�鶹Ů��

The pending departure of the big insurance company UnitedHealth from most of the Affordable Care Act exchanges that it serves has prompted critics of Obamacare proclaiming the coming "death spiral" of the insurance reform. The critics aren't talking so much about the insurers who are reporting profits from the program. Their experience shows how the ACA can be made to work for customers and insurers alike. (Michael Hiltzik, 4/27)

As you have probably heard by now, the stakes in November’s presidential election could not be higher. Control of the Supreme Court hangs in the balance. Ditto the fate of millions of undocumented immigrants. U.S. foreign policy could be in for its biggest shake-up since the Cold War. Yet in one crucial respect the election might make no difference at all. Seventy-five percent of planned federal spending between now and the end of the next two presidential terms is mandatory: Social Security, Medicare and other entitlement programs, plus interest on the national debt, according to Congressional Budget Office forecasts. That money is going out the door no matter who’s president. (Charles Lane, 4/27)

What if we talked about gun violence, and discussed only bullet size? To me, that seems akin to the presidential campaign discussion of women’s health. Somehow in nine Democratic debates, not a single question was asked about women’s health, and when the issue came up elsewhere it was often in the narrowest form, about abortion: Democrats proclaim a woman’s right to choose, and Republicans thunder about the sanctity of human life. (Nicholas Kristof, 4/28)

In very succinct terms, here's the issue. Health care now consumes 16.5% of GDP. The rising costs of Medicare represent the single biggest contributor to America's growing national debt and, even now, serious illness is the most common factor in personal bankruptcy. Among the health care sectors, drug costs are the fastest growing component of overall spending. (Daniel Hoffman, 4/27)

Now that Donald Trump looks increasingly certain to become the Republican presidential nominee after his big primary victories Tuesday in five Northeastern states, we in the healthcare business press will be spending a lot of time poring over his healthcare policy pronouncements and proposals. (Harris Meyer, 4/27)

Now that failed inspections, government sanctions and a criminal investigation have shadowed the once stellar expectations surrounding the blood-testing company Theranos, the big question is turning from whether the company will eventually prevail to why so many people were so enamored of it in the first place. (Faye Flam, 4/27)

Unlike screening for breast or prostate cancer, screening for colorectal cancer promises not only to find cancer early, but also to prevent it from occurring. In the 1960s, Gilbertsen first suggested that polypectomy could turn colorectal cancer into a preventable disease.1 Two decades later, Vogelstein envisioned the polyp-to-cancer progression as a stepwise process and detailed the genetic alterations that occur at each step.2 Colorectal cancer became widely viewed as having a long latency period — providing ample time for both early detection and prevention. Conditions were thus considered ideal for screening to reduce related mortality. (H. Gilbert Welch and Douglas J. Robertson, 4/28)

In his 2016 State of the Union address, President Barack Obama called for a “moonshot” to cure cancer. The announcement energized the cancer community to continue building on the remarkable collective progress made in recent years. The pace of that progress has been dizzying: we already diagnose and treat many cancers differently than we did when I began my medical oncology fellowship in 2010. Cancers for which there had been no treatment advances for decades have seen a surge in new medicines. Drug-approval times have been shrinking, and the embarrassment of riches has renewed the focus on defining the proper sequence and combination of therapies in this field. In some instances, in fact, we have so many established or promising agents that we really don’t know what to do with them all. (Satish Gopal, 4/28)

Should trustees, including those serving on boards of nonprofit hospitals, physician organizations, and nonprofit health care organizations, consider every opportunity to transition from fee-for-service reimbursement to population health management and accept financial risk related to possible decreases in the volume of care patients seek at their institutions? For the purposes of this Viewpoint, population health management is a set of activities focused on a defined population that improves quality and outcomes while lowering the total costs of care and is substantially incentivized through contracts that accept financial risk and gain. From 2013 to 2014, health care expenditures increased 5.3%, substantially above the rate of inflation, and equaled 17.5% of all goods and services produced in the United States.1 Fee-for-service reimbursement results in cost increases by encouraging patient use of medical services. The majority of trustees appreciate that the revenue from fee-for-service is essential to keeping their institution financially sustainable. (Michael Jellinek, 4/26)

Although it looks like hospitals are being targeted, this is probably an illusion. These opportunistic attacks are spread across many sectors — if the door is open, these criminals will come in no matter what kind of business or organization it is. (Denise Anderson, 4/27)

There is a pressing need to optimize performance of the US health care system. This need coincides with a substantial and ongoing remarkable increase in technological innovations with implications for digital health, most notably the advent of mobile computing and communications. Currently, the adoption of digital health—which, in this Viewpoint, refers to the use of advanced electronic communication and monitoring technologies to exchange health information—by clinicians, health care organizations, and patients is increasing. (Stephen O. Agboola, David W. Bates and Joseph C. Kvedar, 4/26)

Medicine is in an era of necessary process improvement and cost cutting — the confluence of two goals that aren’t always as synergistic as administrators would suggest. In academic medical centers, there is a third goal that is equally critical: preserving and enhancing the academic mission in this challenging context. Teaching hospitals, together with medical schools in our universities, are places where medicine moves ahead. They are the envy of the world, and rightly so. For discovery happens there, whether in translational biomedical science or in systems and outcomes improvement. And extraordinary care is given there, combining the science and art of medicine, while training the next generation of pioneers and caregivers. (David Silbersweig, 4/27)

The state’s youngest citizens deserve far better than the help they are receiving from Texas’ overwhelmed child welfare services. Houston-based Katherine Barillas is among the child advocacy experts battling amid the cycles of damning reports and big reform plans that leave the rest of us throwing up our hands in bewildered dismay. Editorial writer Sharon Grigsby interviewed Barillas, who, with more than 15 years experience, serves as director of child welfare policy at One Voice Texas. (Sharon Grigsby, 4/27)