�鶹Ů��

If I had a pill that would extend your life by one day, but it cost a billion dollars, it’s unlikely that many people would argue that health insurance should pay for it. We all understand that while the benefit might be real and quantifiable, it’s not worth the expense. But what if the pill cost a million dollars? And what if it extended your life by 10 years? Such discussions are about cost effectiveness. For the most part, we’re avoiding them when we talk about health care in the United States. (Aaron E. Carroll, 12/15)

It's still too early for a thorough evaluation of the effects of the federal Affordable Care Act, since some major provisions have only recently gone into effect. Still, a deep dive into the data on national health care spending through 2013 offers some reasons for optimism. The data show that even with the economy steadily recovering, overall US health care spending has been increasing only moderately. The 3.6 percent rise in 2013 is the lowest since the federal government started tracking that statistic in 1960. ... As Obamacare critics are quick to note, one circumstance restraining costs is an economy that still isn’t operating on all cylinders. That is true, though with this important qualifier: The use of health services is actually nudging up again, but the effect on total spending has been moderated by lower growth in medical prices. (12/16)

Americans visiting Healthcare.gov to purchase 2015 health-insurance plans are finding a nice surprise: Average premiums for the cheap “bronze” plans have increased only by 3.4% and premiums for the middle-of-the-road “silver” plans are rising by 5.8%, according to the American Action Forum. Where are the double-digit premium increases that so many predicted? Check back around this time in 2016. That’s when you’ll see the real spikes. (Stephen T. Parente, 12/15)

What’s it take to see a doctor in December? ... Medical offices are often jammed these days, and patients and providers can feel the stress. Some spike in business is unavoidable, because flu season arrived early and more now have health coverage, thanks to Obamacare. There’s also a doctor shortage. But much of the surge stems from the way we design insurance and incentivize treatment. Deductibles, co-payments and pretax spending accounts encourage people to delay elective care in the first half of the year and then rack it up in the last quarter. (Mitchell Schnurman, 12/15)

It’s open enrollment again for Obamacare, this time for 2015 coverage. Analysts will carefully count the new enrollments, and the number will become another talking point for proponents of the law who promised that it would significantly expand private health insurance coverage. Yet that’s not how the law is shaping up in reality. Rather than helping those who lack insurance, the law’s far greater impact has been to shift already-insured people into lower-quality, government-controlled health plans by massively expanding Medicaid (the dysfunctional insurance program meant for those with the lowest incomes) and by offering Obamacare plans through exchanges, which mimic the worst characteristics of the Medicaid program. (Hadley Heath Manning, 12/15)

Researchers from Cornell and Harvard have found that, compared with their uninsured counterparts, children covered by Medicaid or CHIP are more likely to complete high school, as well as attend and complete college. Medicaid or CHIP health coverage helps children perform better academically through adulthood, which can help them succeed in life. That's an important finding for Florida policymakers to keep in mind: A state's education and health care investments complement each other. When states invest in robust, affordable health coverage options, they can help children achieve more in school. (Dee Mahan, 12/15)

Jonathan Gruber should have been Time's Person of the Year. The magazine gave it to the "Ebola Fighters" instead. Good for them; they're doing God's work. Still, Gruber would have been better. (Jonah Goldberg, 12/15)

Doctors are licensed by their states to practice medicine, but they’re also expected to be “board-certified” in their particular field — surgery, obstetrics, pediatrics, etc. This certification comes from the professional organization of each field. In my case, it’s the American Board of Internal Medicine. It used to be that you tackled those monstrous board exams just once after residency. Then you went into practice and never looked at a No. 2 pencil again. But in 1990, the boards decided that doctors should recertify every 10 years. This seemed reasonable, given how much medicine changes. Over time, though, the recertification process has become its own industry. (Danielle Ofri, 12/15)

With problems associated with EHRs [electronic health records] so substantial—and physicians’ experiences using medical scribes so positive—are there any risks engendered by the rise of a medical scribe industry and its potential for becoming integral to US health care delivery? Despite scribes’ reported value, this industry should be viewed as what it is: a workaround or adaptation to the suboptimal state of today’s EHRs. ... The answer to today’s inadequate EHRs is not scribe support. Instead, physicians should demand improved products, should educate vendors to ensure that they understand how physicians think clinically, and should clarify what is needed for an intuitive, quick, and navigable user interface. (George A. Gellert, Ricardo Ramirea and S. Luke Webster, 12/15)