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First it was ObamaCare. Then it was immigration. And now, it’s Planned Parenthood. So many who constitute the Tea Party wing of the Republican conference want to see their leaders wage war against President Obama. ... I venture to say that when it comes to ObamaCare, the [GOP] leaders hate it as much as their followers. The president’s executive order on immigration offended the leaders, not only on policy grounds but also as a matter of the constitutional probity. And for Boehner, who invited Pope Francis to address the Congress, the actions of Planned Parenthood pierced his Catholic soul. But there are good fights and there are stupid fights. And unfortunately, some on the hard right, including some members of the so-called Freedom Caucus and, yes, one particular presidential candidate, mistake stupid fights for good ones. (John Feehery, 9/14)

Under the Affordable Care Act, the definition of small group market is scheduled to expand from employers with up to 50 employees to include employers with up to 100 employees. A recent actuarial report projects that approximately two-thirds of mid-sized businesses, their employees and their families could see an average 18 percent premium increase due to how the Affordable Care Act expands the definition of the small group market. ... Premium increases could destabilize the market in these newly expanded small group markets, and a disruption could worsen over time as more and more mid-sized employers opt to avoid the new requirements and related premium increases. Those left in the newly expanded small group market could see significant premium hikes, according to experts. (Sens. Tim Scott, R-S.C., and Jeanne Shaheen, D-N.H., 9/15)

Need a breast exam? Call your dentist. What about an HIV test or pap smear? Find your friendly ophthalmologist. Looking for a birth-control refill? No problem. Visit your local nursing home. These were Louisiana’s utterly unhelpful, sublimely ridiculous recommendations for where to send the 5,200 low-income patients who will lose access to reproductive health services if the state cuts off Medicaid funding for Planned Parenthood, as Gov. (and flagging Republican presidential candidate) Bobby Jindal wants. (Catherine Rampell, 9/14)

It's pretty well known that Americans pay more for health insurance and medical treatment than people in other developed countries — at least until they turn 65 and are eligible for Medicare. But what would things look like if the government-run insurance plan wasn't an option? Kaiser Permanente provided a glimpse of such a prospect when it notified Chatsworth resident Layne Smith recently that his monthly insurance premium would double on Jan. 1 to $1,816.65 from $904.54. Why? Because of "a standard yearly rate change based on your age." Smith turned 65 on Monday. (David Lazarus, 9/15)

A few days before Labor Day, as Americans prepared for the end of summer, we learned that some 300,000 U.S. veterans might have died while waiting for health care at the U.S. Department of Veterans Affairs. Yet due to “generally unreliable” VA data and ineffective systems, even this critical statistic could not be confirmed. These disturbing findings, revealed in a report by the agency’s inspector general, confirm the urgency for VA reform. When it comes to veterans care, Americans are rightfully outraged, and can no longer be content with business as usual: We must seek — and our veterans deserve — real improvements that are bold and long-lasting (Dr. Ben Carson, 9/14)

As surely as the seasons change and the tides rise, pharma will continue raising the prices of medications wherever and whenever it can. In one example from last week, the non-profit Institute for Clinical and Economic Review (ICER) found that the new class of cholesterol medications, the PCSK-9s, is grossly overpriced. The first two brands in that class, Repatha from Amgen and Praluent from Sanofi and Regeneron, each go for wholesale prices of more than $14,000 per patient per year. ICER's analysis concluded that a price representing the true value of those products would fall somewhere between $3,615 and $4,811 a year, a 67 percent discount below their current prices. (Daniel R. Hoffman, 9/14)

One of the few things that people across all backgrounds and cultures value in common is home. An overwhelming amount of research from around the world has shown that home is where most patients and their family members would like to take their last breath. But not everyone has that option. (Haider Javed Warraich, 9/14)

Gallup reported that 82% of government employees were completely or somewhat satisfied by their retirement plans, compared with only 57% of private employees. There was a similar divergence on health insurance and vacation time. Public and private workers showed fairly close levels of satisfaction (factoring in margins of error) on job security, wages and their bosses. Public workers tended to report slightly lower levels of satisfaction with the recognition they receive on the job and with stress levels. ... The question raised by the Gallup survey is why public employees are so much happier with their retirement benefits than their private-sector counterparts. Gallup implies that the reason isn't so much that their benefits are higher, but that they're more dependable. (Michael Hiltzik, 9/14)

In general, the news media has a tendency to pay little attention to suicides unless they are tied to a murder, a celebrity or qualify as unusual in some way. The traditional thinking is that the last thing a newspaper or broadcast outlet wants to do is advertise or glamorize the behavior and thereby inadvertently encourage more people to take their own lives. The problem with this well-intentioned oversight is that it perpetuates a cultural stigma, an unspoken understanding that suicide is a taboo subject. But keeping silent is no way to address what is ultimately a public health issue — a point that advocates recently underscored as part of the recently concluded National Suicide Prevention Week. (9/14)

I got my report card the other week, and I must say I didn’t do very well. I’m pulling around a B, better than average but not by much. My parents would be appalled. I am graded these days not by test performance or classroom participation, but by my success in getting patients to do well. Not necessarily to feel well or to be well, mind you, but to perform well on their own tests. They do well, I do well. They do badly, I flunk. (Dr. Abigail Zuger, 9/14)

If the physical, mental and financial cost of collecting data about one’s body falls, more will take advantage of the technology. Out of curiosity, an abundance of caution, or for fitness reasons, people will monitor their hearts’ rhythms not just when their doctors order them to, but all the time. The data such widespread monitoring would generate might enhance researchers’ ability to learn early cues to potential problems. It might save lives. ... But, notice: These examples are for technology targeted to specific groups with significant heart problems, the people we know will benefit most. What happens when millions of healthy people start recording their hearts’ rhythms just because they can? Even though the devices that enable this may be cheap, collectively we may pay a lot if doing so leads to over-diagnosis and unnecessary procedures. People who need wearable health monitors the least may be among those most likely to use them. (Austin Frakt, 9/14)

When Pope Francis arrives in Washington this month, he'll be greeted enthusiastically. Among American Catholics, the pope is remarkably popular — 87 percent have a favorable opinion of him — and he's the U.S. church's best chance of overcoming a bad case of spiritual anemia. But excitement alone cannot heal one of the deepest rifts in Catholic life, not only among American Catholics but worldwide. It has to do with sexuality, although not the priest abuse scandals that have quite properly received attention in recent years. Nothing has divided the church more than its prohibition against contraception, even among married couples. (Peter Steinfels, 9/14)

On August 7, 2014, Federal District Court Judge Paul Engelmayer blocked the US Food and Drug Administration (FDA) from enforcing restrictions on the marketing and promotion of off-label use of the drug icosapent ethyl (Vascepa), manufactured by Amarin Pharma Inc.1 If the case heralds the future of jurisprudence, responsibility for the oversight of the truthfulness of pharmaceutical promotions may shift from the nation’s leading science-based regulatory agency, the FDA, to the courts. If it does, the market for medications in the 21st century may revert to a time of more claims and less evidence to guide clinical care. (Joshua M. Sharfstein and Alta Charo, 9/14)