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Every remaining Republican presidential candidate supports repealing the Affordable Care Act. Yet their ideas for replacing the law are “still works in progress,” according to a headline last week in the Wall Street Journal. That’s a generous way of saying candidates have no comprehensive proposals. The newspaper said only Ben Carson and Jeb Bush have posted health plans, and both use “broad brush strokes.” (1/13)

Some liberal healthcare policy experts are urging an ambitious, costly program to expand and improve the Affordable Care Act's coverage. Meanwhile, conservative policy mavens are promoting an even more ambitious ACA replacement package they say would reduce the uninsured rate and lower healthcare spending with less government intervention. Falling in between, the centrist Bipartisan Policy Center recommended last month that the Obama administration meet with governors to advance new health insurance approaches, including flexible use of the ACA's Section 1332 state innovation waivers allowing implementation of alternative coverage models. These proposals represent efforts from the left, right and center to frame the health policy options for the next president and Congress. (Harris Meyer, 1/13)

With the polls tightening in Iowa and voting both there and in New Hampshire just a few weeks away, the Kumbaya feeling in the Democratic primary is gone. In particular, the Hillary Clinton camp has evidently decided it's time to go on offense against independent Sen. Bernie Sanders, lest 2016 start feeling like 2008 all over again. Predictably, one line of attack is on Sanders' record on gun control, which certainly has its blemishes. Another, though, makes far less sense, particularly in a Democratic primary: Clinton is lambasting Sanders' proposal for a universal, single-payer health care system. And she's doing it in a pretty dishonest way. (Pat Garofalo, 1/13)

The healthcare sector is digesting an important speech by the man tasked with rescuing Obamacare’s exchanges. Andy Slavitt, formerly of UnitedHealth Group UNH -2.77%, joined the Administration in June 2014. Last February, he took over the Centers for Medicare & Medicaid Services. (John Graham, 1/13)

Medical bills for out-of-network providers can surprise consumers with thousands of dollars in costs they didn’t plan for and sometimes cannot afford. I’m among those who have experienced this surprise despite efforts to determine that all my health-care providers are in-network. ... a significant share of people who had problems paying medical bills say that the issue was charges for providers they did not know were out of network. New York state has a solution to this problem that bears watching. Under the New York policy, patients who are surprised by out-of-network bills pay only the amount of their regular in-network cost-sharing provided they fill out a form authorizing the provider to bill the insurer for the remaining amount. (Drew Altman, 1/11)

Frederick Taylor, a son of Philadelphia aristocrats who lived at the turn of the last century, became known as the “father of scientific management” — the original “efficiency expert.” ... Meanwhile, the electronic health record (EHR) — introduced with the laudable goals of making patient information readily available and improving safety by identifying dangerous drug–drug interactions — has become a key instrument for measuring the duration and standardizing the content of patient–doctor interactions in pursuit of “the one best way.” ... The EHR was supposed to save time, but surveys of nurses and doctors show that it has increased the clinical workload and, more important, taken time and attention away from patients. (Pamela Hartzband,, MD and Jerome Groopman, MD, 1/14)

But when efficiency met medicine in the early 20th century, their relationship was no mere dalliance, and its form often diverged sharply from the Taylorist vision. One of its key figures was the industrial efficiency expert Frank Gilbreth, though his techniques were considered by many to be simply publicity-seeking smoke and mirrors. In place of a stopwatch, Gilbreth employed still and motion-picture cameras in his measurements, and he expanded his visual efficiency services — dubbed “motion study” — from industrial settings to the medical profession in the early 1910s. When he gained access to hospitals, Gilbreth transformed their operating rooms into efficiency laboratories, covering all available surfaces with gridded lines, and requiring the masked surgeons and nurses to don numbered or lettered caps to aid in his analysis of their movements across the axes of the surgical space. (Caitjan Gainty, PhD, 1/14)

The importance of shared decision making in health care has been increasingly recognized over the past several decades. Consensus has emerged that of the various types of decisions we make, those that involve choosing among more than one reasonable treatment option should be made through a process in which patients participate: clinicians provide patients with information about all the options and help them to identify their preferences in the context of their values. (Terri R. Fried, MD, 1/14)

“If you can’t measure it, you can’t manage it” is an often-quoted admonition commonly attributed to the late W. Edwards Deming, a leader in the field of quality improvement. Some well-respected health policy experts have adopted as a truism a popular variation of the Deming quote—“if something cannot be measured, it cannot be improved”—and point to the recent enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as a confirmation of “the broadening societal embrace” of this concept. (Robert A. Berenson, MD, 1/13)

During his Senate confirmation hearing in July 2014 to head the Department of Veterans Affairs, Robert McDonald pledged to “transform” the vast agency. After horrific reports of wait-time manipulation, coverups and even deaths at VA medical facilities across the country, veterans and the American people were calling for honest leadership to restore their trust in the department created to serve them. Sixteen months have passed but the VA’s culture of indifference persists, and the climate of accountability Mr. McDonald promised is nowhere in sight. (Jerry Moran and Jeff Miller, 1/13)

Again and again on the campaign trail, the presidential candidates have been faced by America's rising concern about addiction, particularly to opioid painkillers and heroin. And from Hillary Clinton to Chris Christie, the politicians have responded by pledging their support for drug courts. This bipartisan reaction is correct, in principle: Drug courts, which now exist in every state, can motivate people to overcome their substance-abuse problems more effectively than punishment can. But to make the courts work in practice, states need to see that they’re adequately funded and properly run. (1/13)