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Democrats are wandering around in the wilderness once again, shut out of power in Washington after losing a close, hard-fought presidential battle. The last time this happened, after the 2004 elections, the newly reelected president, George W. Bush, over-read his mandate and launched an ill-fated effort to partially privatize Social Security, providing a rallying point for Democrats to begin turning things around. In an interview with me, House Dem leader Nancy Pelosi argued that history might repeat itself, if House Speaker Paul Ryan — with Donald Trump’s blessing — makes good on his hints to press forward with his plans to privatize Medicare. (Greg Sargent, 11/21)

Early media coverage of the Republican health-care agenda has concentrated on plans to repeal and then replace the Affordable Care Act. The larger story is GOP preparations for a health policy trifecta: to fundamentally change the ACA, Medicaid and Medicare–all three of health care’s major programs–and in the process, fundamentally alter the direction of the federal role in health and core elements of the social contract. (Drew Altman, 11/21)

A clear chronology of developments in health care policy links the shortcomings of Obamacare to Trump’s victory. Despite the law’s best intentions, 30 million Americans are still uninsured, vulnerable to bankruptcy if they fall ill or are suffering from diseases they cannot afford to treat. For the newly insured and those who switched to the health care exchanges, increasing premiums burden low-income working families. ... With a Trump presidency now imminent, we can reasonably expect that the Affordable Care Act will be fundamentally altered, even if more popular aspects of the law remain standing. Yet as we wait in this purgatory — uncertain of what direction our federal government will take on health care reform — we ought to take note of the law’s successes and challenges and critically assess the state of our conversations in health policy today. (Vishal Khetpal and Suhas Gondi, 11/21)

Some of the Republicans agitating to repeal Obamacare say they aren’t worried about taking health insurance away from more than 20 million people. Their theory: The program is wildly unpopular and even the people with coverage wouldn’t miss it, no matter what takes it place. ... Anna Meyers would beg to differ. Meyers, 42, lives in the eastern part of North Carolina. She and her husband, 59, have been getting insurance through healthcare.gov for the last three years. Meyers also has a son, 14, who has autism. He gets coverage through Medicaid ― a program that Republicans say they would like to shrink just as soon as they are done with Obamacare. (Jonathan Cohn, 11/21)

The election of Donald J. Trump gives the Republicans in Congress a chance to act on their often-stated desire to get rid of Obamacare, a wish that Mr. Trump mostly says he shares. Aaron E. Carroll and Austin Frakt, our health policy columnists, discuss: Then what? (11/21)

Data just released by the Obama administration shows just how much of a financial disaster 2015 was for insurers who chosen to sell policies on the Exchanges. The data comes from the government’s Risk Corridors program, which was supposed to essentially tax insurers who made any substantial money on the Exchanges and give to insurers who lost any substantial money. The new data shows that the amount insurers who made money in the individual market were required to contribute in 2015 was $89 million but the claims by losers against that money for that year amount to $5.3 billion. This is a ratio of about 60 to 1. (Seth Chandler, 11/21)

The Department of Health and Human Services (HHS) finally released the 2015 Affordable Care Act (ACA) risk corridor data. The data show the rapid deterioration of the ACA exchanges from 2014 to 2015. The ACA’s risk corridor program was intended to transfer funds from profitable insurers to unprofitable ones for the first three years of the exchanges (2014 to 2016). The program ran a $2.5 billion deficit for the 2014 plan year as far more insurers incurred losses than made profits. In 2015, the deficit increased to more than $5.8 billion—a 132% increase. (Brian Blase, 11/21)

The Department of Veterans Affairs' beleaguered health-care system remains on life support, more than two years after President Obama promised to fix it. ... Substandard care and dangerously long wait times remain the norm for the VA health system, despite a much-touted federal reform effort and fierce public outrage. Unfortunately, in a single-payer system like the VA's, the rationing of health care is inevitable. No amount of federal oversight or public shaming can change that fact. (Sally Pipes, 11/21)

Now on Capitol Hill, members of Congress, along with lobbyists from the pharmaceutical and medical device industries and allied patient advocacy organizations, are touting miracle breakthroughs and a new era of medical innovation with the imminent vote on the 21st Century Cures Act. ... Many organizations representing patients, physicians, academic medical centers, and research societies are going along for the ride, as the legislation is tied to a huge boost in funding for the National Institutes of Health, our treasured biomedical research agency in the U.S. To those of us who have watched and studied the FDA for years, this legislation is the culmination of years of quiet, subtle deregulation—death to the FDA by a thousand cuts – as this new law includes worrying provisions that deftly and severely weaken the evidentiary requirements for the approval of new drugs and medical devices. (Gregg Gonsalves, Daniel Carpenter and Joseph Ross, 11/21)

Among the promises in President-elect Donald Trump’s “Contract with the American Voters” is a pledge to cut red tape at the Food and Drug Administration and speed up the approval of lifesaving medications. Some FDA critics have called for more-drastic measures, such as revoking the FDA’s authority to make approval decisions on drugs, or turning it into a privatized entity. But a scorched-earth approach is not the way to get fast and effective results. (Joseph V. Gulfo, 11/21)

Last week's Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs and Health did a grave disservice to Americans rightfully upset about the rising tide of drug and alcohol dependency in their communities.The report failed to address the root causes of an epidemic that has spread to an estimated 27 million people who abuse prescription opioids or use illicit drugs. Nor did it explain why an estimated 66 million people — 1 of every 4 adults and adolescents — engage in binge drinking at least once a month. If drug companies, pain pill mills or overwhelmed primary-care physicians with uncontrolled prescription pads bore any responsibility for the tide of opioids that swept over some areas of the country, you wouldn't know it from this report. (Merrill Goozner, 11/19)

Over the last 20 years there have been significant advances in our understanding of Alzheimer’s. Unfortunately, there is no cure. As scientific advances continue, our hope is to recognize and diagnosis Alzheimer’s disease as early as possible. It is believed that early intervention is one of our best hopes for stopping the progression of the disease or even curing it. Continued funding in research is essential. (Elizabeth Crocco, 11/21)