�鶹Ů��

The test for any Obamacare replacement remains its ability to provide comparable insurance to at least as many Americans, at the same (or lower) cost. And [the Burr/Hatch/Upton] proposal probably fails on the first two characteristics. Nevertheless, it embraces important principles of the Affordable Care Act: that the federal government ought to fund health coverage for those who can't afford it, and that the insurance market should be required to offer coverage to everyone. (2/5)

Republican congressional leaders were wise to propose an alternative to the Affordable Care Act this week, as the Supreme Court may strike down a key provision of the law after hearing King v. Burwell next month. The case involves subsidies to individuals who purchase health insurance on federal exchanges. The plaintiffs—four individuals who don’t want to be forced to buy ObamaCare—argue that under the explicit terms of the ACA, subsidies enabling that purchase can only be distributed in exchanges “established by the State.” The court is expected to rule by the end of June, and the plaintiffs have a good chance of convincing a majority that the subsidies are unlawful. (Scott Gottlieb and Tevi Troy, 2/5)

Plainly wounded by the Plum Line’s mockery, some congressional Republicans have finally unveiled a plan to replace the Affordable Care Act with their own health care reform. Is it serious? It’s certainly serious enough to examine and judge on its merits. Will it become the plan around which Republicans will unite? I doubt it, just because it’s hard to imagine Republicans ever uniting around a plan to do anything proactive on health care, though that’s always possible. (Paul Waldman, 2/5)

Wow, the breakup between President Obama and his former corporate health-care partners must have been bad. The deal he cut with the pharmaceutical industry to pass ObamaCare didn’t even last as long as his Presidency. We can’t wait for the memoir. The news is that Mr. Obama’s new budget proposal for 2016 reneges on the quid pro quo that some of the dumber drug makers cut in return for supporting ObamaCare in 2009. That transaction was supposed to buy political protection against the left-wing wish list of price controls, weakened patents and other extortion that Mr. Obama now endorses in his budget. (2/5)

Medicare, the government health insurance program for those 65 and over or the disabled, pays one price to independent doctors and another to doctors who work for large health systems — even if they are performing the exact same service in the exact same place. This week, the Obama administration recommended a change to eliminate much of that gap. Despite expected protests from hospitals and doctors, the idea has a chance of being adopted because it would yield huge savings for Medicare and patients. (Margot Sanger-Katz, 2/6)

“We owe female service members the same access to contraception and family planning services as the women they fight to protect,” said Representative Jackie Speier of California, summing up the principle behind a bill she and another Democrat, Senator Jeanne Shaheen of New Hampshire, introduced on Wednesday. Their modest but important measure — the Access to Contraception for Women Servicemembers and Dependents Act of 2015 — would bring contraceptive coverage in the military into line with the coverage afforded to civilian federal employees and required in most health insurance plans under the Affordable Care Act. (Dorothy J. Samuels, 2/5)

Around 11:00 a.m. on January 20, 2015, Stephen Pasceri arrived at the cardiovascular center at Boston's Brigham and Women's Hospital, where he had an appointment to speak to Michael Davidson, a 44-year-old surgeon who had performed valve surgery on Pasceri's mother a few months earlier. Davidson entered an exam room and greeted Pasceri, who fired two shots at the surgeon at close range before killing himself. A team of Brigham surgeons spent 9 hours in the OR in a futile attempt to save Davidson's life. ... Tragedy can have meaning without having reason, and that's as true for us as it is for our patients. To seek reasons for the tragic loss of Michael Davidson is to become afraid. To seek meaning is, in a sense, to do the opposite. To be like Mike is to fear not threats to one's own safety, but the possibility of hurting others and of failing to sustain life when there is still life to be sustained. And it is to help our patients make meaning of their losses. (Dr. Lisa Rosenbaum, 2/4)

Focus, I tell myself, as I consider the mild-mannered woman sitting before me, her gainfully employed, well-educated husband leaning on the guardrail of his son's hospital bed. I'm finding all this hard to reconcile. The parents of this damaged infant seem so pleasant, even charming, their docile demeanors juxtaposed with multiple injuries without known cause. Detach the facts from the people, I remind myself. I'm here to tell his parents I've called child protective services, and they're under investigation for child abuse. (Stephanie A. Deutsch, 2/5)

In 2003, the Agency for Healthcare Research and Quality (AHRQ) released 20 patient safety indicators (PSI) to facilitate measurement of adverse events. Though intended for internal quality measurement and improvement, ... CMS began using AHRQ’s Patient Safety for Selected Indicators (PSI-90) as a core metric in 2 of its pay-for-performance programs: the Hospital-Acquired Condition (HAC) Reduction program and the Hospital Value-Based Purchasing (VBP) program. ... numerous problems exist with the current PSI-90 composite measure .... These flaws may incorrectly identify problem areas for hospitals to address, unfairly penalize hospitals financially, and adversely influence clinician engagement in quality improvement. However, there are opportunities to improve this measure. (Ravi Rajaram, Cynthia Barnard and Karl Y. Bilimoria, 2/5)