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It was remarkable that the Republican presidential candidates’ debate this week, supposedly focused on keeping Americans safe, was devoid of questions and comments about the public health issue of gun violence. ... when they brought up the mass shooting in San Bernardino, Calif., this month, carried out by a couple found to be inspired by Islamic State violence, the discussion never veered to the easy gun access that enabled those killers — and many others — to commit swift and horrific slaughter of innocent people. (12/17)

In 2013, the latest year for which the Centers for Disease Control and Prevention (CDC) has data, more than 33,000 people in the United States died from gunshot injuries and more than 84,000 survived with such injuries .... commentators once again marveled at the vast gap between U.S. rates of gun deaths and those in other developed countries, which either have never witnessed the epidemic of gun violence and the kind of mass shootings that are now routine here or have acted effectively to stop them. If any other public health menace were consistently killing and maiming so many Americans, without research, recommendations, and action by the CDC, the public would be outraged. (Debra Malina, Stephen Morrissey, Edward W. Campion, Mary Beth Hamel and Jeffrey M. Drazen, 12/16)

Late in the day on December 15, 2015, House Republicans released the $1.1 trillion Consolidated Appropriations Act for 2016 and a $650 billion tax extenders package. The legislation embodies an agreement among Congressional leaders that will keep the government open through September 2016. The legislation delays taxes enacted to fund the ACA and limits the effectiveness of some of the ACA’s operational provisions. The bills do not, however, fundamentally change the ACA, although a continued restriction on risk corridor funding included in the legislation could reduce insurer participation in the marketplaces and raise prices for consumers. (Timothy Jost, 12/16)

As health care costs continue to rise and the quality of care remains inconsistent, employers, other private and public health care purchasers, health plans, and providers are now experimenting in earnest with reforms to how we deliver and pay for health care. Investment in such efforts will be well worth it if they significantly improve care and make it more affordable. However, despite the flurry of activity in the payment reform space over the last few years, data demonstrating the effectiveness of these reforms are limited. We still have much to learn about which reforms will work and in what context they will successfully produce their intended outcomes. (Suzanne Delbanco, 12/16)

Last January, Indiana Governor Mike Pence reached a deal with the Obama administration to expand Medicaid under Obamacare. After nearly a year of operation, the data is in, and the early outcomes of the program’s rollout are finally setting in. The results so far have been little personal responsibility for enrollees, and higher costs for taxpayers . Other states considering a similar designed expansion should think twice. (Jonathan Ingram and Josh Archambault, 12/17)

Visiting nurses and other home health professionals are the hidden angels of American health care--they are highly mission driven and in the course of helping people in need they routinely overcome many challenges like bad weather, high crime neighborhoods, traffic conditions, complex health problems and stressed out families--but, they're now confronting a new obstacle, a paperwork mess created by a little known Affordable Care Act (ACA) "face to face" rule. The timing is terrible because home health access and quality is being hurt at the very moment when extra focus on improving home health is needed to prepare for rapidly growing numbers of older Americans. (Steve Landers, 12/16)

It was the only reliable way to guarantee that the specialist would have our X-rays and medical records when we arrived for our appointment in two weeks, a front-office employee of the practice said. So we left home, drove to a building on the northeast corner of the Concord Hospital campus, found a parking space, crossed the lot, went upstairs and retrieved our records. Then we reversed the process and drove to a building just off the southwest corner of the campus, a distance, as the crow flies, of maybe 400 yards. We did all this on crutches. So much for the ease, convenience, improved medical care and cost savings that resulted from the government’s near-mandatory 2009 requirement that patient health records be stored electronically. It was a promising idea. (12/17)