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I have spent the last two and a half years reporting and writing about medical costs, and during that time I have pored over hundreds of patients’ bills. And while I’ve become pretty adept at medical bill exegesis, I continue to be baffled by how we’ve come to tolerate the Kafkaesque stream of nonexplanations that follow health encounters. Bills variously use CPT, HCPCS or ICD-9 codes (more about those later). Some have abbreviations and scientific terms that you need a medical dictionary or a graduate degree to comprehend. Some have no information at all. Heather Pearce of Seattle told me how she’d recently received a $45,000 hospital bill with the explanation “miscellaneous.” (Elisabeth Rosenthal, 5/2)

Sometimes it seemed as if the only “personalized medicine” my mother received over the two months before she came home, frail and battle-worn, was when my brother or I brought a spoon with ice chips to her lips after she requested it. Such is the state of medical care for many of our elderly in our best hospitals. Aside from spending untold dollars mapping the genomes of Americans, we must — once again — learn to provide true “personalized care” to every one of the soon-to-be 72 million geriatric patients in our midst. While not scientifically “precise,” nurturing in caregivers the skillful application of compassion and empathy it takes to do this work will — in the end — benefit us all. (Jerald Winakur, 5/1)

The growth in health care spending is slowing down, and one reason might be that cost sharing is rising. The proportion of insured workers with at least a $1,000 deductible was 41 percent in 2014, quadruple that in 2006. Hidden in the numbers is the fact that increasing cost sharing for patients with chronic illnesses can backfire, causing their health care spending to go up, not down. (Austin Frakt, 5/4)

Every once in a while, glaciers crack on long-stalled public policy issues. That is the welcome case now after decades of inaction on antibiotic resistance — the emergence of bacteria that can defeat the lifesaving drugs used in human medicine since the 1940s. The problem leads to 23,000 deaths and 2 million illnesses a year in the United States from infections that are difficult or impossible to treat. Now, at last, the longstanding refusal of food producers to recognize and address the problem appears to be waning. (5/1)

Data is the future of health. Advances in wearables, like the Apple Watch, and other monitoring tools will bring new meaning to the term, “self aware.” For many, devices will track where we go, what we eat and how we sleep. The result will be a torrent of data documenting our bodily functions in real time. In essence, medical technology will create a synthetic nervous system run in parallel with our natural one. The opportunities for tweaking various systems will be tremendous. The challenge will be how to process all of this new data. (Drew Harris, 5/1)

It’s become a tiresome, fill-in-the-blank news story: “The conservative-dominated state legislature in _________ voted to restrict women’s access to abortion by doing ___________, insisting it’s for women’s safety and health.” ... If legislators were sincere about safeguarding women’s health, the bills getting passed would be about better sex education, more and cheaper health clinics and counseling and contraceptives, so abortion could become what President Clinton once characterized as “safe, legal and rare.” Instead, it’s about preventing women from getting abortions, and controlling them by controlling their fertility, a trick as old as men and women. (Patt Morrison, 5/1)

While the Supreme Court weighs King v. Burwell–the lawsuit questioning the federal government’s authority to provide financial assistance to people who buy insurance in the 37 states using federally operated insurance exchanges–many have focused on potential responses to the outcome. Language in the budget resolution unveiled this week appears to lay the groundwork for the House of Representatives to address this ruling through budget reconciliation procedures. (Chris Jacobs, 5/1)

The heathcare reforms in the 2010 Patient Protection and Affordable Care Act remain a work in progress, with some of the law's mandates causing new problems or exacerbating older flaws. One is inaccurate lists of the healthcare providers in insurers' networks; another is surprise bills by out-of-network providers. California lawmakers have offered proposals to solve these problems, and the Legislature should pass them. (5/3)

The House version of Ohio’s next budget includes one redeeming measure: It continues Gov. John Kasich’s highly successful Medicaid expansion, despite grumbling from Tea Party extremists who care more about rigid anti-government ideology than they do about results. Even so, the House budget includes onerous changes to the state’s Medicaid program: caps on care, higher costs for the poorest families, bureaucratic hurdles that would lead to dangerous delays and gaps in health care, and a murky plan to force recipients, regardless of income, to contribute to health savings accounts. (5/3)

Political arguments at the State Capitol continue to overwhelm the policy arguments over expanding Medicaid insurance coverage for the working poor. It’s as if the legislators set fire to piles of federal funding on the lawn in front of Huey P. Long’s statue, even as the state budget crumbles in the halls inside. Committees of the House and Senate voted almost along party lines, with most Republicans opposed and most Democrats in favor, to kill the expansion of health insurance that would be funded by the Affordable Care Act. That law’s nickname, “Obamacare,” continues to frighten Republicans, even at the state level — and even as the arithmetic argues for Louisiana joining other states in expanding insurance. (5/3)

The Oklahoma Legislature has approved a basic change in the way some of the state’s most expensive Medicaid patients are managed. ... It would potentially shift the management of some of the state’s most expensive Medicaid patients — the aged, blind and disabled — from the Oklahoma Health Care Authority to private contractors. A 2013 study found that such a move could save the state up to $1 billion over five years. The state’s previous experiment with managed care for Medicaid patients was unsuccessful. ... The health care authority maintains one of the nation’s lowest administrative cost ratios. But backers of the new program make an important point: The state budget cannot sustain the fast-growing cost of Medicaid. (5/4)

Proponents say shifting management of Iowa’s Medicaid program to private organizations will lead to better patient outcomes and reduced state costs. But many are concerned the change will upset patient care. ... Managed Medicaid is not new to the country. Roughly 70 percent of Medicaid enrollees nationwide are served through managed care delivery systems, according to the federal government. ... But managed Medicaid is new to most Iowans on the program. “Most of the Medicaid population’s care isn’t coordinated right now,” [Iowa Department of Human Services spokeswoman Amy] McCoy said. “But moving it to private (organizations), doing it that way — many other states do it that way — we believe everybody has a chance to benefit from this, Medicaid recipients and the taxpayers of Iowa.” (Erin Murphy, 5/3)

There is a bewildering blizzard of ratings out there from commercial, government, nonprofit and media groups. Some health care experts say it's a rare hospital that can't find its way onto a top-10-percent list for something. ... So what's a patient to do? Most of us will just go to the nearest available hospital and hope for the best. In the case of acute illness or injury, the decision is especially a function of where you live. But if you're having a serious elective procedure and have insurance that allows you to make a choice, it's best to consult as many substantive measures as you can find, and then make an informed decision. (5/4)

Pakistan now stands as the main barrier to the global elimination of wild poliovirus. In two other countries where it is endemic, things are going well: There hasn’t been a case in Nigeria in nine months, and there has been only one in Afghanistan so far this year. Outbreaks last year in Syria, Iraq and other parts of Africa have been contained. Consider the progress: In 1988, there were more than 125 countries where polio was endemic. But now, all eyes are on Pakistan as the high season approaches for transmission of the virus. Plans are in place for the fight, methods are known, good intentions declared. Now a nation often weakened by its own internal chaos must deliver. (5/3)