canceled and the "competition" that was promised to drive the exchanges has ended. We are rapidly approaching a healthcare apocalypse. (Bryan Rotella, 9/2)

Hillary Clinton made one of the most consequential announcements of her campaign on last week — and hardly anyone is talking about it. The Democratic presidential nominee released a wide-ranging mental-health strategy — and, unlike much of what she has proposed this election season, it has a real chance of becoming law. (9/5)

More than 40 million American adults — almost 20 percent of the adult American population — will deal with mental illness this year. Yet mental health (of the citizens, not the candidates) has not been an issue in the presidential campaign. Hillary Clinton tried to change that last week, announcing a plan that offers hope for improving mental health research, diagnosis and treatment. Central to Mrs. Clinton’s plan is the integration of physical and mental health care and reducing the stigma attached to mental health treatment. (9/5)

As Hillary Clinton rolled out her mental health policy proposals this week, the nation is confronting a mystery regarding access to care. The past decade has witnessed a flurry of federal legislation intended to improve coverage of mental health treatment within private and public sector insurance plans. Why then do research studies continue to document that even people with health insurance often have difficulty finding a psychiatrist? Two new studies of the state of the psychiatric profession help explain this frustrating situation. (Keith Humphreys, 9/2)

On a bright spring morning in late May, I force myself to sit down and make the dreaded call. It is to a national health plan that covers the psychotherapy benefit for many of my patients. Let's call it Community Allied Services For Health, for the fitting acronym "CASH." (Ellen Holtzman, 9/5)

The rate at which women die during pregnancy or shortly after childbirth has fallen sharply in many nations as maternal care has improved. The United States — and particularly Texas — is a glaring exception. In Texas, for instance, according to a study in the journal Obstetrics & Gynecology, the maternal mortality rate doubled from 17.7 per 100,000 live births in 2000 to 35.8 in 2014. Compare that with Germany, which had 4.1 deaths per 100,000 live births in 2014. (9/3)

For decades, public health experts have known that syringe exchange programs reduce the spread of certain viral infections — like H.I.V., hepatitis B and hepatitis C — by removing contaminated syringes from circulation. They have known that programs using sterile injection equipment are both safe and save money. And yet they are rarely seen in the United States. (Austin Frakt, 9/5)

There was no mistaking the diagnostic significance of that little red stick inside a deep blue cell: The Auer rod meant the mystery patient had acute myelogenous leukemia. As slide after slide went by, her bone marrow told a story: treatment, remission, relapse, treatment, remission, remission, remission. I was reading these marrows in 1987, but the samples had been drawn in 1978 and 1979. Median survival of that lethal disease with treatment was about 18 months; however, given that she had already relapsed once, I knew that she had to be dead. Probably someone was being sued, and that was why my hematology colleagues had asked for a blind reading. ... After the work was submitted, I asked the treating physician what was going on. She smiled and said that my report had been sent to the Vatican. This leukemia case was being considered as the final miracle in the dossier of Marie-Marguerite d’Youville. (Jacalyn Duffin, 9/5)

Jan Kern was bitten by a stray dog while traveling abroad and ended up with a jaw-dropping illustration of why the U.S. healthcare industry is completely sick. That’s because she underwent a series of rabies shots in three countries at four medical facilities. What that revealed, and which will surprise no one, is that Americans pay way more for the exact same treatment than people in other nations. Moreover, her experience highlights the lack of uniformity for drug prices, including commonly used medications. One facility might charge a few bucks for the same drug that costs thousands of dollars at a U.S. hospital. (David Lazarus, 9/6)

A funny thing happened on the way to the ballot box this year. Though grassroots referendums and initiatives have been on the wane for two decades, 73 have been approved for ballots so far in the 26 states that allow them. That’s still well below the 1996 peak of 92 measures, but it’s the highest number since 2006 and almost 50 percent more than in 2012. ... Nine states have measures that would legalize or decriminalize marijuana use. Five states would raise the minimum wage. Four would tighten gun controls. One, Colorado, would create an additional 10 percent income tax to finance a universal health-care system. (Paula Dwyer, 9/5)

So it’s time for [Gov. Terry] Branstad to schedule a series of his own public meetings to hear from constituents on Medicaid. Because it’s not clear where he is getting information about how things are going. As low-income Iowans reported confusion and loss of health services, this governor characterized the transition to privatization as “smooth.” When providers reported not being paid, he said the new system is “stopping significant fraud and abuse.” Instead of responding to a question here or there at a news conference, the governor should be publicly hearing and addressing the concerns being reported to lawmakers who didn’t craft or directly approve his privatization project. (9/3)

Efforts to make Iowans healthier feel like going backwards on an endless treadmill. The state has the 12th highest obesity rate in the nation, according to a report released last week by the Trust for America’s Health and the Robert Wood Johnson Foundation. Iowa’s percentage of obese adults was 32.1 percent in 2015, up from 20.9 percent in 2000 and from 12.2 percent in 1990. Iowa shouldn’t be discouraged. In fact, we should look north to see what we can learn. Minnesota was one of only four states in the nation to see a drop in adult obesity rates last year. (9/5)

As an emergency physician, I have seen how often patients are prescribed opioids and benzodiazepines together. This is not based on any scientific efficacy, but common clinical practice. This is not done out of bad intention, but routine and habit. Either one of these medications, when used in excess, can cause slowed breathing and sleepiness, leading to loss of consciousness and death. When used together, opioids and benzodiazepines are an especially deadly combination, increasing the likelihood of a fatal overdose. (Leana S. Wen, 9/2)