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Also left for his successor are entitlement programs that will go bust: the Social Security disability trust fund in 2016, the Medicare hospital trust fund in 2030 and Social Security’s Old Age and Survivor’s trust fund in 2032. The president squandered six years by refusing to make modest reforms to hold down growth in entitlement spending while giving people time to adjust. Mr. Obama likes to claim credit for the slower growth in health spending, but economists suggest that is more likely because of the recession and the success of his predecessor’s Medicare reform, which helped seniors with prescription drug costs, resulting in fewer expensive hospital procedures and stays. (Karl Rove, d4/29)

The Department of Health and Human Services released a report this month highlighting the slowdown in Medicare spending growth in recent years. The administration says that Obamacare has led to slower growth in overall health spending, which in turn has made Medicare more sustainable. Another government document suggests that Medicare spending may be accelerating—but even if it isn’t, demographic trends will create pressure on the program in the coming years. (Chris Jacobs, 4/29)

There’s excitement around a new genetic test that can be ordered over the Internet and determine a woman’s breast and ovarian cancer risk. More women could be tested, and that’s potentially good news, but our cancer genetics team at UT Southwestern Medical Center has concerns that this could be a case of “you get what you pay for.” The new test will use a sample of saliva to analyze 19 cancer-risk genes, including the two main breast cancer-risk genes, BRCA1 and BRCA2. ... But this leads to several questions: Will those results be accurate? Some of the genetic mutations this test will identify are not fully understood. Will the women who discover a genetic mutation have the information they need to take action and prevent the disease? Will they have — and take — the opportunity to be cared for by a team of experts on hereditary cancers? (Theodora Ross, 4/29)

Despite the many ways in which telemedicine may transform health care for the better, it faces a number of major challenges along the way. First, there are enduring concerns about its effectiveness and cost-effectiveness. The aforementioned benefits are theoretical, and the actual data to date are far from convincing. Most studies of telemedicine are methodologically weak before-and-after studies that rarely examine patient-centered outcomes, instead focusing on feasibility and acceptability to patients. Although these aspects are important, they are not the same as — and may not correlate with — patient-centered outcomes such as mortality and functional status. (Jeremy M. Kahn, 4/30)

A recent report from the Institute of Medicine that called for reform of the financing and governance of U.S. graduate medical education has sparked controversy. Its most contentious aspect is its failure to call for more federal funding and more residency positions. Although the report acknowledges the reliance of the United States on a continuous stream of international medical graduates (IMGs) — who account for 27% of the trainees currently in U.S. residency programs — it includes no substantive discussion of IMGs. ... There are numerous reasons why we should pay attention to offshore medical schools: enrollees deserve the best education possible, and successful graduates will enter U.S. residency programs and become the teachers of U.S. medical students and caregivers for the U.S. population. To ignore the education of U.S. IMGs is to overlook a potential resource for meeting the needs of the population. (N. Lynn Eckhert and Marta van Zanten, 4/30)

States that set up exchanges are putting their taxpayers on the hook to the tune of tens of millions of dollars each year for carrying out onerous federal mandates. [Former Gov. Jan] Brewer and [Gov. Doug] Ducey recognized that's an expense Arizona taxpayers can't afford. But Ducey had an even stronger reason for signing HB 2643 into law: Arizona's Constitution forbids the state from setting up an exchange. In 2010, Arizona voters overwhelmingly approved the Health Care Freedom Act, which protects people's right to make their own health-care decisions. It does so by preventing the state from "compel(ling) … any person, employer or health care provider to participate in any health care system" by imposing penalties, fines, taxes or fees. (Christina Sandefur, 4/29)

For most women, giving birth triggers joyful and overwhelming emotions. But for a significant number of new mothers it also causes strong and persistent feelings of anxiety, sadness, and hopelessness — clear signs of postpartum depression. Yet the maternal disorder often goes undiagnosed, or simply dismissed as “baby blues.” State Representative Ellen Story of Amherst has introduced bill after bill for the past six years to mandate postpartum depression screening in the state. On Tuesday night, the restitution of a $200,000 pilot program to screen for postpartum depression in certain communities amounted to a victory — and represents a step in the right direction in support of maternal mental health. (4/30)