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Ideally, states function as laboratories of democracy, and one state’s experiments can spark broader national trends. But when it comes to health care, the administration and Obamacare are offering little flexibility to states whose leaders have differing philosophical objectives. This suggests that, at least in the near term, bipartisan health experiments will remain an elusive goal. (Chris Jacobs, 7/17)

A group of Catholic nuns, the Little Sisters of the Poor, wants relief from the Affordable Care Act's mandate that it offer contraceptive coverage to its employees. The nuns lost a court case this week -- and everyone who cares about religious freedom should be troubled by the reasons why. (Ramesh Ponnuru, 7/17)

A bill passed by the House and ostensibly designed to streamline the Food and Drug Administration is loaded with bad provisions and may not even be necessary. The Senate should either eliminate or rewrite the flawed provisions before passing its version of the legislation. (7/20)

At the dawn of the 20th century, life expectancy in the United States was 47 years. Today, it’s 79. Two decades ago, a diagnosis of HIV/AIDS or hepatitis C was a death sentence. The mortality rate from AIDS has since dropped 85%, to fewer than 7,000 deaths a year from 44,000. Hepatitis C cure rates have reached 90%. These stunning improvements are the result of medical and scientific advances. If they continue, we could someday solve the riddle of such scourges as Alzheimer’s and cancer. Why, then, are some people so willing to jeopardize if not halt this progress? It’s a question that those who seek to vilify pharmaceutical companies need to answer. (Robert A. Ingram, 7/19)

Republicans won’t win the presidency in 2016 without making inroads in the Midwest. Happily for the GOP, two Midwestern governors are running for their party’s nomination. ... The former fought to have his state accept the Affordable Care Act’s Medicaid expansion. He made his case on moral grounds, ... The latter adamantly opposed expanding Medicaid under the ACA, and his speeches are compendiums of every right-wing bromide party activists demand. ... You have no doubt figured out that I’m talking about John Kasich of Ohio, who is expected to announce his candidacy on Tuesday, and Scott Walker of Wisconsin. It’s telling about the contemporary Republican party: Kasich would probably be the better bet in the general election but barely registers in the surveys, while Walker has the better chance of winning the nomination. (E.J.Dionne Jr., 7/19)

Supreme Court Justice John Roberts infuriated conservatives when he wrote the recent opinion to uphold ObamaCare. But secretly, many Republicans in Congress are thanking Roberts from saving conservatives from themselves. And if they aren’t sending him balloons and flowers now, they may do so by the end of the year. (Pergram, 7/19)

Data in the [White House’s annual budget update] show the federal government is on course to record a $455 billion budget deficit this year, which is $128 billion less than the Obama administration had projected six months ago. ... Here’s the problem: This year’s progress is likely to get canceled out later on. The same White House report projects no real improvement in the long-term fiscal outlook, and indeed foresees a slight deterioration. ... These stubbornly high levels of public debt, and the prospect of truly uncontrolled debt in the years beyond 2025, reflect the lack of fundamental reform to U.S. entitlement programs such as Medicare and Social Security. President Obama may be able to boast about lower deficits on his watch, but not his avoidance of this issue. (7/18)

American psychiatry is facing a quandary: Despite a vast investment in basic neuroscience research and its rich intellectual promise, we have little to show for it on the treatment front. With few exceptions, every major class of current psychotropic drugs — antidepressants, antipsychotics, anti-anxiety medications — basically targets the same receptors and neurotransmitters in the brain as did their precursors, which were developed in the 1950s and 1960s. Sure, the newer drugs are generally safer and more tolerable than the older ones, but they are no more effective. (Richard A. Friedman, 7/17)

When an old offense caught up with 28-year-old Robert Lepolszki last year, he had a full-time job and had kicked heroin. But Frank Gulotta Jr., the Nassau County judge assigned to his case, forced him to end the only treatment that had ever worked: methadone maintenance. Judge Gulotta said that methadone does not enable a defendant “to actually rid him or herself of the addiction.” Complete abstinence programs were the only treatments his court allowed. Not long after stopping the medication, Mr. Lepolszki was dead from an overdose. The judge’s position on methadone is common among those who administer drug courts, which are aimed at helping defendants get treatment and avoid prison. (Maia Szalavitz, 7/20)

If you haven't gotten this message already, you should heed it now: The benefits of screening for breast cancer are limited. We should be doing fewer screening mammograms, not more. The data that support this conclusion come from studying the effects of mammography across time and place. A couple of years ago an Oregon colleague and I reported on the effect across time. We found that the initiation of widespread screening in the United States during the 1980s was associated with a substantial increase in the number of women found with early-stage breast cancer, but it didn't yield much of a decrease in the number found with serious late-stage cancer. And, remarkably, no change in the worst stage: The number diagnosed with life-threatening metastatic breast cancer didn't decrease. (H. Gilbert Welch, 7/19)

I don't enjoy being a drain on society, and neither do any of the other ME patients I know. And with the ever-growing research interest in ME, I have hope that someday I'll be able to stand for more than a few minutes, walk for more than a block or two, maybe even resume my career. (It took me four days, with frequent breaks, to write this letter - that's a bit slow for newspaper work.) The causes of ME will eventually be discovered, treatments will be found and patients will enjoy long-term remissions. As the leader of our nation's medical research enterprise, you have a decision to make: Do you want the NIH to be part of these solutions, or will the nation's medical research agency continue to be part of the problem? At the very least, you could ensure that Dr. Lipkin doesn't have to scorch his intestinal tract again just to drum up a few research dollars. (Brian Vastag, 7/20)

Sunday marks the 25th anniversary of the Americans with Disabilities Act. Hailed as the greatest piece of civil rights legislation since the 1964 Civil Rights Act — an "emancipation proclamation" for people with disabilities — the ADA had profound material and psychological impacts, from removing physical barriers to increasing public awareness of the plight of the disabled. When President George H.W. Bush signed the ADA into law in 1990, he referred to it as "the world's first comprehensive declaration of equality for people with disabilities." But 25 years later, the United States has fallen behind other nations when it comes to how we treat people with disabilities. (David Pettinicchio, 7/19)

Fifty years ago this month, President Lyndon B. Johnson signed a law to give American seniors something they had never before had - guaranteed access to affordable health care. We asked the health-policy experts who write for the Field Clinic blog at Philly.com for their thoughts on Medicare at 50, especially as pressures grow to privatize this popular program further. (7/19)

When Prime Healthcare Services dropped its bid to rescue the six floundering Daughters of Charity Health System hospitals, pundits raised two questions: Did Atty. Gen. Kamala Harris put the kibosh on the deal by demanding too much from Prime? Or is it just not possible to preserve a struggling hospital chain that caters to the poor in this state? We'll get the answers to both questions soon enough. (Jon Healey, 7/17)